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    HYDRIATICS, OR MANUAL OF THE WATER CURE,—Especially as practised
  by Vincent  Priessnitz, in Graeffenberg; compiled and translated from the writings of
  Charles Munde, Dr. Oertel, Dr. B. Hirschel, and other eye-witnesses and practitioners.—
  4th edition by Francis Graeter, price 50 cents, with one plate or six engravings.  1844.
    JAHR'S  NEW MANUAL OF  HOMOEOPATHIC  PRACTI('E,_Edited, with
  Annotations, by A. Gerald Hull, M. D., from the third Paris edition.
    Tins  is the second American  edition of a very celebrated work, written in French
  by the eminent Homeopathic Professor  Jahr, and it is considered the best practical
  compendium of this  extraordinary science that has yet been composed.   After a verv
  judicious and instructive introduction, the work presents a table of the Homoeopathic
  medicine., with their names in Latin, English, and German ;  the order in which they
  ?h«i™n,     'W!,h£he,r m°St  ,T1>orta,lt «H»tinctioi«.,  and  clinical illustrations of
  the.r  symptoms and  effects upon the various organs and functions of the human svs-
  PIZ~J fLSCC°^ -V°1Um? pml?race8  »»  elaborate  analysis of the indications in dis-
  ease,  of the  medicines adapted to cure, and a glossary of the technics  used in tho
  work, arranged  so luminously as  to  form  an  admirable guide to every medical stu
  dent.  The  whole system is  here displayed with a modem- of pretension  and «serul
  puloc.ty in statement  well calculated to bespeak candid investigation   This laboriou^
  «ork  is indispensable to  the  students and  practitioners  of Homeopathy  midI Sv
  u.teresting to medical and scientific men of all classes.  2 vol,   Price s"         S  *

   EVER EST ON  HOMCEOPATHY,-byH.G. Hull, M.D.  Second edition   «U
   LAURIE'S HOMOEOPATHIC  Domestic Medicine,-by Dr.  Hull.  18-13   75 cents

 «R-i.£M1S['S£KOANON °f »°m-P^ic ^icine,-by Dr. C. Hering.  Sec!

   JAHR'S PHARMACOPOEIA and Posology of the prenantion nfiTnm™  ...•
 cnes and the administration of the dose.-tmnslated by F  Kitchen II°™<E0I,;lthlc med"

 Jl^Sir^0^™10  EXAMINER,-by G.  Hu„,  „.  D/ 2 ^ 1840 ^



 pnee twenty-five cents.                     ^«nuon  emtion, with additions.   Retail



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 Ha.iKcop.thic Physicians and the  friends  of the sVstcm that h  >                 °
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ENCHIRIDION MEDICUM:
THE  PRACTICE OF MEDICINE
THE RESULT OF FIFTY YE/\RS' EXPERIENCE.
i^
C.  W. HUFELAND,
COUNSELLOR OF STATE, PHYSICIAN IN ORDINARY TO THE LATE KING OF rgUSSIJ
         PROFESSOR IN THE UNIVERSITY OF BERLIN.
   FROM THE SIXTH GERMAN EDITION.

        TRANSLATED BY
CASPAR BRUCHHAUSEN, M. S.

     REVISED FOR THE PROPRIETOR,


    ROBERT NELSON, M. D.
SECOND EDITION.
        NEW-YORK:         ----
PUBLISHED BY WILLIAM RADDE, 322 BROADWAY.
         LONDON:
    H. BALLIERE, 219 REGENT STREET.
           1844.
'7<>6$i, 
Was mich das Leben gelehrt, was inir durchs Leben geholfen,
  Leg' ich dankbar und treu hier auf Hygieens Altar.
Helfen durch Lehre und That, war meines Lebens Bestiinmung
  Mrechte im Tode audi noch Lehrer und Heifer euch sein.
w
&A

     Entered according to Act of Congress., in the year 1842,
                 By WILLIAM RADDE,
in the Clerk's OfEce of the District Court of the Southern District of

                        New-York. 
'       The following lines from Dr. Manley, formerly President
     of the Medical Society of the State of New York, contains
     his  opinion in {ew words of the merits of the book :—
       I am happy to have  the opportunity of recommending to
     the medical profession  the Manual of the Practice of Medi-
     cine, by Hufeland.  It is  not often  that books of this char-
     acter, on perusal make good  the claims which  their titles
     assume, but this is a well marked exception :  its  description
     of diseases though concise are  comprehensive;  its reason-
     ing just and philosophical, and its practice, as a conse-
     quence,  intelligible and  rational.   The  character of  the
     author, and his experience of more  than half  a century, to-
     gether with the unexampled  popularity of the  work in its
     original language,  render in  my opinion all  individual re-
     commendation  superfluous.  I hope that  it  may soon be
     found in the hands  of every medical man, whether pupil or
     practitioner.
                                  James R. Manley, M. D.
       New York, September  7, 1842.

       The following  is my opinion of  Hufeland's Practice of
     Medicine.—The merits of that great professor in the Heal-
     ing Art have been  so  long known,  and his contributions to
     medical science so  highly appreciated, that his renown may
     be safely pronounced national.   His late work, Enchiridion
     Medicum, has met in its rapid  and  extensive  circulation in
     his own country with no more than its just claims to regard.
     As a body of the Practice of Physic it abounds in facts  and
     principles  of substantial value, the  results of close observa-
     tion, patient discrimination and sound  judgment:  its excel-
     lence  is such  as could have  been  secured  only by long
     experience  and freedom   from  the  restraints  of scholastic
     authority.   Hufeland is eminently an  eclectic philosopher,
     competent to discharge the responsible  trust with impar-
     tiality  and ability, arising from the vast stores of  his clinica'
     knowledge,  and the  exercise of a mind of great self-reliance.
     The publication  of his  work  in this  country will aid  the
     cause of sound  medical practice, and the  deepest interest
     of humanity.
                           John W. Francis, M. D.,
         late Professor of the Institutes of Medicine, Obstetrics
                Medical Jurisprudence, etc., New York,
       New York, August 23, 1842. 
   I have read the edition of Professor Hufeland's Manual of
the Practice of Medicine, and am of opinion it fully sustains
the high reputation of its author.  Both in arrangement and
details it is fully equal  to  any work on the same subject I
am acquainted with, and I cheerfully recommend it to the
patronage of the profession.
                               J. H. Johnston, M. D.
  New York, August 31, 1842.
  The writings of the great Hufeland  need no recommend-
ation of mine.   His name, as a medical authority, is so well
established, that I have no doubt this work will find a ready
and extensive sale.
                          John B. Beck, M. D.
        Professor of Materia Medica and Medical Jurispru-
         dence, in the College of Physicians and Surgeons
         of New York.
  New York, 14 Le Roy Place, September 6, 1842.
   I have looked over the Enchiridion Medicum of Professor
Hufeland.  It is an excellent compendium of German prac-
tice, and will be found a valuable vade  mecum to the  stu-
dent and  practitioner.   It  can profitably be  perused,  and
ought to be in the hands of all physicians.  The justly dis-
tinguished reputation  of the  author  will make  it a work
generally sought for.
                             Valentine Mott, M. D.
  The publishers have conferred a benefit upon the medical
literature  of our country, by producing this  translation of
the Enchiridion Medicum  of Hufeland.  Few  works on
practice contain  so  much useful matter in so small com-
pass.   But independently of the value attached to any work
from the pen of Hufeland, this book is especially useful to
Americans, by furnishing them with the modes of thinking
and practising, peculiar to the  medical men of a large por-
tion of continental Europe, to which they have few means
of access.
                          Edward  Delafield, M. D.
  108, Bleecker-street, September 5, 1842. 
LIFE OF THE  AUTHOR.
  Christopher William Hufeland was born at Langensalza,
August 12, 1762.   His father held some rank in the medical
profession, was Aulic counsellor and physician in ordinary to
the court of Weimar. After our author had finished his studies
he began practice as a physician at Weimar. In 1793 he was
appointed professor of medicine in Jena ; and in 1796 the title
of Aulic counsellor of Weimar and physician in ordinary to
the Duke was conferred on him.  He left Weimar for Berlin
in 1801, where he was employed as one of the physicians to
the King of Prussia; here he was made Director of the Medico-
chirurgical Academy, and appointed superintendent physician
to the Charity—both renowned institutions.   In 1810 he was
raised to the  rank of counsellor of state, became a member
of the medical section of the Home Department, knight of the
Red  Order of the Eagle, and  professor of the New University
established at Berlin  in  1809.   Such were his honorable
titles and  his external  relations, and  he  enjoyed  them until
his death.  We shall  now review his labors ; works which
gained him a reputation that was European and almost uni-
versal.
  In a pamphlet " On the Uncertainty of the Signs of Death,
and hints for the establishment of burial houses," published at
Weimar in 1791 and republished in 1824 at Berlin, he broach-
ed the subject of the burial of persons apparently dead.  It is
in a great measure owing  to his indefatigable efforts and
representations that such houses are now so general through-
out Germany,—receptacles  which remove  from  the feeling
mind that horror which is inseparable from the idea of living
sepulture.
  Of almost equal importance are his " Remarks on Small-
pox which prevailed epidemically at Weimar," first published
at Leipzig'in  1789, and in a 3d edition in 1798.   His " Ex-
perience of the use and effects of Muriate of Barytes," first
published at Erfurt in 1792, and again at Berlin in 1794, has
been of great use in the treatment of scrofula.   In  1795 he
published his " Ideas on Pathogeny,"  which work  was re- 
VI
life  of the author.
printed in 179S under the name of " Pathology," and later
as his " System of Practical Medicine."   He derived great
reputation by his " Journal of Practical Medicine," not only
from the usefulness of that work, but also from the ability he
displayed in it as its editor.   It first appeared at Jena in 1795;
subsequently  he had Himly  and Harless as associate editors;
and since 1824, Osann.  This Journal soon became, and con-
tinued to be  the vehicle through which  the  most eminent
German practitioners communicated their ideas and discover-
ies to their brethren,  and was  emphatically called the Ger-
man Medical Journal.   It ranked with  that of Edinburgh.
Hufeland, unlike sectarian  writers, of whom we have  too
many, was a sincere searcher after truth, and readily admitted
into his journal every  thing which promised advancement to
science, in order that it might get an impartial hearing.
  He endeavored to convey useful information  to non-pro-
fessional people in his work " Macrobioticon, or  the art of
prolonging human life."  It gained great favor in the es-
timation of those for whom it  was composed, and has been
translated into several languages.
  The  same  philanthropic purpose he  tried to serve by
editing  Darwin's book " On the physical and moral educa-
tion of females,'' with annotations and additions  of his own.
In 1822—24  he published his " Minor Medical Writings" in
3 vols.*  The last, but not the least of his works was his En-
chiridion Medicum, which we  now offer to the public, and
which he considered as his  Legacy, to be useful even after
his death, which soon followed its  publication.   It was at
the same time an act  of charity, for the proceeds went to a
fund for the support of indigent physicians.
  Hufeland possessed a great  mind, the strength of which
shone brightly in the investigation of Nature.   He was never
limited in his view by the  narrowness of  systems, but  was
eclectic, impartial, unprejudiced and a competent judge ; in-
defatigable in the promotion of the best interests of mankind,
and  took an  elevated  stand not  only  in his profession as a
physician, but also in society as  a truly moral and philan-
thropic man.
ie jubilee of his Doctor-
its. 
PREFACE.
  There are already so  many Manuals of the
practice of medicine, that it seems almost useless
to add a new one to the  number.  But  a  mere
glance at this branch of medical literature will
detect  a deficiency.  While  our bookstores
abound in epitomies of English, and translations
of French practice,  they are destitute  of any
thing on the subject from the rest of Europe.
This is the more to be regretted, since we know
that Germany has long been celebrated, not only
for the profound abstractions and vast erudition
which distinguish every branch of science in that
country; but also, for many practical,  though
peculiar, methods  of exercising the healing art.
This hiatus has not escaped the observation  of
the publisher,—himself a German, and from this
circumstance capable of selecting the most cele-
brated work of his countrymen.  He, therefore,
thinks that such a work as he now offers to the
English reader is  not  only wanted, but  that he
has chosen as a specimen of German medicine
the best manual extant;  for, who is there that
enjoys a higher reputation in the medical profes-
sion than did the late venerable and  learned
Hufeland?  This work of the patriarch  of Ger-
man medicine first appeared in 1836, and has al-
ready passed through eight large editions in Ger-
many ; has been translated into French  by that
great judge of medical literature, Jourdan,  mem-
ber of almost all the scientific societies of Eu-
rope, and in this language it has already passed
through several editions.
   In order to expose the object and plan of the
work,  we shall  let the author speak for  himself. 
Vlll                 PREFACE.
In his preface he says:  " This book is intended to
be a clinical  guide  for junior practitioners; for
such as just enter into practice;—to serve them
as a guide and give  to the mind a right direction ;
to point out every disease; to point out  that
which is essential in a practical point of view;  to
point out the treatment  to be adopted, and the
most approved remedies;—in short, it is intended
to be a complete, though a compact manual, di-
vested of all hypothesis.,
  " In the second place, this book is the Deposi-
tory into which I cast the final result of my long
experience.
  " As regards the  Classification which I have
adopted, I may simply  say that it is the same as
that which I followed when a teacher, and which
I ever found to be the most appropriate for clini-
cal instruction ; the  principal feature of which is:
—the division of diseases into species according
to the most  prominent morbid phenomena, this
being the path  traced  to us by Nature herself.
The first thing which she presents to us is the
external appearance—the image of disease; she
strikes our senses with it; through this physiog-
nomy we must penetrate  ere we reach the inte-
rior in  search of the invisible, there to investi-
gate the nature of  disease, its seat and causal
relations;  and  it is on all these  that we  must
base the method of  our treatment.
  " Such a course presents one great advantage
—that of making us familiar with the generali-
ties which belong to all the classes—with the fun-
damental ideas of pathogeny, and thereby with
the chief indications of cure: hence results a cor-
rect view of all the species belonging to a  class
so seen, and consequently  an equally correct plan
of treatment, making allowance only for differ-
ence of location." 
TABLE  OF  CONTENTS.
	Page
THE RELATIONS OP	
THE PHYSICIAN .	1
NATURE AND ART—	
Physiatric .	19
Sanative power of Na-	
ture ....	19
Medicine, its idea and	
limits ....	22
Its tendency, recogni-	
tion and action .	23
DIAGNOSTICS, Iatrog-	
NOMIC ....	24
Cognition of the sick	25
Constitution of Patient	25
HBreditariness	26
Sex ....	27
Age and period of life .	27
'Temperaments	28
Idiosyncrasy .	29
Weak part .	29
Habit, Mode of Living,	
Occupation	29
Habitual Diseases and	
Crises	30
Climate ....	30
Cognition of Disease .	38
Pathogenesis	31
Symptomatology .	32
Pulse ....	33
Art of feeling the Pulse	44
Respiration .	45
Blood ....	52
Digestion	53
Secretions and Excre-	
tions ....	56
Affections of the mind	
and nerves	61
Complexion, Structure,	
External appearance,
Carriage, Position   .  67
THERAPEUTICS     . ^70
  Order  of  the rational
    mode of healing .    .  73
PRACTICE   ...  75
Maxims  and   general
  rules  for  beginning
practitioners irst Class. Acute Fe-	75
vers .	79
Generalities .	79
Simple Fever	84
Inflammatory Fever Nervous Fever	85 "*90
Putrid Fever	99
Gastric Fever	100
Rheumatic, Catarrhal	
Fever	105
Contagious Fever	107
Typhus Contagiosus	110
Levantine, or Bubon	
plague Yellow Fever, Black	111
Vomit	112
Oriental Cholera .	112
Hydrophobia Carbuncle	113 115
Second Class.  Intermit-
    tent and  Chronic Fe-
    vers  .... 116
  Fever and Ague  .     . 117
  Chronic,  Symptomatic,
    Hectic, Consumptive
    Fevers    .    .     .123
Third Class.  Inflamma-
    tions and Sanguineous
    Congestions    .     . 125
  Generalities  .    .     . 125
  Inflammat. of the Brain 138
  Myelitis, Spondilitis    . 142
  Angina?      .    .     . 143 
CONTENTS.
Stomaitis	. 146
Glossitis	. 147
Pneumonia .	. 147
Carditis	. 157
Abdominal Infla	mma-
tions .	. 158
Gastritis	. 158
Enteritis	. 159
Hepatitis	. 161
Splenitis	. 163
Diaphragmatis	. 163
Mesenteritis .	. 163
Pancreatitis .	. 164
Peritonitis	. 164
Omentitis	. 164
Nephritis	. 164
Cystitis	. 165
Metritis	. 166
Oophoritis	. 166
Psoitis .	. 167
Ophthalmitis	. 168
Otitis .	. 168
Erysipelas	. 169
Zona	. 172
Fourth Class. JRheuma-	
toses .	
Generalities .	. 172
Rheumatism	. 173
Ischias .	. 180
Lumbago	. 181
Catarrhus	. 181
Fifth Class. Gastroses. 184	
Gastric diseases.	Gas-
trie Impurities .	. 184
Various Species	. 187
Sixth Class. Nervous	
Diseases	. 190
Generalities .	. 190
1. Mental diseases	. 196
Insania	. 196
Hypochondria, Hysteria 203	
2. Spasmodic diseases . 210	
Epilepsy	. 210
St. Vitus' Dance	. 214
Catalepsy	. 215
Somnambulism	. 216
Nightmare	. 217
Agripnia	. 218
Raphania	. 218
Tremor	. 219
Tetanus, Trismus	. 219
Asthma	. 222
Palpitation of the heart 227
  Cough  .    •    •    • 22S
  Hooping cough   •    * 232
  Chronic vomiting     • f^
  Hickup  .               239
  Neuralgia   .    •    • 240
  Pruritus     .    •    • 240
  Headache   .    •    -241
  Tic Douloureux   .    . 242
  Toothache  .    •    -243
  Earache    .    •    -244
  Cardialgia, Gastrodyma 244
  Pyrosis  .    . .    •    -245
  Colic    .    .     •    -245
  Hydrophobia     .    .  249
  Polydipsia   .    .    .249
  Pseudacusis, Paracusis  250
  Pseudopia   .    .    .  250
  Nymphomania, Satyria-
    sis,  Onanismus  .    .  251
3. Paralytic diseases     .  252
  Apoplexy of the brain  .  253
  Apoplexy of the lungs  .259
  Syncope     .     .    •  259
  Asphyxia    .     .    .261
  Vertigo      .     .    .263
  Lethargy    .     .    .  263
  Local  paralysis    .    .  264
  Dysphagia  .    .    *.  270
  Aphony, Dysphony, Dys-
    logy  .    .    .    .271
  Apepsy, Dyspepsy    .  273
  Pica.  Malacia    .    .  274
  Impotency   .    .    .  274
  Amaurosis   .     .    .  276
  Deafness    .     .    .  277
  Anosmia, Agustia     .  278
  Anaesthesia .     .    .  278
  Anorexia    .     .    .  279
  Anaphrodisia     .    .  279
Seventh Class.  Emacia-
    tions  .    .     .    .280
  Generalities .     .    .  280
1. Phthisis     .     .    .281
  Pulmonary consumption  281
  Phthisis purulenta    .  291
  Vomica      .  x   •    .  296
  Phthisis Florida   .    .  298
  Tracheitis, Laryngites.  298
  Phthisis hepatica, rena-
    lis vesicalis,  mesente-
    rica   ....  299
2. Tabes   .    .     .    .300
  Pituitous consumption  ,  301 
CONTENTS.                       XI
   Nervous consumption  . 302
   Dorsal consumption    . 304
   Marasmus   .     .    . 305
 3. Atrophy     .     .    .306
   Tuberculous  consump-
     tion  .     .     .    .307
 4. Hectica      .     .    .309
 Eibhth Class.   Hydro-
     pes, Pneumatoses    . 310
 1. Accumulations of water 310
   Generalities .     .    . 310
   Ascites .... 312
   Hydrothorax      .    . 315
   Hydrops Pericardii    . 316
   Hydrocephalus    .    . 317
   Anasarca, Oedema    .  317
 2. Accumulations of air   . 318
   Generalities  .     .    .  318
   Flatulency   .     .    .319
   Tympanitis  .     .    .  321
   Emphysema      .    .  322
   Physometra  .     .    .  323
 Ninth  Class.  Profluvia 323
   Generalities       .    .  323
 1. Haemorrhagiae     .    .  324
   Generalities  .     .    .  324
   Epistaxis     .     .    .  326
   Haemoptysis  .     .    .  327
   Haematemesis     .    .  331
   Haemorrhoids     .    .  332
   Meleena.     .     .    .341
   Hematuria   .     .    .  343
   Haematosis   .     .    .  345
 2. Blennorrhceae     .    .  346
   Generalities  .     .    .  346
   Ptyalismus   .     .    .  347
   Epidrosis     .     .    .  347
   Enuresis     .     .    .  348
   Diabetes     .    .    .  350
   Cystorrhoea  .     .    .  352
  Gonorrhoea   .     .    .  353
   Pollutio      .     .    .354
   Otorrhcea     .    .    .  356
  Lienteria     .    .    . 357
  Fluxus coeliacus  .    . 358
  Fluxus hepaticus  .    . 358
  Diarrhoea    .    .    . 359
  Dysenteria  .    .    . 363
  Cholera     .    .    . 367
Tenth  Class.   Suppres-
    sions .... 369
  Generalities .    .    . 369
  Constipation      .     .371
  Ileus   .     .    .     .372
  Ischury, Dysury, Stran-
    gury, Anury    .     . 375
  Anidrosis     .    .     . 378
Eleventh Class.  Cuta-
    neous diseases  .     . 380
  Generalities  .    .     . 380
  Variola      .    .     .386
  Varicella     .    .     .395
  Vaccinella   .    .     .396
  Varioloides   .    .     .398
  Morbilli      .    .     .400
  Scarlatina   .    .     . 405
  Rubeolas     .    .     . 409
  Essera  .... 409
  Urticaria     .    .     . 410
  Miliaria      .    .     . 410
  Petechiae     .    .     . 413
  Pemphigus   .    .     . 414
  Aphthas      .    .     .415
  Scabies      .    .     . 417
  Herpes       .    .     . 420
  Crusta serpiginosa     . 423
  Lepra  .... 423
  Erythema, Phlyctaenae  . 424
  Tinea capitis      .     . 425
  Gutta rosacea.  Vari   . 426
  Furuncle,  Carbuncle   . 427
  Intertrigo. Rhagades   . 428
  Freckles     .    .     . 429
  Comedones  .    .     . 429
  Callositas  cutis.  Excre-
    scentiae. Clavus. Ver-
    rucas  .... 430
  Plica polonica    .     . 431
  Mole   .... 432
  Alopecia    .    .     . 433
  Ulcera  .... 434
Twelfth Class.  Dyscra-
    sies  .... 434
  Generalities  .    .     . 434
  Chlorosis   .     .     . 438
  Cyanosis    .    .     . 439
  Scorbutus    .    .    . 440
  Icterus      .    .     . 441
  Scrofula     .    .     . 444
  Struma  .... 452
  Rhachitis    .     .    . 452
  Arthritis     .     .    . 453
  Syphilis     .    .    . 462
  Polysarca    .    .    . 480 
XII
CONTENTS.
Thirteenth Class.  Dis-
    organizations, Pseudo-
    organizalions, Para-
    sites  .    .   .    .481
  Helminthiasis    .    • 486
  Lithiasis    .   .    .492
  Stone in the Bladder   .  493
  Stone in the Kidneys  .  493
  Gall-stone   .   .    .  496
Diseases  of  Females.
    Sexual   Diseases  of
    Females   .   .    .  498
  Physical characteristics
    of the female  .    .  498
  Menstruation    .    .  499
  Diseases of menstruation  500
  First   development   of
    menstruation, Puberty,
    Morbid obstruction of
    it     ...     .  500
  Regimen menstruale   .  503
  Suppression of the men-
    ses    .    .    .     .503
  Immoderate flow of the
    menses. Metrorrhagia  505
  Painful, difficult mens-
    truation.   Menstrual
    spasms    .    .     .  507
  Cessation of the menses 508
  Pregnancy  .    .     .  510
  General rules for preg-
    nant women    .     .  511
  Headache  and  tooth-
    ache      .    .     .  513
  Vomiting  of pregnant
    women    .    .     .  513
  Prevention of abortion  .  514
  Convulsions of pregnant
    women    .    .     .»515
  Parturition and childbed  516
  Characteristics  of  this
    state      .    .     . 516
  Treatment after delivery 517
  Puerperal fever   .     . 519
  Lacteal  secretion,  and
    its treatment in cases
    of suckling  and  not
•*  suckling   .    .     . 521
  Flux of milk     .     . 522
  White swelling of lying-
    in women  .    .     . 523
  Whites      .    .     .524
   Barrenness, .     •    • °^°
 Diseases  of  Children.
     Characteristics of In-
    fancy and its Diseases 529
 • Diagnostics  in children 531
   Therapeutics  for  chil-
     dren .... 532
   Regimen for children  . 535
   Diseases of the new-born
     and infants     .    . 536
   Asphyxia neonatorum . 537
   Icterus neonatorum    . 538
   Excoriationes  neonato-
     rum  ....  538
   Thrush      .     .    .539
   Ophthalmia    neonato-
     rum  ....  539
   Erysipelas of infants   .  540
   Trismus and tetanus of
     Neonatorum     .    .  540
   Asthma thymicum     .  541
   Syphilis congenita     .  541
   Diarrhoea    .    .    .  542
   Vomiting    .    .    .  544
   Nervous attacks, spasms,
    convulsions     .    . 545
   Fevers .... 546
   Gastric fever     .     . 546
   Catarrhal fever   .    . 547
   Worm fever .    .    . 547
   Inflammatory,  Pectoral,
    Brain fever     .    . 547
   Exanthematic fevers   . 548
   Difficult teething  .    . 548
   Cutaneous  acrimony.
    Biles.  Crusta lactea.
    Scaldhead     .     . 550
   Croup .... 551
   Millar's Asthma   .     . 553
   Dropsies of the head and
    brain     .    .     . 554
   Decay of Children     . 557
   Limping     .    .     . 558
   Receipts     .     .     .561
INDEX .    .     .     .621
APPENDIX,  OR  THE
  THREE CARDINAL
  MEANS:
Venesection  ...   4
Opium   .    .     .     .15
Vomits  .    .     .     .49 
®l)e Helatiort0 of % {Musician.
  An instinctive impulse to relieve a sufferer was the ori-
gin of the healing art. This pure and noble sentiment must
always prevail, to make the practice of medicine answer its
ideal, and render it a blessing to both physician and patient.
  To live for others and not for himself is a physician's
vocation.  He must  be  ever ready to sacrifice his repose,
advantages and comforts, yea, even higher considerations,
to the end of saving the life and health of his fellow-men.
  The healing  art,  therefore, is something sublime and
really divine ; for its duties coincide with the  first and
most sacred laws of religion and philanthropy, and require
resignation and an elevation of mind far above worldly de-
sires.  None but a really moral man can be a physician in
the true sense of the word, and it is such a one only that
can  find satisfaction in his vocation; for he alone is con-
scious of a higher end of existence, which exalts him above
earthly considerations and the joys and  troubles of life.
To improve his mind, to sacrifice his person for the public
good and a better world, and to disseminate good around
him as much as lies in his power—is what he aims at; and
where can he attain that end better than in a profession
which gives him daily opportunities, yea, compels him to
perform philanthropic acts, acts that are incompatible with
selfishness'?  His professional duties therefore will always
beautifully harmonize with his convictions and principles,
and, so to say, flow from them.  What he ought to do, he
does with pleasure ; and the consequence will be  the high-
est happiness of man, a consonance of external and internal
life.  Wo to the physician, who makes  honor with men,
or money the end of his efforts! He will  be in continual
contradiction with himself and his duties;  he will  find his
hopes disappointed and his  efforts unproductive;  he will
curse a vocation which does not reward—because he knows
not true reward.
                          1 
2                   THE RELATIONS
  This simple view embodies the whole moral or policy so
called of the physician.  Policy—an  improper word ; for
nowhere more than in the medical profession do we see it
exemplified, that the best and only  policy is that which
emanates from an honest and sensitive man.  The rule re-
suiting therefrom, and which must remain a fundamental
law for all the relations of a physician is: " Regulate all
your  actions in a manner, that the highest end of your voca-
tion, which is saving life, restoring health, and relieving the
sufferings of humanity, be attained as far as possible."
  This rule must  ever be present to  our mind; it will al-
ways  direct us to the right point, and guide us safely in
the most complicated cases.
  From this point of view let us now consider and regu-
late the  duties of a physician.   They are triple : towards
the sick,  towards the public, and towards his colleagues.
              A.   RELATION TO THE SICK,


  The physician in the exercise of his art must regard only
man, and make no difference between rich and poor, high
or low.  He who suffers most or is in the greatest danger,
has a  privilege over all others, whatever be their station or1
condition in society. I pity the physician who appreciates
his patients according to rank or fortune;  he knows not
the finest reward of a physician.  What is  a hand  full of
gold compared  with the tears of gratitude  shed by the
poor,  who, unable to speak or to give, pours  out a confess
sion of  eternal indebtedness %  But the rich man believes
himself  redeemed  by his donations of all obligations of
thankfulness, not aware that the fee receives its value only
through a  deeper  feeling;  and the assistance rendered,
without  this, is  placed  in the  range of common services
and works of trade.  How often is the physician the sole
friend left to the poor in distress!  Like  an  angel of con-
solation he appears to him, and raises the vanishing hopes
by the interest  he takes, and  by his art  he pours new
strength into his veins.
  Should  some one be so unfortunate as not  to find satis-
faction in  this sublime feeling, or  should he believe the
practice among the poor will not promote his interests  he
may remember, that the voice of the poor who has been
saved, speaks much louder  and in  a more thrilling tone
than that of the rich, who frequently, by his compensation 
OF THE PHYSICIAN'.                  3
thinks himself entitled to be ungrateful and to undervalue
the services rendered.
  In  medical  treatment  the physician must  exercise his
greatest attention, accuracy and conscientiousness.  He must
not proceed superficially, but with research and knowledge.
He must never consider the patient as a means, but always
as an end; never  as an  object of a natural experiment or
of art alone,  but as a man, as the highest scope of nature
itself.—Seldom,  it is true, can the faults of the physician
be brought before, and punished  by,  a  tribunal, as this re-
tribution depends upon accurate evidence of the case, but
which is scarcely ever obtained.  However, the  most cer-
tain and  the most formidable tribunal is waiting  for him—
his conscience—where no subterfuge, no palliation, no want
of a complainant can guard  him, where nothing will ab-
solve him but a pure and guiltless mind, and the  convic-
tion of havincr done all  within  his power and knowledge
towards saving his patient. Though he may learn through
improved knowledge and experience subsequently acquired
that he might have done  more and better,  he may regret
his former deficiency, but not feel remorse, for at that tirne
he  did all  he was capable of performing.  He must, how-
ever, be  mindful that neither levity,  his own  ease, or any
personal consideration,  or—what may happen  to a better
one—that  no predilection for a system or fondness of ex-
perimenting,  lead him  to neglect his duties;  for then the
internal  judge will  not  remain  silent.  Such  cases will
sooner or  later  meet with adequate  punishment from tor-
menting reproaches.
   But skill and art alone are not sufficient.  He must be
particularly mindful  of his conduct. It is this which recom-
mends him to the public, and creates  confidence  and ad-
mittance ;  for the generality of people are incompetent
of pronouncing on his science; it is,  then, natural for them
to  take their measure of his ability from the measure of
his conduct.  By force of conduct alone a physician of very
moderate talents can become the favorite  of the public, and
without it  the most skillful professional man  remain unno-
ticed and unappreciated.  Of his external appearance also he
must not be regardless; it should comport with the dignity
of his station  and the importance of his duties.—The main
features  of his conduct should be : aptitude to create con-
fidence,  friendly with  dignity, decent without affectation,
gay but  not  ludricous,  serious when he  ought to give im-
portance to his subject and his words, complaisant and in-
dul<rent in all insignificant matters, but firm while execut- 
4
THE RELATIONS
ing important  measures and  sustaining  the  pronounced
sentence; sympathizing and cordial, of sound sense and
regard for religion and  its consolations;  neither taciturn
nor loquacious, much less a messenger of news,  but  de-
voting his whole attention'to the sick, notic;ng every cir-
cumstance, careful in the examination of the  patient,  ob-
serving even those around him, neither eccentric nor vulgar,
neither coxcomb nor pedant, but holding to the middle way
in all  things;  especially  not  passionate and angry,  but
calm and circumspect; for a quiet and sober sense creates
confidence.—It is a great fault  common to young practi-
tioners, particularly of late,  that they strive principally to
create sensation, whether it be by  the newest fashion of
dress  or science, or by paradoxism  and  singularities,  or
even by charlatanism.
  But  there is a great difference between  exciting sensa-
tion and creating confidence ; yea, the former prevents the
latter from taking place, and it  is only by  the latter that a
lasting prosperity is founded.  Exciting sensation can,  of
course, have  the effect of making a physician  the topic of
conversation for some tirne,  even of procuring him a large
concourse of patients, but the attraction of novelty soon
ceases, and the meteor vanishes into nothingness.  On the
other  hand, the silently meritorious, honestly  persevering
and unwearied may  remain for a time unnoticed, but in
establishing himself slowly in the love and confidence  of
the better ones, he lays a surer and firmer foundation  for
future  prosperity.
  A most important point for attaining this end, but rather
too much neglected by our young practitioners, is keeping
a. journal of cases.  When the noise of the day has termi-
nated,  and the silence of the evening invites to reflection,
then the physician may yet devote a few hours  of calm
contemplation to his patients,  write down  the  most im-
portant points in the history of a malady, the alterations
which  have occurred, his remarks and ideas on the origin
and treatment  of  disease,  the  remedies  prescribed, and
reconsider the whole maturely.—No evening must pass
without paying this last duty to his  patients, and thereby
adding the keystone to his work.  Here, in the silence  of
night,  many a thing will appear to him in quite a different
light than during the day ; revelations and  inspirations will
come over him, such as cannot find birth in  the distrac-
tion of busy day.  Only in  this period when  internal life
awakens, also this subject can enter into internal life, and
only now it will receive true interest and reflection. ' For 
OF THE PHYSICIAN.
5
 that alone which affects and fills our mind,  which accom-
 panies  us always even unconsciously, is ours; and solely
 penetrated by such an  object,  we may hope to  become
 great and perfect in it and to arrive at new discoveries.—
 Great Newton once was asked, how he  had come to his
 extraordinary discoveries.  "I  always thought of them,"
 was his reply, simple but certainly all embracing.
   It is not mechanical  dexterity, however careful it be,
 but a deep conception of his object,  which makes  the ac-
 complished artist.  Every cure, in order to be good,  must
 not be a  servile  imitation of others, but  an original in
 itself.
   I do  not, therefore, deny that I  consider this daily habit
 not solely a principal means,  but  an indispensable condi-
 tion for becoming great and perfect in the practice as well
 as in the  art;—an assertion which is confirmed by the ex-
 amples of our most eminent physicians, of Boerhaave, Fr.
 Hofma'nn, Stoll, Lentin, etc., who all observed this habit
 and praised its  utility.  Moreover, there grows out  of it
 this other great advantage—that of obtaining a collection
 of  complete histories of maladies upon which we have,
 ourselves, reflected,—a treasure of experience, which will
 not fail in  after-times to yield much  instruction, and en-
 lighten us by a comparison  of the successive changes of
 our opinions and methods;—to  say  nothing of the great
 utility  which may be derived therefrom for  the  patient,
 serving as an accurate  register of his state of health, of
 his maladies, the remedies which proved particularly bene-
 ficial in such or such a case,—a circumstance of egregious
 moment.
   The  same is true in regard  to visiting the sick.   When
 shall we cease to place confidence in the mere presence of
 the physician, and to  esteem his care by the number of his
 visits'!  Alas! the head cannot keep pace with the  feet, as
 Zimmermann has  well  remarked.  Such  mere  corporeal
 presence and looking-on, however often repeated, will not
promote a cure; and, properly speaking, amounts to no-
 thing more than rendering honors—paying one's respects
 —to the  disease according to its rank.  A visit must be
 made with deliberation, a collected mind,  and be  of  suf-
 ficient  duration.   The physician must not  be present in
body only, but in  mind ; and  must direct his whole atten-
tion to  his patient  and study him.  It is  only such visits
that will answer the purpose sought.  They will result in
a double advantage to the physician,  firstly, in convincing
the patient of the interest which be takes in him, and there-
                          1* 
6
THE RELATIONS
 by gaining his confidence; secondly, in creating that reci-
 procity of feeling and familiarity, which permits of a deep
 insight into the nature of the case; in short, to use an ex-
 pression of the magnetizers, "place the sick in perfect rap-
 port with the physician,"—certainly, in quite a particular
 state  of mind ; one which admits of particularization and
 a deep insight into the "inward man ;" teaches  us to form
 more correct feelings and ideas regarding the suffering of
 nature and  her wants from art,  and gives thoughts which
 strike us the more forcibly since they arise directly  from
 the  patient. One such visit is worth  more than many made
 in haste.   Too many visits in  chronic cases,  since they
 render the patient too common to our  senses,  may blunt
 the keenness of our perception, and obstruct our vision ; as
 the  saying is—" we cannot see the forest for the trees." I
 have experienced,  in such cases, that an interruption of
 the  usual  visits  for several days  will enable us to gain a
 new view of the subject,  and  to bring phenomena to light
 which heretofore had escaped observation.  It must, how-
 ever, be remarked here, on account  of young physicians,
 who, through  delicacy confine their visits to too small a
 number, that in general frequent visits are more requisite,
 since they  enable  one to arrive at a more perfect know-
 ledge of the disease, and  also  preserve  the confidence of
 the patient.  Too frequent visits, unnecessary  visits,  are
 to be avoided, for they give useless anxiety to the patient,
 and  expose the physician to be suspected of interested
 motives.
   The office of the physician is not confined to curing dis-
 eases; it behooves him as a duty and  merit also to prolong
 life  and relieve sufferings in  maladies pronounced incur-
 able.  How much,  then,  at fault are they who  grow  dis-
 gusted or lazy, and neglect or forsake  a patient when there
 is no prospect of cure !  The interest of the artist, it is true,
 maybe annihilated; but  humanity must persist, yea  in-
 crease.   Verily, the unfortunate, who labors under tortur-
 ing pain, distress and despair,  is still  more entitled to  our
 commiseration than he  to whom the prospect of recovery
 lessens all suffering.  It is an act of pity, natural to every
generous heart,  in  such cases to make life tolerable  to
raise dying hope, and to bring consolation at least where
 here is no salvation.   Moreover, we are too short-sighted
to be capable of always deciding with certainty  that JSp
is not possible.   In  the course of a  disease favorable In
ternalrevoutionsmay take place,  or  eaterna? ^fluenc™;
may  operate and glve a  new turn, or give to i« oppOI! 
OF THE PHYSICIAN.                  7
tunity  for successful interference.—Yea, I consider it as
one of the most important rules of practice, never to give
up hope^  Hope generates ideas, elevates the mind to newA <
views  and new endeavors, and can render  impossibility
possible.  He who has given up hope, has given up reflec-
tion, to which apathy and paralysis of the mind follow, and
the sick must invariably die,  because he who has been
called  to his% assistance is already dead. Even in the stage^
of dying the physician ought not to forsake the sick; even
then he may become a benefactor, and if he cannot save,
may at least relieve  departing life.
   To preserve and, if possible, to prolong life is the highest
end of the medical art; every  physician has vowed to do
nothing which might shorten the days of a man.  This
point  is of great weight, and  is one of those from  which
he must not depart the breadth of a line, lest  his practice
be productive of  uncountable distress.  Now, is it always
pondered on  with sufficient conscientiousness and  strict-
ness 1  When a patient is tortured by incurable evils, when
he prays for death as the end of his suffering, when preg-
nancy engenders disease and danger to  life,  how readily,
even  from  the mind of the best the idea will emerge:—■
would it not be permitted,  be even a duty, to rid the mis-
erable sufferer of his burden a little earlier, or to sacrifice
the life of the foetus to the safety of the mother 1  Though
such reasoning be plausible, be supported even by the sug-
gestions  of the  heart, it  is false,  and a mode of  action
based upon  such principles would be a  crime.  It annihi-
 lates  the vocation of the physician.  He is bound in duty
to do nothing but what tends to save life ; whether exist-
 ence be fortunate or unfortunate,  whether life be  valuable
 or not, is not for the physician to  decide.  If he once per-
mits such considerations to influence his actions,  the con-
sequences cannot be estimated, and he becomes the most
dangerous person of the community.  For if he once tres-
pass his line of duty, and  think himself entitled to decide
on the necessity  of an individual's life, he may by gradual
progressions  apply that measure to  other cases.
   Now, the life of a sick person can be shortened  not only
by acts,  but  also by the words or the manner of a physi-
cian, and that most unintentionally on his part. It is, there-
 fore,  his sacred  duty to guard himself carefully in this re-
 spect, and  to avoid all things which have a tendency to
 discourage the  patient  and lower  his  spirits.   He must
 never  forget that  nothing ought  to  emanate  from him,
 which might  have  the  effect of injuring the patient or of 
8                    THE RELATIONS
 shortening his days ;  every word, every  look,  his whole
 conduct must be of an enlivening tendency.  He must not
 forget that his patient looks upon him as judge  of life and
 death, and anxiously  scrutinizes the glances of his eyes,
 the gay or sad features of his countenance, in order to dis-
 cover his sentence. Is.it not a fact that fear, especially of
 death, anxiety and fright are pernicious poisons, that they
 directly paralyze the vital power; while hope and courage
 are the most efficacious' animatives,  frequently surpassing
 all medicines, nay, without which even the best  medicines
 are unavailing!  The physician,  therefore, must be care-
 ful to preserve hope and courage in the patient's mind, re-
 present his  case in a favorable light,  conceal  all danger
 from him, and, the more serious it becomes, show a more
 cheerful appearance;  and least  of all betray uncertainty
 and irresolution, although there be cause for doubt.   He
 can guard himself from  the suspicion of not having fully
 appreciated  the nature of  the case,  by giving  a true de-
 scription  of the patient's situation to the relatives, and if
 they be fickle and negligent, to state it rather darker than
 lighter.  Hence it will appear, how blamable is the con-
 duct of those physicians,  who do not hesitate to  announce
 to the sick the danger, even fatality of their situation, and
 how injudiciously those relatives act, who desire the physi-
 cian to do so.  To  announce death is to give death, which
 is never the business of him, who is employed to save life.
 —Even if the sick  person desires to know the truth, under
 a pretence of arranging his  affairs or the like, it is not  ad-
 visable to  pronounce  his sentence.   I have heard of two
 cases, wherein two excellent practitioners were induced
 by the entreaties of the patient,*to reveal to him the incura-
 bility  of his evil,  and the consequence was that each  pa-
 tient committed suicide.
   It is not life alone, but what  is still more, reputation,
 that  the  physician must risk, when the life  of a sick
 person is at stake.    We meet here with a case, which un-
 doubtedly is one of the most difficult in  the medical  pro-
 fession, and  in which a false  sense of honor is so apt to
 mislead, while nothing but correct considerations and true
 principles can safely guide  us.  The physician  sees, that
 the  patient can be  saved only by one  means;  but  that
 means is  dubious  and the  trial is dangerous, and at the
 same time there is nothing more certain, should it prove a
failure, than guilt will be attributed to him.  The false po-
litician will be prevailed  on by this consideration, think-
ing  it were better  that the sick die  than that he appear 
OF THE PHYSICIAN.
9
 to be killed by the prescription,  and will neglect to make
 this trial.   But the honest physician knows of no other
 consideration, than benefiting the sick ; he conceives that
 to  estimate his reputation higher than the life of the pa-
 tient, is to be guilty of an act of selfishness totally incom-
 patible with his vocation;  he believes that it is not a hope
 of  success but an honest intention which is to direct his
 actions, and that he  has  only to consult  duty and con-
 science, regardless of the  result.   Therefore, he does not
 hesitate to use also this last resort in order  to save his pa-
 tient, and will either enjoy the triumph  of seeing his ho-
 nest  attempt  crowned with success, or  the  still greater
 triumph,  of having sacrificed to his duty  that which is
 most dear to  him; and the  more he is misjudged by the
 public, the more he feels himself exalted above all opinions
 of men, and rewarded  in a  more divine manner, than by the
 honor and fame  which men can bestow.  In general,  the
 physician must be prepared to bear the false and unjust
 judgment of the public, as  soon as he engages in the treat-
 ment of a patient. The result and the opinions based upon
 it are not within our power,  and must  consequently  be
 quite indifferent  to us.  Interrogate the  best physicians,
 and they will tell you, that they, in cases which, terminated
 fatally, have often used more pains and skill, redounding in
 intrinsic merit, than in some most successful cures.  In the
 cure of disease, all that we may glory in, is to have com-
 plied with our duty.  This conviction is sufficient; of this
 reward nobody can deprive us, for it places us above the
 injustice done to us by others,  in the same proportion that
 a rational soul is exalted above brute temporality.
  A circumstance which frequently gives him more dis-
 tress than the disease, and renders his profession a painful
 one, is  the humor of men.  Prejudices  of all kinds,  the
 difference of education, character, temper,  and surround-
 ing objects, unite in hindering good.  In such an instance
 the physician must be  deeply skilled in human nature. But
 what physician will not become familiar with  it, provided
 he is not destitute of common sense ! I do not know of any
 profession which  affords so many opportunities.
  Knowledge  of  man  is derived through correct feeling,
 and prudence,  which alone can  rightly guide him in this
 point, and, in spite of all obstacles, lead to an accomplish-
 ment of his end.   I shall  only mention the most usual of
these characters:—the anxious, the fickle, the credulous,
the  incredulous, the obedient, the taciturn, the loquacious,
the  conceited, the demiphysician.  The most troublesome 
10
THE RELATIONS
are the two  latter, for they do not say what they really
feel;  they are  not satisfied with good advice, they want
to reason with and consult, and they arrogantly make al-
terations in the use of the remedies.  To  such patients we
must  particularly  inculcate the general rule,  to throw the
care  of the  disease,  as well as  the  contemplation of it,
which is sometimes more painful than disease itself,  upon
the physician, and free themselves entirely of it.
  The art of writing prescriptions is very important, and
worthy of more attention than is generally bestowed upon
it.  It is the  last result  of the whole  examination of the
physician, and  the only  perpetual document of his insight
and skill (genius), which has even legal authority bearing
for or against  him.   How readily a little fault committed
in precipitation, an error in writing,  may decide the fate of
the patient and the physician's reputation !   Therefore, it
should always be made with a mind most concentrated and
attentive, and it ought to be an inviolable rule with every
physician, "  to peruse every prescription after it has been
written."
  Dangerous remedies ought never to pass into the hands
of the patient, at least not in such a quantity as might en-
danger life.  It is a horrible sight to see vials of an ounce
or half an ounce of opium in the sick room.  If an accident
happens in such a case, the fault lies always with the phy-
sician.
  No  honest practitioner will  sell,  nor even allow to pa-
tients, nostrums ; for how can he judge of things which he
does not know himself!
  Wherever  it is possible without detriment to the  main
end, the practitioner must always prefer the cheaper to the
more  precious, the native to the foreign remedies.   It is
also a relief of the evil, with which the physician is charged,
to diminish  the expenses,  at  least  not to  increase  them
without necessity, and it  is one of the  duties of a  good
citizen, by using domestic remedies, to save the common-
wealth from  sending money into foreign countries.  It is
indeed cruel  to neglect  this consideration  in the  case of
indigent people,  and to take away the means of living in
saving their lives.
  In this respect  he can become a real benefactor to his
patients, if he  regards their financial  circumstances not
only with benevolence but with delicacy. I do not speak
here  of the really poor,  whom the state  or public charity
takes  care of, but of that class of persons, who, whilst in
good  health,  barely make their living, and as soon as at- 
                   OF THE PHYSICIAN.                11

tacked by sickness are thrown into indigence, and  those
who are really poor, although they do not wish to seem so
—the bashful poor.  It is almost only the physician who
has a  chance to find them out, and he also is best able to
relieve their misery, and—what is the main thing—with-
out allowing them to perceive it.  I will only refer to one
means, by which the expenses of cure may be exceedingly
diminished without the appearance of gratuitous medica-
tion,  which would place the patient amongst the poor : it
is to make an agreement with an apothecary of a charitable
mind  to this effect,  that he will  not charge profit on re-
ceipts marked with a concerted sign, by which expedient
the sick may save  a third, sometimes  a half, of the ex-
penses.  In this way we may succor the indigent, and not
offend the feeling of honor, so sacred a circumstance.  To
do  this is really to benefit.  In extending  benefits all de-
pends upon the manner in which it is done.  How happy
is the physician when he is enabled by his profession to do
good, complying with the injunction, that the " left hand
must  not know what the right does," and that even the in-
digent does not know whence the benefit comes, and re-
ceives it, thanking  God as he would for a heavenly dona-
tion.  It  is in this way  that in  every act of kindness, the
true sense and object  on the part of the giver as well as of
the receiver, is attained.


              B.   relation to the PUBLIC.

  To no one is public opinion so important as to the phy-
sician.  He is the man of the people in a true sense; the
voice of the people'decides what shall be his station.  He
must, therefore, be most anxious to win reputation, and not
unmindful  of the means proper for that purpose.   It is a
vain  and unseasonable pride  in  young  practitioners, to
boast of being elevated above public opinion and not to
care for it.  The pride of a wise man^s, to  accomplish bis
end in the  most correct manner:  now he who aims at an
end, must  use also the means  necessary for attaining it.
The principal end of the physician is curing; the more op-
portunity he can find for practising it, the more completely
he  will attain it, and become  a benefactor of mankind.
Now, that depends mainly on the good opinion of the com-
munity, and consequently it devolves upon the physician
as a duty,  to make efforts for acquiring and establishing
himself in it. 
12                  THE RELATIONS
   Extraordinary talents and striking success, it is true, can,
 so to say, force public opinion, and raise a physician even
 in spite of general dislike.   But these are rare exceptions.
 The common course is this : the young practitioner has
 gradually to raise a public sentiment in his favor, by which
 the public may be encouraged to commit to him the high-
 est earthly goods—life and health.
   The principal means for obtaining that end, are, (besides
 careful and conscientious attendance on his patients,) un-
 shaken probity, regularity of habits, temperance, prudent
 conduct, as previously described, modesty, discretion in all
 his  utterances  and judgments, precaution in the selection
 of his company, attention, not alone to essentials but also
 to appearances.  The physician, especially the beginner,
 must never forget that he is more observed than  other
 men.  He belongs to the community; it  is the  interest of
 every one to become acquainted with  him, lest he may at
 some  time have to commit his life to  his care;  and  every
 one arrogates for himself a right to judge him.
   The physician is of no party,  he belongs to all.  Popu-
 larity is his element, and freedom of mind and of political
 relation^ his noblest prerogative. He must therefore care-
 fully avoid to join a party, or enter into connections which
 compel him to do so.  On the contrary he may congratulate
 himself, that his vocation permits, even obliges him, to take
 no notice of parties and the external relations of men, and
 see only mere man.
   It is  also highly recommendable and advantageous to
 disseminate, by conversation or by writing,  sound  ideas,
 and correct notions respecting the  preservation  of health
 and a rational treatment of diseases, to combat prejudices,
 and  to promote  institutions ameliorative of the general
 state of health.  This is certainly  one of the surest and
 most glorious ways, by which the physician can be use-
 ful,  bring his name into notice,  and acquire  a reputa-
 tion and public confidence.   He  must, however, proceed
 captiously and prudently,  in  attacking deeply rooted pre-
judices and favorite habits of the public;  for, by treating
them impetuously and sarcastically, he is likely to fail and
render himself hateful without correcting the evil.
   Wit and a satyrical disposition are dangerous  gifts to a
young practitioner.  In no man are they so prejudicial and
incompatible with the nature  of his  vocation, as in the per-
 son, to whom man has to expose himself in all his naked-
ness, and has to detect infirmities and secrets, which no-
body else is destined to  learn.   The  greater part of the 
OF THE PHYSICIAN.                 13
 public will rather have recourse to a man of small capacity,
 than to a scoffer and witling.  How many have contracted
 inreconcilable enemies by a  single pun !  A real injury  is
 more readily pardoned than  mockery.
   Secrecy is one of the first and indispensable qualities of
 a  physician; for,  by his  vocation he learns the most im-
 portant secrets, and takes the place of a confessor.  The
 happiness, not only  of single men, but of whole families,
 lies at his discretion, and  it would be an act of baseness to
 betray such confidence,; or abuse it intentionally. He is to
 avoid not only being, but  even appearing to be indiscreet;
 therefore,  he must  speak as little as possible of other pa-
 tients, answer laconically and indefinitely questions asked
 about others, and the least of all to go into particulars and
 narratives  of domestic life.
   Above all things'the physician should not be  reputed a
 gamester,  a tippler, or a  libertine, for these habits are in
 strict contradiction with his  profession,  and infallibly will
 take from  him the confidence of the public.  The first of
 these vices interferes with that interest which is due to the
 patient;  the second deprives him of the  command  of his
 senses ; and the  third  of that purity and respectability of
 character,  which is absolutely indispensable in his  profes-
 sional  relations.   It  is, therefore, an advantage that the
 physician be married, and lead a good domestic life.  He
 hereby will acquire  more confidence,  especially  among
 females,  and also escape many a suspicion, even improper
 desires.
   He must not appear too desirous of gain. It debases the
physician and his art,  deters the poor  from  applying to
him, and takes  away that which is worth more  than all
riches—good repute.


             C.   RELATION TO COLLEAGUES,

  Is double, partly general, partly in regard to the sick.
  The  first embraces mutual respect, and when that is not
possible,  let at least indulgence be the principal law of
conduct.   Nothing is more difficult than to judge others;
but nowhere is it more so than in the practice of medicine.
It is, therefore, unpardonable in the public; but it is revolt-
ing to hear physicians, who know the difficulties of the art
and of forming opinions regarding it, judge their colleagues
with severity, harshness, contempt, or disclose their faults,
and try to raise themselves by lowering others.
                           2 
14                  THE RELATIONS
  Oh! that I were as able to impress the minds of my bre-
thren with the truism, as forcibly as I am penetrated by it:
He who  degrades a colleague, degrades himself and his
art.—For,  in the first place, the more the public becomes
acquainted with faults of physicians, the more will physi-
cians become exposed as contemptible and suspicious, and
the more will such exposure impair confidence ; and con-
fidence in  the whole body being  diminished, every single
one,  and the censurer included, will lose  a share of it.
The public would be less prone to  censure the medical
profession, and  its  faults would not be a favorite topic of
conversation, if the members themselves did not broach it,
and set the bad example.  It shows a shortsighted selfish-
ness, and want  of all common spirit, when a physician acts
in  such a manner, and thereby hopes  to raise himself in
the same proportion as he degrades others.  Further, such
conduct is in opposition to the  first principles of morals
and religion, which command us, not to lay bare the faults
of  others,  but to overlook and excuse them.   Such a cha-
racter will be more lowered in the esteem of sensible men,
than he whom he endeavored to degrade ; for, the detracted
loses only as an artist, while he loses as a man, and  a bad
action is esteemed worse than  a bad medical treatment.
Finally,  they should reflect, that the  same measure they
apply to others is applied to themselves.   He, who treats
others in a harsh and haughty manner, may rest assured,
that he will be  dealt with in the  same way—which is but
justice.  Modesty in conduct and judgment behooves  every
 one, most of all a young physician;  it will procure him
 friends and opportunities for instruction, and  promote his
 external interests as well as his  internal improvement.
    The medical art is  still  far from  that degree of perfec-
 tion  and certainty,  which would enable us to pronounce
 sentence on all methods of curing diseases; we do not yet
 possess a  legitimate universal code ; every  one is still at
 liberty to form his own views about the human system and
 its treatment,  provided  they  are not against  reason and
 experience. Nobody will deny,  that cures may be  effected
I in quite different ways,  and that the  apparent  contradic-
i tions in treatment may dissolve  into unity, by  the various
i operations of the organism.  Organic nature is not confined
; within such narrow limits as are our systems; if it were so,
 one  after the other would not have had its ascendency, and
 been applied with success.—After all, our experience, and
 the result rightly derived therefrom, are the only true and
 constant rules to be followed in medicine ; and the longer 
OF THE PHYSICIAN.
15
and the more sagaciously a physician has observed the ope-
ration of the living organism  against the influence  of the
external  world,  and especially  the influence of medica-
ments ; the more he has learnt to appreciate the powers of
the latter, and to use them with  adroitness,  the more per-
fect physician has he become. Let every one, therefore,
have his own system,  his own views of things; let, espe-
cially,  the  young practitioner feel happy to possess the
newest and most finished theory, and  to be able to deduct
all according to the rules of the  school ; but none must be-
lieve  that  he is alone in possession of truth; he must re-
spect the opinions of other physicians, particularly  of old
ones, matured in experience ; and  he must often  admonish
himself that he,  who believes himself sage,  is only  on the
threshold of art,  and that to doubt, and to search for that
which is  unknown to us, is the surest sign, and at the same
time the  only means,  of proficiency.
  The young physician will see  in the  old practitioner ma-
turity  of experience ;  profound  practical scrutiny ;  extent
and solidity of knowledge ; discrimination of what is essen-
tial and  proper  in art from  what is accessory  and vain;
practical tact; the art to transfer generalities into the spe-
cific form of the subject, and to  individualize the case as
well as its  treatment—an art which is not to be acquired by
science, but by practice, and which makes the great prac-
titioner ; a  knowledge and appreciation of the medicaments
and their specific niceties; and finally,  an adroitness in
hitting the right place, time and measure.  He'must try to
acquire the confidence and friendship of the elder one  by
modesty, and a desire  of knowledge;  to  profit by his con-
versation, and in this he will not only improve himself, but
also gain a support,  of which a young practitioner is so
much  in need.   On  the other  hand,  it  behooves the old
practitioner,  to  respect  in the younger one the freshness
of his insight;  the  modern view he  has learnt regarding
nature and art; the vigor,  desire for knowledge, research
after truth, diligence and application,  the merit of honest
earnestness, the  scientific and  systematic education; the
old one will remember that he had to travel the same road,
and how  difficult it was to the beginner ;  and will not with-
hold from  him that paternal benevolence, but give  to him
from  the treasure of his experience;  point out to him his
faults with friendship,  palliating  and excusing them before
the public  ; especially in case  of treatment and consulta-
tion in common, he may be cautious and kind, for it is here
that a word from the old master  may be decisive  of the fate
of the young man. 
16                  THE RELATIONS
   Moreover, it  is  an axiom  in medicine, that  the  most
 trifling circumstance is  capable of  altering the  state of
 things and  their signification,  and it is utterly impossible
 to judge of the medical treatment of another, unless one
 has himself been present, and has been informed  of all the
 particulars.
  It consequently follows  that  it is  always indicative of a
 deficiency of mind, or of knowledge, or of malignity and
 bad  conscience,  in a  physician, to  speak ill  of his. col-
 leagues,  and it behooves the honest practitioner, when he
 is asked his opinion, to excuse  himself from giving it,  by
 saying that it is impossible to judge  in  medicine, without
 a most accurate  knowledge of the  case;  or if this is not
 practicable,  to  give explanations favorable to his profes-
 sional  brother,  which is not a difficult thing to do.  Thus
 he will ever respect himself and his profession.
  As to the second point,—the relation of colleagues to the
 sick,—consultation is first to be discussed.
  In general, the use of consultations, especially when they
 are numerous, is very problematical.  When opinions are
 alike,  consultation  is of no avail; when they are diverse,
 confusion and disorder in the treatment is likely to ensue.
 It too easily happens that passions and personal feeling get
 mixed  up in a consultation; and what is still worse,  a re-
 gard for the sick  and desire  of cure are but too readily
 divided and  diminished, even in  a well disposed physician,
by the  interference of plurality.   But there may be cases,
in which Consultations are  useful,  yea, unavoidable:  as
when a disease is very complicated and obstinate, and the
physician grows uncertain in his view and his course ; when
 the patient  hesitates  and loses  confidence  in him; when
 there is great responsibility attached to the treatment,  or
 there intervenes the feeling of a relative, in which we dare
 not trust ourselves.
  However, in  order that a consultation may prove really
 useful, the following conditions must be complied with :
  The  consultations must not be numerous ; two,  at most
 three physicians  are  sufficient; and they must not be de-
 cided enemies of each other, obstinate partisans of different
 sects,  but be ripened by mature experience, and have a
 talent  to understand and to enter into the ideas of others.
  Their  office  is principally to  ascertain  the  diagnostic
 causes and character of the disease,  and then the mode of
 cure to be pursued. The  execution and guidance of a cure,
 however, must  not devolve on  a committee, but only on
 one, the physician in ordinary.
   The great principle to be observed by every consulting 
OF THE PHYSICIAN.                 17
 physician, must, however, always remain this, namely, to
 have in view nothing but the welfare of the patient, and to
 that end he must entirely sacrifice his personal feeling, in
 order that all his powers may unite for a common purpose.
 If physicians in their consultations would be penetrated by
 this simple sentiment, there  never would be altercations,
 scandalous scenes, and misunderstandings;  and  consulta-
 tions would always prove beneficial to the patient.  But on
 the  contrary,  physicians often seem  to  assemble  only to
 show their reciprocal importance, and to discredit the treat-
 ment of the ordinary; and instead of harmonizing together,
 to sustain their individual opinions.
   Consequently, in the first place, the patient is never per-
 mitted to be witness of the consultation, but learns the  re-
 sult of it as well as he is able, after  the deliberation  is over.
 It would be most ungenerous, and at the same time  cruelty
 to the sick in the consulted physician, to intimate that the
 treatment hitherto used had been wrong. Every one should
 express his opinion modestly  and  show his reasons for it,
 and  if the opinions differ, they must mutually try to make
 themselves understood,  to give explanations without  ca-
 price, and to enter into the ideas of each  other,  in order
 either to  join  opinions, or by a more  efficacious persua-
 sion to create a better one.   For, now-a-days especial^-,
 the cause of quarrel lies only in a difference of view and of
 language,  and it is only  necessary  to translate the opinion
 of one,  into the parlance of the other,  to  do away with  all
 difference.  Should one be prepossessed of a favorite idea,
 or of a favorite remedy, the other ought to yield willingly, if
 there is nothing injurious to the patient in it; to do so will
 make it apparent,  that we are  not led by  caprice, and the
 more complaisance in return  may we  expect in  the main
 matter.   But  should  it happen, that the  opinions and the
 plan of treatment can by no means  be agreed  on, there is
 no other expedient left, but an appeal to the decision of the
 patient.  He must  declare to whom his confidence leans,
 and the plan of this one must be prosecuted.
  Nothing is  worse  than  the  habit  of some  patients  to
 clandestinely consult  other physicians, besides the  physi-
 cian in  ordinary;  and nothing  is  more reproachable than
 the habit of some physicians to yield to such demands, even
 to profit by them,  to  raise suspicion against the ordinary,
and  to procure admittance for themselves.   No  honest
professional man can act so base  a part;  he will  rebut
such a demand, and insinuate to its authors, how indiscreet
and  impossible  it  is,  to  judge and to give advice without 
18          THE RELATIONS OF THE PHYSICIAN.
consulting the physician in ordinary, and without knowing
the plan of cure which  he pursues.  No one must think
that there is no harm in giving a general opinion on a dis-
ease and a cure.  Such utterances made without the least
bad intention, tend to raise doubts and suspicions in the
mind  of the  sick, and create difficulties and disagreeable
embarrassThent for the ordinary physician. But should he
be convinced  that the  sick is falsely treated—salvation of
the patient being the supreme end of the healing art—re-
gardless of all political and collegial considerations it must
prevail. This end must be attained, and in cases of urgent
danger, he must immediately do what conscience and duty
advise,  without farther reference.  No physician of a rea-
sonable mind can find fault with such a proceeding. But on
the contrary, when the case is not urgent, he must either
propose a consultation, or, if the patient will not agree to
this, he  must clandestinely  suggest to the  physician in
ordinary, what kind of treatment would be better accord-
ing to his  opinion.  Thus he can comply simultaneously
with the obligations towards  the sick  as well as his col-
league,  and relieve the one, without injuring the  other.
But when the  sick has entirely lost confidence in his phy-
sician, and he is resolved, to give himself up to the care
of another, the latter dare not and cannot refuse to com-
ply, nor the other take it ill,  for the confidence of a man
rests with himself and is to be respected.  Each one must,
however, proceed with that  frankness  and  forbearance
which becomes well educated gentlemen.
   When a  sick  person passes from one  physician to an-
other, it is very common, in order to excuse this step, that
he speaks ill of the former physician, right or wrong, and,
alas!  it is the  policy of the common  practitioners to coun-
tenance this conduct,  and  to  find the treatment hitherto
used erroneous.  But it  is not so with the honest profes-
sional man. He is aware, that such conduct is ungenerous
towards his colleague, and cruel towards the patient, who
will certainly  feel double  grief on becoming convinced,
that he has lost, not only time and pain, but that his dis-
ease has perhaps become worse and incurable.  I cannot
conceive how it is  possible for a man  of sense and feel-
ing to embitter the last days of a sufferer's  life by  such
declarations.   Consequently, the  treatment hitherto pur-
sued is to  be  approved, if not as a matter of collegial po-
liteness, at least in pity for the patient; the doubts of the
patient are to be appeased,  and the want of success in the
treatment attributed to other causes. 
NATURE AND  ART.
19
Nature  an&  QVrt.

     PHYSIATRIC.
Natura sanat, Medicus curat morbos.
   All cures of diseases are effected by nature; art is only
her assistant and cures but by her means.
   As the external  appearance of a disease is caused and
exists only by an internal morbid state  of organic life, an
internal  process  of disease, so is every external cure  de-
pendent  on an internal curative process, an activity of or-
ganic life for altering and restoring the abnormal condition
into the  normal, and  it  is  in this way alone, that cure is
possible.
   This is true of all diseases without exception. In visible
diseases, surgical so called, nobody doubts that this is  the
case.  Every  surgeon admits,  that it is not he  who* cures
a fracture, a wound, or an ulcer; but it is Nature, the vital
power, which restores health through her wonderful ope-
rations of exsudation,  conglutination,  suppuration, expul-
sion of corrupt matter and regeneration ; and that his office
is merely to guide these operations regularly and properly,
and to remove obstacles.
   The same principle  holds good in internal diseases,  the
internal  relations of which  are hidden from our  senses;
differing  only in this, that in the latter case we  cannot  see
with our  eyes the curative operations of alteration, secre-
tion of corrupt matter, regeneration and restoration of  the
balance.   This observation  applies not only to acute dis-
eases, in which life is most  agitated, but also to  chronic
maladies, where vital activity is less prominent. In slight
cases we daily see health restored without the  assistance
of art; the same, however,  may be met with  in serious,
even in the most  serious  maladies.  In the whole catalogue
of diseases there  is  none,  from the  most violent inflamma-
tory fever to the  putrid plague, from suppressions to pro- 
20                 NATURE  AND ART.
 fluvia, from dynamic diseases to dyscrasias, that  has not
 been cured by Nature alone.  What then does art do to-
 wards curing !  We bleed in inflammations, abstract powers,
 and are under the impression, that we have cured by that
 process.  But the sole merit,  which we can claim is, that
 we have removed impediments, excess of blood and agita-
 tion; and have thereby enabled nature to accomplish that
 internal healing process, which is peculiarly her own, and
 which must always take place, when our treatment is suc-
 cessful.  In the  adynamic nervous state we  support  the
 powers,  and believe we thereby make a cure; but in so
 doing we only raise the curative power of nature  to a de-
 gree that is requisite for performing those internal curative
 operations,  which are necessary to  recovery.  Even  the
 direct cure of diseases by specifics, so. called,  is the work
 of nature ;  for the remedy used acts only as an excitative,
 and the reaction it awakens, and the alteration for the bet-
 ter, are  solely owing to the internally working p*ower of
 nature.   Thus far also homoeopathy, which claims  so high
 a stand  above nature,  is the best proof of her power ;  for
 Hahnemann's  doctrine is nothing more than a method of
 curing diseases by specifics, and in selecting such a remedy
 as will create a disease similar to  that which  already ex-
 ists, affecting the very organ diseased, excites the reaction
 of nature in this  part, and produces that internal curative
 process which heals the disease. Even in dyscrasias, where
 a specific poison  has been received into the system, the
 curative power of nature  might possibly suffice.  Need we
 mention the thousands who have been restored without any
 remedy in venereal affections; yea, intentionally without
 the  use  of mercury!  Now, in venereal diseases deeply
 seated in the organism, what could mercury do without the
 co-operation of this internal  curative power, which alone
 effects the secretion of the virus and simultaneously of the
 poisonous remedy administered  against it, the regenera-
tion of  healthy humors indispensable for completing the
 cure, the normalization of specifically altered secretions,
 and  the restoration of disorganized organs!  How often
 does the use of quicksilver in its different forms prove use-
 less, until the vital power of the enfeebled body is raised
by generous diet and strengthening medicines,  to that de-
gree of energy which is requisite for the internal curative
 operation and even for mercurial action !
  The internal curative power  is most  conspicuous in
those wonderful changes which are often produced by it
 alone, in quite an  unexpected and most surprising manner 
NATURE AND  ART.
21
to wit—in crises, metaschematisms and metastases, which
entirely remove or alter severe chronic maladies that have
withstood for a long time all artificial means.  The patient
whom we in the evening considered fated to death, has in
the night a profuse perspiration, and we find him in the
morning  out of danger.   In a severe acute disease, which
we combat in vain by our remedies,  suddenly an abscess is
formed in some external part, and the disease is gone. The
greatest  triumph yet  of the curative power of nature is
manifested in her conquering the multifarious, most oppo-
site and  injudicious methods of medical treatment.   Is it;
not of daily occurrence  that sick people living in the coun-
try get well without any assistance, yea, in spite of the
most  perverse  treatment!   And even as regards rational
treatment, I have long  since become convinced,  that the
greater number of cures are not due to the labors of the
physician, but  to nature ; the patients  get well with the j
physician assisting, but by far  the least solely by his as-!
sistance.
   This is the true meaning of the great word crisis, handed
down to us from the remotest antiquity with sublime and
mysterious significance!  Not the critical evacuation, not
the external change, but the internal healing process, the
disease internally operated  upon, the work of the internal
vital  power, which assimilates,  secretes,  metamorphoses
and  creates anew, that alone  lies at the bottom of those
external  appearances:  this  is what is comprised in that
word,  and was understood by it by all professional men,
who,  true to nature, penetrated into her mysteries, un-
blinded by  scholastic systems,  since the time of Hippo-
crates to the days of Sydenham, Hofmann and Boerhaave.
   A system of medicine which embraces nature in this
sense,—which acknowledges and respects the laws of life,
and the  activity of nature as its superior,—which regards
not itself as the agent, but merely as an instrument of this
internal  healing process, which takes its indications for
acting only from the wants and demands of morbid nature,
and determines accordingly,—which appreciates all that is
going on in the organism (disease as well as its own cura-
tive operations, and the effects of medicaments)  as living
and as actions of life ;—in short, which  lives in life itself,
and as it considers  all that lives, exalted by life to a higher
sphere of existence, and which therefore only moves and
acts  in this sphere and becomes one and the same with
curative nature,—such a system I call Physiatric.
  In a general sense this word signifies  natural cure;  I 
22
NATURE  AND ART.
  mean to designate by it the healing art founded on natural
  principles.  It is the only true art of healing, based on the
  eternal laws of nature.  It is this system which since the
  time of Hippocrates has been the Ideal of physicians, and
  which has never departed from skillful practitioners,  even
  amid the  changes of schools. It is this which I profess and
  have ever professed.
    From these preliminaries a correct idea may be formed
  of art, of its relation to nature,  and of the position of the
  physician.  As certain as it is that every recovery depends
I  upon the  curative process of nature, and cannot be accom-
;  plished without it, as certain is it too,  that the cure can be
  facilitated, aided, promoted, yea, sometimes made possible
I  only by art.  In this  truth resides the  necessity and the
!  value of art.
    I shall  now point out its province more distinctly in the
  following lines.
    1.  Art  sometimes can take away the whole disease by
  removing the exciting cause, and so dispense with the in-
  ternal curative  process of nature, e. g. by removing  a fo-
  reign body, a poison,  a gastric  accumulation which  pro-
  duces the disease.
    2.  The vital power is sometimes too exalted, and its ope-
  rations too impetuous and violent, so much so, that it  may
  consume itself or injure noble organs.  Here art can effect
  that degree of reduction and depression,  which is requisite
  to bring on a perfect crisis, and to prevent dangerous oc-
  currences.
    3.  On the other hand  nature may  not  have sufficient
i  power, to perform the internal curative process.  Here art
  interferes, raises and makes up, by suitable strengthenincr
  remedies, the deficiency, and thereby only  renders the in-
  ternal cure possible.
    4. Art can remove obstacles, which  render the curative
  process of nature difficult  or impossible.  Under this head
  falls  the  important point  of a proper diet, quietness  in
  febrile diseases,  guarding from the influence of impure air
  injurious aliments and the like.
    5. Art can support nature in combating particular forms
  of disease by appropriate  remedies,  conformable to the
  malady.
    6. Art can assist  nature  in the commencing crisis  and
  bring it to perfection.
    7. Finally, there are morbific matters and conditions of
  which unassisted nature cannot get rid, e. g. the syphilitic
  virus, mechanical lesions.   In such cases  the assistance of 
NATURE AND  ART.
23
art is indispensable either for improving the quality of that
matter by means of agents counteracting its virulence, or
for lending mechanical or surgical assistance.
  Such is the province of the art of healing, and such are
its limits.  The physician must not pretend to be magister,
but minister natures,  her  servant  or rather assistant, ally,
friend.  He is to go  with nature hand in hand, and in per-
forming  his great task he must never forget that it is not
he,  but nature who operates;—regard nature, be always
guided by her, and never interfere to  disturb her.
  Two errors hence may  originate,  which the physician
must carefully avoid.
  The first is doing too little, the negative treatment which
leaves all to nature.   To this fault especially is  the new
(homoeopathic) school liable; a fault which may be follow-
ed by fatal consequences  in  those cases, where there is
really  something positive  to  be done.  Such a course is
proper only when there is no definite indication for action ;
—where time and patience are necessary for a cure,  or
where nature takes upon  herself, her powers being well
balanced, to carry the disease through a certain space of
time and wear it out, e. g. mild small pox, measles and the
like.
   A second error is that of doing too much.  Here  it will
not  be amiss to caution against carrying venesection and
the  use  of other remedies to such an extent, that the or-
ganism suffers more by  their administration than by the
disease.
   The art of healing comprises two parts : recognizing dis-
 eases, and acting against them. 
24
DIAGNOSTICS,  IATR0GN0MIC.
£)ictgn0£ttC0,  iTatrognomir.
COGNITION  OF  THE  OBJECT  TO  BE  CURED.
   Cognition of disease is the first condition of cure. Now,
 what is meant by cognition of disease !  It does not mean
 to give a name to disease, or  to  conceive  solely its exter-
 nal phenomena.  Such is nominal, physio-historical, noso-
 logical diagnostics, which can  only lead  to  an external,
 superficial, symptomatic method  of curing. What is meant
 by cognition of disease,  is a knowledge  of  the internal
 morbid state, which causes the external phenomena:  this
 alone  is the object of every radically curative treatment.
 This is  the  idea of practical diagnostics, of which I am
 now going to speak.  It is the art of recognizing  the in-
 ternal  morbid state, the seat of disease, and consequently
 the object of cure ;  the  demands of morbid nature  on art,
 and  thereby the indication of treatment,  as far as  it is
 founded on these premises.
  Practical diagnostics not only comprises the cognition of
 disease,  but  also a  knowledge of the sick  person,  i. e. of
 the individual affected with disease, and the most accurate
 determination of his individuality and his characteristics.
 For there is a vast difference between the same disease exist-
 ing in this or in that  subject,—a difference which influences
 most essentially the formation, modification, and treatment
 of disease.  The niceties of it can  be determined upon only
by a knowledge and consideration of these particularities.
Experience teaches  us, that in the judicious observation of
them rests the eminency of the most skilled and successful
 practitioners.
  We shall first treat of the cognition of the sick, and then
pass  on to the cognition of the disease. 
DIAGNOSTICS, IATROGNOMIC.              25
                          I

             COGNITION OF  THE SICK.

           CHARACTERISTICS OF THE  INDIVIDUAL.

  We have to consider:

             1.  Constitution  of the Patient.

  We  distinguish the following principal species of phy-
sical difference in man.

  a.  The plethoric, phlogistic,  or sthenitic constitution. The
sanguineous  system is  predominant;  quick and rich san-
guification, full, strong pulse, florid complexion, warmth
of body, energy in all the manifestations of life, disposition
to congestions of blood, hemorrhages and inflammations.
  b.  The adynamic, weak, feeble  constitution.  Pulse weak,
easily compressible, deficiency of warmth, weakness of all
the functions,  particularly the voluntary;  easily fatigued,
dyspnoe  in  exercise, necessity  of frequent restoration by
nutriment as  well as by fresh air, perverse condition of ex-
citability, either too much exalted or diminished ; the same
habitude as  regards  secretions, which are either too co-
pious or too scanty.  Disposition  to adynamic diseases,
stagnations, profluvia.
  c.  The nervous constitution.   Nervous system predomi-
nant, great irritability  and sensibility  of  both body and
mind; inequality and  changeability of habit; disposition
to spasms, and other anomalies.
  d.  The dry  or  rigid constitution.   (Constitutio rigida,
sicca.)  Firm fibre, dryness, meagerness of the whole body,
scanty secretions and  excretions,  deeply  colored  urine,
small and hard stools, dry skin,  and commonly of brown
complexion,  disposition to congestions of blood, obstruc-
tions, especially in  the abdomen, sthenic diseases.
  e.  The lax, spungy constitution.  (Constitutio laxa, hu-
mida.)  Lax fibre, soft spungy flesh, bloatedness, pale color,
deficiency  of warmth,  chilliness,  generally a  fair com-
plexion,  liable to  catarrhs, mucous accumulations in  all
organs.'which secrete mucus,  either in the head, chest, or
abdomen, to serous and lymphatic accumulations and ex-
travasations^ profluvia, obstructions,and imperfect crises;
chronic character of diseases.
                           3 
26              DIAGNOSTICS, IATR0GN0M1C.
  /.  The lymphatic, mucous constitution coincides with the
foregoing.
  g.  The gastric, bilious, atrabilious constitution.  Irregular
and imperfect digestion and evacuations, constant disposi-
tion  to disorders of the stomach and intestines, hypochon-
driasis,  in  the bilious a morbid irritability of the liver, so
that  from the  most trifling cause effusions  or retentions of
gall arise, in the atrabilious yellowish hue of the skin, dark
urine, constipation of the bowels, hemorrhoidal complaints.
  h.  The rheumatic, catarrhal constitution. Feebleness, mor-
bid sensitiveness of the skin, therefore defective and easily
suppressed perspiration, great disposition  to rheums and
catarrhs.
  i.  The psoric constitution.  Apt to disordered secretion
of the skin and appendages, hence always  foul skin, prone
to eruptions and ulcers ; therefore in all diseases and crises
a tendency to shift to the skin.
  k.  The venous  hemorrhoidal constitution.   The venous
system  and venous blood predominate, especially  in  the
abdomen,  the portal  system is liable to plethora, causing
hemorrhoidal  congestions.
  1.  The phthisical constitution.  A long slender body, ra-
pid growth, long neck, flat chest, depressed thorax, wing-
like protruding shoulder-blades, excitable vascular system,
quick pulse,  red  circumscribed  cheeks, hot  hands after
eating, disposition to  ebullitions and congestions  of blood,
want of breath in exercise, great liability to diseases of the
lungs, pneumony,  hemoptysis and  pthisis throughout life.
  m. The apoplectic constitution.   Short thick neck,  large
head, closely  attached to the shoulders, short stout body.
Disposition to affections of the head, to apoplexy.
                   2.   Hereditariness.

  The state of health the parents have enjoyed, or the dis-
eases they may have suffered under, is of the greatest im-
portance for the recognition and characteristics of the in-
dividual  state of health of a patient.  For by procreation
not only real diseases are transmitted, but also the  dispo-
sition to diseases, which at certain periods of life, or under
favoring circumstances, will break  out into  actual mala-
dies.   Of that number are consumption,  gout, calculus
scrofula, piles.   Enfeebled  and aged parents engender
weakly children. Even syphilis is transmissible to offspring. 
DIAGNOSTICS, IATROGNOM1C.               27
                        3.  Sex.

  Sexual  difference imparts to the organism a different
pathological  character, and establishes  a  disposition to
different maladies.  The  male possesses more power, en-
ergy, constancy, and disposition to sthenic diseases;  th|j
female more sensibility, greater excitability, with less en-
ergy and stability  of reaction, delicacy and laxity of fibre,
is liable to lymphatic and adipose accumulations, to  nerv-
ous diseases, hysterics.  Powerful influence of the sexual
organization  and its functions, menstruation, pregnancy,
parturition, lactation, cessation of the  sexual  functions,
(catamenia.)

                4.   JJge and Period of Life.

   Every age has its peculiar  character and maladies, and
clisposition to diseases of its own; mortality also varies
according to the periods of life.
   From birth to first dentition presents an  imperfect  half
finished life, progressive development and  creation, great
irritability  and  sensitiveness, violent  excitability  from
slight irritating causes, disposition to  spasms and conges-
tions to the head ; the largest mortality, one-fourth die.
   Infancy, up to the 7th year, is marked by laxity of fibre,
great excitability and little strength, easy  exhaustion and
 easy restoration, disposition to congestions, inflammations,
 disorders of  the vegetative and productive system (ence-
 phalitis, exsudatoria, angina polyposa, hypertrophy and atro-
 phy, dyscrasias, scrofulosis, helminthiasis). Great mortali-
 ty, one sixth of all born. The second period of infancy (from.,
 the 7th to The 14th year,) or age of puberty, shows more .,
 harmony in the functions and powers, less disposition  to
 diseases, a smaller amount of mortality.
   The period of youth from the 14th to the  21st or  24th
 year, (young man and virgin,) is distinguished by growth,
 predominance of the vascular system, disposition to inflam-
 mations, particularly congestions to  the  lungs  and the
 brain ; commencing of the sexual functions.
   The period of  the full-grown, from the 24th to the 50th
 year is of a stationary character, showing no increase or
 decrease ; equilibrium, the least of  sickness or mortality.
   The period of  advancing age, from the 50th to  the both
 year may be recognized by decrease of strength, indolence
 and disturbance of functions, cessation of sexual desires.
   Senility is characterized  by  decreasing sensibility, by 
28               DIAGNOSTICS, IATR0GN0MIC.
diminution of the five senses and of memory, of muscular
strength, of secretions, of nutrition, rigidity, dryness, even
tendency to ossification, disposition to dyscrasias, degen-
erations and disorganizations, to lithiasis.

 •               5.  The Temperaments,

  Exhibit the relation of the mental influence on organism,
and the different characters  resulting therefrom.   The
temperaments are infinitely  diversified ;  they  may,  how-
ever,  be  reduced  to four principal  categories ; each of
them admits of two subdivisions ; either irritability is eas-
ily aroused {irritable temper), with reaction of  short  dura-
tion in the sanguine, or  with reaction long and lasting in
the choleric ; or the irritability is  defective which  forms
the torpid temperament, called  phlegmatic, if of short and
difficult reaction ; melancholic, if of lasting and strong  re»
action.
  The following is a delineation of the different tempera-
ments.
  The sanguine temperament.  All irritations and impres-
sions, corporeal as well as mental, are easily aroused, but
transient; which is  productive of  an easy mind, hilarity
and gayety.  As for the body, it is easily excited, but long
intervals of ill health are  of rare occurrence.  It is fur-
ther marked by quick and abundant sanguification, which
gives rise to plethora, predominance of the vascular sys-
tem, and creates disposition to congestions of blood and
inflammations.
  The choleric  temperament exhibits great  excitability
with violent reaction of  the  whole organism, but particu-
larly of the biliar system.  Thence all irritations and ex-
citements readily create  an increased secretion of bile  al-
tered  in its quality ;  but on the other  hand the biliar  stim-
ulus reacts and imparts  even to the mental more inclina-
tion for anger, bitterness and violence of effect.  Abun-
dance  of  bile,  yellowish or  brownish tint ; black hair ;
firm  dry  fibre.  Disposition  to violent  excitements and
inflammatory diseases, to bilious affections ; also all other
diseases are prone to partake of the bilious character.
  The phlegmatic temperament is characterized by not beino-
easily affected, and exhibiting only weak, tardy reaction,
tardiness in  all functions, corporeal  as well  as mental ;
betrays a deficiency  of warmth, laxity of  fibre, disposition
to lymphatic  accumulations,  profluvia, chronic diseases of
atony and weakness. 
                DIAGNOSTICS, IATR0N0MIC.               29

  The melancholic temperament is excited with  difficulty,
but exhibits deeply seated, not violent but lasting reaction.
The feelings  are not lively nor easily excited ;  but  such
impressions as-are made, penetrate deep and are lasting, pro-
ducing physical as well as mental effects which progress
in a concealed  manner.  Hence a tendency to reflect, to
meditate,  a disposition to  hypochondriasis, sadness and
melancholy.  As for the physical, a  disposition to  all
chronic diseases, especially of the abdomen, obstructions
of the intestines.
  It is  well to observe that the temperaments do not  al-
ways occur simple, but are more frequently mixed, com-
pound of several.

                    6.   Idiosyncracy.
  A mode of perceiving impressions  and reacting upon
them, which is peculiar only to certain individuals.  Such
oddities are of physiological, pathological and therapeuti-
cal importance, and must be carefully regarded by the
physician, since they are essential to recognition and treat-
ment of diseases.

                  7.  The  Weak Part.
  Every man has an organ relatively weak, which is most
susceptible of disease, and which deserves particular atten-
tion.  We may ascertain which it is,  by inquiring what
part is most frequently subject to morbid affections, what
part is most directly influenced by  morbific causes, colds,
heat, mental affections.

          8.   Habit, Mode of Living, Occupation.
  Habit  becomes second nature.  Reference  to this has
diet, the usual articles of food and the usual remedies, e. g.
the habit of bleeding, purging, etc.  at a certain time.
  As for occupation, all that live can, pathogenetically, be
divided into two principal classes,—each of which imparts
to man an essentially different character, thus constituting
two classes of men differently characterized ; the sedenta-
ry life, and the motory life.
  The sedentary life, which is usually connected  with
confined air, predisposes to  maladies of the abdomen, ob-
structions of the intestines, especially of the liver, hemor-
rhoids, hypochondriasis, and by corrupt air to diseases of
the lungs. 
30               DIAGNOSTICS, IATROGNOM1C.
  The molory life in free air (the life of the country peo-
ple)  is in accordance  with nature, and secures against the
disease before mentioned.  This accounts for the striking
disproportion of consumption between the-inhabitants of
cities and those of the country.  Also the various ways of
living, whether rich, luxurious,  idle, poor, or  exhaust-
ing ; the occupation, whether more  mental or  corporeal,
makes momentous differences and forms the character of
the individual.

            9.   Habitual Diseases and Crises.

  Every man has his particular disposition to disease and
to crises. In one, nature has a tendency to restore all mor-
bid disturbances by sweat, in the other by diarrhoea, etc.
This the physician must not disregard.

                     10.   Climate.

  The influence of climate on the character of the inhabit-
ants is exceedingly great.   Remember the difference  be-
tween the  inhabitants of warm and cold  regions,  of  the
coast and of the continent, of mountains and of plains.



                          II.

              COGNITION  OF DISEASE,

   Is obtained from the following sources :
   Pathogenesis, which embraces what  has  past—a  know-
ledge of the preceding and actual state of internal and ex-
ternal morbific influences, the phenomena of an actual mor-
bid state which strike the senses ; analogy, reagency.
   The two first sources, namely, pathogenesis and  symp-
tomatology are the most important.  Analogy, which com-
pares the  case  under  consideration  with similar  cases
which have been observed by us or others,—is an  auxilia-
ry for distinguishing disease in difficult cases, where  the
first do not furnish sufficient light.   The same maybe said
of reagency—the administration of  external agents, in or-
der  to judge by the reaction they produce, what may be
the state of organic life—as the chemist uses reagents for
his purposes : abstraction of a little blood,  the use of wine
in order to determine  in dubious cases, whether there is
an inflammatory or an adynamic state. 
               DIAGNOSTICS, IATROGNOMic.              31

  By the proper use of these modes we arrive at a rational
idea of the essence of the disease—the  image of the inter-
nal state of the sick, of the internal change of organic life
which lies  at the bottom of the external phenomena—the
very object of cure.


                  I. PATHOGENESIS.

   To determine the origin of disease, we have to ascertain
 the following points :
   1. The prevalent constitution of disease.  It deserves the
 first attention of the practitioner.   He  must always live  in
 and be  familiar with it; it is to him of the same importance
 as the spirit of the age is to the philosopher, or the state
 of the  money market  to  the merchant.  It is the product
 of generally predominant influences, therefore, of universal
 nature, of which man is a  component part, and which  is
 manifested in and by him.  The means for ascertaining this
 condition  are a daily observation  of  the barometer and
 thermometer ; the direction of the winds ;  humidity and
 dryness ; sudden changes ; state of atmospheric electricity.
 Besides these, we must also regard the generally prevalent
 injurious  influences of moral  and physical causes,  e.  g.
 universal failure of the  crops,  famine, anxiety, calamities,
 horrors of war.
    The morbific constitution is either  subject to regular
 changes dependent on the seasons (constitutio  annua), or
 to  a character persisting through  all  changes  of  season,
 even for years (c. stationaria) ; or  is accidentally created
 anew (epidemica) ; finally, a real epidemy, that  is to  say a
 newly created  disease  of  a decided  form  and character,
 often quite a novel pathological creation, which  never ex-
 isted before, which seizes a multitude of  persons simulta-
 neously and irresistibly, continues a while, and  runs, like
 any other disease, through its  stages of increase, acme and
 decline.   It bears to  the epidemic constitution the  same
 relation as disease does to a morbid disposition.
    2. The genius loci, the endemic constitution—climatic
 influence.   Every place has  its  own peculiar character,
 "and which it impresses on its  inhabitants, influences their
 health and  modifies  their  diseases.  The physician must
 carefully  study  it; for it will afford him excellent informa-
 tion both for distinguishing diseases, and treating them ;
 indeed there are diseases which are peculiar only to such
 and such a place or climate (endemic maladies). 
32               DIAGNOSTICS, IATROGNOMIC
    The circumstances which determine the genius loci, and
  the climatic influence are : the degree of latitude, elevation
  above the surface  of  the  sea,—the prevalent winds, the
  drafts of air, frequent and sudden change of temperature—
  quality of the ground (mountainous or flat), quality of the
  soil  (moist, marshy or dry,  sandy or rocky), vegetation
  (sterile, meadows, cultivated fields, forest),—water (stag-
  nant, running),—neighborhood of the sea (important diff.
  erence between islands  and  ripuarian countries of conti-
 nental regions),—way of living and occupation, (difference
 between the pathological character of large populous cities
 and  the plain country,—between the inhabitants of manu-
 facturing places and those of agricultural districts.)
   3.  Predisposing causes (morbific disposition), are  such
 as are inherent to the individual—hereditariness, one part
 of the body weaker  than the rest,  long continued external
 influences,  e. g. dwelling, business, surrounding  persons,
 disposition of mind, etc.
   4.  Exciting causes (causae occasionales).   Of that num-
 ber are all potencies pathogenetically affecting the human
 system,  mechanical, chemical, psychical,  especially air,
 temperature, food and drinks, poisons, contagions,  over-
 heating,  taking cold, excessive exertion and prostration,
 suppressed secretions, passions.
   5.  Preceding or lingering diseases.  The whole patho-
 logical life  of the patient may be a remote cause of the
 actual state ; for the present evil is often traceable to an
 ancient one, and not to be discovered but by a careful ex-
 amination of the intermediate  metamorphoses.  Here may
 be mentioned also the method of curing and the medicines
 previously used, yea, all other habits.
  In  order  to  find out those pathogenetic relations, the
 physician must necessarily command a  thorough knowT-
 ledge of  anatomy and physiology, of  general pathology,
 especially aetiology, as well as of natural philosophy, chem-
 istry, and of nature  in  general, as far as it respects living
 organization.


               II. SYMPTOMATOLOGY.

                 Interpretatio Naturce.

  The physician  must be  the interpres et minister natural.
The first  requirement and  essential qualification  of a prac-
titioner is to understand the language of nature,—the voice 
DIAGNOSTICS, IATROGNOMIC.              33
in which she utters her sufferings and demands relief. This
language  consists in the perceptible phenomena of the
morbid action, generally called symptoms or signs (signa).
They are a vocabulary, in which each word has its definite
and original meaning.  As words are susceptible of differ-
ent significations by combination with other words, so in
diseases does  the simple meaning of a sign, when connect-
ed with other  signs, become susceptible  of various signifi-
cations and interpretations.   In this instance, however, as
well as in others, the original import remains always the
principal one,  and diseases as well as compositions will be
never correctly understood and interpreted without reflect-
ing on this truth.
   It is impossible for me to expose all the inferences which
these signs tend to,  unless I  were to  write a  complete
semiotic, for which space is here wanting. I shall content
myself with laying before the eyes of the beginner the ori-
ginal signification of the most important phenomena and
their practical value ; I cannot omit to recommend to him
the careful study of a complete system of semiology.*
                     1.   THE PULSE.

  When you see a sick person for the first time, the pulse
may guide you in determining upon the four principal ques-
tions: what state of life is existing, what kind of disease
is he affected with, of which character is the disease, and
whether there is danger of life or not!  It would be more i
practicable  to judge and treat rightly the patient according j
to the pulse, without knowing any thing else of his malady, j
than  to  do  so without the pulse, after having  been made i
acquainted  with all  other symptoms.f  Even  of life  the
pulse is decisive. There are cases, in which we may learn
only by this sign, if the sick person  is really or  only appa-
rently dead.
  As for theirs* question, that of life, the pulse is the only
certain determinative,  for  it indicates  the power  of  the ,
heart and blood; the first  being the central point  of life, j
the latter is the  vehicle of the vital  power.

  *  Besides the older writings on that subject, I would recommend
particularly the Seiniotic of Professor Albers of Bonn, as a classical
work.
  t  The Chinese physicians prove, in a most  striking manner, how
much may be ascertained by the pulse by  a competent person. They
rarely ask a single  question, they go only by feeling. 
34              DIAGNOSTICS, IATROGNOM1C.
  The second and most important diagnosis afforded by the
pulse is, whejher the disease is febrile or not.  This ques-
tion  is only answered by the quickness or slowness of the
pulse.
  We  distinguish farther by the  pulse the two principal
forms of fever,—the intermittent and the remittent. In the
first  the pulse  is at certain periods entirely free of fever,
and calm; in the latter it never becomes entirely calm, but
is always, sometimes more,  sometimes less agitated ; by
which  in remittents the period of remission and exacerba-
tion, in the former  that of apyrexia and paroxysmus is de-
termined.—This distinction is very momentous towards a
cure ; for, in complete intermission some remedies,  e. g.
cinchona, can  be used, which would be  injurious in the
remittent state.  Yea, in the febris intermittens perniciosa
life  depends upon  this distinction, for an apoplexia inter-
mittens must be treated in  quite a different way  from an
intermittent fever.
  It  is by the pulse that we  recognise in chronic diseases,
whether  they have already  attained  to the  hectic stage,
i. e.  lingering fever, or not.
  By the pulse we distinguish between asthma and phthisis,
for in the first disease the pulse is quiet, in the latter quick
and feverish.
  In all  fevers the pulse is  the main  sign for determining
the  increasing or decreasing febrile action, and, conse-
quently, danger.  Increasing quickness of the pulse shows
always increase of disease and danger, diminution of quick-
ness decrease of disease and danger.  The more the pulse
approaches to the normal one, the more the sick approaches
to health.—This sign  is the most certain of all;  so  that,
notwithstanding all other symptoms being unfavorable,  if
the pulse becomes more tranquil and normal, amelioration
is to be expected;  and on the other hand, though all other
symptoms appear favorable, yet if the pulse be frequent, a
bad  issue is to  be looked for.
   In termination of the fevers, in the  period of crisis, it is
the pulse alone which decides, whether the crisis was per-
fect or imperfect, i. e.  if the disease has  entirely ended.
When the pulse continues irritated and quick, we  may rest
assured, in  spite of all other important signs, that the cu-
rative process is not finished, and that either a relapse or
a metastasis, or a metaschematism, that is to say, a transi-
tion into hectic fever, in short no  perfect recovery is to be
expected.—An exception to this  rule marks the nervous
fevers, wherein the pulse retains an unusual frequency some- 
DIAGNOSTICS,  IATR0GN0M1C.             35
times for weeks, solely by a continuation of increased irri-
tability in the vascular system; and here, also, it indicates
a slow convalescency.
  The third question : whether disease be of a sthenic or
of an adynamic character, is likewise best determined by
the pulse : a strong hard pulse,  difficult to  compress, is
always indicative of a sthenic character ; a soft pulse, easily
compressible (unless local causes  impart  to it this  cha-
racter), is indicative of an adynamic state.  In this respect
it is veTy  important to  observe  what are direct and indi-
rect relations, which heat and other febrile symptoms bear
to the pulse.—When the relation is direct, i. e. when the
heat, pain, delirium, or any other symptom is increased, in
proportion as the pulse rises and  becomes  more frequent,
the disease is of an inflammatory character, and requires a
debilitating method. When, on the contrary, the relation is
indirect, i. e. the more the pulse decreases,  the more does
heat, pain, delirium, etc., increase, in such a case  it is
a sure sign of  an adynamic character, and indicates  a
strengthening method.   In the first case an abundance of
power,  in the latter a deficiency of it is the cause; in the
first, diminution, in the last augmentation of power corrects
the attacks.  Wine cools, and assuages the pulse, the de-
lirious state, and the pains.
   Moreover, by the pulse the nervous character is best re-
cognised, in acute as well as in chronic diseases,,  When
the pulse is unequal (one beat different from the other), or
changeable (for some minutes or  even hours slow, full,
large, then small or quick) in fevers, it is a sign, that the
fever under consideration is not inflammatory but nervous;
and in chronic diseases,  that the blood is not affected, but
only the nerves,  hypochondriac or hysteric,  and  cojise-
quently  requires quite a different  treatment.  Here must
be  mentioned a most important distinction between the
character of different local affections, and merely spasmo-
dic inflammations.  There can be a most violent pleuritic
pain, with oppression and threatening suffocation;  or the
most violent fixed pain  in a part of the abdomen, which
might lead one to consider it a violent local inflammation ;
and yet a venesection would kill the patient.  Here  it is
only the pulse,  and some other accessory circumstances
which can inform us of the true nature of the case.  If the
pulse be at the same time small, unequal or remittent; urine
pale and watery ; the extremities cold; and the patient in-*
clined to weeping,  the disorder is spasmodic and requires
the use of nervina.   If, on the contrary, the pulse be hard, 
36             DIAGNOSTICS, IATR0GN0MIC.
 full, and strong; the urine red and fiery ;  and the patient
 hot, then it is inflammation, and bleeding is called for.
   The fourth question—how far  has danger advanced 1 is
 likewise decided most satisfactorily by the pulse; for, it is
 from  the exertions of the heart,  as punctum movens of all
 life, and  from the phenomena exhibited by the circulation
 and the impediments to  vital  action as immediately con-
 nected with  it,  that  the actual stock of vital power is as-
 certained.  The more unequal  and remittent therefore the
 pulse is, or extremely small and quick, the more imminent
 will be the danger.
   But also  in the  selection of medicaments the pulse is a
 principal guide ; yea, in some cases of danger of life, it is
 the only one on which salvation depends.  I allude  here to
 those  cases  in  which the administration of Peruvian bark
 prevents  fatal apoplexy (F. intermittens perniciosa), and to
 some  dangerous inflammations and congestions  of blood,
 where phlebotomy must be resorted to.
   Even for appreciating the effects of medicines and deter-
 mining their  application, the pulse is a principal sign.  In
 the first place, it indicates generally whether the remedies
 affect the  system or not; and in the second place, whether
 that effect is  good or pernicious,  whether to be increased
 or to  be  diminished.—This observation applies to either
 species of fever.
   In inflammatory  fevers the pulse  is the chief guide, in
 resorting  to the  most important remedy—venesection.
 Blood  must be abstracted, until the pulse is reduced  from
 its inflammatory height and strength to one that is normal;
 the pulse is here the votum decisivum.  Although the  local
 affection (oppressio pectoris, dolores pleuritici, delirium, etc.),
 to relieve which bleeding has  been resorted to, does not
 cease; if  the pulse  sinks, venesection must  be disconti-
 nued.  In like manner the repetition of phlebotomy is de-
 cided upon, according as the pulse again increases in height,
 or is contra-indicated by its decrease.
   To ascertain,  in a dubious case, whether the state is a
 phlogistic, or an adynamic one, the pulse,  as qualified  by
 venesections, is the best diagnostic sign.  But this requires
 accurate and  practical observers.  If you feel  the pulse, as
 soon as blood begins to  run,  simultaneously becoming
 smaller and quicker, it surely shows an asthenic character,
 and the vein is  immediately to be closed.  But when the
.pulse  from the  beginning becomes somewhat fuller, and
 then softer,  more quiet and not smaller, there is certainly
 an inflammatory disease. 
                DIAGNOSTICS, IATR0GN0MIC.              37

  In adynamic fevers the pulse is  the only sign even for
knowing whether  the organism reacts  against the medi-
cines, and whether they have produced a sufficient degree
of irritation.
  All depends  on  this—whether the administration of a
new remedy  is  followed by a change in the pulse for the
better;  whether the quick,  small  pulse  becomes  slower
and fuller; the tardy oppressed one more vivacious.  This
alone is sufficient  to prove the curability of the disease,
and at the same  time the propriety  of the  remedy, for  its
quantity as well as for its  quality.  When there is  no
change  at all in the pulse, even by increased doses, it is
the worst sign and announces a bad issue.—Augmented
quickness and irritation of the pulse is generally  a proof
that our remedies are too strong and ardent, and we must
diminish them, unless we would kill the  patient by over-
action.
  (In general the young practitioner must be very cautious,
not to consider the increasing rapidity of the pulse always
as a sign of increasing weakness, but first  to examine whe-
ther it  is not rather the consequence of too strong irrita-
tives, and of which he will soon be made aware by a small
diminution of them ; while on  the contrary, led by the
former supposition, he will attack the patient with stronger
irritant  medicines and destroy him.)
  In all evacuations, whether of blood or of other  humors,
in fevers as well as  in  chronic diseases,  the pulse is the
only sure sign, whether they are critical or symptomatica!,
wholesome or injurious, and consequently  to be suppressed
or allowed to go on.
  From the  pulse in general we-may  recognise  the fol-
lowing :
  1. The power of the heart,  and,  by this, the vigor of the
vital power in the  whole body.  The pulse is nothing else
but the  rebounding of blood in the arteries, caused by the
contraction of the heart; and it is therefore evident, that
by  the  stronger or  weaker  resistance, which the blood
makes against the  pressure of the  finger,  the stronger  or
weaker  power of the heart, and consequently of the whole
vital power, of which the heart is the principal source and
central  seat,  may  be recognised.   Therefore, it is by the
pulse that the greatest  abundance of vital energy (inflam-
matory  state) as well as vital weakness is  so surely recog-
nised.  The greater the power of the heart, the more pow-
erfully will it impel the  blood  into the arteries,  causing it
to strike harder against the fingers placed  over the vessels,
                          4 
38               DIAGNOSTICS, IATROGNOMIC.
 and make them more resistant against compression.  The
 weaker the  heart,  the weaker will  be that rebound  and
 counterpressure.
   2. The quality of the irritability of the vascular and nervous
 systems*  The contraction of the heart  is caused by the
 entering blood operating as an  irritative  on the internal
 partitions,  and brings their  irritability into action.  The
 greater the irritability, the  quicker and  livelier will  the
 contractions be excited, and the more rapid and frequent
 will be the pulse; the weaker the irritability,  the  slower
 and tardier  the pulse  will be.  This  does  not apply to  the
 arterial system.  But, as the nervous system is intimately
 connected with it,  it will also express the changes which
 occur in nervous irritability, and the pulse becomes thereby
 a very important sign of nervous irritations, such as—pain,
 emotions, gastric irritants, worms, flatulency,  etc. being
 present.  By change of irritability the pulse is altered, not
 alone  in regard of quickness and frequency, but also of re-
 gularity and equality (unequal, remittent pulse),  and even
 abnormal irritability is communicated to the heart and  ex-
 hibited by the pulse; therefore,  inequality and remission.
 Likewise, by the  influence of nervous irritation the ves-
 sels can be affected, and become harder, tenser, and more
 contracted.
   3. The quantity and quality of the blood. The more  blood,
 the fuller and less yielding the artery ;  the less, the less
 distended and empty is the vessel to  the touch.   Even the
 quality of the blood may be recognised in the pulse : inas-
 much  as it  is richer  in  cruor and fibrine, the firmer and
 more difficult to compress will it be ; the more watery and
 serous the blood,  the softer and more yielding the pulse ;

  * In modern times, especially since Parry's experiments, the part
 which the arteries take in pulsation, has been too much undervalued.
 It is forgotten, as it happens too frequently now-a-days, that  the pa-
thological state is different from the physiological ; and that in the
former, powers may become effective in some part or other, of which
 the physiological condition might not give the least anticipation.   It
is undeniable and is plain to the touch, that the contractility of the
arteries is increased by inflammatory or nervous  irritation and by
 spasm ; and that the arteries acquire by  increased contractility more
hardness, tension, and even diminution ; whereas they become softer
and more extensile by an absence of such influences.  Yea, that the
operation of the arteries is essential for moving the blood we  clearly
 perceive in paralyses  of  single limbs,  where the pulse is much
weaker, and  sometimes  even entirely stopped, although the heart
propels the blood into them with the same power as into the  rest  of
 the arterial system.  Even the increased [pulsation in an inflamed
part, as well as the difference of the pulse indifferent arteries, which
 is observed in some diseases, is a proof in favor of my assertion. 
                DIAGNOSTICS, IATR0GN0MIC.              39

farther, the richer the blood in irritant substances or calo-
ric, the more frequent and rapid it is.
  4. Mechanical impediments in the vascular system,  which
are due to  obstructions, hepatisation of the lungs, polypi,
enlargement of the heart and the large  vessels, hydropic
accumulations in the pericardium and the chest, also to con-
siderable impediments in more remote systems, especially
of the abdomen.
         The Most Important  Varieties  of Pulse,

  Are  the frequent and  rare (pulsusfrequens et rarus);
the quick and slow (pulsus celer et tardus).
  The  pulse is  called frequens,  when the heart contracts
oftener than in the healthy state,  in adults more than 70
times in a minute,  varying however according to indivi-
duality;  in  children of less than two years more than 90
times.   Celer, when the act of contraction of the heart is
quicker than in the normal state. It  is rarus, when it beats
less frequently than in the healthy state, i. e. less than 70
times in a minute; tardus, when a single contraction hap-
pens more slowly and tardily.
  Frequentia and  raritas have reference to the number,
celeritas and tarditas to the quality of contraction.
  Acceleration of the pulse indicates either an increase of
irritability,  or an increase of irritation.   It is therefore, in
the first  case, the most common sign of fever ; and as aug-
mented  irritability can  be the  consequence of exalted as
well as of sinking vital power, quickness of pulse can arise
from either state; nay, be still greater in weakness,  inas-
much  as the irritability  from weakness is still more ab-
normal than that from strength. In the latter case it is due
either  to idiopathic augmentation  of the irritant mass in
the vascular system, i. e. an increase  of the quantity of
blood,  or apparent plethora  occasioned by distention,  or
relatively greater  accumulation of blood  in  the  heart,
owing  to retrocession from  the periphery  occasioned  by
cold, contraction of the skin,  tight lacing  or mechanical
pressure ; or sympathetic irritation  arising  from the mind,
the senses,  pain,  inflammation; in  short any irritation in
whatever part  of the  body has a tendency to produce it,
the more so, the more sensitive the part is.
  Diminishing frequency of the pulse in fevers is the surest
sign of  abating disease ; continued frequency  after  the
crisis  shows that the crisis is not perfect,  that something 
40              DIAGNOSTICS,  IATR0GN0MIC. >
 of  the disease remains, and that there is reason to fear
 metastases.
   The utmost  frequency (150—200 beatings in a minute;
 a greater number cannot be counted, and becomes trem-
 bling of the artery) indicates extreme weakness or a putrid
 state.   The weak heart tries to make  up by frequent and
 imperfect contractions, to  carry  off the blood, what it is
 not able to perform by  slow and energetic ones; hence the
 pulse is frequent and small.  We need not therefore con-
 clude from the increased frequency in such cases, that the
 circulation of the blood en masse is accelerated ; quite the
 contrary.—The utmost frequency accompanied with small-
 ness, celerity and cessations, is the pulse of the dying.
   Pulsus rarus.   Rareness  of the pulse is natural to some
 individuals ; there are men,  who have only 50, nay 30 beat-
 ings per minute.  In  diseases it indicates  decrease of irri-
 tability,  therefore decrease or entire intermission of fever
 (apyrexia) ;  decrease of the quantity of blood (therefore to
 be  found after great loss of blood) ; old age ;  also in cases
 of pressure  on the brain, which diminishes the sensibility
 and irritability of the vascular system.
   Pulsus celer is produced by the heart contracting too
 quickly, so  that no  perfect distention  is possible, and in
 this case the pulse is  pointed  to the touch.  It  is gene-
 rally connected with  frequency; it can, however, be also
 rarus.  It indicates a spasmodic state and great weakness,
 the last in most cases,  where it is rarus at the same time.
   Pulsus tardus, tardy  contraction of the heart, indicates
 great deficiency of irritability, a typhoid,  or a torpid state
 in fevers, especially a pressure on the brain.  For  that rea-
 son pulsus rarus et tardus is called pulsus cephalicus,  apo-
plecticus, and is indicative of pressure on the brain, which
 brings on the threatening  or already existing apoplectic
 state;  such  a pulse is therefore ominous after injuries re-
 ceived on the head, also in  other diseases, which  threaten
 exsudation.
  The hard  and soft  pulse  (pulsus durus  et mollis).  The
 feeling  of hardness or softness  determines this difference.
 Hardness of pulse depends either upon the membranes  of
 the artery, and then  indicates  a  distended  and irritated
 state  of the vessel, a most  important sign of local inflam-
 mation and of convulsions, which the accompanying symp-
 toms are to decide.   Sometimes it (hardness) is owing  to
 exsiccation,  approaching to ossification of  the  arteries
 which happens in old  age; it is therefore the usual pulse
 of  persons advanced in  years.  Or it is  caused by  a forced 
DIAGNOSTICS,  IATROGNOMIC.             41
 action of the heart,  which impels the blood  with  great
 power into the arteries ; here the pulse is at the same time
 magnus,  and accompanied with great  warmth of the  body.
 Or it is due to great solidity, dryness, or  coagulability of
 the blood.   Thin watery blood renders the pulse soft.
   Softness of the pulse is indicative of the reverse,  of ab-
 sence of inflammation and convulsions.
   The strong pulse,  difficult  to compress (pulsus fortis),
 and  the feeble pulse (pulsus debilis).
   The pulse is cMedfortis, when it strikes powerfully the
 finger  placed upon it; in a high degree it  cannot be  com-
 pressed at all, but leaves a feeling of  puffing up under  the
 strongest pressure.
   Debilis,  when it strikes but feebly and can be easily or
 entirely compressed.
   Pulsus frequens, fortis  et durus, always indicates inflam-
 matory fever, and in consequence  the  propriety of  vene-
 section.   Sydenham says: In such a pulse bleeding must
 be resorted to, even if the disease was the plague.
   If with such a pulse there is also pain in someone of the
 important viscera, an inflammation is supposed  to be com-
 ing  on or to exist already.   Inflammation of the internal
 substance of the lungs, and inflammations of the abdominal
 viscera, especially of the intestinal  canal,  are not to be
 judged of by this rule. Here the pulse is often very small;
 in the  first case  small and soft; in abdominal inflammation
 small and hard, like a tense string.  The cause of it in pul-
 monary inflammations is due to the  passage of the  blood
 through the  lungs being obstructed, or the inspiration  im-
 peded  by pain ;  by which too small a quantity of blood en-
 ters into the aorta and the general circulation.
   But  we must be careful not to confound it with the  pulse
 of debility.  The  discriminative signs  of which are  the
 preceding  spmptoms  expressive of an inflammatory cha-
 racter, the accompanying  symptoms  and the momentary
 rising of the pulse, if you cause, in the first case, the breath
 to be forcibly retained, and in both cases the pulse becom-
 ing fuller, as soon as a vein is opened and some blood
 let out.
   On that the following maxim is founded:  Pulsus debilis
 et facile comprimendus  (if the local affections just  mentioned
 do not  exist), shows  always  vital weakness and indicates
 the administration of  wine.
  The  large and the small pulse (pulsus magnus et parvus),
the full and the empty pulse (pulsus plenus et vacuus).
  The  pulse is called  magnus, when the artery is large and
                          4* 
42             DIAGNOSTICS, IATR0GN0MIC.
extended to the touch; parvus, when on the contrary, the
artery appears diminished,  almost as thin to the touch as
a thread.
  Largeness indicates full extensibility of the artery (there-
fore absence of cramp and irritation, a fine sign of perfect
crisis), plenitude of blood (which  however  may be a tur-
gescence, a distention produced by heat,  fever, abnormal
irritation of the nerves,  distinguishable by  being at the
same  time full or not), and vigor of the heart.
  The small pulse indicates that the artery is not suffi-
ciently distended by the blood. This may result from two
causes,  cramp  or weakness.  We must also discriminate,
whether it  is at the same  time hard or soft.
  Pulsus parvus et durus is  the convulsive pulse; it shows
that the  artery  is so contracted by spasm as not to allow
of proper distention.
  Pulsus parvus et mollis  indicates that the heart  has not
sufficient power to force enough blood  into  the arteries;
therefore it is a pulse of the utmost debility or deficiency
of blood.
  Pulsus plenus,  the full pulse, differs from the magnus in
this, that  the artery is not only perfectly distended, but
presents  to the touch a  feeling of being entirely filled;
wherefore it is more difficult to compress it.   It is indica-
tive of that sanguineous plenitude called plethora.   When
large  and at the same time easily compressed, the  fullness
exists only in appearance,—turgescence of blood.  This is
particularly observable in adynamic typhous fevers,  in
which the  pulse  sometimes appears full; but to take this
for  a sign of real plenitude and act accordingly would be
a dangerous mistake.  It  is discriminated by being easily
compressed.
  Pulsus vacuus, the  empty pulse, is  always small, and
therefore coincides with the pulsus parvus et  mollis, and is
indicative of the same state.
  I will further remark that the pulse can appear periodi-
cally; large and full on  account  of  local congestions of
blood to the heart, especially of a hemorrhoidal character,
and it is then a sign of accumulation of blood in the portal
system.
  The unequal pulse (pulsus incequalis),  the intermittent
pulse (pulsus intermittens).
  The pulse is  called unequal,  when the beatings do not
follow each other regularly in number,  or when the beat-
ings differ from each other in largeness, fullness, vigor.
  It indicates a disturbance of the regular motions of the 
DIAGNOSTICS, IATKOGNOMIC.             43
heart dependent  either upon  spasm, to which the heart,
like  every other  muscle  is liable,  or upon deficiency of
vigor in it, sometimes also, but more seldom, upon obstruc-
tion  of the circulation either in the lungs (as in the last
stage of pneumonia), or upon  organic derangement of  the
heart.  Therefore  it is a principal sign of nervous and ady-
namic fevers, and in general of a nervous state.
  The intermittent pulse (when one or more beats entirely
fail)  indicates in the first plsRe a momentary stoppage of
the  contractions of the heart, which is most frequently
owing to spasm, sometimes also to weakness and organic
derangement.  Most commonly, however, this pulse is in-
dicative  of a spasmodic affection of the heart, created by
sympathy  with the  abdomen, and  it is therefore rightly
termed pulsus abdominalis et intestinalis, for it arises most
commonly from diarrhoea or a disposition to  it; likewise
from local congestion of blood in the abdomen caused by
hemorrhoids.   Is  it  at the same time  full and strong ; it
shows then abundance of blood and indicates phlebotomy.
  A  few  particular kinds  of the pulsus incequalis deserve
special attention.
  Pulsus myurus, where  a series   of  beatings  becomes
smaller and smaller, so that they cannot be felt; it is the
pulse of the dying.
  Pulsus dicrotus, where  one beat  seems to be divided in
two  ; generally a foreboding of critical bleeding at the nose.
  Pulsus inciduus, where a series of beatings succeeds be-
coming slower and  slower, and then again quicker and
quicker;  it is  commonly  a sign of an approaching crisis,
especially by perspiration.


                   Palpitatio Cordis.

  The beating of the heart, a too violent and irregular mo-
tion  of the heart,  which can be felt and sometimes heard,
when it is called  the sounding heart. It is indicative either
of too much rushing of blood to the heart, which can arise
from plethora general  as well as local,  e. g. hemorrhoidal
and  menstrual congestion; or it shows nervous irritation,
especially violent emotions, as  fright or anxiety,  violent
pains, consensual irritations from the abdomen, particularly
worms, spasms, especially hysteria  and hypochondria,  me-
tastases ;  or  it indicates great weakness (spasmus a deple-
tione), e.  g. in too profuse evacuations of blood and other 
44              DIAGNOSTICS, IATROGNOMIC.
humors, and is then a forerunner of fainting; or finally, local
diseases  of the heart and organic derangement, hypertro-
phy, aneurisms, polypus, hydrops pericardii.   In  hysterical
and  hypochondriacal subjects it is of no significance.  A
continual  or always returning beating  of  the heart with
fainting leads to suspect organic diseases of the heart.
               Art of Feeling the  Pulse.

  In order to arrive at such conclusions as we have stated
above, we must know how to feel the pulse.  It is not suf-
ficient to place carelessly the finger over the artery.  We
must apply three or four fingers, so as to be able to observe
a piece of several inches of it at once; we must continue
touching it at least a minute, sometimes longer,  with our
attention intensely concentrated to that point; we must in-
crease, diminish and variously modify the pressure of the
fingers, compressing  sometimes the artery, then quickly
letting loose,  in  order to ascertain whether the blood can
be entirely displaced by  this compression, or not, whether
the artery refills quickly or  slowly,  etc. In  short,  one must
have practice  in it. The physician must act with the pulse,'
like  the virtuoso with his instrument; he must learn to play
it and become familiar with it just as well as the  musician
with his instrument.   It  is only such a physician  that will
make  discoveries in  and by the pulse which another one
cannot think of.  Such an adept discovered by this means
a concealed love as the cause of a malady.  It is  therefore
advisable, that tyros in medicine  should  very frequently
feel the pulse, even in healthy persons.
  Nor must the physician feel the pulse immediately after
entering the sick room;  for being looked upon as a judge
of life and death, his visit will not  fail to produce an alte-
ration in the pulse of a sick person.  He will soothe the pa-
tient by  friendly conversation,  and then proceed calmly
and  naturally  to feel the pulse.
  Not less recommendable, in  order to avoid delusion, is
a careful attention to those accessory circumstances which
often alter the pulse.   These  are  especially warmth,  or
certain stimulants, by which the pulse small in  itself can
be  made full  and large,—preceding emotions, and corpo-
real exercise. 
DIAGNOSTICS, IATR0GN0MIC.              45
                    2.  RESPIRATION.

  Next after the pulse this  function affords the most mo-
mentous signs, penetrating  into  the  innermost life, as  it
is  immediately connected with life and its conservation.
Hippocrates says:  Respiratione bond semper salus speranda
est,  etiamsi  reliqua non  bona essent.   (Respiration  being
good, salvation may always  be  hoped, although the rest be
not good.)  This is true especially of fevers.  Farther, it
is in many diseases the only signum diagnosticum  in asth-
ma, tussis, pneumonia, catarrhus suffocativus and apoplexia.
  Respiration indicates:
  1. The state of the lungs, as regards their mobility, and ex-
tensibility, or the  hinderances to these, arising from  in-
flammation,  or spasm, or accumulation of mucus and other
matters in the bronchia  or  in the substance of the lungs,
hepatisation, emphysema, oedema, tubercles,  vomica and
other organic disorders.
  2. The state of the trachea, its permeability or obstruction
caused either by inflammation or spasms, or foreign bodies
therein, which close or straiten it mechanically, or exter-
nal  compression from strumatose tumors.
  3. Obstacles within the pleura to the free motion and exten-
sion of the lungs, consist of either an accumulation of water,
air, fat, pus  ; or by inflammation of the membranes, spasm,
or inactivity of the muscles, ossification of the costal carti-
lages, malformations of the  osseous system ;  also impeded
motion of the diaphragm from inflammation, abdominal  in-
tumescence caused by water and swellings of the viscera.
  4. Organic disorders of the heart, hypertrophy, aneurisms.
  5. Condition of the circulation, especially the important
distinction between a truly accelerated motion of the blood
from only an apparent one,  since a quickness of the pulse
is by no  means always a proof of a truly accelerated mo-
tion of the  sanguineous mass.   To discriminate  this dif-
ference,  observation  of the proportion of pulsations  to
respiration is serviceable.  For  there are in a perfectly
normal circulation four  pulsations to one  respiration, and
in the healthy normal state this proportion  remains the
same in the  accelerated,  as well as in the retarded circula-
tion ; likewise in all fevers, and it serves to prove a truly
accelerated  motion of the sanguineous mass.  But when
this proportion ceases and the breathing is not accelerated
proportionally with the  accelerated pulse, it proves that
the  contractions are augmented, but  that the sanguineous 
46              DIAGNOSTICS, IATROGNOMIC.
mass itself, from want of power, is not quickened, and the
necessity of accelerated respiration is not called for.
  6. The condition of the vital power in general,—as far as
a sufficient degree of power is required to put the pectoral
muscles and lungs into proper activity.  Therefore  great
prostration renders breathing difficult; weak  men are very
apt to get  out of breath by exercise.
  7. The condition of the nervous system.  As  respiration is
a voluntary operation, it is influenced by the  different de-
grees of sensibility.   Thus a state of low sensibility, or of
surprise, can have this effect, to cause the sick  person to
feel less the want of respiration,  and therefore  breathes
more slowly, as it should  happen  in  accordance with the
condition of the circulation, as in typhous fevers, in a pres-
sure on the brain, the snoring in apoplexy.
  8. The condition of external air.  Air saturated with im-
purities, not fit for  breathing,  can be a cause of difficult
respiration.

           Varieties  of Anomalous Respiration.

  The frequent and  rare respiration (respiratio frequens et
rara).
  Respiration  is called frequens when it happens in a cer-
tain space of time oftener than in the  normal state; rara,
if it is the contrary.
  Frequency indicates : in  the first place accelerated cir-
culation,  therefore,  is met with  in fevers; and  the  more
frequent  the  respiration,  the  more  violent  the fever;
weak lungs, when it is produced by the least  exercise ;  in
men who get easily out of breath, the lungs try to make
up by frequent repetition what they are unable to accom-
plish by energy in single respirations ; finally, an  impedi-
ment, which hinders the lungs from  perfectly distending
themselves; therefore the  respiration  is at the same time
parva, e. g. in pneumonia, hepatis, hydrothorax, flatulency.
  Respiratio rara is  indicative of  easy circulation of the
blood, of  sound lungs, free circulation through  them and
unimpeded distention of them.
  Respiratio magna et rara (deep and unfrequent breathing)
accompanied with great exertion  of  the  muscles, shows
great deficiency of power ; mixed with groaning, threaten-
ing fainting and spasms.  Resp. rara,  parva et frigida is a
sign of dying.
  The quick and tardy respiration (resp. velox  et tarda) has
reference  to the mode in  which the act  of respiration is 
DIAGNOSTICS, IATROGNOMIC.              47
performed, whether the expiration  succeeds the inspira-
tion quickly or tardily.
  Velox indicates :  painful affections of the chest and the
abdomen,  which are increased by a distention of the cTiest;
therefore  we endeavor to diminish and shorten these affec-
tions as in cases of abdominal and pulmonic inflammations ;
or such an irritability of the bronchia, that the  extension
causes at the same time spasmodic contraction, (generally
connected with  convulsio pectoris (tussis) as in catarrhs);
or an obstacle which does not  allow the lungs to expand,
e. g. tuberculous condition,  suppuration.
  Tarda is indicative of the contrary,  free extensibility of
the lungs, free circulation through them, absence of irrita-
tion and spasm.   It is therefore the fairest sign of pectoral
health, and the best test of the lungs, when a man can take
a deep inspiration and retain the air for a long time.  There
is, however,  also an excessive  tarditas in diseases indica-
tive of great weakness.
  The long (deep) and the short respiration (resp.  magna
[profunda] et parva).
  It is called magna, when a great quantity of air is t >ken
in by inspiration and thrown  out by  expiration  ; it is in
general a  good sign that the lungs and circulation are free ;
of absence of spasms and power of the muscles for the per-
fect dilatation of the thorax.  But it must be simultaneously
long and  without any  difficulty, when it  is at the same
time tardy.
  It has a different meaning when,  with great exertion of
power and force it is accompanied with anxiety and audi-
bility (magna cum molestiis).   Then it indicates plethora,
spasms, especially  in the praecordia, also a soporous  and
delirious state, particularly  when the intervals are long.
  Parva is indicative of the contrary.  Here the distention
is impeded by spasm and weakness.
  The difficult and the  easy respiration (respiratio  dijfici-
lis etfacilis).
  Difficilis has  various  degrees: dyspnoea, oppression of
the chest  ; resp.  anhelosa, the panting  (asthmatic), suspiri-
osa, the groaning,  orthopnea, the suffocating* respiration,
the highest degree,  of which the following is a description.
The patient can  breathe only in a  sitting or upright pos-
ture, with his neck protracted and great exertion of all pec-
toral muscles.
  In every kind of difficult respiration the circulation of
blood through the lungs is more or  less impeded ;  and in
consequence a smaller quantity  of blood streams to  the 
 48              DIAGNOSTICS,  IATROGNOMIC.

 left of the  heart, whence arises either an accumulation of
 blood in the head by the reflux being obstructed, therefore
 a soporous  state, or diminished influx of the blood through
 the a'orta into the whole body, and therefore small, empty,
 and remittent pulse, and cold extremities.
   Difficulty of  breathing indicates  either  an impediment
 within or without the respiratory organs (in men, besides
 a good state of health, plethora, and abundance of blood in
 the lungs) ;  or  a  spasmodic condition of the  respiratory
 organs;  orthopncea;  an  insurmountable  obstacle,  the
 highest degree  of pneumony,  hepatisation of the lungs,
 extravasated matter in the bronchia, trachea, external com-
 pression of the  lungs by water, pus and  the like, suffoca-
 tion,     i
   The equal and the unequal respiration (respiratio cequa-
 lis et incequalis).
   Inmqualis indicates  either  an  irritation  which  affects
 spasmodically the pulmonary nerves, or an impediment to
 respiration.
   The sonorous respiration (resp. sonora).  There are the
 following varieties :
   Stertorosa,—a rattling respiration ; it indicates an accu-
 mulation of  mucus or pus, or blood  in the bronchia, or a
 paralytic state  of the lungs, consequently the  rattling of
 the dying.
   Clangosa,  sibilans,—the  whizzing  respiration,  shows a
 straitening  of the tracheal tube, which is due  either  to
 spasm (as in spasmodic  asthma) or to exsudation of coagu-
 lable lymph, as in  angina polyposa.
  Crepitans, uttering a crackling noise at every  inspiration
 like that of  dry  paper or parchment, shows great dryness
 in the  mucous membrane of the bronchia, or accumulation
 of very tenacious mucus or pus.
  The hot and the cold  respiration (resp. calida et frigida).
  Calida indicates, in general, an accelerated circulation
of the blood ; fervens,—very hot  breath, either universal
inflammatory diathesis, or inflammation of the lungs, also
of other abdominal viscera situated near by,  (is especially
important for their diagnosis, in infants often the only sign.)
In consequence, the worst sign of an inflammation  is hot
respiration,  and  at the same time cold extremities.
  Frigida,—cool respiration indicates a slow, tardy circu-
lation of the  blood, watery blood,  stoppages in  the lungs ;
cold respiration  indicates departing life, therefore is pres-
ent in internal mortification (gangrene) and in dyino- per-
sons. 
DIAGNOSTICS,  IATROGNOMIC.
49
  Offensive breath (resp.  male olens), indicates often  only
uncleanliness of the sick, decayed  teeth ;  besides impuri-
ties in the stomach, worms,  or long fasting ; or a putrid
diathesis of the blood (therefore in  excess of animal food,
especially of  raw  meat, as  in all  carnivorous animals),
scorbutus, of which it is a principal sign ;  putrid typhus ;
purulent cacoehymy, or suppuration of the lungs, of the
larynx ; likewise abuse of mercury.   In some females  it
is indicative of menstruation.

          Pressure, Straining, Pain in the Chest.

  All these complaints point either to congestion in the
lungs, or to  a spasmodic affection, a nervous irritation
(frequently merely consensual  or metastastical), or  local
derangement  of  the  lungs.  Therefore, they are of mo-
mentous  significance only  in  a  phthisical disposition.
Pain in the chest with fever indicates either a rheumatic or
an inflammatory affection of  the pleura.

                  Sounds in the Chest.

  We distinguish two kinds,—the sound which the chest
renders on percussion, and that which one perceives in the
chest during  inspiration,  either by placing the ear or the
stethoscope on it.
  The sound from percussion  is either clear as from  an
empty barrel, or dull as from a full barrel.   The first shows
the lungs and thorax free of morbid accumulation, the latter
the presence of it.
  The various sounds different from the normal one, which
are heard by means of the stethoscope during inspiration,
may indicate either an impervious spot in the lungs (there-
fore inflammation, hepatization, tubercles, vomica), or mat-
ter  existing  in  the  bronchia  (mucus,  blood,  pus) ;  or
hydropic accumulations  in the thorax and adhesions of the
pleura?.  Also organic disorders of the heart are recogni-
zable by particular sounds.
  But all these audible signs  are only auxiliary, they prove
nothing, when there are not other signs which confirm and
rectify the sentence.

                         Cough,

  Indicates next, and in general, an irritation and momentary
convulsion of the respiratory organs,  and  is therefore of
various significance.  For the  irritation which excites it, 
50              DIAGNOSTICS, 1ATRCGN0MIC.

may originate in enhanced irritability of the lungs, as well
as in something irritant, which may be  either idiopathic,
i  e. having its seat in the lungs, or consensual and antag-
onistic, i. e. out of the lungs.  It may consequently be a sign
both of an affection of the lungs, either of an irritability of
them  augmented by inflammation, or  nervousness, or  ca-
tarrh, or of something irritating, e. g. congestion of blood,
tubercles, metastasis, suppuration, as well as a sign of dis-
ordered digestion and gastric impurities (stomach  cough);
or of morbid  liver, spleen,  and other abdominal  viscera.
This word therefore, in order to be explicit, always requires
an attributive  which points out the special diagnosis.
  The following generalities will be serviceable in practical
cases.
  In every acute  (not catarrhal) fever a cough  setting in
deserves the greatest attention ; for it  may be the first  in-
dication of a commencing  pneumonia.   It may, however,
arise also from the  irritation of an exanthematic  matter;
for  instance, a short dry cough with much  sneezing and
lachrymation, in the onset, is indicative of the measles.
  In all individuals of a phthisical disposition every attack
of cough must be  carefully attended to; for it indicates
the commencement of consumption.
  Men, in whom every morbid irritation excites coughing,
and such as are affected with cough after the least  exer-
tion of the  lungs,  as running,  speaking, laughing,  even
emotions, labor under a morbid irritability of the lungs and
phthisical disposition.
  Chronic dry cough, easily excited by the least  exertion
of the lungs,  with stitches in the chest once in a while  ap-
pearing, and  breath not entirely free, indicate  the exist-
ence of tubercles.
  Chronic cough with much expectoration of mucus  leads
to suspect the beginning of phthisis pituitosa.
  Absence of cough is the best sign of pulmonary health.
In healthy as well as in sick persons, in acute as well as in
chronic maladies, it is the best test of the lungs.   We may
cause the patient to make a deep inspiration and to retain
the breath for some time.   If he is capable of doing this,
without perceiving an  irritation  to cough, his lungs  are
sound ; the reverse is always suspicious.

                    Voice and Speech.

   Vox rauca—hoarseness—indicates that mucus or pus ex-
ists in the larynx, or an inflammation of the mucous mem- 
DIAGNOSTICS,  IATROGNOMIC.              51
brane; therefore it is a sign of catarrh, phthisis laryngea
and angina.
  Aphonia indicates the highest degree of inflammation of
the throat or phthisis of the throat, or spasm or  paralysis
of the vocal organs.
  Loss of speech indicates either spasm  when  it appears
periodically, most frequently caused  by hysterics and con-
sensual gastric irritations, especially verminous ; or paraly-
sis of the organs of  speech, as in apoplexy and  typhous
fevers, injuries  of the head, in which  cases it is always
ominous.
   Vox balbutiens—stammering—indicates in  fevers always
a dangerous affection of the nerves of  speech  and of the
brain, bordering on a paralytic state, which  very often in
the onset  of fevers is manifested by the patient not clearly
pronouncing single letters;  a circumstance worthy of the
physician's attention.

              Yawning, Groaning,  Sneezing.

  Yawning always indicates a too tardy circulation of the
blood through the lungs,  which nature endeavors to pro-
mote by a very deep inspiration and forced  expansion of
the respiratory organs.  It indicates therefore weakness or
spasm, in  the onset of the fever and ague.
  Groaning without moral cause, is of the same  significa-
tion.
   Sneezing is a convulsive expiration, and indicates an
irritation  of the nose, therefore catarrh or measles ; or of
the lungs, therefore it is present in  pneumonia, commencing
suppuration ;  or an irritation in the abdomen, therefore the
frequent sneezing of children indicates worms.

                 Weeping and Laughing.

  Weeping in disease always indicates spasm, nervousness ;
therefore  an inclination to weep  is  a  principal sign of a
hysteric state.
  Profuse lachrymation in fevers indicates  congestion in
the head ;  in the beginning of fevers it indicates measles.
  Laughing always indicates considerable irritation of the
nervous system, mental or physical;  therefore, in fevers it
is often foreboding of delirium and convulsions.   An incli-
nation to  laugh  at  trifles indicates a  hysterical state, as
inclination to weeping does, and therefore often pass from
one  into the other. 
52              DIAGNOSTICS, IATROGNOMIC.
  Risus sardonicus, violent convulsive laughter, may set in
as a symptom of diaphragmitis.

                     3. THE BLOOD.

  The blood  evacuated  by venesection  or  hemorrhage
shows various anomalies differing from  the normal state,
which may serve as signs of diseases or morbid dispositions.
  In the  first place the varieties of consistency come into
consideration.   They indicate either an abnormal coagula-
bility, or  an abnormal proportion of the watery constituents
to the cruor.
  Too firm consistency indicates:
  Either an increased coagulability, plasticity  of the blood
(the inflammatory  consistence).  The  blood coagulates
quickly and forms a firm mass, from which only a little  se-
rum is separated.  It indicates in healthy persons a strong
constitution and an inflammatory disposition  in  diseases,
an inflammatory diathesis, or an already existing inflamma-
tion.  The signs of inflamed blood  are :—it coagulates
quickly, often immediately after  escaping  from the vein,
into a very firm cake, from which only a little serum is sep-
arated, on the surface of which a white firm coriaceous coat
(corium, crusta pleuritica) is formed ; the  firmer and thicker
it is, the higher the degree of inflammation, yea, in the high-
est degrees it  is so firm that it is difficult to cut through it.
But it may be well  to observe, that it is  sometimes want-
ing in inflammations, and that its absence must not lead to
a conclusion that there  is no inflammation ; farther, that its
formation may depend upon the opening in the vein, and that
a small opening, where the blood does not  run freely, pre-
vents it;  and finally, that it may be found also in rheu-
matic complaints and in pregnant women.  But in this last
case this coriaceous crust is not solid, and is less tou°-h.
The genuine inflammatory corium is distinguished  by  its
whiteness and solidity.  When  it is yellowish, greenish,
flocky, loose, it indicates a nervous state, not genuine  in-
flammation.
  Or deficiency  of water,—dryness of blood,— atrabilious
condition.
  Too little consistency  indicates either  a deficiency of
plastic constituency and coagulability or an abundance of
lymph (the watery part  of the blood), and is therefore of a
double kind.
  Thinness (fluidity) of blood (tenuitas serosa).  Abundance
of serum indicates feeble  assimilation, chlorotic diathesis 
DIAGNOSTIC?, IATROGNOMIC.
53
 hydropic disposition ;  dissolution of blood (colliquatio san-
 guinis),  deficiency  of coagulability and  plasticity ; the
 blood is  dark and does not form into a solid coagulum, but
 into a pap-like  mass,  in which cruor and serum remain
 mixed, indicates a disposition to putrid dissolution, a scor-
 butic state, putrid typhus.
   Secondly, the color.  Dark red and  solidly coagulable
 blood indicates a strong constitution. Too dark, black blood
 indicates an abundance of carbon, of venosity ; it is found
 in scorbutic atrabilious diseases of the abdomen,  cyanosis.
 Too pale, limpid blood, indicates an abundance of serum,
 and is indicative of weakness.  If it is at the same time light
 red, it indicates dyscrasia, e. g. an arthritic  or rheumatic
 state.  Also the color  of the serum deserves  attention.  If
 it be distinctly separated, it is an  excellent  sign  of good
 sanguification  and health;  if  it be cloudy, milky, it indi-
 cates weakness; if it be very  yellow, bile in  the  blood; if
 it be bloody, a putrid state.


                       4. DIGESTION.

   After the circulation of blood and the respiration, diges-
 tion is the most  important function of the human system,
 and therefore also the most  important for the practitioner
 to understand ; for we  may recognize by it
   1.  The state of the digestive organs, which is  the chief
 source of support.
   2.  The state of the whole organism by reason of the in-
 numerous nervous combinations which  connect  this sys-
 tem with all parts of the body.
   3.  The quality of the humors, for this system is the seat
 of the principal emunctory and secretory organs.
   In  general a good digestion  indicates a strong, vigor-
 ous constitution, little susceptibility to external physical or
 mental morbific influences, vivid and easy reaction in dis-
 eases, and a macrobiotic disposition.
  Men of strong digestive power are more liable  to acute,
 those of weak digestion, to chronic  diseases.

                       Hiccough.

  Impeded swallowing  indicates either, if connected with
pain, inflammation of the throat, or  spasm, or paralysis, or
a mechanical obstruction ; or, if it be only for fluids, hydro-
phobia.
                           5* 
54              DIAGNOSTICS, IATROGNOMIC.
                        Hunger.

  Want of appetite is next in order, and indicates most fre-
quently noxious indigestible matters  existing in the stom-
ach, besides  a  febrile  state,  for all  fevers  take  away
appetite, except the  rheumatic and hectic ; or finally, ner-
vous discordance, as in hysterics, melancholy, weakness of
the stomach or organic disorder  of it.
  Excessive appetite, greediness—pica—indicates want of
nutritious substance in the stomach as well as in the blood ;
therefore accompanies diseases which evacuate quickly the
food from  the stomach, chronic vomiting, diarrhoea, like-
wise in hectic and phthisical maladies ; or an irritation of
the nerves of the stomach and  intestines, as in  worms, ac-
rid  gastric  matters, metastases  ; or morbidly increased irri-
tability of the stomachical nerves, as in nervous diseases,
hysterics, frenzy, pica, in pregnant women.
  Extraordinarily strong desire of certain things is a sign
of a salutary and natural instinct, and must be  profited of
in diagnostics as well as in therapeutics.   Thus an appetite
for  lime and earth, for salted things, is indicative of slime
in the stomach ; for acids, of putrid corruption ; for wine,
of weakness and a need of strengthening.

                         Thirst,

  Indicates dryness  of the mouth, want of exhalation, con-
sequently internal heat  (is therefore a sign  of fever  and
inflammation) ; or of spasm as in chills ; or an acidity in the
stomach or blood ; or  finally^ a deficiency of water  in the
blood, hence the  insatiable thirst in  fevers, a sign of the
highest inflammatory degree of the blood.

                  Nausea and  Vomiting.

  Vomiting is a convulsive affection of the stomach, and
indicates either  an extraordinary irritation in the stomach
or  without it,  which affects the  stomach consensually ;
or an  increased  irritability, consequently injurious  irrita-
ting matters in  the stomach itself, which is proved  by the
condition of the tongue, and the  vomited matter ; or spas-
modically  increased irritability; or inflammation,  if the
patient instantly ejects food and  drink ;  or a  consensually
operating irritation, as from inflammation  of the liver, of
the  intestines,  accumulation  of  faeces  in  the  intestines
gall, or nephritic stones, concussion of the brain, and accu- 
DIAGNOSTICS, IATR0GT0MIC.              55
mulation of water ;  or finally, organic derangements of the
stomach and  neighboring viscera.
  Nausea or vomiting  in  the  morning without signs of
gastric impurities is often a sign of gravel;—in  women, of
incipient pregnancy.

                Flatulence, Meteorismus.

  Frequent winds indicate accumulations of injurious sub-
stances which disengage much air, ructus if in the stom-
ach, flatus  if in  the intestinal canal.  A continual  dispo-
sition to it indicates weakness, especially atony.
  Meteorismus or f.atus in fevers is always a bad sign, and
indicates either  a great accumulation of corrupt and putrid
matters, at the same  time great atony; or if the  belly is
much distended  and painful, inflammability. Meteoric dis-
tention of the abdomen in  children indicates worms.

             Evacuation from the Intestines.

  The  examination of the matter discharged from the
intestines is important; partly to recognize the  matters
contained  in them ; partly to distinguish their  morbid
state and  that  of  the  abdominal  viscera  connected with
them ;  partly to discover the substances  separated from
the blood  in the intestinal  canal, and in consequence, the
disordered quality  of humors in general;  partly for ascer-
taining the dynamic consensual and antagonistic affections
of  the organism.
   It is therefore necessary in all diseases  of the abdomen
to  examine the  quality of  the excrements; in gastric mal-
adies  their morbid quality calls for the administration  of
evacuants.
   We must regard their consistency, color, smell and kind
of  discharge.
   We must distinguish between increased and  diminished
evacuation from the rectum.
   Increased  evacuation (diarrhaa)  indicates  either  the
presence of injurious and excessively irritating substances
in the intestinal canal,  of which number are worms ; or an
irritation in its membranes, as ulcers, metastases; or in-
creased irritability of  the canal,  either  inflammatory  or
nervous ; or a deposition of injurious matters in it, such as
pus, critical  secretions ; or consensual, even mental (c. g.
fright) and antagonistic irritation, that is to say, suppressed
function of the skin;  or  finally, the highest degree of 
56
DIAGNOSTICS, IATROGNOMIC.
 weakness of the intestinal canal, even of the whole system,
 colliquation.
   Green stools in infants  indicate acidity ;  dark brown
 ones, abundance of bile ;  not colored ones, want of bile.
   Diminution of discharge frotn the rectum (obstructio alvi),
 indicates either a deficiency of the natural irritability of
 the intestines, of bile ; or atony, spasmodic contraction, or
 want of fluids, neglect  of drinking, or turning of the hu-
 mors towards other parts, especially to the skin  by perspi-
 ration, or mechanical obstacles, organic disorders.
   Painful  discharge from the rectum (colica) and forced
 straining to stool (tenesmus)  indicates either irritating
 acrid matters in the intestinal canal or increased sensibil-
 ity of  it, which may be either nervous or  inflammatory.
 Tenesmus indicates'hemorrhoids or dysentery.
   Involuntary discharge from the  rectum.  We  must dis-
 tinguish the unconscious (inscia) which happens in dreams,
 in delirium or by too fluid excrements, and is insignificant,
 from the involuntary (involuntaria),  which indicates a par-
alytic state, and is indicative of great danger in fevers.
             5. SECRETIONS AND  EXCRETIONS.

                Perspiration and Sweat.

  From the state of cutaneous secretion we may in general
deduce the following inferences : in the first place, the state
of vital power. The more vigorous  the impulse is towards
the periphery, the  more lively, i. e. gas^like, will be the se-
cretion, the more vital power.   Secondly, the  free unimpe-
ded  condition  of  the blood.  Thirdly, the quality of  the
blood and  humors.  Fourthly, the crisis, the critical pro-
cess of healing ; for sweat produces the most perfect crisis,
and without the perspiration accompanying, all other crises
are imperfect.
  We must make a distinction between perspiration (tran-
spiratio insensibilis) and sweat (sudor).  The first one is an
imperceptible gas-like secretion, never ceasing and indis-
pensable  to life ; the latter is a dropping, watery secretion,
taking place only under certain circumstances.—The first,
gas-like,  is the living normal  secretion ; the sweat a newly
created  abnormal   chemical process, even  sometimes a
merely passive profluvium.
   A soft, open, slightly perspiring skin shows undisturbed
imperceptible perspiration, and is therefore in all diseases, 
DIAGNOSTICS, IATR0GN0MTC.              57
 particularly in fevers, a favorable sign, and  a  proof that
 there  is no spasm, no disturbance  of circulation, and no
 impediment to the  crisis.
   Dry, rough, parchment-like skin is indicative of the con-
 trary.
   In  diseases, especially the  febrile, it is most important
 to discriminate between critical sweats and  symptomatic
 sweats.  The former is a salutary operation of nature, the
 latter is a sign of a morbid state.
   Critical  sweat may be distinguished  by  the following
 observations:  When it does not arise immediately in the
 commencement, but in the critical period, that is to say,
 about the  seventh  or fourteenth day of the fever (mere
 catarrhal and  rheumatic fevers make an exception) ;  when
 it is general (local  sweats, e. g. on the head, on the chest,
 indicate congestion or inflammation in these parts) ;  when
 it is clammy ; when it is warm (cold sweats indicate exces-
 sive weakness, and are forerunners of death) ; when it is
 not light and disappears quickly, but continuous, and when
 it alleviates the malady, and soothes the pulse in fevers.
  Symptomatic, premature, excessive, not alleviating sweats
 indicate either a very violent motion of the blood  with de-
 bilitated skin  (frequently caused  only by too warm cloth-
 ing, feathe.r beds, confined air); or gastric accumulations ;
 or  great general  weakness and  colliquative disposition.
 They always lead us to expect febris or petechias.
   Sour-smelling sweats indicate miliary fever; fetid sweats
 putrid typhus.
   Sweats  in  the  morning,  not usual, indicate  a  hectic
 fever.
   To be easily thrown  into perspiration shows a  weak
 constitution.

                   Secretion of Urine.

  The  urine affords the  most  important  diagnostic  sign
for distinguishing the quality of the blood, and the chemi-
cal processes going on in the system, since"no secretion is
so immediately connected with  the circulation as this one ;
for this may  already  be  conceived by the  circumstance
that the nutriments taken, and the admixture of chyle are
recognized in it.  It therefore  deserves the greatest  pro-
fessional attention  that has  been bestowed upon  it in so
high a degree  by the ancient physicians, and is now-a-days
too much neglected.
  In order to  judge rightly concerning morbid urine, we 
58              DIAGNOSTICS,  IATROGNOMIC.
must  first know the discriminating signs of that which is
healthy.   They are the following: It  is straw-colored, of
a specific but not fetid odor ; and  remains clear.  The fol-
lowing circumstances, however, which the physician must
carefully consider, have an influence on it.
  The constitution—a strong  one has higher colored and
more  odorous urine,  weak persons more pale and frothy
urine  with some sediment.
  Season—in summer it is scanty  and  more dark colored,
in winter more copious and paler.
  Mode of living—motory labor reduces its quantity, and
makes it darker ; sedentary life increases the quantity and
the paleness.
  Age—in old persons it is diminished, darker, and fetid.
  Sex—females  have always paler urine and more  sedi-
ment  in it.
  Digestion and food.—Much drinking augments the urine
more  in quantity and paleness;  rhubarb  and  curcuma
make it light yellow; asparagus,  fetid.  During digestion
it is cloudy  on account of the admixed chyle.  We distin-
guish, therefore, urinapotus, 1 to 4  hours after a meal, which
proves nothing ; and urina sanguinis, 6 hours after a  meal,
which alone is to be used for examination.
  In order to form a  correct judgment  it is farther neces-
sary,  that the urine be left untroubled for 2 hours in a cool
temperature, and be not brought quickly from a cold into
a warm  place, or the reverse.
  We recognize by it,
  1. The condition of the blood, of the organic matter, and
of the chemical process of life.—Especially the presence
of the phlogistic state ; therefore the red (rubra) urine with
accelerated  pulse is  the  principal sign  of fever,  internal
heat and inflammation ; this sign is so momentous, that it
is decisive in dubious cases, whether  the affection be in-
flammatory  or spasmodic.—Farther, the  colliquative  state
of the blood inclined to dissolution, is indicated by a muddy
thick urine, with much  sediment, and  bloody  (turbida,
crassa) ; a high  degree of putridity, and inflammation ter-
minating in gangrene, by a thick black urine  (nigra) ;  in
a high  degree  of hectic dissolution,  it  is  greasy on its
surface.   Also  foreign substances contained in the blood,
e. g. bile, which is  seen  in the saffron-colored urine (cro-
cea), is a sign of gall-stones, and if it gives a yellow  color
to linen  or paper dipped in it, is a principal sign of icterus ;
urina viridis is a sign of corrupt bile ; of matter in internal
suppuration. 
DIAGNOSTICS, IATROGNOMIC.              59
  2. The  internal  chemical process  accompanies every
general curative process, and is the process of crisis.  This
imparts to  urine a diagnostic importance in  fevers.   We
distinguish  here three stages of critical operation ; the
crudity, that  state in which there is not yet  a vestige of
critical working; the coction, a commencement of critical
operation in  which particular indications of the crisis are
visible; the  crisis, the finished critical operation, and the
secretion of the morbid substance.  This affords the three
varieties of critical urine : urina cruda, cocta,  critica.
   Urina cruda.  Signs of crudity exist when the urine, (the
pale as well as the red,) is  perfectly clear and  pellucid,
and remains so ; or when it (as it happens often in nervous
and gastric  fevers) is  cloudy, thick, and jumentous  (like
turbid water or a cooled decoction of Peruvian bark), and
remains so.
   Urina cocta.  Signs oY coction, when the urine, heretofore
clear,  grows muddy and exhibits a light little cloud.   This
happens sometimes only on the 4th or 11th day (dies index)
and then disappears,  but  leads  to  a  hope, that a critical
urine  will succeed the 7th or 14th day.  The coction and
beginning crisis show themselves  sometimes also in the
 clear  i;rine by  a  nubecula  (a  light  little  cloud which
 remains on the surface), or by an enoeorema (a cloud which
 sinks  to the bottom of the glass).  The latter is a favorable
 foreboding of an approaching crisis; but the little  cloud
 which lemains on  the  surface,  or after it had  subsided,
 rises  up again, indicates, it  is true, a  commencement of
 crisis, but leads to a fear that it  will be imperfect.
    Urina critica, sign of completed crisis, when the  urine,
 before clear, leaves a sediment, or the  urine, before  thick
 and turbid, decants clear from above, and leaves a sediment
 below.                            9
    But the sediment may be also critical and not critical, the
 knowledge and discrimination of which are very important.
 The critical sediment is of this character:  it falls  down
 soon after urination, is not too much nor too little in  quan-
 tity (about f or i of  the  whole), white or grayish,  light,
 uniform, and a little convex on the surface.
    The sediment is not critical and ominous when it is too
 large, filling h or * of the glass, thick and heavy, distracted
 and livid. °Red, bile-colored sediment indicates intermit-
 tent fever, or a rheumatic character of the disease; a  white
 chalky sediment in thick dark-colored urine, indicates an
 athriiic character, also urinary calculus ;  dark, black sed-
 iment, a putrid state. 
60              DIAGNOSTICS, IATROGNOMIC.
   3. The nervous spasmodic state, limpid, aqueous urine,
 which is generally accompanied with frequent urgency to
 urinate, indicates spasm ; pale, turbid urine, but particularly
 changeable urine in fevers, indicates a nervous character.
   4. The condition of the digestive system.  Urina jumen-
 tosa is a principal  sign of  a gastric state ; milky urine  in
 children, of worms.
   5. Augmentation or diminution of other serous  secre-
 tions.  Thus sweat  and  diarrhoea, even the use of purga-
 tives, produce dark-colored urine.   Suppression of perspi-
 ration by the skin  renders  it  watery  and  increased  in
 quantity, even to diabetes.
   6. Local diseases of the kidneys and the bladder.  Slimy
 urine indicates blennorrhea vesica? or calculus vesica?; pur-
 rulent urine, suppuration of the bladder or prostate gland;
 bloody urine, a bleeding from the kidneys or bladder ; ex-
 cessive quantity and aqueous quality of urine,  diabetes.
   Also the chemical examination must  not be neglected in
 some cases ; the most usual is that on litmus paper,  in or-
 der  to ascertain the presence of a free acid ; still more im-
 portant is the discovery of sugar in it, in order to discover
 diabetes mellitus, a disease, the existence of which cannot
 be recognized in any other way,  and which may terminate
 fatally by emaciation.  Never omit this examination in all
 kinds of emaciation which cannot be accounted for.
  Also the manner of discharge is of diagnostic importance
 in the evacuation of urine as well as is that of faces.  It
 is either painful,  difficult, impeded, and then indicates
 spasm, inflammation, local diseases ; or it is passed invol-
 untarily, indicating paralysis; in fevers  the highest, fatal
 weakness, in which, however, as  in the  evacuation of fae-
 ces,  the unknowing is to be distinguished..
                     •

            Salivary Secretion, Expectoration.

  Increased flux of  saliva indicates  either a local irritation
of the salivary glands, e. g. angina, or  is consensual with
the abdominal disorders, especially  impurities in the stom-
ach,  worms, constipation of the abdominal viscera, par-
ticularly  of the pancreas,  therefore frequent spittino- is a
sign  of hypochondriasis ;  also congestion of the  salivary
glands, and the head, as in apoplectic dispositions.  Here
critical salivation is to be also mentioned, which in diseases
may  arise from suppressed perspiration of the skin in lin-
gering nervous fevers, and in small-pox. 
DIAGNOSTICS, IATROGNOMIC.
61
 Deficiency of saliva indicates spasm and great dryness of
 the blood.
   Expectoration (sputa).  All that  which is  expectorated
 after hawking or coughing, indicates increased secretion
 in the  mucous  membrane  of the throat or trachea, or of
 the  lungs, or also the existence of foreign  matter in these
 organs, e. g. pus, blood, tubercles, even calculary substan-
 ces; pituitous mucus, continually discharged, and in great
 quantity, blennorrhoca pulmonum, phthisis pituitosa,  pu-
 rulent matter, phthisis purulenta ; sweet salty matter, gray,
 blackish, cloddy tubercles ;  yellow-colored bitter  bile in
 the  blood, liver complaints.
   In inflammatory pulmonary diseases the expectoration
 is the most important local crisis, and is indispensable to
 a perfect resolution of the disease.  The signs  of the critical
 expectoration are : sputa cocta, subacta, i. e. expectoration
 thick, yellowish, like  a  thick emulsion,  sometimes mixed
 with small streaks of blood and easily expectorated.
   We must  distinguish spitting of blood (sputum sangui-
 neum) and bloody cough.   The first is only a secretion of
 blood from the mouth and the upper  parts  of the throat
 and  the windpipe, which is in nowise related to the lungs.

                  Evacuations of Blood,

   Indicate either true plenitude or turgescence of blood,
 distention by the blood, or local congestion, or inflamma-
 tion  of a part,  or relative weakness of a  part,  so  that it
 cannot resist the impetus of the blood; or a dissolution,
 putrid state  of  the blood ; sometimes  also a crisis, espe-
 cially in acute  fevers.  Thus bleeding at  the  nose  in
 inflammatory fevers, congestion and inflammation  of  the
 brain, is the most salutary and decisive crisis.


          6. AFFECTIONS OF THE MIND AND NERVES.

          Activity of the Mind, Senses, Feeling.
   Delirium—raving—indicates  always an affection  of  the
brain ; but, as this may arise from various causes, it is also
of different significance and importance.
   In the first place, however, we must  remark, that there
are persons who, in  the slightest  feverish indisposition,
even in a  slight catarrhal fever, rave during  sleep, yea, who
speak while asleep even  in good health  ; hence, in judging
of delirium, we have to make  inquiries on that account.
                           a 
62               DIAGNOSTICS, IATROGNOMIC.
   Morbid raving always indicates a disturbance of the nor-
 mal activity of the  brain, either an excitement  of it, in
 which case the delirium is active, with excitement, accom-
 panied  frequently with violent exertion or fury (delirium
 activum, furibundum) ;  is either idiopathic, such as  arises
 from a  violent rushing of blood to the brain, indicative  in
 fevers of the higher degrees of inflammatory diathesis, or
 real inflammation of the brain, metasastes, the irritation  of
 exanthematic matters,  e. g. of small-pox ;  or  consensual,
 and here  especially proceeding from the  stomach and in-
 testinal canal, e. g. accumulation of bile,  worms, narcotic
 poisons.
   Or want of cerebral action.  Here the delirium is silent,
 internal, as  it were, accompanied with slumber  and  other
 signs of weakness (delirium blandum, somnolentum typhu-
 sum), such as in nervous fevers, in typhus, pressure on the
 brain, parenphymatic  accumulation  of  blood in cerebral
 inflammation, or extravasation, hydropic accumulation.
   Also chronic deliria may arise from both sources. Here,
 however,  it  will be well to observe two points:  hypochon-
 driacal and  hysterical persons are very liable to delirious
 attacks, which are only symptoms of these diseases and of
 no other signification. We must distinguish delirium from
 insanity and frenzy.   We call a person insane, in whom
 delirium has become permanent and  isolate.
   Sleep and  waking.   A quiet, natural, and not too long
 continued sleep is in all diseases one of the most favorable
 signs, in crises the best companion, and a sign that they
 are perfect.  Children  sleep generally more than adults,
 and we  must not conclude too quickly, that there is here an
 affection of the brain.   There are also men who, in fevers,
 like animals, sleep continually and recover best by it.
   Sleep is morbid  when it is connected with delirium, con-
 vulsive movements and starting up, which is continual, and
 in which the patient awakes by the slightest noise and falls
 again asleep instantly  (coma vigil), or cannot at all be
 roused  (coma somnolentum, sopor).  It indicates great af-
 fection of the brain (hence a sign of typhus or cerebral
 inflammation); the  worst, when it  sets  in  immediately
from the commencement of the fever.
   Restlessness (agrypnia) is less  dangerous than  somno-
 lency, but in fevers is a sign of a continued irritation of
 the sensorial system.
   Giddiness (vertigo), indicates  either plenitude of blood
 (oreneral or  local congestion of the  brain), or  a nervous
 ailection,  most  frequently  proceeding from the stom- 
DIAGNOSTICS, IATRONOMIC.               63
ach and  abdomen, in which case it  is a principal sign of
gastric turgescence  upwards.  In old age and in persons
disposed to apoplexy, it is a bad omen of that disease.
  Eye and sight.  The eye and look afford very important
expressions of internal life in general, and of the sensorium
in particular ; and are worthy,  therefore, of the greatest
attention on the part of the diagnostician.
  Squinting (strabismus), when it is not habitual, always
indicates spasm of the ophthalmic nerves, and shows either
an affection of  the sensorium (thus in the  commencement
of the hydrops cerebri acutus  of children), or consensual
gastric  irritation, impurities  in  the  stomach,  especially
worms.  Staring look, fixed on one object, betrays  deliri-
um.   Languid  look  of the eyes suddenly  setting in, indi-
cates either sinking  of the vital powers  or  gastric turges-
cence, or imminent vomiting.   Dilatation of the pupil indi-
cates either pressure on the  brain,  a  principal sign of
encephalitis  and hydrops  cerebri;  or  gastric irritation,
especially  from  worms; also abdominal stagnation and
amaurosis.   Contracted  pupil and great  sensibility to light
indicates increased sensibility ; on the  contrary,  a  desire
for light great  weakness, and  is a bad omen in fevers.
  Black flocks before the eyes or obscuration of sight indi-
cate either congestion  of  blood  to the head  or gastric
turgescence, or sinking of power, imminent fainting.
  Double-seeing (diplopia), and half-seeing is always a
sign of spasm, and indicates commonly gastric irritation,
frequently it is also only a hypochondriac or hysterical
symptom.   Protruded, reddened, glittering eyes indicate
great sanguineous congestion in the brain ; sunken eyes,
weakness.
  Hearing.  Too sensible hearing  indicates in fevers an
excessive  sensibility of  the whole  nervous system, or an
inflammatory affection of the brain.   In fevers weak hear-
ing is better than too sharp hearing.  Tingling and buzzing
in the ears  indicate sanguineous congestion, frequently
also catarrhal,  serous congestion to the ears.   Weak hear-
ing, deafness in fevers, especially typhus, .is a good sign.
  Smelling.  Loss  of smell  indicates  either a catarrhal
state  or  an important nervous affection ; putrid smell indi-
cates  a putrid ulcerous  local  disease in the  nose, or
palate, or a putrid  diathesis of the  blood  ; an uncommon
smell like to burnt feathers, spasmodic nervous affection.
  Taste.  Loss of taste is indicative of the same as  that of
smelling, also great  stoppage  with phlegm   Foreign taste
indicates either diseases of the mouth and throat, or of the 
64               DIAGNOSTICS, IATROGNOMIC.
lungs (thus the putrid or salty taste  in phthisis purulenta),
or gastric impurities (the bitter bile,  the slimy phlegm, the
sour acidity) ; or where these causes do not exist, either a
false tone of the nervous system (as for instance in hyster-
ical, also in some pregnant women), or in fevers a putrid
diathesis of the blood.
  Cutaneous feeling.   Chill and heat,  itching  without
eruption, indicate in fevers  imminent eruption of critical
sweat, without fever—acrimony of humors ; deafness, want
of feeling in single parts, stagnation of the blood or nervous
affection, spasm, sometimes concealed gout.
  In the changes  of temperature  we  must distinguish  the
sensation of it (frigus et color ad sensum) and the real phy-
sical  alteration (frigus et color ad thermometrum);  for
both cold as well as heat may sometimes  be only a sensa-
tion of the skin, a nervous affection, without a real increase
or diminution of caloric.
  The sensation  of chill  is always  due  to  a cutaneous
spasm, and is of different degrees : shivering, chair depoule,
cold trembling fit, numbness (horripilatio, horror, rigor).
It  is  always a  rnomentous.sign..  We must distinguish
chills In the commencement of  fever and in the course of
it.  When the first chill is very violent, it indicates either a
violent fever, generally of an inflammatory character, or  the
beginning of an intermittent fever; when it is weak, alter-
nating with heat,  either a catarrhal, rheumatie or a ner-
vous fever.   In acute fevers it sets in only once, in inter-
mittent fevers it repeats with every  paroxysm.   When a
chill sets in in the course of an acute fever, it must always
excite the greatest attention of the physician, and is indi-
cative of the following : either an intermittent fever, added
to the acute (hemitritaeus), or  an incipient  local inflam-
mation, and in  inflammations already  existing,  a transi-
tion into suppuration (very important in pneumonias), or
into gangrene, or a metastasis, or also sometimes an immi-
nent crisi*, especially by the skin.  In intermittent fevers,
slight  chill  with  great  heat indicates an inclination to
change  into an acute  fever; great and  long-continued
chill with little heat, inclination  to a chronic state.
  Coldness of the extremities indicates impeded circulation
of the blood (hence accompanies fevers,  internal inflam-
mations), or spasm, or vital weakness;  and hence the  icy
cold of the dying.  •
  Heat in diseases indicates either an accelerated circula-
tion of the  blood  and of vital action, and is therefore a
general sign of acute fevers, which are  thence called hot 
                 DIAGNOSTICS,  IATROGNOMIC.             65

 fevers, and of inflammation, color  vivus ; or commencing
 dissolution of the blood and of organic matter, calor chemi-
 cus s. mortuus, as seen in putrid fevers.  On this depends the '
 important distinction of heat  in inflammatory and in putrid
 fevers.  In the  first  it is a vital heat, and is distinguished
 by this, that it is very violent but  not disagreeable to  the
 touch of the hand laid  on  the sick body,  assimilates, so to
 say, with the sense of feeling after  being dwelt upon  for
 some time, and  corresponds with the strength and hardness
 of the pulse.  In putrid fevers it is the product of an inci-
 pient  chemical dissolution, a chemical  dead heat (calor j
 mordax), and  is distinguished by its violence, and a sensa- I
 tion of burning and stinging to the touch, and is disagree:
 able, and this effect increases, the  longer the hand is held
 on the sick body,  leaving  that impression for some time
 after the hand is removed : it is further to be remarked,
 that this kind of heat augments in proportion as the pulse
 sinks and becomes weaker.
   Heat of one part, either to be felt externally or  internally
 by the patient himself, indicates sanguineous congestion or
 inflammation  of that part.  Thus heat in  the preecordia is
 always a critical sign of an internal inflammatory state.—
 Flying heat is a nervous symptom, and  common in females
 after the cessatio mensium.  Hot  hands after eating, indi-
 cate hectic, and in  healthy persons a hectic  disposition.
   Pain and anxiety.  Pain  is  the most  general expression
 of nature, to  indicate the  existence  of a local complaint.
 This can be  either  inflammatory  or spasmodic ; and  we
 can therefore always conclude regarding one or the other ;
 every pain, however, if it be violent, creates at last san-
 guineous congestion.   One of the worst signs is, when the
 patient does not feel any pain, although there exist causes
 of pain.   Sudden ceasing of violent pains in inflammations
 indicates transition into gangrene, if there does not follow
 a  metastasis.
   Pressing headache in the forehead with  vertigo indicates
 gastric  impurities; in the back part of the  head, sangui-
 neous congestion ;  semilateral cephalagia or headache of
 only a small spot of the head, hypochondriasis and hyster-
 ics; pain in the back and  the  loins, piles.   Pain in  the
praecordia bjr  external pressure, is  in fevers  always omin-
ous, and indicates, especially if connected with  heat and
straining of this region—inflammation of the abdomen  or
chest.
  Anxiety, a particular sensation of the precordial nerves,
still more disagreeable  and  insupportable than pain, indi-
                           6* 
66
DIAGNOSTICS, IATROGNOMIC.
cates either great sanguineous congestion in the precordi-
al region, and hence is present in inflammation ol the neari,
lungs, liver, stomach, and other abdominal viscera, organic
diseases of the heart, plethora abdominalis, or accumulation
of injurious, irritating, flatulent substances in the stornacn,
especially of bile and eructations;  or a mechanical hinQer-
ance to expansion of the lungs, seen in pectoral and abdo-
minal hydrops ; or mere spasm ; of this kind is the anxiety
of hypochondriacs, which may increase to desperation.

                   Muscular Motion.

.  Trembling (tremor) indicates either weakness or plenitude
of the vessels, (e. g. plethora) or nervous irritation ; thus it
is in the  beginning of a  fever a principal sign of its nervous
character.                                 .
  Spasms with convulsions are indicative either of a  ner-
vous irritation, such as  gastric irritation owing to impuri-
ties, worms, exanthematic and contagious irritatives, small-
pox, purples, typhus, foreign bodies which affect the nerves,
brain, or spinal marrow  ; wounds of tendons ; or they indi-
cate plenitude of the vessels and sanguineous congestion to
the head and spinal marrow; or exhaustion of power (hence
most ominous in  hemorrhages and  other profluvia).  But
we must bear in mind,  that in children and hysterical per-
sons they may arise from trifling causes, and are not so sig-
nificant ; generally, in either of them, they originate m the
intestinal canal.
   By cramps (spasmus) we understand, accurately speak-
 ing, a continued  contraction  of the  muscular fibre, by
 convulsio—contraction  and relaxation  alternating.   The
 highest  degree of spasm is tetanus ; the highest degree of
 convulsion is epilepsy. Spasm and convulsion may take
 place  alike  internally  and externally ;  thus a number of
 internal affections, e. g. palpitatio,  vomitus, tussts,  cohca,
 ischuria, singultus, fall  under this category.  In the widest
 sense, also, all anomalies of  sensibility, are called spas-
 modic affections.
   Singultus indicates in  the first place a  little convulsion
 of the diaphragm which arises from very different causes,
 and therefore is of different significance.   Thus it is com-
  monly indicative  of  distention of the  stomach in infants;
  also of  cold, and  is of no significance at  all.   But in hot
  fevers it indicates either abdominal inflammation, or is in
  nervous fevers a  malignant nervous symptom.
    Paralysis indicates an enfeebled or annihilated activity 
DIAGNOSTICS, IATROGNOMIC.              67
of the motory organs of the muscles, in a more extensive
sense, also of sensation even of the mental faculties, e. g.
loss  of memory, stupor, fatuitas, and in all these cases is
either a sign of nervous power impeded and bound  up by
external influence, or weakened and annihilated in  its in-
ternal sources ; hence of different significance. In the first
case it is often very insignificant  and transitory ;  in the
latter case it is very momentous and dangerous,  most so
when it proceeds from a weakness  or affection of the ori-
ginal source  of sensibility, of the brain and spinal marrow,
e. g. from apoplexy.

Fainting (Lipothymia, Si/ncope), and Apoplexy (Apoplexia.)

   In  either there  is debilitation or entire annihilation of
nervous activity, sensation, motion  and consciousness, with
this  difference, that in syncope there is also a reduction of
the activity of the heart  and circulation, hence  pulsation
and  warmth  are alike  weakened, even  sometimes entirely
annihilated ;  in  apoplexy on the contrary, the circulation
continues undebilitated, even frequently is increased ; and
it often leaves the body paralyzed,  which is not the case in
faintings.  Syncope, therefore,  indicates a momentary an-
nihilation of the activity of the heart ; apoplexy,  a ceasing
of the activity  of the  brain and nervous life.   Faintino-,
therefore, is  of little significance in hysterical persons, and
is to be considered only as a common attack of spasm.  It
is of consequence in the onret of fever, and a certain sitrn
of its nervous character;  and in cardial affections is con-
firmatory of an organic derangement of the heart.   Apo-
plexy indicates always the  most  important and highest
affection of the brain in its inmost life.
7. COMPLEXION, STRUCTURE, EXTERNAL APPEARANCE, CARRIAGE,
                        POSITION,

  Serve  as  signs, not only of actual diseases, but also of
morbid dispositions.
  Frame and  structure.—Broad, high chest, and a  good
proportion of all the limbs, indicates a robust constitution,
and durable health.   Tall, slender and quick grown bodies
with a long neck, flat chest  and wing-likeshoulders, are
feeble, and show a constitution disposed to consumption.
Short, stout bodies are always stronger, and with a  short
neck, are liable to apoplexy.  In general, inequality in the 
68               DIAGNOSTICS, IATROGNOMIC.
 proportion of the limbs indicates a  disposition to disturb-
 ances of circulation and sanguineous congestions, e. g. too
 short feet or curvations of the spine.
   Excessive emaciation, when  not  due to a want of ali-
 ments  or mental affections,  or fever,  must always lead
 our attention to a disorder in the abdominal and digestive
 organs, or in the lungs, or to a morbid excretion, e. g. of
 blood or of semen, diabetes.  Extraordinary obesity is al-
 ways suspicious, and generally indicates disease of the liver.
   In  all  chronic  diseases,  examination of the abdomen
 ought never to be neglected, in order to discover whether
 one part of  it be distended more than another, or hardness,
 indicative of physcony, obstruction, or other organic  de-
 rangements of some one of the  viscera.  But we must not
 allow ourselves to  be  deceived by this  appearance in in-
 farctions, and accumulation of hard  excrements in the co-
 lon, which are  recognizable  by  their being movable from
 one place to another.
   Complexion.   Pale color indicates the presence of mor-
 bid substances  in  the  prima? vise, especially acidity and
 worms, or spasm,  or  want of blood,  or watery blood, or
 tardy sanguineous circulation and weakness ;  white com-
 plexion, chlorosis;  red complexion,  plethora or  sangui-
 neous congestion to the head ; circumscribed red cheeks,
 hectic disposition.   Light  yellow complexion  (abdominal
 complexion), diseases of the abdominal viscera ;  yellow
 complexion, diseases of the liver, icterus ; blue complex-
 ion, cyanosis;  blue spots,  scorbutis, dissolution  of the
 blood ; in old  age, stagnation of it, danger of apoplexy.
 Suddenly and entirely changed appearance of the sick, indi-
 cates great danger ; the same is true  of an entire  change
 of habit.
  Position of the sick.  The more it is in accordance with
 his natural  habit, the better.   To Jay immovably in one
 spot, shows  either stupor or  great  weakness.   Continual
 moving about, indicates either internal anxiety and pains, or
 some  irritating quality in the blood,  e. g. an exanthematic
 matter, frequently also gastric accumulations, and on criti-
 cal days, a coming crisis.  To be able to lay on either side
 and on the back equally well, indicates that the chest and
 abdomen are free from considerable disorders of the visce-
 ra; the first  especially  when  the patient can breathe well
 with the head bent back.  Not to be able to lay well on one
 side indicates, generally, a disorder of a  viscus in the op-
posite  side.   Throwing the feet towards the abdomen,
indicates  abdominal pains ;  indecent  denudation,  either 
               DIAGNOSTICS, IATROGNOMIC.               69

great delirium  or great anxiety ; the same, when the sick
cannot endure  clothing on the body ;  still more, when he
continually rises and starts ; the sinking of the patient in
his feet, greatest vital weakness ; still more the catching
after  illusory objects, which is  generally, but  not always,
the forerunner  of death.
  Also  the  chemical examination of the  evacuated sub-
stances may be used for throwing light  on the disease,
especially for discovering its  chemical character.  This
applies mostly to the analysis of urine.
  Also  the examination of animal  electricity, whether  it
be positive or negative,  a*nd the examination  by the stetho-
scope, both of which, however, give disclosures more of a
physical and  material than of  a dynamic state of the sys-
tem, and are consequently of  more value  in regard to the
natural history of the patient at the time, than of practical
utility. 
70                   THERAPEUTICS.
therapeutics.
  Disease  is a deviation  of life  from the  normal  state ;
consequently an internal change of life itself.  Cure is a re-
duction of this  deviation to the  normal state, and resto-
ration of health.  Disease, therefore, as well as cure, must
be regarded as vital operations, and in order to  conceive
and appreciate them, we  need correct ideas of life and of
the origin of disease.
  All external phenomena of life, and also the abnormal
one, disease,  are nothing else than the manifestation of
an internal prevailing power, which cannot be seen or ima-
gined—the vital power.
  This manifestation appears in a threefold manner ; and in
these actions consist the phenomena of life and the dis-
tinction between living  and dead  bodies.
  In the first place,  the body enters into a particular rela-
tion towards  external things,—into the irritative  relation.
It perceives and reacts differently  on external influences
from what the dead  body  does.   It  is irritable, excitable,
and external  impressions become irritations to  it.  This
quality of the living body is manifested in two principal
forms,—firstly, by a contraction and oscillation of the fibre
(irritability, contractility),  and secondly, without a percep-
tible alteration of the fibre,  by internal reception  and pro-
pagation of the irritation (sensibility)—a property of the
nervous fibre.
  In the second place, the general chemical laws of nature
are thereby  partly  annihilated,  partly modified,  so  that
matter puts on a particular character (living organic chem-
ismus, vitality of organic matter),  and in  so far also the
humors, especially the blood, are animated.
   In the third place, all ingredients,  powers and operations
of the body constitute a unity, and tend and are excited to
one end—its formation  and preservation ; i. e. the  body be- 
therapeutics.                   71
comes an individual, possessed of the power to form and
develop itself, according to a specific character, and to de-
fend itself  against injurious  influences,  to transmute and
excrete the incongruous, to regenerate the loss, to keep the
whole  in balance and proper mutuality, and to restore it
when disturbances occur  (the plastic  creative power, in
diseases the healing power of the organism).
  Every living body  is consequently elevated to a higher
degree of existence.
   Every action in  the living body is a living action, and
 comprises  always an  alteration of all the relations men-
 tioned heretofore, material as well as dynamic.
   Every morbific influence operates as an actio viva, and
 only as such can excite disease.
   Every effect  of a remedy is likewise an actio viva, and
 can only as such produce a healing effect.
   In every disease we must, therefore, ascertain the in-
 ternal change of life, a change which lies at the bottom of
 the malady, and the  perceptible external phenomena pro-
 duced by it, and which are called the  symptoms of disease.
 These are  differently  related to  disease.   Some are insep-
 arably connected with it (symptomata essentialia, pathogno-
 mica); some are not so, and are only accidental (sympto.
 mata accidentalia.)
   The internal  alteration  of life,  which gives rise to the
 external phenomena, is termed the proximate cause (causa
proximo).  A causa proximo, therefore, is one, in which
 disease  originates, with whose existence the disease exists,
 and with whose removal disease ceases.
   The causes which  produce the internal alterations are
 termed  remote  causes, and bear  a different relation to the
 generation of disease, sometimes  nearer, sometimes re-
 moter.  They may be external and internal,  and are dis-
 criminated from the proximate cause  by this, that their ex-
 istence does not always give rise to the disease; therefore
 they also can exist without producing disease.
   These remote causes are divided into predisposing and
 exciting (occasionales).
  To cure is to change the abnormal state of life into the
normal;  that is to say, not only to take away the external
phenomena of disease (symptoms), which never will effect
a radical, permanent cure,  since the  .symptoms, when the
internal cause continues, of necessity return (symptomatic 
72
therapeutics.
 cure), but to remove and annihilate the  internal change of
 life,  the proximate cause, which lies at the bottom oftheper-
 ceptible disease ; thus by pulling out the root, the fruits and
 blossoms fail of themselves (the radical cure).
   Now this can be effected either by taking away the remote
 cause, which gave occasion to that internal change;as when
 we take away a splinter, or any other foreign body, we re-
 move the irritation and inflammation created by it; by re-
 moving gastric impurities the complaints arising therefrom ;
 in  suppressed excretions by restoring them; in too pro-
 fuse  ones by stopping them. Thus, even other diseases can
 be causes of the present malady, and  the cure  of the first
 will effect the cure of the latter (causal cure).  We easily
 conceive,  that this cure is preferable to any other;  for if
 the cause  continues, either amelioration is impossible, or
 if it is effected in another way, the evil will return.  Or a
 cure may be effected, by attacking the internal alteration
 of life, which is indispensable to disease,  indeed is the dis-
 ease  itself, and changing it into the normal state (direct or
 specific method).—This method is adopted when no rational
 cure  is indicated or possible.
   But since every abnormal state of life can be  changed
 into the normal, only by the reaction  and co-operation of
 the vital power, and every cure depends on an internal cu-
 rative process (as shown above), it  follows that direct
 curing by art consists only in supporting this internal cura-
 tive process of nature and bringing it to perfection.   This
 is done either
  By removing the cause of disturbance and the obstacles
 to its action;
  Or, by supporting and raising the vital power when it is
 too weak ;
  Or, by reducing it,  when it is too strongly and tumultu-
 ously excited;
  Or, by remedies, which have either a specific action on
the suffering organ, so as to give it another character, or
to arouse properly the vital  activity, or which are  capable
of producing an amelioration of the morbific matter and all
the material relations.
  This is the causal, rational, radical method of curing.
  We can also perform cures which are only apparent, as
removing the morbid symptoms while the cause of the dis-
ease continues (the  symptomatic palliative  method of cur-
ing).  This  is only  sometimes practicable;  but  we may 
therapeutics.                   73
easily  conceive  that this  cure cannot be permanent and
radical.  The accidents sooner or later reappear, either in
their former shape, or, what is still worse, in another and
more dangerous form. It is the method of quacks, and will
be avoided by every rational physician.   It is only in two
cases  that it may be resorted to:—in the first, when a
symptom  is accompanied with imminent danger of life ; in
the second place, if one symptom hinders  even the radical
cure,  or makes it difficult,  such as violent pain and diar-
rhoea, which evacuates the remedies as soon as taken.
   Finally, the treatment can refer to a disease not actually
existing,  and have for its end prevention  of it (the preser-
vative cure).  This  is done  either by removing the  dispo-
sition, or  taking away the causes as far as they are within
our control.  But we must  here be careful not to carry
it  to abuse, or undertake it without sufficient reason.
  The means for obtaining the end of healing embrace all j
nature, not alone  corporeal but also  spiritual  and mental. !
All that affects the human system, can be used as a remedy.
  The selection (heuristic) of the remedies is made :
  Either in the rational way, as  by  a plain recognition of
the wants of morbid nature, and  of a remedy which has re-
ference to them,—a venesection in plethora or excessive
sanguineous  excitement,  wine and  cinchona in deficiency
of power:
  Or in an empirical way, i. e. through the knowledge ac-
quired by  experience, that such or such a remedy has a
particular relation, and curative power, as regards a cer-
tain organ or morbid condition of the system ; such are the
effects of  cantharides on the urinary organs, of mercury
on  syphilis—specifica. — Also  the   principle:  " Similia
similibus curantur," the knowledge of medicines,  which
produce in a healthy state symptoms similar to the disease,
may be very well profited  of, in order to discover such re-
medies.


  The order of a rational mode of healing is therefore as
follows:
  First, to recognise the present morbid state, which re-
quires of us to carefully  ascertain  all phenomena hetero-
geneous to a normal state.   In doing so, we must not con-
sider  any thing as trifling and insignificant; for a symptom
may in the beginning  appear trifling and insignificant, but 
74
therapeutics.
which will become very important and momentous. It will
be best—that we may not forget  any thing—to observe a
certain  order in our  method, and  that according to the
functions. First the vital functions,  pulse and respiration ;
then digestion, secretions,  and  excretions; mental and
nervous condition.
  Then to inquire for the precedent or causal relations.
  It is not proper to commence with this, as some do ; for
the mind gets thereby preoccupied with an idea of the dis-
ease, and then it considers also the phenomena in and by
this view, consequently not in a mere objective manner,
as they  are and ought to be seen by him. Every prejudiced
opinion disturbs the correct and complete  conception of
the actual image of disease.   In the anamnestic investiga-
tion we must go back as far as possible.
  Then  examine the  constitution, the individuality of the
patient as well as the general prevailing epidemic, endemic,
stationary constitution.
  This finished, we must turn our attention to the internal
state, and try to form a correct idea of the internal morbid
condition, the seat and character of the disease, whether  it
be inflammatory, nervous, adynamic, dyscrasic ; and in dif-
ficult cases we  may have recourse to analogy and reagen-
cies.
  By this will appear the object of cure and the indication,
for whose fulfillment  the proper remedies  will be found
either in the rational or in the empiric way. 
practice.                    75
practice.
maxims and general rules for beginning practitioners.


  Art is eternal, system transient.
  Art pertains to the internal sanctuary of man; system to
time, whose product it is.
  We have names, even forms of diseases, remedies, no-
tions and explanations different from those of antiquity ;
but the art of healing is still the same,  nature the same,
and the same capacities are required for becoming an adept
in medicine as at the time of Hippocrates.
  There is only one art of healing ; for it is something in-  *
ternal resting on the eternal laws of nature ; but there are  j
many  systems, and they  are  of  necessity;  for they are
something external, dependent upon the spirit prevailing at
the time,  and on the degree of external knowledge  which
we have attained.
   We  have  had systems enough to know, that medicine
does not lie  in scholastic systems.  This has been incon-
testably demonstrated by history,  especially of the last 30
years.  Every one pretended to be the only true one, the
only beatifying one, until it was destroyed by a new one,
which made the same pretensions as its predecessor. This X
will always continue, to the end of time.
   But there is a consolation and a gratification in  observ-
ing, that amid all the changes of systems, and the greatest
aberrations of schools,  the sense  of true art has been pre-
served in the minds of some single individuals. There has s
ever been an invisible church of genuine physicians, who, j
always faithful to nature, animated by her spirit, acted ac- j
cording to her intimation, and preserved her holy word;
who ever and anon thought  and willed one  and the same
thing,  who understood and ever will understand each other
through all  changes of ages and languages.   There have
always been such  men as Hippocrates,  Aetius, Aretseus,
Baglivi, Sydenham, Huxham, Boerhaave, Werlhof, Brendel,
Zimmermann, Lentin, Frank. 
76                     practice.
  Let us then no longer catch at shadows, but seize the in-
ternal essence of science itself; let us discriminate between
word and spirit, form and  life, or—what is the  same—
system and art, that we may no more lose the spirit by the
letter, the art by the system, as but lately it threatened to
happen.
    Every art has a secrrt of its own. This cannot be learnt
  or acquired from without,  nor can it be conjured by cer-
  tain formulae and ceremonies; every one must have it ge-
  nerated within himself, and only such a one will participate
  in it, as he who imbibes it from the spirit of nature, con-
  ceives it purely in  his inmost mind ;  lives in and becomes
  familiar with it.  Such a one only is initiated and receives
J  revelations ; he alone understands the word.
  Without reflection there is no reasonable action.  Thus
also medical action presupposes something reflected upon
(theory).   But the practitioner's reflection must proceed
from nature and life,—not from a system.
  There is therefore a particular theory  of practice,  as
there is a theory of science.  The  latter always  appears
more consequent  in itself; for it is mind's own primitive
product, and holds good in the school.   The first appears
less agreeing with scholastic rules; for it is the reflection
of nature,  and its principles  are derived  from nature, a
datum, not an excogitatum ;  and it holds good  in the opera-
tion of nature, i. e. by the sick bed.
  As organic life is nothing else, but an exaltation of things
to a higher degree of existence,  thus also  the essence  of
the healing art is nothing else but an exaltation of empirico-
historical  knowledge to a  higher degree of existence  in
mind.   All knowledge must become animated, every phe-
nomenon elevated to a  higher sphere, every  action to an
act  of life ; then art lives in life, then it is true art.  Hence
true medicine has had  a language  of its  own,  since the
days of Hippocrates, to  designate the world of life,  which
is its element, and which is properly inexpressible.   Hence
such words as coction,  crisis,  metastasis, even reproduc-
tion, assimilation, and metamorphosis, etc., are ever like
symbola or mythes, inaccessible to systems, but intelligible
to him who can fathom the  depths of life.
The most accurate systematizers are the worst empirics. 
practice.
77
It  is far worse to urge  a system than a medicament or
nature.
  What  is developed, so to say, in conversation with and
intuition of nature, is of more value than all that which has
been excogitated and learnt.  It alone is possessed of true
life, i. e. the spirit of nature, and is as eternally true as na-
ture is.
  Familiarity  with nature, intuition, and observation are
the only true ways to  obtain it, and the internal require-
ment  for it is a direction and  exertion of an appropriate
mind—a spirit of observation.  It is acquired partly by the
careful study of nature itself, partly by studying the works
of such men, who observed her, who looked at her and de-
scribed her in a pure unadulterated hippocratic light.  What
the study of anticks is  to the artist, the study of Hippo-
crates is to the physician.
  Every sick person is  a temple of nature ;—approach it
with awe and devotion,  devoid  of  frivolity,  egotism and
want of principles ; then nature will look at you with grace
and disclose  you her secret.
  Bear always in mind, who you are and what your office
is. You are employed by God as a priest of the holy flame
of life,  and  as  administrator and distributor  of the high-
est gifts, health and life, and of the secret powers, which
he has bestowed throughout nature for the benefit of man-
kind.   A sublime, a sacred task ! Perform it purely, not to
your advantage, nor to your fame, but to the glory of the
Lord, and to the salvation of your  fellow man.  You shall
have once to give an account for it.
  Maintain always  the dignity  of  the profession in your-
self and in others; and never degrade it so as to make it a
trade, and the means of bad purposes.
  Discriminate well the malady and the patient, and always
regard both in the act of curing.   The same disease  in
one individual requires often a method of cure quite differ-
ent from what is proper in another.
  The principle of the art consists in  generalizing diseases,
and individualizing the patient as much as is possible.
It is better that the patient die than be killed by you. 
78
practice.
    If you cannot help, at least do no harm.
    The cure must not be more pernicious than the disease.
    Dubious remedies are better than none.
    In imminent danger to the sick you must risk all, even
  reputation.
    In general, never think of yourself, but of the patient.
    Be not tardy to  do what is necessary.  The favorable
  moment does never return.
    Do nothing without sufficient reason.  It is better to let
  nature operate  alone, than to do something wrong or un-
  seasonable.
   Especially in chronic diseases,  get  accustomed  to pa-
  tience, and know how to wait for the time.  For  they are
  curable at one time, and incurable at another.  You  will
  not succeed by impetuosity, but more frequently do injury.
  Nature undisturbed often continues her work  secretly, and
  effects improvement, even  cure ;  or  changes the form of
  the disease  into another which  is curable ;  or creates a
  crisis, a metastasis, of which the  physician can profit to
  perform a cure.
   Never  forget, that it is not you who heals diseases; but
I  that it is nature which  accomplishes the cure ; and that
  you have to consider yourselves only as assistants, who
;  can promote, support, aid her work, even make it possible
  and introduce it, but also, alas !  hinder and render it im-
  possible.
  Never forget to regulate the diet of the patient.   Many
a cure has been effected by a strict regimen, excluding all
injurious matters, which nourish the disease ;  and on the
other hand, the best medicinal treatment can be frustrated
by excess or faults in diet.   We  have in this to regard not
only the quantity, but also the quality of the aliments ; a
department which requires a competent, acquaintance with
the qualitative differences of food, etc.
  The most sublime vocation of man, after worship of the
Deity, is that of being priest of the holy vital flame, and
an administrator of the highest divine goods, and the most
secret powers of nature—physician.
  Do you think,  when you  appear  before the  throne of
eternal truth, you will be asked, According to what system
did you  actl  Did you comply with  it,  and  have you
brought it to perfection 1   The question  will be this :  I 
acute fevers.
79
made you steward of the wonderful  powers which I have ]
placed in  nature, and of her products to benefit  man- I
kind ; how did you  distribute  those  treasures 1  To the
benefit of mankind, with gratitude and veneration 1 or to
honor your name,—with selfishness and egotism ? Did you,
in your researches and actions, strive merely for  truth, to
save your brethren, or was it all for self-interest 1
   To him, to whom medicine becomes not a religion, it is
the most disconsolate, troublesome and ungrateful art  on
earth ; yea, it must become with him the greatest frivolity
and  sin,  for only that which is done in God, is holy and
beatifying.  How is it now-a-days with many 1  Nothing
but mere speculation, a means to make a fortune, to win
mdney ;  notoriety; even  with the better  sort of practi-
tioners, the pursuit of the healing  art reaches no higher
than an investigation  of Nature.
                 FIRST CLASS.

                  ACUTE FEVERS.

            febres acut.se, febres continue

                      Generalities.

  There  is only  one acute  disease,—it  is fever.,   The
fundamental character of  it is :  increased activity of the
vascular system, and accelerated vital action, indispensably
accompanied with increased generation of warmth.  Every  v
fever, consequently, has for its essential  character a phlo-
gistic (i. e. inflammatory) state, from which a real inflam-
mation  may easily be developed merely  by graduation.
Therefore, it is confined within certain limits of duration.
Life cannot long continue in such an exalted, accelerated
state, without either destroying itself, or retrograding, or
assuming another form of malady. Every fever, in the very \
same individual, can be transformed into all the different !
species  of fever, and  exhibit them successively.   It may •
be first a simple irritative fever, which, by  hot drinks may
be changed into an inflammatory one, and again altered
into a nervous one by too  much bloodletting or an  omis-
sion of it and  over-action ;  finally, it can pass into an in-
termittent. 
80                   acute fevers.
   Diagnosis.   Cold, heat, accelerated pulse, lassitude, al-
 tered urine.   The fever never entirely leaves the patient j
 sometimes it  persists in an unvarying  degree (feb. conti-
 nens) ;  more  frequently in a degree  varying in virulence
 (feb. remittens, excerbatio, remissio).
   Course, duration and crisis.  The duration is from 7 to 14,
 21, 28 days, which are called critical days, since the deci-
 sion of the  morbid state happens  on them.   The  course
 comprises five stages;  the  onset, the  increase, the acme,
 decrease, convalescency.
   The acme, the point of culmination, is the period when
 the crisis, the decision, succeeds.  A good and perfect cri-
 sis is always accompanied with critical evacuations ; espe-
 cially by the skin, and sediment in the  urine.   This con-
 tinues through the whole stage of decrease. The imperfect
 crisis creates, either a local change (metastasis), or a change
 of form (metaschematismus) of disease.   It terminates  in
 either health or another malady, or in death.   Death fol-
 lows either by a general exhaustion of the vital power, or
 by the disease  attacking an organ, the disorder of which
 (especially of the lungs)  impedes directly the process of
 life,  or whose affection injures the whole system.
  The only sure  signs of a perfect crisis  and  of real im-
 provement are: a uniformly  open, moist skin, a  critical
 urine, (i. e. a urine, which after it has previously been en-
 tirely clear  or thick  and turbid, clears up and becomes
 straw-colored on the  surface, and has  a uniform, gray,
 white, or reddish sediment on the bottom) ; but before all
 stands the pulse,—a decrease in  its quickness,  and a tran-
 sition into a  calm, soft one.  Without this diminution of
 the pulse, all other signs of improvement, even the feeling
 ease and comfort, are illusory. If the pulse remains quick
 and irritated, even whilst the other symptoms* have ceased,
 a transition into an after-malady is to be  feared.
  Pathogenesis.  The causes may  be manifold ;  all that can
 excite a considerable irritation, or disturb the equilibrium
 of the organism, can excite  fever  ; most frequently change
 of temperature, gastric accumulations, epidemic and con-
tagious influence.  There is also  a  certain disposition not
to be denied.  It rests more  in  the irritable than in the
 sensitive system, for nervous, hypochondriacal, and hyster-
ical  persons  are  much less liable to acute fevers than
 others.
  It  is an error to suppose, that fever always originates in
a local irritation.   This is, of course, true  in the plurality
 of cases;  but  very often  a general  feverish  excitement 
acute fevers.
81
appears first, and the local irritation, inflammation, etc., is
only the effect of the former.
    Variety of the Acute Fevers, Practical Division of them.

    Fever, although essentially one and the same thing, as-
 sumes several modifications  by the variety of the system,
. from which it  proceeds, or which it particularly attacks.
 We determine accordingly the various kinds, or character
 of fever, and base upon them the various methods of cure.
    Either no system is particularly affected, or there exists
 at least, no symptom of the  various species—in this case
 it is simple fever (febris simplex).
    Or the  system most affected is the cordial and vascular
 system, which  always acquires an increased  vital activity
 in the heart and blood—this is inflammatory or vascular fe-
 ver (febris inflammatoria, synocha).
    Or the nervous system  is particularly affected, always
 accompanied with an inclination to diminished vital energy,
 nervous fever  (febris nervosa, typhus).   When the vital
 power of the blood is destroyed by the disease, it is termed
 putrid fever (typhus putridus, febris putrida).
    Or the gastric system is particularly affected by morbid
 substances (febris gastrica).
    Or the  fever proceeds from the cutaneous system, and
 affects chiefly the serous and mucous membranes, and is
 accompanied with a serous morbific  matter  (febris rheu-
 matica,  catarrhalis).
    The causes producing the various febrile characters are:
    1. The character of the  exciting causes which  imparts
 itself immediately to the whole fever  succeeding; e. g.
 violent fright creates  a nervous fever, violent anger a bil-
 ious fever, excess in overheating and wine, an  inflammatory
 fever, communication  of putrid substances or  contagion, a
 putrid fever.
   2. The constitution and disposition of the individual, on
 whom the  exciting cause operates, as the soil in  which the
 seed is developed.  Thus, e. g. the very same exciting cause
produces in a debilitated person a nervous fever, in a ple-
thoric one, an inflammatory fever.
   3. The prevalent epidemic constitution.   Its  power  is
extraordinary, and it can impart to all individuals an iden-
tical febrile character.
   4. The course of the fever itself can alter its character.
Thus e. g.  exhaustion follows immoderate exertion.  Thus, 
82
acute fevers.
an inflammatory fever passes into a nervous one ; thus, by
febrile irritation, corrupt secretions of the intestinal canal,
and gastric impurities, are frequently engendered.
  5. From accidental causes.—Thus, fright operating du-
ring the fever, or  anger,  or faulty diet, even the medical
treatment.   Very often a  simple fever is  transmuted into
an inflammatory ; a simple or inflammatory into a nervous
or putrid fever, by excessive overheating.
  Therapeutics.—Every acute  fever is a phlogistic  state of «
the body, and consequently the remedial means called for
is antiphlogistic.  Therefore, in the commencement, and
as long as the character of the fever is not established, the
antiphlogistic treatment is the best.
  Further, we must never forget, that in every acute  fever
the healing principle and  the vital power are one and the
same thing ;  nay more, fever itself is nothing  else than  a
curative process which brings about  critical  alterations,
termination, and a restoration from disturbance to healthy
equilibrium,—yea, in many cases, nature uses no  other
means than fever to cure  disease.   Therefore the office of
art is by no  means  to  remove fever itself, but solely to
guide its operation in such a manner, that it attains  the end
of effecting a perfect crisis ;  art can do no more  than to
clear away obstacles which oppose it, to moderate the vital
power, when too violently excited, to raise and strengthen
it when too weak ; in short, to confine it within that medi-
um degree of activity, which alone can effectuate a critical
operation.
   The general indications are the following :
   The first is, to remove the exciting cause, e. g. gastric
matter.
   The second is, to ascertain what is  the febrile character,
and to adapt to it a method of cure.
   The following principal methods for curing a fever are
advised : the antiphlogistic ;  the nervine; and the exciting ;
the roborant, antiseptic ; the gastric ;  and the diaphoretic or
 anti-rheumatic.
   The third, to treat the  local affections  according to cir-
 cumstances.
   The fourth, to regard  carefully the crisis and  curative
 operations  of nature,  here so important, and to aid  them,
 the least of all to counteract  them.
   The fifth, to watch  attentively the changes  going  on  in
 the fever, and the transition of its character into  another.
 Here it may be well to remark, that the  species of fever
 are by no means  so clearly  and distinctly separated from 
acute fevers.
83
each other by nature as they appear in a  printed compen-
dium.  Frequently, several become mixed ; and there often
occur complications of several species, e. g. of the inflam-
matory and nervous, of the gastric, with all other kinds of
fever,  etc.; often  the  species shows itself only in a  low
degree, e. g.  the  nervous  fever merely as a nervous
state.
  The practitioner has to look upon the original fever  as a
unity, as a phlogosis ; and  all the  so called species  and
sorts as mere deviations and modifications of this funda-
mental state, which they always  retain as their base, and
to which  they may easily return again.
  Therefore,  in a case of decidedly and clearly marked fe-
brile character, the best mode of  treatment  is to use op-
posite means;  but in  all other  cases,  a more negative
course is  to  be observed—an  antiphlogistic temporizing
one, and a vegetable diet.


                General Diet in  Fevers.

   1.  Every febrile patient must lie down  and rest, corpore-
ally as well as mentally.  This is an essential rule, which
nature herself prescribes through a feeling of fatigue felt
in  every fever.  It is incredible, how much a horizontal
position contributes towards diminishing a fever ; it calms
the pulse, renders the  circulation of the blood uniform,
 permits nature to dispose of  all her vital powers for cura-
 tive operations, and thus promotes and alleviates a crisis.
 In short, it is  an  indispensable condition in the  cure of
 every fever.
   2. Every febrile patient must drink freely of diluents, for
 the thirst which accompanies  every  fever is  the voice of
 nature calling for fluid.   Water is the best  beverage  ; but
 when the stomach is weak, let the water be boiled—as bar-
 ley, toast, or apple water ; in this form it is more readily
 taken into the circulation.
   3. A febrile patient must not be allowed food. This, also,
 is a  commandment of nature, for she refuses appetite in
 fever.  Let no substantial food be taken.  Nature cannot
 bear it;  she wants  the d;gestive powers to  aid in pro-
 curing a crisis.  Should aliment be taken, it would remain
 undigested in the stomach, and form sordes.  It will  nour-
 ish the disease, not the  sick.  Nothing stronger than  gruel
 and the like, and  stewed fruit should be  allowed.  All ani- 
84                   simple fever.
 mal food is generally forbidden, since it  increases  phlo-
 gosis.
   4.  The air of the  apartment must always be cool and
 pure, an essential rule for diminishing febrile actions, and
 preventing them from being changed into inflammatory or
 putrid fevers.  Impure, hot, confined air of the sick  room
 is sufficient to transform a simple fever into  a  putrid ty-
 phus..  The temperature must  range between 14—15° of
 Reaumur (50 to 55° Fahrenheit).
   The best means for purifying the air of a sick room is
 by renovation—admitting fresh air.   All chemical amelio-
 ratives do not accomplish this end, and they are especially
 apt to injure the lungs.   The only chemical means advisa-
 ble is to sprinkle the apartment with vinegar.
   5. The covering of the sick must be sufficient but light.
 Discard  feather beds, and take matresses and  a woollen
 covering (blankets).
   6. The greatest  mental  tranquillity is  indispensable.
 Every emotion, of joy as well-as of grief, is pernicious.
   7. Daily discharge from the bowels is necessary, if  only
to expel flatulencies.  Therefore, if stewed fruits have not
 the effect of moving them, emollient injections must be
administered in the evening.
                      simple fever.

            Febris Simplex, Nullius  Generis.

   Diagnosis.  The general  symptoms of that fever which
has no distinct character.   It  lasts  sometimes  only 24
hours, and performs in this short time  its course and crisis
(ephemera, fever of a day).
   The simple  irritative fever occurs commonly in  healthy
individuals, in the middle and stationary period of life • it
is acted on by slight  causes or  even by contagious influ-
ences, giving rise to what is called mild small-pox, measles
scarlatina, and the like.
   Simple  fever  is very often  the  commencement—the
morbus fiens—of a  case, the  character  of which  is not yet
apparent, but is  about to be developed.  While the  case
retains this undecided character, we  must look upon it
simply as  one  of irritative fever, and be careful not to de-
cide upon  what it may turn out to be, without sufficient rea-
son ; nor to attack the system vigorously, since it is possible 
INFLAMMATORY  FEVER.
85
that the fever, if left  to  itself, might have easily yielded,
but now increased  by our treatment is made a dangerous
malady.   An erroneous anticipation of what the fever is to
be, may lead to the application of irritants in an incipient
inflammation, or to debilitating means in an incipient ner-
vous fever.
   Therapeutics.  The cure is the  general cure of fever and
the general febrile diet, described above.
   The best treatment is a negative, temporizing, indirect
one ; consisting in rest, horizontal position, abstaining from
food, and slight antiphlogistic  remedies, such as the Rive-
rian saturation (s. JNo. 1.) or pulvis  aerophorus (s. No.  2),
cremor tartari, especially in  solution (s. No. 3), frequent
drinking ; and this will often suffice for a cure.
   It will, however, be very useful to give  a ntild, cooling
purgative of sulph. sodae, tamarinds, or manna, because,
very frequently impurities in the primse vise do exist, and
are retained there by the fever.   Besides, it is of great ad-
vantage in cases of incipient  violent fever to clear the pri-
ma? viae early.
                  INFLAMMATORY FEVER.

              Febris Inflammatoria, Synocha.

   Diagnosis.  Great chill in  the  onset; hard,  strong  and
 frequent  pulse.;  great but lively heat; thirst; red  urine;
 dryness of the skin and tongue ; continuance  of the same
 state of  the  pulse and all  the other symptoms; pulse
 harmonizing with the respiration ; increase and decrease
 of all the  symptoms in accordance with the pulse.  Rapid-
 ity and regularity of the course; strict observance of the
 stages  and  critical days;  perfect crises by sweat, urine,
 or hemorrhages.
  Duration. It does not exceed 14 days.  Sometimes  it
 mutates into nervous and putrid fever.
  The character  is not malignant.  It is ardent, but easily
 soothed by an appropriate antiphlogistic treatment in the
 beginning.  Apt to local inflammations.
  Pathogenesis. The proximate cause is excessively increas-
 ed sanguine life; therefore increased energy and irritability
 of the  arterial system, and  augmented coagulability and
plasticity  of the blood.   It coincides with what  the mod-
erns term  phlebitis universalis ; for in so general an inflam-
                          8 
86
INFLAMMATORY  FEVER.
 matory diathesis of the blood, the internal surfaces of the
 vessels cannot fail to become inflamed.
   The remote causes are: epidemical, endemical, an  in-
 dividually inflammatory constitution, dry severe cold, high
 Btand of the barometer, north and northeast winds, age of
 15 to 30 years, sanguineous plenitude, motory life in free
 air, living on meat and wine.
   Exciting causes : violent  overheating, taking cold, vio-
 lent emotions, wounds, local inflammations; and in general
 every febrile  irritation, which affects  internally or exter-
 nally, an individual  disposed  to  synoeha;  every  pyrexia
 enhanced by mismanagement.
   Therapeutics.  The indications are :  to reduce  the vital
 power, and that of the cardial and sanguineous systems ;
 to relax the fibre ; to fluidify the coagulable blood, to  ab-
 stract warmth.  The remedies  are very  simple : in the
 first  place  bleeding, nitre  and  all antiphlogistic  salts,
cooling purgatives; secondly : water, drinking largely;  in
the third place: calomel and nitre, potassa, soda ; fourthly :
cool air and cool water.
  The chief remedy for this fever is venesection ; it com-
bines the attainment  of all the indications.  But we must
never forget that it is the most potent  remedy within our
reach, since it takes away from  the patient a part of life
itself, a bold liberty which our art must not abuse.  As cer-
tain as it is that bleeding is the  only remedy  in  high  in-
flammations, and one that cannot be replaced by any other,
and that life exalted by inflammation often requires and bears
large abstractions of blood, we must nevertheless be cau-
tious not to lavish it  to too  great an extent, or to no pur-
pose, since  grave and irreparable consequences may follow
such prodigality.   For, in the  first place, a  merely  inflam-
 matory state  may  suddenly change into a nervous one,
 yea, into an adynamic or putrid state ; in the second place,
 it may deprive nature of the  power requisite for effect-
 ing what is indispensable—a crisis;  in local affections,
 resolution,  without which no  perfect restoration and re-
 turn to  the normal state  is possible ;  and  finally,  in the
 third place, it  may bring on  a  chronic  weakness and slow
 recovery, and  even important subsequent maladies.
   It is therefore necessary to make a distinction  between
 the two degrees, in which this fever occurs.
   1.  The  mild degree.   Here  the indirect  method  of
 cure is  needed.  It consists in withholding aliments from
 the patient; in a strictly antiphlogistic diet, rest, drinking
 water, in short, has reference to  the general cure of fever j 
INFLAMMATORY  FEVER.                87
and the use of cooling purgatives and of nitre.  Should
the digestive  powers be  impaired,  and nitre  purge too
much, sal ammoniacum, with a little addition of emetic tar-
tar will be proper (vide No. 4).  Should it be necessary to
continue the use of nitre, while there is some fear of debi-
lity, nitrate of soda in the same dose and form  will prove
serviceable (vide No. 5).  Here, also a cooling purgative is
very recommendable (No. 6).
  2.  The higher degree is indicated by great violence in
all symptoms,  but  especially by a strong, full, hard  pulse.
Here venesection  is the principal agent, and it  often hap-
pens that nothing else is required, besides a proper regimen,
to perforin the cure.  But in  this case, as in many others,
all depends upon the right form and the quantity of  bleed-
ing, to attain fully the desired result.   When too  small, it
will  be unavailing; when too large, it will prove  perni-
cious.  By a  judicious, a  right administration of  it, we
may  even save much blood ; for a single venesection done
in the right manner, operates more decisively towards the
removal of inflammation, than several repeated abstractions
of blood inappropriately performed.
  The following are the rules to be complied with, which
I cannot recommend too urgently :
  Venesection must be performed at an early time. The ear-
lier it is resorted to in the incipient inflammatory state, with
the more certainty, and with less loss of blood shall we sub-
due the inflammation in its rise; but at a later period, when
the  inflammation  is  fully formed,  the same  effect can
scarcely be accomplished by three  or  four times as  many
repeated venesections, and the loss of  much blood.
   A quantity of  blood requisite  to annihilate inflamma-
tion, and no more, must be abstracted.  This quantity is not
to be determined  by measure and weight, but by the state
of the pulse ; for a pound in  one  constitution will equal
one and a half or  even two pounds in another.   We must
therefore feel  the  pulse during the venesection, and allow
the blood to flow until the hard, strong, full, frequent pulse
becomes soft, less agitated, and calm.   But we must, how-
ever, not continue bleeding unto fainting;  for when there
is a  great disposition to coagulability, a coagulation of
blood in  the heart or the  great vessels, and thereby poly-
pous formations, even pneumony mightarise duringthe stop-
page of the circulation.  This danger will be prevented by
a horizontal position, and  by closing the  vein  as soon as
the pulse becomes unequal.
   We must effect a quick evacuation, which is best done 
88
INFLAMMATORY  FEVER.
 by a sufficiently large opening of the vein. It is only when
 the blqod spouts out arch-like, that it produces the salutary
 collapsus vasorum, which is indispensable for subduing  in-
 flammation.  When the blood trickles down  the arm, or is
 forced out by  pressing,  no benefit  will  result.   The
 velocity of discharge will supply the quantity, and  one
 pound evacuated in this manner, is of more use than three
 or four pounds abstracted slowly.
   The best place for venesection in inflammatory diseases,
 is the  arm, and as near  to the heart as possible.
   The indication for venesection is urgent in the following
 cases : when the constitution of the patient is plethoric, ro-
 bust, youthful—between 18 and 30 years ; when he is accus-
 tomed to bloodletting, or the usual time for habitual venesec-
 tion isarrived,at which natural hemorrhages, such ashemor-
 rhoidal flux, bleeding at the nose, would relieve him ; when
 the prevalent (morbid)  constitution or epidemy is of an in-
 flammatory character, in the months of January, February,
 March, especially when severe dry cold, with a  high stand
 of the barometer, shows  the period at which the human
 system bears venesection best, and in large quantity; final-
 ly,  when there are indications of an incipient local inflam-
 mation, as  a short cough, a little  pain in breathing.
   These considerations can serve as auxiliary indications,
 and confirmatory in  those cases  where we  are  in doubt,
 whether we are to let blood or not; and where the physi-
 cian finds himself in the dilemma,  that if he does not bleed,
 the patient must die under an inflammatory fever, if  he
 does,  under a  nervous one.  Here one expedient is  yet
 left:  a  testing venesection  cautiously performed.  We
 open the vein, and observe accurately  the pulse whilst the
 blood  flows.  If, after a few ounces are drawn,  the  pulse
 becomes smaller and quicker, the  vein  must  immediately
 be closed.   So small  a loss of blood can do no injury  to
 the patient,  and  by its effect we discover what is the  real
 condition of the system—a local inflammation.
   It is an error  of judgment to believe that leeching  or
 cupping  can replace  venesection; for, the inflammatory
 germ in the  blood  can only be annihilated by a quick and
 large evacuation of blood so as to produce collapsus cordis
 et vasorum.  It is a great mistake to  believe that  a gradual
 evacuation of the cuticular vessels, even if 40 or 60 leeches
 are applied, and they draw  several  pounds of blood, would
answer the same end.  It is only in infants, or in very feeble
persons, laboring under  local inflammations, that we may
substitute leeches  for venesection.  One venesection  is 
INFLAMMATORY  FEVER.                89
not always sufficient.  Inflammation is not always entirely
subdued by the first evacuation. It may attain, after the lapse
of 8, 12, or 24 hours, new vigor and ascendency ; the fever
reaching again  to its former height.  Here  a repetition of
phlebotomy is necessary.  The rule is to repeat venesec-
tion as often as the pulse reacquires its former hardness
and strength ; the more will  this practice  be useful, the
quicker  it  is  done, and  the less blood  has been  ab-
stracted  formerly and the firmer and stronger the inflam-
matory crust on the blood.  Thus  we are  sometimes
obliged to repeat venesection  three or four times.   As for
the quantity, we must always be guided by the state of the
pulse, since the inflammatory  crust does not always give a
decisive sign ;  for we  might take away all  the blood the
patient has, and the crust still continue.
   Conjoined with, or  after venesection, an antiphlogistic
purgative must be given  in divided doses, so as to produce
three or four stools.  Here also it is to be borne in mind,
that an  excess  of purging  is  noxious, and can operate as
an irritation to  increase the fever. After this, two to three
drachms of nitre may be given within 24 hours, along with
small doses of emetic tartar; also sal ammoniac, according
to the prescription already given.
   By such treatment a favorable case of fever will entirely
cease, and we shall have nothing else to do from the begin-
ning to the end, but to continue the antiphlogistic diet and
to attend to the crisis, and keep the patient  in bed.
   Metastasis is not uncommon  in  this fever, especially
when the general crises have been disturbed by colds or
other accidents ; but this happens more frequently in ner-
vous and putrid fevers.  Such metastases are either dyna-
mic, as  when the morbific principle acts  on the nerves,
producing paralysis, deafness, loss of memory ; or material,
as  when  abscesses,  or exanthemata appear.  In the first
case, vesicatories, kept up for a long time, will be proper;
and in the second, to acc?lerate suppuration and breaking
we must apply emollient, or even stimulating cataplasms.
   Sometimes, however, the fever continues, or even it in-
creases, without showing signs of an'inflammatory state ;
or the crises do not  duly succeed on the sixth or seventh
day.  Here spiritus Mindereri, 30 to 60 drops every two
hours is the best remedy to bring about the crisis, and to
pass from a debilitating  to a  mild stimulating method of
cure.  In these cases we must carefully avoid the  use of
such stimulants as would tend to  reproduce  the phlogistic
state.  If this be unavailing, the case must be of a double
                           8* 
90
NERVOUS FEVER.
 nature: Either that which is the most frequent, the  phlo-
 gistic state is removed, but an erethic (nervous) irritability
 of the vascular system has remained.  Here we must com-
 bine with spirit. Mindereri aqua laurocerasi  one drachm
 within 24 hours.  Or, as it commonly happens after too
 copious bleeding, there has  been a  transition  into an ady-
 namic state ; nervous, putrid,  or hectic fever,  are the con-
 sequences.  Now  the  treatment must  accord  with the
 respective species of fevers.
  After simple  fever, strengthening remedies are seldom
 needed ; on  the contrary, we must avoid cinchona and
 similar medicines, which might easily again create sangui-
 neous agitation.  The  most serviceable remedy is elixir
 visceraleHofmanni, 60 drops to be  taken twice a day.


                    NERVOUS  FEVER.

           Febris Nervosa, Typhus Nervosus.

  Diagnosis.  The beginning is not  announced by a severe
 chill as in inflammatory fevers, but imperceptibly sets in with
 slight chills, alternating with heat.  The head  and nervous
 system are particularly affected, as is made manifest in the
 commencement  by  headache,  giddiness,  and  vertigo ;
 sometimes there is also fainting and trembling ; and  later
 in the disease, we meet with delirium, stupor, spasms of
 all kinds, external  as  well as internal, convulsions ;  great
 debility  and lassitude  ; the pulse is small, weak, soft, easily
 compressible, moderately frequent,  sometimes even  slow,
and very  changeable, not harmonizing  with  respiration,
being quick, while the latter is moderate.  In general there
is great changeability in all the  symptoms, especially of
 the urine, which is sometimes red, sometimes pale, most
 frequently jumentous ; discordance  between the symptoms
 themselves and  the condition of the disease : dryness in
 the mouth, and  no thirst; cause for  pain, as from sina-
 pisms, yet no pain felt; violent sickness, and no perception
 of it, yea, assurance  of feeling well; hence the name  ma-
 ligna, malicious  (specie  levis,  revera gravis),  absence  of
 the signs  of  other species  of fever,  particularly of the
 purely inflammatory, which is characterized by  the strength
 and hardness of the  pulse, constancy of symptoms, espe-
 cially of the pulse and urine, the  regularity of the course
 of the malady, and the harmony of  the phenomena among
 each other, especially  the  correspondence of the pulse
 with respiration. 
NERVOUS FEVER.                  91
  Sometimes, however, all signs are so  uncertain that it
becomes very difficult, especially in severe local affeciions
of noble viscera, to decide whether the fever is purely ner-
vous or inflammatory.  Here  it may be  permitted to use
with cautiousness reagencies, in order to discover the true
character of the malady. Of this number is a testing  vene-
section,- performed with great  care.  We let a few ounces
of blood run, and attentively observe the effect.   If the
pulse is raised and becomes slow, it indicates an inflamma-
tory character,  and  you may let more  blood  flow ; if it
sinks, becomes smaller and quicker, the disease is evidently
of a nervous character.  In this case, the vein must imme-
diately be closed and an anti-nervous treatment is to be pur-
sued.
  The difficulty of diagnosis produced by the deceitfulness,
contradiction and inequality of  the phenomena, has often
been the cause of mistaking and confounding these fevers..
They have been  called nervous fevers, when they were not
such, and the reverse.—We must also distinguish a ner-
vous state  from an actual  nervous fever.  The first asso-
ciates itself easily with all other kinds of fevers in nervous
and  sensitive persons, without being therefore a real ner-
vous fever.
  The course is likewise  very irregular and uncertain.
The forerunners (cloudiness, dizziness of the head, vertigo,
somewhat trembling in the limbs, headache, sleeplessness,
dreams and visions)  generally last for several days or even
weeks.   Duration, 21 to 28 days, or even longer.  Conva-
lescency is slow and troublesome, and apt to relapses ;
after violent nervous fever, a perfect restoration does  not
happen before two or three months.
  The issue seldom occurs  by  a  perfect crisis (whence
these fevers have been  termed acritica, and  on account of
their irregularity atactai), but these fevers are characterized
by imperfect crises,  metastases, or  metaschematisms, pur-
ples (which are commonly symptomatic, but, if they appear
later on the critical days, can  be critical), boils, abscesses,
even gangrenous (gangrena critica), or metastases to  the
nerves,  deafness,  blindness,  loss of memory  and  other
mental  faculties, chronic nervous complaints,  pulmonary
and abdominal maladies.
  Death succeeds either through extreme  exhaustion of
the vital power, nervous paralysis, nervous apoplexy, or
through local affections and inflammations of noble viscera,
or by colliquation, putrid dissolution.
  The danger in nervous fevers depends on exhaustion of 
92
NERVOUS FEVER.
the vital power, on colliquation or a local affection of some
noble viscus, most  frequently of the head ; and it is very
apt to pass into paralysis, or inflammation, or gangrene.
  The discrimination of danger is difficult  on account of
the deceitfulness of the patient's feelings, on  account of
the uncertainly and fluctuation of the symptoms, nnd their
discordance with the internal parts.   The  principal'rule is:
spera infestis,  metue secundis.   With the  most favorable
signs, a patient may suddenly die by the supervening of a
nervous paralysis, and may recover, though the most des-
perate appearance exists with all the general lethal signs.
  The chief sources for forming a judgment are :
  a. The pulse.   It is here the  main sign for  determining
the danger of  life, chiefly its quickness.   The more accel-
erated the  pulse, the more the danger increases; the more
quiet and equal, the more hope.
.  b. The  urine.  When it is perfectly clear, very thick,
brown, bloody, or with a cloud floating in, or rising towards
the surface, or with a very copious sediment, and  which
does not clear the urine above, great danger is indicated ;
on  the contrary, gradual clearing up of a previously thick
or moderate turbidness of the previously clear urine, is in-
dicative of improvement; finally, moderate sediment suc-
ceeding, and the urine above it being entirely  Clear, citron
or straw-yellow, points to recovery.
  c. The  head  and nervous  system.  The  more  dizzy,
soporous and insensible the head is, when the  patient feels
well in a  severe malady, the more local paralysis  shows
itself, as of the  tongue in speaking, in protruding it, diffi-
cult swallowing, incontinence of urine and stool, or violent
convulsions, tetanus opisthotonus:  the greater is the dan-
ger.
   d. The skin.  The more it  is unequally  warm or dry and
languid, or covered with immoderate local viscous sweat
or premature symptomatic purples and petechia?, the worse.
   e. Finally, The signs of colliquation, of putrid  dissolu-
tion ; hemorrhages, especially by urine and stool, colliqua-
tive diarrhoea, petechiae, putrid, fetid smell, local gangrene,
decubitus.
   The  signs of the approaching death  are :  stupor with
silent delirium, coma vigil, crocidismus, carpologia, meteo-
rismus, with colliquative diarrhoea, deglutitio difficilis ; but
also these  are sometimes illusory. I have seen patients who
labored under all these symptoms, recover.
   It is remarkable that deafness is generally a good sign.
   Varitty and division.—The difference is in the first place 
NERVOUS FEVER.
93
 determined by the degree of virulence '.febris nervosa mitis
 and gravis ;  then by the type : febris nervosa continua and
 intermittens ; then by  the duration : febr. nerv. acuta and
 chronica,  finally by complication, which  constitutes the
 most  important difference for practice.   We have here to
 regard chiefly whether the nervous fever attacks more or
 less the vascular system and the sanguineous mass.  Is tho
 affection  inconsiderable, it is termed febr.  nerv. simplex.
 Is the sanguineous system more violently seized, and aug-
 mented in its energy (which is likely to happen in  young,
 robust persons, in rapidly attacking contagious nervous fe-
 vers), it becomes/eAr. nerv. inflammatoria.   On the other
 hand, when the sanguineous system  is much  debilitated,
 and even the vitality and plasticity of the blood diminished,
 so that a disposition to dissolution exists, it is called febris
 nervosa putrida.  Is the gastric system at the  same time af-
 fected,—febris nervosa gastrica ;  and does  rheumatic or
 catarrhal  complication exist, febris nervosa  rheumatica et
 catarrhalis (catarrhus malignus).
  Pathogenesis.  Proximate cause. The power of the fever
 concentrates in  an  affection of the brain and nervous sys-
 tem,  with more or  less sympathy of the  vascular  system
 and inclination to debility.  Therefore the principal, often
 the only  signs of its existence, are cerebral and nervous
 symptoms.  Hence the varieties  of vascular fever, which
 occur in  it.   Sometimes the vascular system, the pulse,
 and warmth, are not in the least altered.  Sometimes in
 an inflammatory disposition there is an inflammatory state,
 with  an asthenic disposition, an anasthenic state, which is
 apt to pass into  a putrid one, by reason of the great disturb-
 ance  in the nervous systems which preside over nutrition
 and reproduction.
  Remote causes. All that has a tendency to lower and impair
 the vital power,  and especially the nervous power, such as :
 deprivation of the necessaries of life, starvation, scarcity,
 corrupt food, deficient vitality of  the air (animalized air),
 crowding many men  into small rooms, uncleanliness, de-
 bilitating epidemic constitution, great loss of blood or other
 humors ;  thus excessive venesections can change every
 fever  into a nervous one.   Or exhaustion, consumption of
 the vital, especially nervous power.  Overaction, immod-
 erate  exertion, corporeal or mental, excesses in venery,
 excessive heat, loaded beds, confined sick rooms, over-irri-
 tation from ardent  medicaments, or omission of a neces-
 sary abstraction of blood, previous disease, the fever itself;
every acute fever can in this manner,  by the  exhaustion of 
94                  NERVOUS FEVER.
power connected with it, pass  into a nervous  fever.  Or
finally, the influence of  potences  directly depressing the
vital or nervous power : grief, sorrow, contagia of nervous
or putrid character, dampness, cold, atmospherical consti-
tution, deficient in vital power, the epidemic nervous con-
stitution, which is observed especially in continued damps,
(west) wind, and low stand of the barometer.
  Therapeutics.  The fundamental indication is to restore
the normal action of the  nervous system, and the balance
between the vascular and  nervous systems ; with continued
attention to the existing weakness.  Therefore,  when there
is inflammability, depression of the vascular system by an-
tiphlogistics, but never so  free and large as in  pure  syno-
chus, since the inflammation is nervous; in great debility of
the vital  power, and a disposition to putrescency,  vigorous
elevation and invigoration of the vitat power ; in  predomi-
nant  and threatening spasms, and nervous attacks,  the
soothing antispasmodic method ; especially a careful indi-
vidualization of both the  subject and the epidemic, and re-
gard to the exciting cause, whether the  disease has been
engendered by an external contagion or  internal  develop-
ment.  This latter  circumstance  is  momentous in  the
treatment.   For, when the fever is  due to the  contagium
typhosum,  i. e. to an external  cause (which can  even
happen in a perfectly healthy and strong person),  there ex-
ists always a state of excitement and inclination to inflam-
mability ; on the contrary, in internal development, it  has
more the character of weakness.  We must  ever bear in
mind, that  in this fever the vital power of nature, and the
crisis, are less to be depended upon ; that it does not ter-
minate within a less period than three weeks; and that the
assistance of art  consists in keeping the  patient alive  du-
ring this space of time, dangerous to life, and which com-
monly lasts to the 18th day.
  The special treatment  is very various, according  to the
numerous modifications in which nervous fever manifests
itself.  They  are:  the  simple,  mild  nervous  fever;  the
violent nervous fever (brain fever) ;  the inflammatory ner-
vous fever, and the putrid ; which sometimes succeed each
other in the same malady,  as so many stages,  sometimes
remain in one and the same form from the beo-innino- to
the end of the disease.
  1. The simple nervous fever of a mild degree, often  the
first stage of the violent.
  Diagnosis.   The general symptoms of  nervous fever in
a mild degree,  with moderate frequency of the pulse, and 
NERVOUS FEVER.
95
only transitory, or no delirium.   Here the main rule  is
more a negative treatment than a positive one, to do rather
too little than too much.
  The best  remedy, and often alone sufficient, is chlorid
water, acldum  muriat. oxygenatuin (vide No.  7),  -£- to 1
ounce daily, rest, horizontal position, uniform temperature,
sinapisms on the lower extremities.  I  can assure, that I
have seen a great  many cases of nervous fever perfectly
cured by this simple treatment.  Is this not sufficient, then
a weak infusion of valerian (vide  No. 8), spiritus Minde-
reri, liquor  anodyn. Hofmanni ; acet. vin. mixed  with the
beverage ; sinapisms, particularly lukewarm baths, to invite
perspiration.  The cutaneous crisis is the most important.
But we must never neglect to pay  attention to the compli-
cations, and to act accordingly.  In gastric accumulations,
an emetic and laxatives, in a rheumatic admixture, mild, not
heating diaphoretica, spiritus Mindereri.
  2.  Violent nervous fever,  typhus.   Great affections  of
the head, increasing delirium, or a soporous state, incipient
convulsive movements of the tendons, are significative of
this degree of typhus.
   The first question must here be: whether these accidents
arise from an inflammatory state  of the brain, or  from a
nervous irritation  of this part.
   The first—inflammatory state—will be recognized by the
eyes of the patient being  reddened and  glittering ;  the
whole face more red and bloated, the vessels of the head
and neck swollen and pulsating, the head hot, the urine red,
the pulse more frequent and filled ; it may, however, be
 more slow, occasioned by the pressure on the brain.
   Auxiliary signs  are: the inflammatory character of the
 epidemy, the  youthful and  strong constitution of  the pa-
tient, and in dubious cases even by the use of reagencies,
as some  spoonfuls of wine, whereby delirium and pulse
will increase in an inflammatory, but decrease in a nervous
state.  Even a small testing venesection is permitted, with
 the indispensable  condition, that the physician be present,
 and ready to close the vein as soon as the pulse sinks and
becomes smaller and more rapid.
   Here antiphlogistics are to be resorted to, always bear-
 ing in mind the fundamental character of the fever—which
 is  a  debility  of the nervous system ; therefore local ab-
 stractions of blood (by  leeches,  on the temples, by the
 ears, or the neck, or cupping the neck) are preferable to a
general venesection, which  is allowed  only in youthful ple-
thoric individuals, and subjects accustomed to venesection, 
96
NERVOUS FEVER.
 the pulse being strong and full, and in the first stage, espe-
 cially in the typhus  contagiosus, and  must  be  made with
 precaution,  not  too  great a loss of blood at  once,  but
 rather to be  repeated.   Hence  no  nitre, which would
 weaken too  much the whole tone of  the system, but sal.
 ammoniacum, tartaruspotassae, with small doses of  tartar
 emetic ;  but especially cold  fomentations on the  head and
 ice cataplasms ; finally,  every  two hours cold affusions,
 and injections with three or four  ounces of vinegar,  and
 daily repeated sinapisms on  the calves of the legs.  If this
 be  not soon followed by an alleviation  of the cephalic
 symptoms, then one to two grains of calomel every two or
 three hours.  Generally in every  phlogistic  nervous  fever,
 cold lotions of the body cannot  be too  strongly recom-
 mended.   They ought to be  repeated several times a day,
 as often as a great dry heat sets in ; but not during perspi-
 ration.  Should the pertinent application of these remedies
 fail to produce within a few days an amelioration of the
 cephalic symptoms, though the redness and heat may have
 decreased ; should the pulse become  small  and  soft, then
the inflammatory irritation has changed  into a nervous  one
of the brain, and the principal, indeed  only salvative reme-
 dy is  opium combined with calomel  (every two  hours -J-
grain of opium with  1 grain  of  calomel), and a vesicatory
on the neck.
  Does no  inflammability exist, or  is  it removed and  the
fever continues violent notwithstanding ; or the symptoms
even increase—there is  always debility of the whole ner-
vous system, yes, of the whole organism, and now the fun-
damental indication becomes striking : Invigorate, animate
and soothe the nervous  disorder !  Excitantia, analeptica,
 antispasmodica, acida and fixed roborantia  are the reme-
 dies.  Here  the case  is the reverse of inflammatory fever.
 All symptoms, most  violent  deliria, pain, acceleration of
 the pulse, indicate weakness, and excitantia are here of the
 same effects as venesection there.  Vinum refrigerat,  sopit.
pulsum retardat.   As in the former case, a decrease in  the
 celerity and vigor of the pulse is  a sign of  amelioration ;
 here an increase and  a rising of the pulse is desirable.
  But we must here discriminate three states, which  mod-
 ify the cure : the  spasmodic,  irritable, erethic, the paralytic,
 and the putrid.
   The first and most  common is the spasmodic,  irritable,
 merely nervous state  (typhus irritativus,  erethicus, versa-
 tilis).
   All the symptoms betray spasm and increased irritability 
NERVOUS FEVER.
97
and sensibility, photophobia, violent phrenetic deliria, con-
vulsions, spasms,  even tetanus.—The pulse is small but
somewhat hard.
  Here, caution is to be observed from the commencement,
not to over-excite a system already suffering under exalted
irritability, lest by so  doing  we create  an inflammatory-
state.  In this respect we must be guided by the pulse and
the symptoms.   We may use nervina, antispasmodica, and
excitantia both externally and internally, beginning with
small'doses,  and gradually increasing them, if the  symp-
toms do  not yield. This increase consists in the augmen-
tation of the  doses, in the  frequency of repeating them, in
varying  their quality,  and in  their  mode of application.
The remedies  are acida rnineralia  and sulphuricum, the
first to acidulate the beverage, the latter when there is too
great a disposition to  diarrhoea ; Rhenish  wine, (better, if
twenty years old,) should be given from  the  commence-
ment until the end of the disease.  It alone is often capable
to cure, administered in small or large doses, according to
the degree of debility ; strong  infusion of valerian with
angelica, arnica (vide No. 9 and 10) ; olea setheriea (Vale-
riana, cajeputi, cinnamomi) diluted in liquor anod. Hofman-
ni,  as debility  increases ;  also aqua ammonia? succinata.
Should these not suffice, give aromatica balsamica (balsam.
Peruvian. Balsam  vita? Hofmanni), naphtha, sulphuric, mu-
riatic, and acetic  acids.  Finally,  in great debility  and
affections of  the head, and small, soft,  empty  pulse, cam-
phor ; in violent spasms, with a small and  somewhat hard
pulse, musk ;  castoreum, and especially opium in violent
delirium, spasms,  pains, vomiting, diarrhoea, very small and
rapid  pulse; opium in large doses,  however,  it must be
remembered, operates more as a narcotic, in  small doses
as a stimulant; hence  large doses are proper in violent
nervous attacks, and small  doses in  great debility.  At the
same time lotions, aromatic fomentations to the pit  of the
stomach, sinapisms every  twenty-four hours, in imminent
danger to be repeated  every twelve  hours ; strengthening
injections, particularly the lukewarm (28°) aromatic bath
of ten minutes duration repeated daily.  Also lightly nour-
ishing, animating  substances, water with eggs and  wine,
hartshorn-jelly with wine and broth.
  When  the state changes into paralysis, or when paralysis
exists from the beginning (a state recognisable by insensi-
bility,  stupor, sopor, bland delirium, coma, and finally pa-
ralysis of the sphincters),  the united and most vigorous
                           9 
98
NERVOUS FEVER.
application of the above  named irritative remedies is re-
quired, to which must be added ammonium, old wine, alco-
hol,  phosphorus,  and the application  of cold,  cold fresh
air, current of air. Life  in these cases is often nothing but
an artificial state  of existence, a true product of art, where
the spark of life always  near extinction  is maintained,  and
ever rekindled by the renewal of strong irritants.
  Even in the highest degree of this state, the  approach-
ing weakness of  death, when the patient lies debilitated,
stupid,  unconscious,  senseless and motionless ; meteoris-
mus,  even involuntary  discharge of stool and  urine have
set in, sometimes the following remedies have proved  ser-
viceable : very old Rhenish  wine, poured in  by  spoonfuls,
four vesicatories  simultaneously applied,  one  on the pit of
the stomach, the  others on the extremities, a vigorous  ro-
borative bath at 28° along with aromatic herbs, mixed with
wine or brandy ; ice-cold fomentations on the abdomen  and
head, injections  of a few ounces of wine, the analeptic
drops (vid. No. 11), even the application of  a  cautery to
the head.
  Lastly, the putrid state, which  may likewise grow out of
the foregoing,  or, in very malignant fever, can set in im-
mediately from the beginning (vide putrid fever).
  Especial consideration is due to

                  Typhus abdominalis.

  What is meant bythis, is
   1. Typhus  gastricus,  the combination of a gastric,  or,
what occurs frequently, of a verminous state with  nervous
fever.   It has for signs those of the gastric  state and of
the nervous fever united.  Commonly the first cause of this
fever is a gastric putrescency, an accumulation of gastric
putrid substances in  the intestinal canal, from  which the
most malignant putrid fevers may arise.  The  treatment is
that which is proper for  the cure of nervous and gastric
fevers combined, the nervines and gastric purgatives, where
great caution is to be observed, lest great debilitation
happen.
  2. Typhus  enteriticus, is that  state, when the glands of
the intestines, especially  those of the  ileum, become in-
flamed,  forming small inflamed spots, which pass into pus-
tules and ulcers, as  have been discovered after death.
They are not genuine inflammations, but exanthematic and
metastatic depositions  of the febrile substance on the in-
testinal glands, similar to the aphthae, which are formed in 
PUTRID FEVER.
99
the upper part of the intestinal canal under similar circum-
stances,  and the formation of pimples on the skin.  The
signs of this condition are very obscure :  diarrhoea with
dull pain in the lower abdominal region, especially of the
left  side, only complained of when pressed  upon, and
bloatedness of that region.
  The treatment consists (besides the general cure of the
nervous  fever) in the application of leeches to the painful
spot, cold fomentations on it, and the internal use of chlorid
water (acidum muriaticum oxygenatum), with gum arabic ;
when more violent and obstinate, calomel 3 to 4 grains two
or three times a day.
  In  every nervous fever, that  becomes protracted and
commences to be chronic, I know of no remedy which is
more efficacious for its quick removal than the daily use of
lukewarm baths.
  The consecutive debility, also, cannot better be removed,
and  the  recovery hastened, than by these daily  lukewarm
baths, in which malt has been boiled.

                     PUTRID  FEVER.

            Typhus Putridus, Febris  Putrida.

  Diagnosis.  The symptoms of typhus, together with the
highest degree of vital debility, very rapid, small, easily com-
pressible pulse, calor mordax(a. particular heat, which com-
municates to the hand placed on it a disagreeable feeling of
pungency and burning, which, instead of abating gradually,
and, so to say, assimilating, increases  more and more the
longer  the hand  lies on the patient, and leaves an after-
feeling—a mixture of the living and dead  chemical heat,
which is not the product of active secretion, but of already
commencing dissolution)—putrid odor of the perspiration,
of the breath,  and other secretions; the signs of a com-
mencing organic  dissolution (colliquation).  Such  are:
petechia?, profuse, oily, clammy sweats, thick, dark urine,
colliquative diarrhoea, discharge of blood by the nose, urine
and stool, decubitus, tendency to gangrene ; the blood ab-
stracted in venesection is dark colored and does not sepa-
rate into cruor and serum, but forms a pappy mixture.
  Pathogenesis.  It  is either a consequence  or a transition
of a preceding ardent fever, most frequently  of the nervous
fever ; it can,  however,  be developed  from every other,
even from an inflammatory fever, by keeping toowarm, by
uncleanliness,  corrupt air,  ardent remedies; or it appears 
100                 GASTRIC FEVER.
from the beginning as a putrid fever, engendered by a con-
tagium putridum, or in men with very corrupt humors, scor-
butic diathesis, and after the abuse of mercury.
  The essential character is an extreme  vital  debility, to-
gether with a disposition to putrid dissolution.
  Therapeutics.  The indications call for a lively arousing
and elevation  of the prostrated vital power,  by which the
operation of the dead chemismus in the  organism may be
counteracted,  and dissolution checked by chemically anti-
dotive remedies.   This is the  particular  discrimination
which is to be observed in the treatment of the putrid from
the purely nervous fever. The first indication is answered
by the most efficacious excitantia, especially wine, and all
remedies recommended  in the more violent degrees of ty-
phus nervosus. The second—by  such remedies, as increase
the cohesion and contraction of  the organic fibre and mat-
ter, and chemically resist the putrescent process.  Of that
number  are principally cinchona (also its surrogate, cortex
salicis), mineral acids, alum (vid. No. 12), and cold, which
latter may be  used either in the way of cold fomentations
on the head, pit of the stomach, and cold lotions with  vine-
gar of wine,  even rubbing with ice,  or  in cold beverage,
but particularly in frequently renewed cold air, since a con-
tinual renewal of the atmosphere, which surrounds and
evaporates from the  sick, is of the greatest importance.
Vesicatories are to be avoided,  because they have a  tend-
ency to  pass into mortification.—In local gangrene fomen-
tations of cinchona with wine, alum, sal ammoniac, myrrh,
and in order to absorb the fetid smell, chloride of lime.
                    GASTRIC FEVER.

Febris Gastrica, Mesenterica, Intestinalis, Biliosa, Mucosa,
                          etc.

  Diagnosis.   Foul tongue, with a yellowish or brownish
coat, aversion to food, nausea, bad taste, either bitter, pu-
trid, or slimy,  a feeling of pressure,  or fullness at the pit
of the stomach,  unusual lassitude, headache, dizziness, ra-
pid pulse, but it is not so hard as to be considered inflam-
matory, nor so weak and small as to be mistaken for debi-
lity or a putrid fever.   Negatively—the signs of another
febrile genus  are wanting,  and a  regard to the exciting
causes that relate to the gastric system and the constitu-
tion of the patient, are here of great moment. Frequently, 
GASTRIC FEVER.
101
 when the gastric character of the disease is not apparent,
 the effect of reagencies,—such as the fruitless application,
 or the apparent noxious operation of stimulant and deplet-
 ing remedies, must be consulted.
   Duration and course are very indefinite: simple  sabur-
 ral  fevers often last only a few days; others,  especially
 bilious and mucous fevers, several weeks.   The stages no
 less vary: often merely gastric from the beginning to the
 end; sometimes first gastric, then general; either nervous
 or inflammatory ; sometimes also, in the beginning gene-
 ral, then  gastric, then again general, and of various febrile
 character.—The same is true of crises.   In one  gastric
 fever there is only one crisis, gastric evacuations by vomit-
 ing or purging ; in that which is connected with or passing
 into a general fever, general crises by sweat and urine suc-
 ceed and are necessary.  Frequently, however, it is imper-
 fect, and there succeed  eruptions,  aphtha?, petechia?, ab-
 scesses, and other  metastases,  which happen especially,
 when in the beginning the necessary evacuants have been
 neglected, and  diaphoretics  and stimulants have been ad-
 ministered  instead  of them,  whereby a part of the gastric
 morbid matters pass into the* second ways—the blood.  Be-
 sides, it is possible  for the gastric fever to pass into a ner-
 vous, a putrid, or a chronic and hectic fever.
   Gastric fever may differ by reason of the different quali-
 ties  of the gastric contents; it  is  therefore divided into
febris gastrica saburralis (from indigestibles) ; biliosa, mu-
 cosa, verminosa ; or by the difference in the general febrile
 character, into febris gastrica  inflammatoriu,  nervosa, pu-
 trida; or from  the organ which.it particularly affects into
febris gastrica pleuritica, hepatica, cephalica, phreniticu.
   Pathogenesis.  The essential of the gastric fevers consists
 in  this—that they  cannot be cured but by cleansing  the
 first  ways.   Impurities, morbid matters in the intestinal
canal, which cannot be eonquered by the ordinary digestive
power, and their immediate effects on the intestinal canal,
and sympathetically on  the  whole  vascular and nervous
system, are consequently to be considered the proximate
cause of this fever (vid. gastrosis).
  These impurities  may originate in a double way, either
externally or  internally.   Externally by taking aliments,
which surpass the powers of digestion by their quantity or
by their quality, and therefore  remain undigested masses
(crudities); internally from secretions of the stomach and
  *  Prima via, the whole digestive tube ; vice secunda, chyliferous
and sanguineous canals.
                           9* 
102
GASTRIC FEVER.
intestinal canal, or of their annexes—as that from the liver,
either increased in quantity or variously  corrupted in qua-
lity; hence the formation of bilious and mucous accumula-
tions to an incredible extent.  Although  in the latter case,
the liver and its morbid irritation and  secretion are to be
considered the source of the impurities,  and these not as
the primary cause but as the material product  of  it;  they
are to be regarded in the treatment of the case as the prox-
imate cause  of the disease, for no cure is possible with-
out removing them.
  The disposition to this fever may  be  partly individual,
partly general.  Individual—weakness of the stomach and
the digestive organs, irritability of the liver; men, who al-
most continually  labor under phlegmasia of the prima? via?,
and from  slight causes under bilious accumulations.   Se-
dentary life,  debauchery, indigestible aliments.  General
—continued  moist  and changeable  atmosphere (thence
especially  accumulation of phlegm),  continual heat  (by
which bilious accumulation is brought on), habitual use of
indigestible aliments, melancholy.
  Occasional causes must be  mentioned:  overloading of
the stomach, anger, pain, taking  cold, every violent irrita-
tion in predisposed  persons ; hence  fever of any other kind
may excite gastric complications.
  In this way gastric fevers become epidemic. These fevers
are most  frequent  in the intermediate  climates,  in those
regions where cold  and  heat alternate, and the seasons par-
taking of this character, end of the summer,  autumn, and
in places where gluttony is indulged in (vide gastrosis).
  Therapeutics.   The cure  consists merely in  solution and
discharge of gastric impurities;  for the  very  doctrine of
gastric fevers has originated in  the observation of those
fevers which yield to no other remedies  than emetics and
purgatives.  At the same time the character of the fever is
to be regarded.
  Here three cases may possibly occur:
  1. The  patient  shows all the  symptoms of gastric fever,
but without  accumulation  of impurities.  Here digestive
remedies  are indicated,  as the dissolving neutral and pur-
gative salts, in such doses as do not excite purging : Cream
of tartar, Glauber salts in small doses ; in tenacious phlegm,
sal ammoniacum,  sulphate of potash. In very sensitive sub-
jects, pulvis aerophorus, spiritus: Mindereri; should watery
diarrhoea exist, sal ammoniacum.  These remedies mildly
promote secretions and excretions, causing the  fever to
disappear, or produce an accumulation  of impurities either 
GASTRIC  FEVER.                  103
in the stomach, or in the intestines, whence, either emetics
or purgatives  will  discharge them.  Sometimes  none of
these effects take place.  The gastric symptoms continue,
but show no definite accumulation, and the fever increases.
Here, either  a phlogistic state exists, which calls for a
cautious venesection; or a nervous state with spasmodic
symptoms in  the abdomen and the pra?cordia, for  which a
combination of digestive with antispasmodic remedies, as
valerian, hyoscyamus,  castoreum, musk,  are serviceable.
  2. The patient exhibits all the symptoms of accumulation
in the stomach. Here  an emetic in divided doses must im-
mediately be given (vide No. 13).  Let half an hour elapse
after the first effect of the emetic, and then repeat the dose,
in order that  the patient may throw up three times, which
is indispensable; after each operation give a cup of cha-
momile tea. In inflammatory complications, hard full pulse,
a venesection first, and immediately after the emetic, next
a purgative.  The  emetic must always be given in divided
doses; for we cannot  exactly anticipate the degree of irri-
tability of the stomach, which is sometimes very great,
and  a full dose of the emetic administered at once might
produce hyperemesis, which may prove dangerous.  In great
irritability and spontaneous  vomiting,   it  need  only  be
aided, and brought into full operation.  Oxymel scilliticum
and  tea of chamomile will suffice.  There is only one excep-
tion, when the emetic has been neglected and the  stomach
has  become inactive and inirritable, and the patient labors
under  watery diarrhoea, every thing tending that  way,
small doses  of the emetic would  only  increase  the diar-
rhoea, without clearing the stomach. In such a case let the
emetic be administered in a  full dose, and not tartar, emet.
but ipecacuanha; and when  the sensibility of the  stomach
and  diarrhoea! disposition is too great, let a vesicatory on
the  gastric region and a few drops of laudanum internally
precede the remedy.
  One of the greatest and most dangerous  errors of prac-
tice  is to consider the effect of  emetics and purgatives
alike, and to believe one may be  substituted for the other.
That which nature will evacuate by emetics, cannot be dis-
charged by purgatives ; nor can the dynamic change, which
an emetic produces in the nervous and  secretory system
of the stomach and liver (and which stops in bilious fevers
the source of all impurities),  be effectuated by purgatives.
Besides a  purgative is more tardy,  thence much more
weakening, and favors absorption.  Never  give an emetic 
104                   GASTRIC FEVER.
while the bowels are constipated;  for it is apt to create
ileus ; in such cases precede the emetic by an injection, in
order to free the intestines.
  3. The patient has symptoms of intestinal accumulation,,
pain in the back and loins, rumbling bloated abdomen, bor-
borigmi, discharge of fetid winds, and vitiated stools. Here
purgatives are to be used, also in divided doses, choosing
for  irritable persons tartarized soda, Glauber salts, manna;
in torpid cases Epsom salts and sulphate of potassa, in still
more torpid ones  the same mixed with folia senna? (vide
No. 14), in much debilitated nervous individuals, rhubarb,
calomel, oleum Ricini.
  The continuance and  repetition of the evacuanls is de-
termined upon only by the signs of impurities, and the in-
crease or decrease of the fever.   If the fever and the gas-
tric signs  decrease, under the use of laxatives, and  the
stools continue vitiated, we must persevere in this course
until the symptoms disappear and appetite  returns, after
which  we give  roborants.  Do the evacuations  become
watery, and the gastric symptoms continue, digestives are
again  to be  resorted to.  If new embarrassments appear,
we  have again  to  give emetics or purgatives.   The cure,
therefore, may last three days or three weeks.
  Nor must we  neglect the complications that may belong
to the fever:  in the inflammatory—proper antiphlogistics;
in  the nervous or putrid—stimulants,  roborants,  antisep-
tics; in bilious—tartaric acid and tamarinds ;  in putrid—
sulphuric and muriatic acid, also mucilaginous beverages;
in mucose—acrid incidentia, sal ammoniac, squills, senega,
emetic-tartar.
  If,  after the proper evacuations and the removal of the
gastric symptoms,  the fever continues,  it is either in con-
sequence of" the gastric acidity  having passed into the
blood, or a persisting  febrile complication; this requires
the general crisis, which is besj produced by spiritus Min-
dereri, antimonials, Selters water, or by treating the promi-
nent complicated fever present, which is commonly ner-
vous;  or, if there is great weakness, by roborantia.
  Every gastric fever calls at its close for roborantia; they
may be required even whilst the gastric signs continue in
feeble  persons, and  when the gastric state is protracted, in
order to guard against impurities,  which are often engen-
dered by debility.
  It is  best to prescribe at first dissolving, slightly bitter
extracts:  Extr.  taraxaci,  marrubii,  trifolii  fibrini  (vide 
RHEUMATIC, CATARRHAL  FEVER.          105
 No. 15), and  then quassia (vide No. 16) according to cir-
 cumstances mixed with rhubarb, which is best borne by the
 weakened intestinal canal.

           RHEUMATIC FEVER, CATARRHAL FEVER.

          Febris  Rheumatica, Febris Catarrhalis.

   Diagnosis.  Chills and heats alternate, painful stretching
 in the limbs, frequent desire to urinate, which  is accompa-
 nied with pain, urine turbid and deposits a tile-colored se-
 diment, disposition  to perspiration, which evacuation gives
 immediate relief, while cold, on the contrary, as constantly
 aggravates.   These symptoms are preceded, accompanied,
 or followed by a locai affection, which  may be either rheu-
 matism or catarrh.
   If rheumatism, there is local pain without swelling most
 commonly in an aponeurosis, osseous membranes, or mus-
 cular structures.  It may be fixed  or wandering, shifting
 from part  to part, even to distant ones,  and when  from the
 surface to an internal organ, there is danger.
   If catarrh, the local affection, may be, of  the nasal mu-
 cous membranes (coryza) : there is frequent sneezing, ac-
 companied with an  acrid watery discharge, which is some-
 times mixed with  blood at the commencement,  and gra-
 dually  changes  into purulent matter when the local  and
 febrile  symptoms  abate:—or  it may  be of  the trachea
 (tracheal, pectoral  catarrh),  frequent  cough, hoarseness,
 and roughness in the  throat, at first expectoration of thin
 acrid matter, becoming at last concocted and purulent, with
 a corresponding diminution of  the fever.  Not  unfre-
 quently both  kinds of local affection coexist,  or  one may
 pass into the other.
   Pathogenesis.  The proximate cause is an inflammatory
 irritation, either of a muscular  or a membraneous part, or
 of a mucous membrane, due to a disturbance in  the func-
 tion of the skin (therefore antagonistic),  combined with a
 serous acidity, which has thereby been created, and  which
. keeps  up the irritation.  Every rheumatic or catarrhal af-
 fection is therefore a superficial inflammation, but only of
 the serous vessels; this is evident  from the slight redness
 and heat,  and the rare  transition into suppuration.  It  can,
 however,  by  aggravation or additional causes, easily affect
 the blood-vessels and become true inflammation.
   Remote causes.  The disposing are: either individual,
 weakness and  morbid irritability of the skin,  sweaty skin, 
106          RHEUMATIC, CATARRHAL FEVER.
 general debility  produced by bad habit, too warm rooms,
 too warm clothing, exclusion of free air, a particular muco-
 serous  dyscrasiasis of the blood;  or general epidemic:
 rheumatic catarrhal disposition in the spring and autumn,
 particular  atmospheric constitution, by  which catarTho-
 rheumatic epidemics are formed, endemic and climatic dis-
 position, whole countries (the mountainous), places, even
 single houses, which  by  their situation and construction
 are exposed to continual draught of air or change of tem-
 perature.
   The occasional causes :  Taking cold, quick change from
 warmth to  cold, or vice versa, the worst draught of air,
 leaving off an habitual warm piece of dress.
   Therapeutics.   The fundamental  idea of cure is restora-
 tion of the cutaneous action, paying at the  same time re-
 gard  to inflammability, which exists locally  as well as ge-
 nerally  in  every  acute rheumatism  and catarrh.  All de-
 pends upon the virulency of the fever ; for every rheumatic
 affection can  be  changed into a true inflammation merely
 by augmenting the  degree of its intensity.   Is the fever
 violent, or an indication of plethora, venesection is to be
 resorted to, and  nitre  with antimonial salts to be adminis-
 tered : a strict antiphlogistic regimen, with a uniform and
 not too hot temperature must be  observed.
   Rheumatismus universalis, one  of the most painful and
 afflicting maladies, throws the patient into a state similar
 to tetanus,  yea can pass  into  it,  always requires general
 venesection, which will often suffice alone to cure. When
 the fever is slight, or abated by the above  treatment, dia-
 phoretic, but  not stimulant remedies are of  use, such as:
 spiritus Mindereri,  antimonials,  flores  sambuci  (vide
 No. 17), vesicatories.  In still slighter cases camphor with
 nitre (vide No. 18), aconitum (vide No. 19), radix senega?,
 stip. dulcamarse,  gummi guaiaci,  sulphur;  a  principal re-
 medy are vesicatories;  in a nervous constitution with vio-
 lent  spasmodic pains, opium.
   Too large or unnecessary abstractions of blood will tend
to protract  rheumatism and make it chronic; nor ought
blood to be taken from a rheumatically affected part. In pec-
toral  catarrhs, on. the contrary,  venesection is indicated
not only by the  general  febrile  symptoms, but  also by
 stitches or pains  of the chest, dyspnoe,  and  dry couorh
 (signs of a beginning pneumony, bronchitis), also by phthi-
 sical disposition and pulmonary maladies, in which catarrh
 is apt to change into a  pneumony, capable of passing into
 phthisis. 
CONTAGIOUS FEVERS.
107
   Generally, we must never forget that catarrhal and rheu-
matic fever may be complicated with every other genus of
fever, with the gastric and nervous, and then the treatment
must be varied to meet that  which these states indicate.
Especial attention is  due to the momentous,  sometimes
fatal nervous complications (Hoftnann's/eiris catarrhalis
maligna) which call for commensurate treatment.
v   Local treatment.  The catarrh requires a diminution of
irritation  in the  mucous membrane,  proportioned to the
concoction of the expectoration.  For  that purpose  give
emollient mucilaginous beverages, warm vapors, mellagi-
nea, linctus, antimonials, sulphur, flor. sambuci, sem. foeni-
culi, anisi, rad. and succus liquiritia?, (vide No. 20 and 21),
flannel  on  the  chest.
   In  local pains of chest without indication  of venesec-
tion, vesicatories on  the spot (vide catarrhus, bronchitis,
pleuritis rheumat.).
   Rheumatism requires a local crisis by sweat, which  may
be brought on by  uniform warm covering of flannel, wool,
or oiled silk.  In very violent pains, vesicatories and keep-
ing  up a suppuration near the part;  in inflammatory  indi-
cation, redness, heat  of the part, leeches  or cups;  in irri-
tability and increased sensibility, opiate; ointment   and
plaster (vide No.  22).
   Does the fever  cease and rheumatism remain,  or catarrh
exceed the  duration of acute disease, then we are to fol-
low the treatment for chronic rheumatism and catarrh.
                   CONTAGIOUS  FEVERS.

               Febres Acuta Contagiosa.

  They are distinguished by this, that they are caused by
contagious matter  received  from without, that each kind
has its peculiar symptoms, course and duration thereby de-
termined, and that the treatment  must be modified accord-
ingly, especially in regard to the danger of communication
with others.                     •
  Of this class are : the typhus contagiosus, typhus icterodes,
pestis,  carbunculus malignus contagiosus,  cholera orientalis,
variola, morbilli,  scarlatina, miliaria, and petechia  conta-
giosa, tussis convulsiva, hydrophobia.
  Pathogenesis.  The proximate cause of all is in the com-
munication and  operation of a foreign matter, which has
the peculiarity of producing the  same disease in every in- 
108
CONTAGIOUS FEVERS.
 dividual, and of engendering its like.  It is either the pro-
 duct of a morbid organic body (contagium), or is formed in
 the atmosphere out of an organic matter  (miasma, epidemic
 contagious matter).
   This contagious matter has a double effect,—first, repro-
 duction of itself; secondly, irritation and excitement, but
 only where it finds  the receptivity requisite for  its per-
 ception.
   The effect of contagious matter has  two analogies in na-
 ture,  fermentation  and procreation.  In either case the
 communication of a matter is capable of producing a trans-
 mutative or  assimilative  process in other matter, and  of
 creating its like  (a new living something).  Every conta-
 gion is to be regarded as a semen possessing  its own vital
 and procreative power, parasitic in  the system,  capable  of
 reproducing its like and the effects dependent on it. Thus
 far every contagious disease is to  be regarded as a hete-
 rogeneous  pathological vegetation and fructification of two
 classes: one is remarkable for the fixed  duration of its pe-
 riods of blossom and  fruit, quick and regular  in  its phases
 like the short-lived or annual plants; it includes  the  febrile
 and  acute  contagia,  called  exanthemata, and  the other
 secretive products  striking the senses:—the other vege-
 tates  and is reproduced perpetually in the system compa-
 rable  to perennial  plants, and  embraces  the permanent
 contagia. This view is of practical importance, for it shows
 that we have to treat  not the virus communicated, but that
 which  has  been generated, multiplied, and reproduced in
 the system.
   Hence arise certain peculiarities  proper to this class of
 fevers,  which are:  1. In  all  there  is  excitement (on ac-
 count  of the heterogeneous admixed matter),  the first  and
 fundamental effect.   Thence  in the  first period  an inflam-
 matory character. 2.  But this inflammation, since it does
 not originate from internal causes, but is excited  and urged
 on from without, is not genuine inflammation, therefore  it
is  less permanent, less affecting, apt to pass into a con-
trary character, except where it finds a soil predisposed to
genuine inflammation.  *3. Its effect  is  always modified by
the variety of the irritant matter itself, and by the variety
 of susceptibility in the recipient body.
  Firstly, the contagion or miasma by its very nature  dif-
 fers  in  quality : the one directly asthenizing and depress-
 ing the vital power, as the  contagium putridum, the other
 exciting it.  The second variety, that of the  constitution
 of the individual, is the most frequent cause of the various 
CONTAGIOUS FEVERS.                109
reaction ; thus the very same contagious irritants may pro-
duce  multifarious fevers,  inflammatory,  nervous,  putrid,
gastric. Moreover, the influence of the epidemic constitu-
tion is here most momentous, sir ce it can impart to all or-
ganizations a certain  tone and disposition to a  certain
morbid character; hence at particular times  small  pox,
measles, nervous fevers, etc.,  have an inflammatory, at
other  times  an  adynamic, and  again a gastric  character.
4. All contagious fevers have a disposition to exanthematic
phenomena,  to  metastases, and in  general to imperfect
crises, since the heterogeneousness and poisonlike quality
of the matter does not admit  of a perfect assimilation and
crisis.  5.  In all, the  reproduction  and multiplication of
the contagious matter is proportionate to the height of the
fever  as well as  to the  external circumstances favoring
or hindering the febrile reaction.
  Thereby  arise  certain  external  alterations  or stages
(stadia), which every  contagious fever goes through : 1.
The stage of infection, the period  of communication,  of
sowing, without perceptible effect;  it is  of uncertain du-
ration, varying from 3 to 14 days.  2. The  stage of irrita-
tion or fever, the period when the poisonous  grerm is en-
livened and reaction exists.  3.  The stage of efflorescence
and fructification, the period when  the pathological vege-
tation arrives at blossoming and fruit (exanthema,). 4. The
stage  of decrease, the period when the contagious  plant
dies and fades away.
   Therapeutics.   The fundamental indication in all  is to
ascertain what is, and to treat in a proper manner the febrile
character,  pertinent respect being paid to  the contagion
and its variable character.
  The disease,  or the fever, is to  be looked upon as the
endeavor of nature to operate on and to throw out the poi-
sonous matter,  so that in  a  slight degree  of fever nature
alone performs the whole cure according to certain stadia,
and within  a definite time, and art ought not to interfere.
  In violent and decidedly characterized fevers the treatment
must  be co-ordinate with the  variety of febrile  character.
It is,  however, always  better  in the  onset to use antiphlo-
gistics. Every contagious fever must bo regarded as a poi-
soning, and at the same time as a reproductive and multiplica-
tive process of the poison, and we are to consider, that the
more  violent the fever and the greater the heat,  the  more
poison is created in the patient.  Hence, it appears evident,
how great and obnoxious was the error, under which phy-
sicians of former tim-ss  labored,  in striving to drive out the
                           10 
110               TYPHUS CONTAGIOSUS.
virus by heat and heating diaphoretics, a practice which
could only increase the quantity of the virus, and thereby
the force of the disease.  Hence also appears the moment-
ous  advantage of modern practice, which has for rule to
moderate  the fever and heat as  much  as possible, and
thereby to diminish the regeneration of the virus and aug-
mentation of the disease. It is, consequently, indispensable
to keep the patient cool, in an atmosphere not exceeding
14 degrees of Reaumur,  to cool and refresh it in the sum-
mer season,  by  placing  vessels filled with cold water in
and  sprinkling the  room.  Discard feather beds,  which
keep up heat, and  retain noxious exhalations, and substi-
tute a matress and a light covering, and  have recourse to
cold fomentations  even in  the  higher degrees of putrid
fever.
  In all contagious fever the chief rule  is: to purify and
renew  the air,  to  observe cleanliness and separation of
the sick.
  Hence results the second rule: to consider the patient
as surrounded by a  poisonous atmosphere, ever exhaling
from his own body, and which continually reacts on him-
self, consequently  careful attention must he paid to its re-
moval,  and  to  renew the  atmosphere.   Of  late  many
chemical  means have  been recommended for  destroying
contagion  in the atmosphere.  The chief are fumigations
ofchlorirfe and nitric acid; but their usefulness has not been
confirmed, and their detriment, particularly to the lungs,
is certain.
  Renewal of air, then, continues to be the best purifying
remedy, which is best  effected by a draught of air, which,
however,  must run  diagonally through the sick room, com-
ing  in at  an opening  near the floor, and going out  at an-
other near the ceiling,  for the  corrupt atmosphere forms
heavier and lighter  strata. It is a matter of course that the
patient must be protected from the immediate impression of
that draught on his body.
  Several patients should not be permitted to lie together
in one bed or in  one room, or in a crowd of men, since that
favors the multiplication of the contagion, and all secre-
tions must be speedily  removed.

                  TYPHUS CONTAGIOSUS.

   Diagnosis. The symptoms of the nervous or putrid fever
generated by infection.
  The character is inflammatory  in the  first stage, and 
LEVANTINE PLAGUE.                HI
passes later into the nervous and putrid ; the first character
may,  however, remain.   That depends partly on  indivi-
dual disposition, partly on the prevailing epidemic constitu-
tion.  Therefore we meet with inflammatory, putrid, and
nervous epidemics of typhus and military plague.
  Therapeutics.  The treatment is that which is laid down
for typhus, but with a special regard to the variety of cha-
racter, and particularly to antiphlogistic treatment in the
first stage (vide typhus), besides an observance of the ge-
neral  rules for contagious diseases, especially free and al-
ways  renewed air.
            THE LEVANTINE OR BUBON PLAGUE.

                   Pestis Bubonica.

  Diagnosis.  The appearance of buboes and anthraces,
i. e. inflamed glandular swellings, which are  gangrenous
from the beginning, anl pass rapidly into sphacelus, espe-
cially below the shoulders and in the inguinal region ; like-
wise  of petechia? and ecchymoses in the first days of the
disease, connected with a very violent fever, great anxiety,
vomiting  and cerebral affections, putrid fetid smell of all
secretions, the highest degree of prostration and vital de-
bility.  The fever is acutissima,  proving fatal  often within
the first twenty-four hours, generally decided by the third
or fourth day; the mortality enormous,  generally three-
fourths die.
   Origin—the coast of the Levant (thence it is also called
the Levantine plague), especially Egypt, Smyrna, Constan-
tinople ; but  by  infection it can be spread  everywhere,
even in the  most northern  regions  (London,  Koenigsberg,
Moscow).
   The infection takes place only by contact, never by the at-
mosphere ; therefore by avoiding to touch the sick, or bodies
which have been touched by him, it can be prevented from
spreading.   On that rests the great benefit of complete ex-
tinction and removal by mere separation, by means of qua-
rantine and  boundary cordons, a practice observed  in all
civilized countries since the eighteenth century.
  The treatment must conform to the varieties of its cha-
racter ; it may just as well be antiphlogistic as antiseptic,
exciting, roborating;  even venesection has proved service-
able in some epidemies and constitutions. The main thing
is  to promote the crisis by a good suppuration of the bu- 
112
YELLOW FEVER.  CHOLERA.
 boes.   The greatest care is to be directed to free ventila-
 tion.  In the highest degrees of the putrid  stale, rubbing
 with ice has sometimes worked wonders; persons already
 apparently dead  have thereby  been restored to life.

           THE YELLOW  FEVER, OR BLACK VOMIT.

                     Typhus let erodes.

   Diagnosis.  Yellow color of the skin ; vomiting and pur-
 ging of black matters, great anxiety and  prostration, vio-
 lent fever.   Rapid course, and great  fatality,  as  in  the
 plague.   It originates in the  coastward regions of  the
 West Indies and the Southern States  of North America,
 but only to the 46th  degree of northern latitude.  By in-
 fection it can  be transplanted into Europe, but will  not
 become epidemic above the degree of  latitude mentioned.
   Therapeutics.   Like the plague it is to be treated accord-
 ing to  its different febrile  characters.   Venesection and
 large doses of calomel have proved the most serviceable.

                    THE COLD  PLAGUE.

                   Cholera Orientalis.

   Diagnosis.   Evacuations of thin, gruel-like matter by
 vomiting  and purging, great  anxiety,  bluish  tint of the
 skin, hoarse voice, pains in the stomach and abdomen, vi-
 olent cramps in  the  lower extremities, especially in the
 calves of the legs, marmorlike  coldness of the extremities,
 of the body, and even of the tong/ie, suppression of urine,
 small, intermittent, imperceptible  pulse, total want of cu-
 taneous action, asphyxia.
   Course as rapid as  in  the plague and yellow fever, fre-
 quently fatal within the first twenty-four hours by asphyxia,
 generally within two  or three days.   Mortality always
 equals  one half, even  two thirds of the affected.  Often
 when the cholera abates, it passes into a typhus  fever
 which may also terminate fatally.  For a  lon<* time after
 there remains a nervous debility, and weakness of the  di-
gestive organs.
  It  originates in the litoral regions of the East Indies
especially of the Ganges, but may  spread  farther by  infec-
 tion and progressive  miasmatic  generation over the whole
globe, crossing  even  the ocean (to America).  But in this"
disease, as in the yellow fever and the plague, elevated dry 
CHOLERA.  HYDROPHOBIA.              113
regions are less exposed to  infection ; and personal infec-
tion is far more dependent on circumstances, and occurs
more  rarely than in the plague.
  Therapeutics.  The  principal remedies are, in all cases
where the debility of the individual does not  forbid, to im-
mediately administer  a venesection and an emetic.   The
latter often removes the whole attack.  Sinapisms and warm
aromatic fomentations on the stomachical regions are use-
ful. Should it not  abate after this, give calomel, injections,
and order frequent drinking of cold water ;  cold injections,
cold applications on the abdomen ; and rhubarb to evacuate
the retained bile.   In  the higher degrees,  even  cold  affu-
sions.  The  typhus  which follows, must  be adequately
treated, particular attention being  paid to the sanguineous
congestion to the head, which often requires abstractions of
blood.

                      HYDROPHOBIA.

                        Rabies.

  Diagnosis.  Impossibility of swallowing  water or fluids
in general, extreme aversion, even so as to excite convul-
sions, against touching, yea, looking at fluid or even bright
objects (e. g. looking-glasses);  and yet the individual is
able  to  swallow   solid things freely,  and without  pain.
Such  are the diagnostic symptoms of rabies  canina, either
in the onset or associated with it subsequently, a period of
anxiety, lassitude, various nervous affections,  watchfulness,
and frightful dreams,  especially of dogs, having preceded.
With the appearance of hydrophobia the proper rabies sets
in.   It is morbus acutissimus, lasting not longer than three
or four days, and  terminates  in death  under convulsions
and apoplexia nervosa. It may exist with or without fever,
the sensorium  commonly remains  free, and  the patient is
conscious to the last.  There occur, however, often violent
attacks of rage, compelling the patient to spit out, to  bite,
to imitate the barking of dogs, intermixed with fits of faint-
ing and convulsions ; great anxiety, and excitemeut of the
genital organs  (priapismus) particularly appertains to this
malady.
  Pathogenesis. The essence of the disease  is a poisoning of
the nerves, generated by the infection of the canine virus,
through wounds or parts covered with tender epidermis as
lips, eyelids, internal  surface of the  nose, genitals.   The
infection may be  direct (by bite), as well as indirect (by
                           10* 
114                  HYDROPHOBIA.
     transferring objects).  The virus can  remain for a long
     time  latent on the  spot  of  infection,  commonly two to
     three weeks,  sometimes  months, even years.  Then ap-
     pears an itching or smarting, with redness in the place of
     the bite, long since healed and forgotten ;  and from  this
     the disease  breaks out.   An occasion for  breaking out, or
     awakening and enlivening'the dormant germ, is given by.
     violent over-heating, passions, ardent spirits.
       The fundamental  character of the disease is therefore
     only nervous, not inflammatory.  This is proved by all the
     symptoms, the absence of fever, and the manner of death j
     also in dissections we generally find  no vestige of an inter-
     nal inflammation, for the  reddened  spots perchance  here
     and there exhibited, may be explained as merely secondary
     effects of the violent irritation.
       The hydrophobic virus seems capable of being generated
     not only by a system laboring under it, but  also by a very
     violent  rabid affection  of mind; at least  there  are in-
     stances recorded, that bites of extremely exasperated crea-
     tures have produced rabies.
       Therapeutics.  The only sure cure is prophylactic; the
     cure of the developed malady is rarely possible.
       For that purpose, the diagnosis of the infection is requi-
     site, but  this is not always easy,  since  the  dog often es-
     capes or is killed before we can ascertain the existence of
     the  disease  in  him.  In   dubious  cases, however, it is-
     always better to use the preservatives, since the danger to
     which one is exposed, is so horrible,  that a mere possibility
•    of doing good is sufficient reason for their employment.
       The principal indication in the preservative  cure is to
     destroy the  poison in the place of application, since expe-
     rience teaches, that  it can  there remain locally fixed for a
     long time.
       The second indication is to destroy  and neutralize  the
     poison already received in the organism, for which  pur-
     pose mercury is the  principal remedy.
       The third  indication, to  remove  the  receptivity of the
     nervous system against the poison ; for which, according
     to all experience, belladonna is most efficacious.
       We must therefore hasten to act as follows: First, scari-
     fication,  cupping, and  cauterizing the wound by gunpow-
     der, which is preferable to hot iron, for the flame penetrates
     into the fissures and cavities of the bite, carbonizing them.
     In this way, the poison, as well as the  organ which received
     it, is destroyed.   Next, dress the  wound with an ointment
     containing red precipitate  and cautharides, and keep it in 
CARBUNCLE.
115
free suppuration for six weeks ;  even at the expiration of
this time the sore is not to be closed, for we learn that the
disease has broken out, after such a sore has long been cica-
trized ;  change the wound then into a fontanel, which must
be kept open a year.—When the wound is so situated, as
in the eyelid, the lips, the face, as not to  admit of this treat-
ment, we must content ourselves with scarifying and wash-
ing it with salt water and lye.
  With this local, the  following general  treatment must be
connected.  One drachm of mercurial  ointment must be
rubbed  twice  every  day into  the circumference  of the
wound and to  a distance around  it, and two grains of calo-
mel, together with  one grain of rad. belladonna?, be taken
morning and  evening,  until  a  moderate  salivation  com-
mences, which must be  kept up for a fortnight.
  The treatment of rabies when broken out.   The most
serviceable has been the following : As soon as the^rst in-
dication of the disease appears, we must re-apply the local
treatment to the original sore as above described, and use
embrocations of unguent, mercur. on different parts of the
body, especially on  the  neck, in  order  to  produce saliva-
tion as quickly as possible, which alone may create a cura-
tive  crisis.  At the same time  administer two grains of
calomel together with one grain  of rad. belladonna?, in in-
creasing doses  every  three  hours.  In young,  plethoric
persons, venesection to fainting is good;  if it is practicable
in any way, warm baths.

                      CARBUNCLE.

                Carbunculus Contagiosus.

  Diagnosis.  The carbuncle virus is communicated either
by being wounded by animals affected with it, or by eating
of their flesh.   In  either case  a  fever ensues, which  is
marked by great prostration, vertigo, anxiety, frequently
also by vomiting and  diarrhoea,  followed after a  few days
by the eruption of one or several carbuncles.  They appear
first as little blisters, which are followed by an eruption of
several  small ones filled with lymph, which assume after
a few days a brown, then  a black color, and  form finally
an anthrax, larger or smaller, which often penetrates deeply
into the substance,  sometimes only superficially ; absence
of inflammation or pain ; the limb swells and becomes in-
sensible, and even perishes.
  From the commencement, especially after eating much 
116        INTERMITTENT AND CHRONIC FEVERS.
 of the poisonous meat, the fever may  pass into  a putrid
 one, generating rapidly spreading putrefaction, and ending
 in death before pustules can form.  Such a  case is accom-
 panied with general colliquation, inten.-e anxiety,  abdomi-
 nal pains, bloody diarrhoea, and terminates fatally  in twen-
 ty-four or forty-eight hours.  More frequently, however, it
 abates on the appearance of a carbuncle, critical perspira-
 tion or diarrhaa, and becomes localized, the danger being
 now confined to the virulency of the local gangrene which
 can prove fatal in  its course.  In  favorable  cases  a sepa-
 ration  succeeds, with expulsion  of the carbuncle ;  this,
 however,  always takes a Jong time (six or  eight  weeks),
 and is accompanied with weak and bad suppuration, termi-
 nating in recovery.
   The cause of  this malady is infection of  the carbuncle
 virus, which takes effect  only by  contact, external as well
 as internal application, never by the atmosphere.
   The cure consists in the treatment of the fever  and the
 local one of the carbuncle.  The  fever calls for an emetic
 in the onset; and when it is violent, for that which is laid
 down in the cure of putrid fever, especially camphor and
 cinchona,  vinegar mixed  with the beverage; also  butter-
 milk has proved  very salutary. The boil  must be surgically
treated by incisions, and antiseptic cataplasms, to promote
reaction  and suppuration. — Experience has,  however,
taught  that the continued application of warm  emollient
cataplasms of linseed and the like, perfectly  suffice for the
cure.
                SECOND  CLASS.


     INTERMITTENT AND CHRONIC FEVERS.

       FEBRES INTERMITTENTES,  LENTAE, CHRONICAE.

  The difference between the class of fevers we have now
described, and the one we are now entering upon, consists
in this—in the former, fever  essentially  constitutes  the
disease ; while in  the second class, fever  is only a  form,
producible  by various causes, indefinite in its  duration'
and variable in its treatment. 
INTERMITTENT FEVERS.              117
         INTERMITTENT  FEVERS,  FEVER AND  AGUE.

                  Febres Intermittentes.
                                              m
   Diagnosis.  A chill,  followed by  heat,  terminating  in
 sweat, with a urinary deposite of red sediment, constitutes
 a paroxysm.   It  returns at  definite, sometimes at indefi-
 nite periods, leaving an interval entirely free from fever,
 with good pulse and health.  The state of fever is termed
 paroxysmus, and its absence, apyrexia.  Every paroxysm is
 an acute  fever on a small scale, a series of which consti-
 tutes the malady.  Generally the paroxysms return at reg-
 ular and certain periods of time, once in twenty-four hours
 (quotidana), or every forty-eight hours (tertiana), or every
 seventy-two hours (quartana) ; even greater intervals have
 been observed, as of  seven days (octana) ; or two  par-
 oxisms take place within each  period of time (febris du-
 plicata, quotidian.,  tertian.,  quartan, duplex).  They are
 recognizable by the  paroxysms which are alternately simi-
 lar to each other in  regard to time, violence, and duration.
   Commonly  the  febrile symptoms  are clearly exhibited
 (febris  intermittens  manifesto); but  sometimes they are
 wanting, being  replaced by  periodical morbid  symptoms,
 as cephalaea, colica, cholera, odontalgia, ophthalmia, and pneu-
 monia ; even any  kind  of disease  may  put  on  this form,
 ceasing in the intervals (febris intermittens larvata).  They
 are principally  recognized  by lateritious sediment appear-
 ing in  the urine, after the paroxysm.  When  the attack
 exhibits danger of life,  the cases are termed febres intermitt.
 maligna s. perniciosa s. lethales, such as apoplectica, sopo-
 rosa, convulsivce, suffocatoria.
   They may be either simple (simplices), or, like any other
 fever, complicated with a variety of  febrile character ; in-
flammatory, gastric, rheumatic, nervous.   They can  also be
 combined with acute fever (hemitritaus).
   The duration is indefinite.  Sometimes  they terminate
 with the third or fourth paroxysm, sometimes they last for
 weeks, months,  years, especially the  quartana.
   Intermittent fever in itself is perilless, but it may become
 dangerous, either by accidental symptoms or by long dura-
 tion, which may bring  on a  particular cachexia,  obstruc-
 tion, and physcony of the  abdominal viscera, dropsy, and
 nervous diseases ;  it may also be very wholesome, and cure
 obstinate maladies.
   Pathogenesis. Intermittent fever presents a particular mix- 
118              INTERMITTENT FEVERS.
ture of acute and chronic disease.   Every paroxysm  is a
febris acuta on a small scale, fostered  by, and  dependent
on, a nervous state.  The essential character is periodicity,
an appearance and  disappearance of symptoms at certain
periods, ^ot the disease itself; for  that can  exist without
periodicity, as we frequently see  an intermittent fever pass
into an acute  one,  and vice  versa.   It  is this periodicity
alone  which makes the fever an intermittent  one.   The
cause  of the periodicity  resides in the nervous  system j
therefore an intermittent fever is essentially a nervous dis-
temper, the proximate  cause of which is both  the  material
of the fever and that which  imparts to it the intermitting
form, the latter being  due to a particular state of the ner-
vous system.  Hence the causes  of intermittent fever may
exist even  in its absence.  Hence for a series of years in-
termittents may frequently  occur,  and  for another series
happen rarely.  Hence, also, mere  mental  affections can
excite  and also cure them ; and  hence  the febrifuge pow-
ers of  all nervine medicines.
  The remote causes are all those which can impart to the
nervous system a periodic disposition ; such are: the en-
demic  constitution, created by marshy regions and  stagnant
waters; the epidemic  constitution,  the effect of actual epi-
demies, frequently subsisting for years, due to atmospheric
relations ;  farinaceous or fish diet for habitual food.
  Exciting causes are  the same,  which generally  produce
fever,  assuming under this disposition the character of an
intermittent.  The  most frequent are ;  indigestion, taking
cold, infarcts and obstructions of the abdominal viscera, also
lurking morbid matters, as gout, syphilis, even a mere local
irritation, as a carious tooth.  But when the fever continues
for some time, causes are created by itself, which influence
its  duration.   Here habitus is to be mentioned.
  Therapeutics.  Two principles must be borne in  mind in
the cure of intermittent fever.
  The first: that a too rapid suppression of it may be per-
nicious, since something critical  must be  attributed to
every  intermittent fever, and it is often  a very salutary en-
deavor of Nature, and  which a cure would suppress.
  The second : that, as every intermittent fever weakens,
and can produce bad  consequences, an unnecessary con-
tinuance of it is just  as much to  be avoided.  It is fre-
quently a difficult task  to unite both considerations ; there-
fore I  submit the following rules.
  The first indication, is to remove  the remote  cause, and
to treat the fever like a  remittent.  In this way we can 
INTERMITTENT FEVERS.              119
accomplish a cure, especially in the onset of vernal cases,
and in those wherein a febrile pulse continues in theapyrex-
ial stage, and where they are disposed to change into acute
fever. Therefore, in foul stomachs from overloading or other
impurities—emetics, purgatives and digestives ;  after ta-
king cold or a merely epidemical atmospheric  influence—
the .treatment for rheumatic fever : sal ammoniac, spiritus
Mindereri, diaphoretic regimen ; in worms, anthelminthica,
etc.   This  treatment will at the same tftie be the best pre-
paration for the administration of  cinchona and other sup-
pressing remedies.
   The  second  indication,  is  to operate directly on 4.he
proximate cause,—the nervous anomaly ; it is the  methodus
directa,  specifica, antifebrilis.   It must take place, when the
fever still continues after the remote  cause has ceased, or
no remote  cause can be discovered.   In common  fevers,
and where  there  is nothing particular to be considered, it
is always advisable to wait for five or six  paroxysms be-
fore  we suppress it violently ;  commencing  with such
remedies as will cure the fever but not stop it too rapidly.
Of that  number are  sal. ammoniac (two drachms  daily),
emetics a few hours previous  to the paroxysm, flor. cham-
omilla?   romanae, herb,  trifol.  fibrin, millefol. in substance
or extract.   Should the fever not cease by these means, or
other reasons exist for  stopping it quickly,  then cinchona
is the principal remedy, and by which  we can immediately
suppress every fever  and have it  entirely under  our con-
trol,  provided we understand its power and the manner of
administering  it.  For this  purpose, a knowledge of the
'conditions and rules for its administration is required.
   The  conditions are the following:
   1.  The principal one is  that the stomach  be clean, and
the tongue not furred.
   2.  That  the  apyrexia be perfect, i. e. the pulse  during it
entirely normal.
   3.  That  the fever be not complicated, but a pure, simple
intermittent.
   Cinchona is more sure and safe  after an emetic has been
given.   The mode of administration is this:  In the inter-
vals of  the paroxysms,  one ounce of finely pulverized cor-
tex chinae regalis is to be  taken in doses of half a drachm
every two  hours, or if the  interval is short, every one hour
(vide No.  23 and 24).  The same effect  is  obtained  by
quinine, eight to twelve grains to  be taken in the  apyrexia,
one grain  every two  hours (vide  No.  2o).   The  last dose
must be the strongest, and be given immediately before the 
 120             INTERMITTENT FEVERS.

 paroxysm.  If quinine creates purging, it will not cure the
 intermittent fever ; this may easily be prevented by adding
 one drop of tincturaopii every three  or four hours.  When
 it^creates costiveness, a few grains of rhubarb may be ad-
 mixed.   When it produces pressure on the stomach, nau-
 sea or vomiting, cinnamon or a spoonful of wine must  be
 admixed with  every dose ; in cramp-like affection*, Valeri-
 ana or castoreum.
  This  method  is*generally sufficient; the  fever  ceases
 after the first  or second paroxysm.   In two consecutive
 apyrexial stages  we  give  » whole dose ; in the next two
 apyrexias only one half, then one third,  finally one fourth,
 and continue thus some eight or fourteen days.  The time
 is determined  on according to the duration of the fever.
 The longer it lasts, the longer must be its subsequent use;
 as the surest means to prevent a recidive.  Simultaneously
 the patient must observe proper diet,  avoid all indigestible,
 farinaceous food,  fish,  taking cold,  and  coitus, and ap-
proaching to waters ; also purgatives, which are capable
of immediately exciting a paroxysm.
  Now, the effect of quinine is double.  It can increase the
fever, give an  uneasy feeling in the stomach, and keep the
pulse irritated during the apyrexia.   This proves that Pe-
ruvian  bark has been given too early, and  it may tend to
change the intermittent into an acute fever.   When this is
the effect, it must be discontinued, and an emetic and pur-
gatives are to  be  administered ; or if there is a complica-
tion of deep-seated visceral  affections or other complica-
tions, they must  be  removed ; after which bark is again
admissible.  Or   it  does not make  the fever wor?e nor
remove it.  Here nothing but  an addition  of  opium  is
wanted ; one grain added to the last  dose previous to the
paroxysm.  In children, or where there is an impossibility
of taking this  medicine, the same effect may be obtained
by injections of cinchona, and at the same time applying a
few ounces of the powdered bark  steeped  in wine to the
 stomachical and abdominal regions ;  also according to the
endermic method.  When quinine cannot be  obtained, or
the patient is too poor to pay for it, substitutes may be
used.   The best of them are cortex salicis,  hippocastanus,
 rad.caryophyllat. They  are administered in the same form
 and dose as cinchona.  Besides, nearly all amara, nervina?,
 setherea, aromata  (especially pepper) and astringents are
 also febrifuges; even mechanical means, as hoisting up of
 the extremities; and superstitiosa, amulets,  the efficacy of
 imagination, of faith,  may prove serviceable. 
INTERMITTENT FEVER.
121
  It is of the greatest moment in the use of the bark not to
administer it too early, nor too late, nor for too short a
time.
      Obstinate  Fevers, Quartan  Fevers,  Recidives.

  The cure is sometimes  very difficult.   Either the fever
does not cease under the use of cinchona, or it disappears
and returns after a longer or shorter interval.  The cause
of this may be triple.   Either the cinchona or another feb-
rifuge has been  given too  early, and without previously
removing the remote cause, which  continues to operate
and to  regenerate the fever.  In such a  case the remote
cause must be first  annihilated, and  emetics, resolventia,
resorted to ; sometimes also deeper seated dyscrasias, as la-
tent syphilis, etc.,  are to  be combated.   Or cinchona has
been given too late, not in sufficient quantity nor  for a suf-
ficient time.   Here a repeated and  long continued use is
necessary.
  But sometimes all  this is unavailing, and the fever per-
sists in  returning, which is  especially the case with quar-
tana.   Here  the principal remedy  is belladonna, two or
four grains a day ;  more so especially when there is an
indication of obstructio viscerum. Calomel, together  with
extract, chelidonii; iron, particularly flores ammoniac, mar-
tiales.    Finally, if all prove inefficacious, phosphorus  re-
mains, a remedy, which I  can recommend on my own expe-
rience (vide No. 26).
   Some advise arsenic in these obstinate cases ;  but it is a
remedv too unsafe, inimical to all living organism, and too
perilous in its  consequences.  I have always succeeded
with the remedies above stated.

                      Hemitritaus.

   I understand by it a case where intermittent fever is con-
nected with afebriscontinua.  The original disease or its com-
mencement is a continua, which associates  earlier or later
with an intermittent.  The patient is continually feverish, the
pulse also remains accelerated; but from time to time, at defi-
nite or indefinite periods, he is attacked by chills, followed by
increase of heat, accelerated pulse, and other febrile symp-
toms.   It is a complicated morbid state, which makes the
malady doubly affective and dangerous.  We must  hasten to
remove at least one of the fevers, in order to simplify the
disease. That which may  most easily*be removed, is the in-
termittent.  Generally, the  character of the fever is nervo-
gastric. We must, therefore, after having administered emc- 
122
INTERMITTENT FEVER.
tics, prescribe cinchona according to the rules before men-
tioned, in the intervals of paroxysms, notwithstanding that
the febrile  irritation continues; in this way we generally
are able to remove  the admixed fever.

       Febris  Intermittens  Maligna  S. Perniciosa.

  Thus the intermittent is  called, when every paroxysm is
associated  with some  fatal symptom, as sopor, apoplexia,
cholera, suffocatio ; according to which the fever receives
different  names: feb. soporosa, apoplectica,  cholerica, etc.
Such a variety of the disease is most dangerous; for the
patient often dies in the first attack, leaving it, of course,
doubtful  whether it was an  intermittent fever or not;  or
he dies in the second, certainly in the third attack.   Here
all depends on preventing the next paroxysm; and that is
done by taking in the interval one ounce of pulvis cincho-
nse regalis, and shortly before the attack a double dose, to-
gether with one grain of opium.  Opium is also the chief
remedy  during the apoplectic fit.   One  grain  must be
taken every two hours, and in increasing doses, until the
patient recovers his mental and other powers.  When he
is unable to swallow, an injection of two drachms  of lau-
danum is to be  given.  We  would find ourselves greatly
mistaken in attempting to cure such an apoplexy by vene-
section.  For it is not genuine apoplexy,but only a spasmodic
symptom of the paroxysm of an intermittent fever, which
exists and is cured only in this way.   It is only in very ple-
thoric persons that a moderate venesection may be made in
the interval, but only as an alleviating, not as a curing rem-
edy.  In the apyrexia which succeeds, the same proceeding
must be followed as in the first.  This suppressive method
must, on account of the imminent danger to life, be resorted
to  even where gastric impurities and indications for pur-
gatives are present.  The latter must be  retrieved after-
wards, after the fever is suppressed.

         The Consequences of Intermittent Fever

   Are multifarious; almost all kinds of diseases can result
from it.  Sometimes it is changed into an acute ; but more
frequently it terminates in chronic  distempers, cachexia,
hydrops, icterus, asthma, phthisis, nervous maladies, colics,
 oftenest in obstructions and physconias of the liver, and
 most frequently of the spleen, in those indurations  called
 ague-cakes.
   The causes are  either a too quick and  premature sup- 
CHRONIC FEVERS.                 123
pression of the fever, without having previously done away
with the remote causes, or a too long duration of the fever
and too late or too weak use of cinchona ;  or finally, the
continuance of a disease which originated the fever, in the
intermittent or another form.
  The cure must  vary accordingly.  The acute after-fe-
vers are treated according to their  character and  indica-
tions ; in the chronic after-maladies it  is best to use first
resolventia of the strongest kind, calomel,gummi ammoniac,
sal  amnymiac,  chelidonium, belladonna; intermixed  be-
tween them, evacuants.—Regard  must be had to the form
of the disease, e. g. hydrops, for  which  diuretica are ser-
viceable ;  in physconia viscerum, the emplastr. de galbano
worn on the spot.  If the patient be feeble, and have taken
but little or no cinchona,  then the use of  bark and mar-
tial remedies  are  proper.   In  physconias of the  spleen
(ague-cakes) the use of cinchona  has proved exceedingly
efficacious.  Is there continuance of a previous disease, the
cure must be adapted to that, e. g. to syphilis larvata, mer-
cury.  If  all should fail, the intermittent fever must  be
regenerated—a difficult task—which may be  accomplished
by saline purgatives, sometimes also by belladonna.
 CHRONIC SYMPTOMATIC FEVERS, HECTIC, CONSUMPTIVE FEVERS.

                Febres Chronica, Lenta.

   Diagnosis.  All fevers, which exceed the space of time,
which an acute fever would take.   They can  continue for
months, for years, have the intermittent type so that the
pulse always appears irritated and frequent,  even in the
morning; and when of long duration, are  connected with
disturbed reproduction (emaciation), finally with  dissolu-
tion of the organic matter, colliquation, by which they ter-
minate fatally.
  Pathogenesis. They originate either in general debility, by
which this  increased  irritability of the vascular system is
produced, in consequence  of violent, ardent corporeal fa-
tigue, excess in venere et onania, loss of blood, or in a gen-
eral chronic irritation, caused  by  heterogeneous  matters
received into the body or engendered  in it, e. g. poisons,
arthritic, psoric, scrofulous matters ;  chronic pains,  even
long continued mental excitement, grief; or  in  a  chronic
local  irritation, e. g.  chronic  inflammation,  suppuration,
disorganization of an organ. 
124                 CHRONIC FEVERS.
  Therapeutics.  The cure of these fevers consists in taking
away the causes, the debilitating potencies, dyscrasias, he-
terogeneous bodies, chronic inflammation or suppuration,
and in raising the  sunken vital power by roborantia, and
in restoration by nourishing food.
  We distinguish
  Febris lenta nervosa.  It is characterized by this, that it
is not causally connected with any local affection of a vis-
cus,  exhibits a great debility of the nerves and all functions
dependent  on  them, a quick,  small, but  variable pulse,
variable urine, more chilliness  and cold than  heat, no  or
only slight sweats,  affections of the head,  spasmodic com-
plaints, hypochondriac humor, low spirits,  mutability  of
mental  disposition, especially  a feeling  worse,  and in-
crease of fever in the  morning, and when jejune ; feeling
well and the  fever  diminished after a meal,—the contrary
of hectic fever.
  It  results often as a consequence and continuation of an
acute, particularly  the nervous fever ;  after  violent and
continued exertions of the body or mind, and after violent
excess in coitus or  masturbation ; also from continued loss
of humors  and blood,  chronic hemorrhages and blennor-
rhoeas, fluor albus, gonorrhoea, diarrhoea, epidrosis.
  Therapeutics.  The cure requires the removal of the de-
bilitating  causes—the profluvia, nervous  irritation,  exer-
tion  ; a soothing of the increased nervous irritability, and
a proper invigoration and a restoration commensurate  with
the degree of irritability.
  Particularly salutary are lukewarm baths,  impregnated
with aromatic herbs and malt, a pure country air, exhilara-
tion, the use  of cinchona  in all forms, of iron, especially in
subtile, easily digestible mineral waters, mixed with milk;
in great irritability, rad. Colombo, caryophyllat. ;  easily di-
gestible animal food, a mild, sweet, but generous wine,  as
Alicant, Malaga, Xeres, Tokay; a milder, warmer climate.
  Febris phthisica.  It  differs from the slow nervous fever,
before mentioned, in this, that there exists more  increased
warmth and disposition to overheating  and inflammatory
affections; that  the fever is greater  after  a meal, and the
patient gets hot hands, hot and  red cheeks; soon also the
morning sweat supervenes, as in general a greater  disposi-
tion to colliquation exists than in any other lingering  kind
of fever.   At the same time there are signs of an internal
or external suppuration, with which  this  fever  is  always
combined,  and in which it originates.
  Febris hectica is similar  to the preceding  one, except that 
           INFLAMM.  AND SANGU1N. CONGESTIONS.        125

it  has less heat and  inflammability, and does not pass so
quickly into colliquation as the suppurative fever does.  It
originates  in  indurations  or other  disorganizations  of
essential viscera (vide f. hectica, atrophia, tabes).
  Febris lenta symptomatica—that chronic fever, which as-
sociates with chronic dyscrasias, arthritis, syphilis, scrofu-
losis, etc.  The cure consists in the cure of the original
disease, united with  nourishing and roborating remedies,
especially milk and cinchona.
                 THIRD CLASS.

 INFLAMMATIONS, AND  SANGUINEOUS  CONGES-
                       TIONS.

     INFLAMMATIONES TOPICJE, CONGESTIONES SANGUINE.

                      Generalities.

  Diagnosis.  Redness, swelling, heat and pain of a part.—
 In inflammations of the  viscera, of course, many of these
 signs do not  exist; often  only one of  them, pain,  besides
 the disturbance in the function  of the part affected, together
 with an inflammatory fever.  Sometimes, however, the heat
 of the internal part maybe perceived by our feeling, when
 the affected  part is near  the  surface,  e. g. the liver; or
 by the hot condition of its secretion, as of the breath in
 pulmonary inflammation,  of the urine  in inflammation of
 the bladder.  The swelling likewise may be recognized by
 feeling, when the part 'affected is superficial and not cov-
 ered by bones.  Pain also, which is sometimes great, as in
pleuritis, gastritis. But this sign is fallacious, for sometimes
 there are violent inflammations unaccompanied by pain,
 and which terminate in  death (inflammationes occulta)
 This discrepancy depends  on the seat of the inflammation :
 When it is located in membranes, or the membranous  sur-
 faces, there is much pain ;  less when  in the parenchyma of
 an organ (pleuritis,  peripneumonia, encephalitis dolorifica
 and stupida); also  less when  situated in  the gangliary
 system, the innervation of which is  normally  insensitive.
 By an  inflammatory action the natural  condition may be
 altered, and the part become  affected, sensitively  or not.
 Therefore the physician must  not  omit to  feel and press 
126
INFLAMM. AND SANGUIN.  CONGESTIONS.
the body of the patient in cases of abdominal inflammation ;
doing  which will enliven the  patient's feeling, and cause
him to complain of pain, of which he was not before aware,
or which he seemed  to  feel in another spot than the  real
seat of disease.
  It is often very difficult, and  always very important in
practice, to discriminate internal inflammations from  vio-
lent internal neuralgias  or other spasmodic affections.
Pain and oppression of the chest, or  pain in the  stomach
and abdomen can be as  violent as in the highest inflamma-
tion, although it be but spasm and nervosity which cause
it.  This discrimination is of  the highest  importance, yea,
often decisive of life  ; for in the  first case, a venesection is
the only serviceable  means ; in the latter, opium, and  this
might  prove fatal in  the first.  Here,  therefore, great pre-
caution is to be used, and I recommend the following points
for research :   1. The presence of fever, whether the local
complaint has set in  with chill or heat, thirst,  accelerated
pulse ; if  so, we always suppose the existence of inflam-
mation.  2. Hardness,  fulness and strength of the pulse,
however, may not exist in  abdominal inflammations,  and
in the higher degrees of pneumonia.  3. The urine, which
deserves special  attention, if red, is indicative  of fever
and  inflammation ; if pale  and  watery, a principal sign,
often  the  only one,  to  distinguish  spasm from inflamma-
tion.   4. Permanency.    Pain always  permanent, points
to inflammation ; if changeable,  to  spasm.  Finally, 5. In
abdominal inflammation, external pressure.  If the patient
can bear it, even feels the pain diminished by it, his disease
is not  inflammation.   But we  must remember, that every
long continued painful affection of a viscus, although in the
beginning only spasmodic, can at last create inflammation.
In dubious cases, a cautious test by abstraction of blood,
best local, near the seat of the pain will set us aright.
  The duration of an acute inflammation is seven to four-
teen days, rarely longer.   It terminates either in perfect
resolution, which is always accompanied  by general and
local crises of sweat, critical urine, hemorrhages, local secre-
tions, as expectoration  after pulmonary inflammation ; or
glides  into chronic  inflammation,  or induration, formation
of tubercles, all kinds of pseudo-organization, hypertrophy,
or suppuration, or  mortification.   Frequently it gives rise
to after-maladies:  exsudation of lymphatic and  serous  hu-
mors  in the  neighboring cavities,  as hydrops cerebri, h.
thoracis,—adhesions after cerebral and  pulmonary inflam-
mations.   Finally, local weakness, even paralysis of  the 
INFLAMM. AND SANGUIN.  CONGESTIONS.       127
inflamed  part, as imbecility after cerebral inflammation ;
blennorrhoea pulmonum after  pulmonary  inflammation ;
amaurosis after the ophthalmic inflammations ;  as well  as
morbidly  increased local irritability.
  Perfect discussion of an internal  inflammation is recog-
nized by cessation  of the  fever and  the  accompanying
crises.  Continuation of feverish excitement in the pulse,
although  the local symptoms have abated, always indicates
that the discussion is imperfect.   Transition into suppura-
tion is recognized by a chill suddenly setting in, abatement
of pain, but not an entire cessation  of the local complaint,
and continuation of fever ;—into gangrene,  by sudden and
complete cessation of pain and  local complaints, immedi-
ately  followed by a  sinking, small,  intermittent pulse, and
coldness of the extremities.
  Pathogenesis.  The proximate  cause is increased vitality
of the vascular system and  of the blood ; an  increased
vital and formative process of one  part, exhibited  by aug-
mented irritability and increased action of  the vessels,  by
equally increased  sensibility  of the nerves, and by aug-
mented plasticity of the blood.   .
   The immediate  consequence  is  (on  account of the  in-
creased  action of the arterial, and not  equally increased
action of the less  irritable vehous vessels), a sanguineous
overloading of the part, causing extravasation  in the cellu-
lar tissue, exsudation of lymph,  even of blood, and hence
swelling of the part.  From the same cause, and from the
increased vitality, proceed the augmented warmth, redness,
and  from  enhanced sensibility, pain.   Therefore, in the
essence of inflammation a double character appears: phlo-
gosis (the augmented  irritability of the solid parts), and
plasticity (the  augmented  vitality  of  the  blood),  and  on
these are founded the two principal varieties of inflamma-
tion, when  one of both elements  is overpowering.  The
dry (inflam.  sicca), where tension, irritability of the fibre
 prevails; the moist (inflam.  exsudatoria), where lymphatic
coagulability and exsudation preponderates.
   A  sanguineous  congestion exists in every inflammation,
but not an inflammation in every congestion.  It may exist
and continue without  inflammation, but can  also create
inflammation.   Congestion becomes  inflammation,  only
when it  produces in the part  a new state of  vitality, that
one alone which constitutes the essence and  existence of
inflammation.—There is likewise irritation in every inflam-
mation ; but every irritation is not an inflammation. There
is a purely nervous irritation,  of which the vascular system 
128       INFLAMM. AND SANGUIN. CONGESTIONS,
 does not partake at all.  There is even vascular irritation,
 which is not inflammation.   Therefore, we can call irrita-
 tion inflammation  only  when  there is generated in the
 irritated part a new plastic reproductive life in  the blood ;
 and which is made apparent by the signs before stated.
   This newly  created pathological vital  process, like a
 local fever, goes through its stages of increase, acme, and
 decline, within certain periods of seven, fourteen, or twenty-
 one days, and may undergo the following internal changes:
   a. Perfect crisis (complete resolution),  where the  phlo-
 gosis and extravasation is simultaneously removed, but
   b. The plasticity and stagnation (stasis inflammatoria) re-
 mains, by which are subsequently formed indurations (most
 frequently due  to weakness or abstraction  of blood carried
 too far, or warmth, or local application of cooling remedies
 which suppress the inflammatory process).
   c. Exalted irritability is  removed, but augmented sensi-
 bility of the part remains (pain, erethismus nervosus,  most
 commonly met with  in  sensitive persons, or in those in
 whom sanguineous abstraction has been carried too far).
   d. Or  the  inflammation  arrives at its height while the
 vital power continues in  force.   Here an entirely new and
 particular vital process, possible  only after this augmenta-
 tion of vitality,  is produced,—suppuration, which generally
 takes place when the debilitating remedies have been  neg-
 lected, or the inflammatory irritation has been increased by
 stimulants.
   e. Or the inflammation not only reaches its height, but
 simultaneously consumes the vital power of the part.  Here
 succeeds mortification, when the system or the part was
 previously feeble or disposed to putrefaction, or has  been
 extravagantly  debilitated, or when  the necessary debili-
tating remedies have been neglected ; and when on the  con-
trary additional stimulants have been administered, causing
excess  of  irritation.   Summus  gradus inflammationis est
initium putredinis.
  f.  Or finally,  there  remain watery effusions or pseudo-
organic productions and adhesions.
  Of the remote causes the predisposing ones are, augment-
ed irritability of a part, either innate or acquired ; general
inflammatory diathesis, youth, high living;  general inflam-
matory fever, apt to be associated with local inflammation as
effect, as local concentration of the inflammatory state,  san-
guineous plenitude of a part either natural (as in the lungs)
or acquired, as by chronic congestion, local weakness.
  The exciting are: all that can produce an adequate  irri- 
INFLAMM. AND SANGUIN.  CONGESTIONS.
129
 tation, either local, such as :  mechanical irritation, wounds,
 concussions, poisons, acids,  morbid matters (e. g. arthritic,
 syphilitic, acicfbile"); warmth and cold ;  extravagant exer-
 tion (even of thinking) in the brain ; local spasm—summus
 gradus spasmi est initium inflammationis—sanguineous con-
 gestions, organic disorders, e. g. tubercles in the  lungs ;
 or by  sympathy which can transfer an irritation  to remote
 parts,  especially gastric sympathy, or the generation of
 inflammation bv gastric irritants in remote parts, the throat,
 lungs, brain, skin ; in the liver by concussion of the brain ;
 or antagonistic by suppression of  organic action, by which
 another can be produced and increased to the degree of
 inflammation, e. g. inflammation of internal parts by taking
 cold ;  suppressed cutaneous action, by metastases.
   Variety of inflammation.  Inflammation, therefore, differs
 greatly,
   1. As regards its degree;  it may be violent or mild.
   2. As regards its seat, the constitution, and age  of the
 person affected.  It  is more violent in the superior vital
 organs ; more  chronic in the inferior mucous membranes,
 lymphatic vessels, bones; more phlogistic and distinguished
 by increased sensibility in the nerves (inflammatio erethica
 nervosa).
   3. In reference to its origin: either in the inflamed part itself
 (inflam.  idiopathica) ; or by a remote cause, engendering it
 sympathetically (inflam. sympzthica which is either consen-
 sualis or antagonistica, e.g. the gastric bilious inflammation).
   4. As to  its  character.  The inflammation is phlogistic
 or phlegmonous, dependent  on the blood ;  nervous or ere-
 thic, affecting  the nerves, and less distinguished by phlo-
 gosis than  by  augmented sensibility ; rheumatic or serous
 (less phlogistic and less resting in the blood and sanguine-
 ous vessels, but more in the serous) ; erysipelatous (slight,
 more exanthematic, existing only in  the epidermis and de-
 pendent  on  a gastric state); putrid  (generally secondary,
 sometimes primary, where the inflammation is accompanied
 with weakness  and exhaustion of the vitality of the part,
 e. g. the scorbutic, the  pestilential, carbunculus malignus,
 angina gangraenosa) ; specific (engendered by a particu-
 lar morbific matter,  e. g. the syphilitic,  scrofulous, arth-
 ritic, etc.).
   Finally, the  difference of  inflam. sicca  and exsudatoria,
 which  is often  accompanied from the  beginning by lym-
 phatic  extravasation,  e.g. angina polyposa, peritonitis, puer-
peralis, encephalitis exsudatoria.
   Especially important in practice,  is the difference be- 
130        INFLAMM.  AND SANGUIN. CONGESTIONS.

tween  the  proportion of the vital power to the inflamma-
tion.  In this respect it is divided into inflam. activa, where
the local inflammation  is combined with  a generally in-
creased vital energy; and into passiva, where vital energy
is wanting  either in the whole or in the affected part.  Of
this there are different degrees : the nervous, which, so to
say, keeps  the  middle between active and passive inflam-
mation, and where a  certain degree of energy in the vascu-
lar system  may  exist; the atonica, caused  by a violent
stroke, a contusion or  commotion, by  which the  power is
impaired ;  the putrid or gangrenosa s. maligna, which exhi-
bits vitality annihilated, a transition into  dissolution and
putrescence, created either by general debility of the sys-
tem, putrid diathesis, or by  the paralyzing power of the
matter which excites the inflammation, e.g. contagium pu-
tridum, carbuncle matter,therefore receiving that character
either immediately from the beginning or in  the course of
the disease ; chronica,  where an inflammatory irritation of
a part continues for  months  and years, without  really in-
creased energy of its vascular system, even frequently with
impaired energy of  it, rather a  congestive state  than real
inflammation, brought on either by former active and not
fully resolved inflammation as a consequence, or by con-
tinued local irritation, either mechanical or chemical, or
metastatic, or organic  (tubercles) ;  or by local debility of
the part.
  Periodical inflammation must yet be mentioned ; it is one,
which returns according to certain times, and entirely fails
in the intervals.   It must  by no means be considered  a
real inflammation, but is always the product of the nervous
system, on  which in  general depends all morbid periodicity.
  The notion of inflammation, especially of the chronic, as
well as the  application of the antiphlogistic method, espe-
cially of abstractions of blood, has recently been too much
extended.  Inflammation is thought to exist in every topical
affection with pain, or with increased irritability ; in  every
disease, where, after death, redness, or extravasation, or
pseudo-organization  is found.  But  that topical  affection
may depend merely on local  erethism, and  may be purely
nervous ; that redness may be merely the consequence of a
congestion or sugillation arisen after, or with death.  The
exsudation and pseudo-organization may be brought on by
inactivity and stoppages of reproduction, as well as by in-
flammation.  Even  genuine  inflammation, as soon as it
becomes chronic, is  founded  on weakness of the  part, and
must always be considered with the passive. 
INFLAMM. AND SANGUIN.  CONGESTIONS.        131
  Therapeutics.  The first  indication must always be  to
remove as quickly as possible the irritant morbific matter,
that causes the inflammation, e. g. the splinter, poison, or
gastric humor.  The second : to examine into the charac-
ter of the inflammation, which may be multifarious, and to
adapt to it a proper treatment.  The third :  to effectuate a
perfect resolution of the inflammation, i. e. a perfect local
crisis, by which, not only  the  actual inflammatory affec-
tions, but also its consequences, are annihilated.
  Perfect resolution, therefore, must be  the principal idea
and  the  chief object in the cure  of inflammation.  Now,
this  resolution, it is true, is the work of the healing power
of Nature, a local as well as a general crisis in the fever ;
but it must be well  understood and pertinently supported
by the physician, and in this regard mistakes frequently are
committed.  Therefore the physician must be careful while
annihilating the inflammation not to disturb, nor to impede
the operation  of healing nature.
  Not alone diminution of vital  action  in the inflamed
part, but also removal  and  re-absorption of the stasis pro-
duced by inflammation, stagnation in  the  venous vessels,
even extravasation and exsudation of coagulable lymph are
understood by the word  of entire resolution of the inflam-
mation.  This must a.lways be the object of cure.  It com-
prises,  therefore, not only  debilitation, but also  a solvent
and  re-absorbent action,  a negative and  positive part.
 Hence  debilitation  (antiphlogosis) is the  principal indi-
 cation, but always observe not to carry  it too far, so that
 power may remain  to effect solution and resorption of the
 effusion, and that a transition into a nervous or a paralytic
 state  be prevented, nor stagnations, indurations, exsuda-
 tions in the inflamed part be left behind.
  The principal remedy is abstraction of blood, local and gen-
 eral ;  above all, venesection, which, if made in time, in the
 proper quantity, and with quick evacuation, will  annihilate
 the  very germ of the  inflammatory process and  effect the
 whole cure ;  but, if carried  too far, may cause an imperfect
 resolution, a transition into induration, gangrene, or into a
 nervous and putrid febrile state.  It is indicated where
 there exists a general inflammatory diathesis (signs of febr.
 inflam. universalis), and is  to be repeated until these symp-
 toms are removed.  The first  venesection must be made
 early and boldly, allowing the blood to flow until the hard,
 full  pulse becomes  softer and smaller, or  the suppressed,
 small  pulse fuller, and the inflammatory  symptoms have
 disappeared  or abated.  The pulse is the  chief sign to 
132        INFLAMM.  AND SANGUIN.  CONGESTIONS.
 guide us in  this case.  Generally it is full and  hard, but
 sometimes also  small, as  in  inflammation  of the lungs
 (which impede respiration and the circulation through the
 lungs), and  inflammation of the abdominal viscera, and
 calls the  more urgently for venesection.   The main pre-
 caution is to prevent fainting, by which,  where there is
 great coagulability, coagulata and  concrements are apt to
 form during the stoppage. Local abstractions of blood are
 advisable  only when a full flow of blood  and the general
 phlogistic diathesis are  already  diminished  by  general
 phlebotomy, since  retarded circulation  and  moderated
 phlogosis tend to sanguineous congestions  in the inf amed
 part; or in such cases, where general phlebotomy is not
 necessary, or is injurious on account of a  nervous or de-
 bilitated state.  With abstraction  of blood  must be com-
 bined  directly debilitating  antiphlogistic  remedies, the
 appropriate application of which can save  much  blood  to
 the  patient.   The principal  remedies are nitre, and vege-
 table acids and water, cold, applied locally (vide inflamma-
 tory fever).
   We must next resort to  derivation of the  irritation by
 contrastimulants, for which purpose, stirring up the intes-
 tinal  action  and  secretion,  and cutaneous irritation  (by
 sinapisms, vesicatories), are serviceable ;  but  only, when
 the violence of the sanguineous phlogosis has been assuaged
 by abstraction of blood, without which every additional ir-
 ritation augments  inflammation.   These derivatives  will
 often remove the remainder of local irritation.  In such
 cases the  application of dry cups (ventoses) in the neigh-
 borhood of the inflamed part, is also of use.   They with-
 draw a part of the blood from the circulation in the inflamed
 part, without causing debility by direct  loss.
   While doing all this, we  must not lose sight  of the ne-
 cessary dissolution  of the inflammatory stagnation, and of
 resorption.  This end is sometimes obtained by the reme-
 dies mentioned above ; but the symptoms of local stagna-
 tion often  remain.   For this purpose tartar emet.,  calomel
 and potassa? carb. are of use, and are the principal remedies
for the perfect solution of the inflammation.  They must be
used in the beginning in  exsudatory  inflammations, such
as angina polyposa, peritonitis, puerperalis,  hydrocephalus
 acutus.
  Now, the phlogistic state of inflammation  may  have been
removed, and in consequence of having carried debilitation
too far, its nervous  property may continue as augmented
sensibility, erethismus, spasm in  the inflamed part.  The 
           INFEAMM. AND SANGUIN. CONGESTIONS.        133

local symptoms of irritation do not abate, and there is no
further  indication for phlebotomy,  on the contrary, the
pulse and other symptoms indicate nervosity.  In this case
the phlogistic inflammation  has passed into a nervous (ere-
thic) one, and  now antispasmodic and narcotic  remedies
(hyoscyamus, aqua laurocerasi, opium), with derivative con-
tra-stimulants,  as vesicatories, are the  best, yea, the only
means for entirely annihilating the remaining inflammatory
state.   Regarding vesicatories it is well to observe, that if
they are to  be of any service in local  inflammations, they
must be sufficiently large,  and remain applied  until they
draw blisters;  for the local  evacuation is also important.
   When the inflammation passes into gangrene, or shows a
tendency to it from the beginning, as  in angina gangrenosa,
and carbuncles, roborant, animative,  antiseptic, anti-dissol-
vent remedies  are called for: acida mineralia, cinchona,
serpentaria, arnica, wine, camphor.
   It is of great moment to pay due regard to  the different
causes, species, character, and localities of inflammation.
   As for the first (causes), we must  distinguish:
   The purely phlogistic, phlegmonous inflammation.  Here
the treatment just mentioned is to  be applied in  its full
extent.
   Nervous (erethic) inflammation requires from the begin-
ning cautiousness in the abstraction of blood, especially
general bloodletting.  Cupping and leeching are preferable.
Here derivatives, especially  anti-stimulants, mild, not heat-
ing nervines, as aqua laurocerasi, hyoscyamus, connected
with antiphlogistics, are most useful; and in extreme weak-
ness, Valeriana, arnica, and  lukewarm baths.
   The putrid gangrenous inflammation totally  prohibits ab-
straction  of blood, and requires from the commencement
the use of strong roboratives and antiseptics.
   Gastric, especially bilious  inflammation, requires emetics
and purgatives, combined with antiphlogistics. Sometimes
they alone suffice for curing the inflammation, and there is
no need of phlebotomy.
   Exsudatory inflammation calls for  abstractions  of blood
from the  onset, and  for the  use of dissolvent, resorptive
remedies, calomel, digitalis.
   Rheumatic and catarrhal inflammation, as it  is not phleg-
monous by its nature, does not call  for  abstractions of
blood, by which, on the contrary, it would be made chronic
and its crisis disturbed; but only for antiphlogistic reme-
dies, diaphoretics, antimonialia, cutaneous irritations, espe-
cially vesicatories.  It is only when the rheumatic catarrhal
                           12 
134       INFLAMM. AND SANGUIN. CONGESTIONS.

inflammation is increased to a phlegmonous one, that phle-
botomy is required ; generally, however, local abstractions
of blood are sufficient.
  Erysipelatous  inflammation  requires, on  account of its
nature, no abstractions of blood, which on the contrary are
unavailing, or render it chronic, or  effect  a rapid disap-
pearance and metastasis ; but  it calls for purgatives which
here fully replace abstractions of blood.  When erysipela-
tous inflammation  reaches to a phlegmonous one, abstrac-
tions of blood are necessary.
  Metastatic, specific inflammation (the arthritic, syphilitic,
scrofulous, psoric), requires, besides the antiphlogosis, par-
ticular attention and  regard to the morbific matter, in order
to annihilate, derivate or evacuate it; that is, in the arth-
ritic, vesicatories, sinapisms, antarthritica; in the syphilitic,
mercury, etc.
  Atonic inflammation after commotions, calls for cold and
arnica.
  Periodic, intermittent inflammation is cured by cinchona,
given during the intervals.
  Every acute febrile inflammation requires for  its perfect
cure universal crises by the skin and urine (vide inflamma-
tory fever).


                 Chronic Inflammation.

  Its fundamental  character must always be considered as
weakness, passivity, and therefore the treatment must tend
to a proper invigoration, modified according to the differ-
ent degrees of vascular irritation, which may be sometimes
effected by cooling strengthening remedies  (cold and cold
water are  the  principal  means); sometimes  also  by the
strongest  and most ardent roborantia, as cinchona, iron.
At the same time a special regard must be paid to the san-
guineous  congestion already  existing or  accruing from
time to  time,  and  which requires in the meanwhile, local
abstraction of blood ; and also to the morbific matters and
metastases, all which perpetuate the irritation and organic
disorders.  However, here also let it not be forgotten that
sanguineous congestions may be caused by local weakness,
and call for abstraction of blood ; a local one is  best  and
must be done with due respect to the  original character of
the disease, being regarded only as a palliative and symp-
tomatic not as a radical remedy. 
INFLAMM. AND SANGUIN.  CONGESTIONS.        135
                Sanguineous  Congestion.

   The doctrine of sanguineous congestion  is one of the
 most important of the medical art;  for sanguineous con-
 gestions are among the most frequent affections, are the
 foundation of innumerous maladies, and  as such, also the
 true, the only objects of treatment.
   Diagnosis.   We understand by it every abnormal pleni-
 tude of blood in a single organ or system of the body. The
 signs are: More or less disturbed function  of the organ,
 increased or diminished irritability and sensibility, varying
 according to the different degrees of congestion; in mode-
 rate sanguineous plenitude these symptoms are augmented,
 and are diminished ia great accumulation, distention, and
 pressure  of the vessels, which cause want  of action, and
 even paralysis ; especially in cerebral congestions ; in mod-
 erate accumulation there is liveliness of thoughts; in greater
 there is stupefaction; in still greater, paralysis, apoplexy,
 feeling of fullness ; increased warmth in the organ affected,
.the  fits augmented by  exercise, ardent beverages  and
 meals.
   The next effects are  all  accidents of disturbed function,
 and thus  they  can produce  all kind  of nervous diseases,
 from the most simple spasm to hypochondria and epilepsy;
 likewise  all kind  of local diseases; in the stomach, spasm
 of this viscus and indigestion ; in the intestinal canal, colic,
 diarrhoea; in the liver, disordered secretion of bile ;  in the
 lungs, asthma, cough,  phthisis; in the brain, cephalalgia,
 delirium,  madness; in the  organs of the senses all kind of
 diseases  peculiar  to them; in the secretory organs, pro-
 fluvia, suppressions, etc.  Farther, inflammation of the, or-
 gan too rich in blood by too highly increased irritation. In
 an increased degree  paralysis, apoplexia, paralysis dorsa-
 lis s.  medullaris.  In still  a higher degree  of distention,
 ampliation,  tenderness  of  the vessels, varicous, aneuris-
 matic distention, finally rupture.
   The best  instance of all  these effects is exhibited  in the
 hemorrhoidal disease, which is nothing else than a conges-
 tion of the abdomen,  plethora abdominalis (vide  hemor-
 rhoids.)
   Pathogenesis.   Sanguineous congestion consists in too
 great an accumulation in the vessels of an organ. It differs
 therefore  from inflammation  in this, that augmented pro-
 ductivity, that new pathological life, which constitutes the
 essence of inflammation, is here wanting ; but it is  com- 
136        INFLAMM. AND  SANCUIN. CONGESTIONS.
bined with every inflammation, and inflammation may arise
from every congestion.
  Sanguineous congestion may originate in three different
ways:
  1. In local weakness of a part (passive congestion)—the
most frequent cause of congestion, which acts in a double
manner.  In the first place it is a fundamental law, not only
of the human system but of all nature, that an equal impulse
given to a fluid, will cause it  to accumulate most,  where
it finds the least resistance ; therefore, congestion will take
place where there is debility, be  it vital weakness,  atony,
or relaxation.   Thus congestion arises in every part debili-
tated by violent concussion ; thus it arises in every relaxed
vessel, e. g. the local  hemorrhoidal congestion, when the
rectum is relaxed by too frequent injections.  In the second
place,  by  local weakness: the^power  of the blood-vessels,
principally of the venous, being diminished in an organ,
the circulating action is made more difficult  and inert, the
necessary consequence of which  must be stagnation and
accumulation  of blood in them. Thus hereditary weakness
of the  lungs  engenders continual sanguineous congestion.
in them (dispositio phthisica) ; the innate weakness  of the
portal system the dispositio hamorrhoidalis.  Thus the most
innate or hereditary dispositions may be derived from that
original cause.
   2. In local irritation of a part (active congestion).  Irri'
tatio attrahit is a fundamental  law of organic life.   Every
local irritation of  a part, be it mechanical, chemical, or
organic,  produces  by the thereby increased action of the
arterial vessels an increased  afflux; and as the action of
the venous vessels is not equally increased,  an  accumula-
tion of blood  in the irritated parts follows. Thus irritation
of the skin generates cutaneous congestion, irritation of
the eye by a grain of sand,  ophthalmic congestion.   Thus
perpetual mental irritation of the brain by meditation, cere-
bral congestion.  In the  same way operate pathological
irritations.  Tubercles in  the lungs entertain, like hetero-
geneous bodies, a constant irritation ; thereby a continual
sanguineous  congestion  in  them, which gives rise to
ha?moptysis and phthisis. Indurations  in the uterus sustain
a constant sanguineous congestion in it, thereby frequent
hemorrhages.  Of particular moment,  deserving especial
attention,  are  the metastatic irritation, the  shifting of a
morbific matter into an internal organ, by which chronic
irritation  and  chronic  sanguineous congestion  is  enter-
tained. 
INFLAMM.  AND SANGUIN. CONGESTIONS.
137
   We now come to an important consideration—variety
 of irritation.   It may be either  local (idiopathic),  or re-
 mote  (sympathetic), and thus congestion  also  may  be
 created by local or by remote irritation (idiopathic or sym-
 pathetic congestion).  The sympathetic, again,  may  be
 double, either consensual or antagonistic.
   Consensual irritation is that kind which happens accord-
 ing to the  law of consensus ;  is a reciprocal concordance,
 especially of the nerves, a propagation of an irritation from
 one part to another; it is  capable of producing a sangui-
 neous congestion,  the  primary irritation of which lies re-
 mote from the seat of the congestion.  The most important
 centre of irritation lies  in the nervous system of the abdo-
 men ; whence proceeds the frequent occurrence of consen-
 sual sanguineous congestions  to the head and lungs.
   Antagonistic irritation is that which arises according to
 the law  of  opposition (antagonismus), which means:  the
 suppression of an organic action (also  of a pathological
 one)  calls forth  another, operates as an irritant to excite
 another.  It is a rich source  of congestions.  Thus, sup-
 pressed action of the skin  generates  violent congestions
 in  internal  organs;  suppression of the catamenia, of the
 hemorrhoidal flux,  congestions to  the  lungs,  stomach,
 brain, etc.
   3. In mechanism.  Congestions may arise in obedience
 to  purely mechanical laws, and are of frequent occurrence.
 A common  case is found in the mechanical stoppage of the
 circulation  of the blood in one part, by  which there must
 necessarily  occur an accumulation of it in some other cor-
 related part. Thus a ligature produces congestion in parts
 situated  above it.  In the same way operates the pressure
 of  tumors,  of  enlarged  viscera,  of indurations, as from a
 wen,  sanguineous congestions in the head,  from enlarged
 indurated liver, sanguineous congestions in the portal sys-
 tem, piles.  The same  effect  is produced  by tight dress ;
 thus, tight lacing, and compression of the abdomen by con-
 tinued  sitting,  produce  sanguineous congestions in the
 portal system.  Even the law  of gravity  produces conges-
 tions ;  as a low position of the head may bring on cerebral
 congestion,  or hanging down of the legs one in the feet.
  Hence result two  essential  differences in regard to the
 character of congestion : the active and the passive.
  Therapeutics.   In the first place we must examine,  whe-
ther general plethora is  at  the bottom of the congestion.
This is recognizable  by  a full  incompressible pulse, con-
nected with heaviness in the  limbs, dyspnoe and palpita-
                         12* 
138                   BRAIN-FEVER.

tion  of the  heart in all kind of exercise.   In this case ge-
neral and local abstractions of blood,  cooling derivative
remedies ; and for a radical cure of the sanguineous pleni-
tude, meagre diet,  diminution of sleep, drinking of water,
and consumption of the humors by strong exercise, and a
cool regimen,  are the principal means of cure.   We must
next ascertain, whether it  is a local irritation (idiopathic
or consensual), or a specific humor that gives rise to and
sustains the congestion.  If so, it must be removed, and it
will often suffice alone to cure the congestion j  and with-
out the removal of it all other  remedies are of no avail.
Regarding the  first, attention must be paid to local habitual
irritation, as of the  brain  from continued study;  of the
lungs from crying and too  loud singing,  etc.  If from the
consensual irritation excited by gastric sordes, infarcts, or
worms; these  are  to be removed.  As for the second, we
must investigate,  whether  there exist a syphilitic, psoric,
rheumatic,  arthritic  cause. But when  it is  the conse-
quence of a debilitated or spasmodic state, strengthening,
antispasmodic  remedies are serviceable;  bearing constant
respect to  the excitement  of the vascular system, which
forbids the  use of heating  remedies.  At the same time
local  diminution of  the  plethora must  be resorted  to,
partly by local abstraction of blood or other humors (arti-
ficial sores, derivatives), partly by  a local application of
repelling and astringent potences, among which cold ranks
first.
        BRAIN-FEVER,  INFLAMMATION OF THE  BRAIN.

                 Encephalitis, Phrenitis.

  Modern  authors make a  further distinction into menin-
gitis (inflammation of the dura mater), and arachnoitis (in-
flammation of the arachnoidea) ; but these subdivisions are
only of anatomical, not of practical value, and furnish no
particular indication.
  Diagnosis.  Constant delirium or sopor, or both united
together, with fever and indications  of sanguineous con-
gestion in the head, redness and fullness of the face  and
eyes, hot forehead, pulsation of the cervical veins, and fre-
quent attempts to grasp the  head.
  But  it is well to remark,  that every delirium or sopor
together with fever is not inflammation of the brain ; for
then every violent inflammatory fever, every nervous fever, 
BRAIN-FEVER.
139
would also be one;  but this is not the case.   The essential
symptoms are: the signs of sanguineous congestion to the
head, and the  permanence of delirium or sopor.  Some-
times also very violent pains in  the head  are combined
with it, sometimes not.  This seems to depend on the seat
of the inflammation, for when it seizes on the membranes
of the brain, there  is pain; when it affects  the sabstance
of the brain, instead of pain there is a pressing, dull sensa-
tion,  (similar to the difference between pleuritis and peri-
pneumonia).                                   t
   This inflammation terminates either in perfect resolu-
tion,  or it leaves debility  and derangement in the cerebral
action (chronic madness,  imbecility, loss of single senses) ;
or, what is very common, it ends in effusion, dropsy of the
brain ; or it passes into  disorganizations, as induration,
even  suppuration of the brain; finally, into gangrene;  this
is however a rare occurrence, for  it is generally anticipat-
ed  by death.  It proves  fatal by  paralysis  of the brain
(apoplexia).
  Pathogenesis.  The proximate cause of the phenomena is
irritatio cerebralis  inflammatoria.   As every  other kind of
violent  cerebral irritation can create the same  apparent
phenomena, delirium and sopor,  so also the symptoms of
inflammation of the brain may be present when there is
none. Hence arose the old dispute whether phrenitis were
or not of an inflammatory  nature, the decision of which is
to be found in  the varieties of encephalitis, which practice
admits and must admit.   Irritation of the brain  is either
of a sanguine  character  (enceph.  inflammatoria), or it is
merely nervous, without rXartaking in the vascular system
(enceph. nervosa), or it  is purely consensual, arising from
the abdomen, especially from precordial irritations (enceph.
gastrica),  which also may  have an  inflammatory or a nerv-
ous character.
  The remote causes are : all that has a tendency to violent-
ly irritate the brain,  and bring it into increased and anom-
alous  action: as great heat and cold, mental emotions, too
great  exertion  of the intellectual faculties, excess in alco-
holic  spirits, concussions and wounds of the head, re-
bounding  concussion from falls on the back or buttocks,
great  sanguineous congestion, metastases, contagia, espe-
cially those which  tend to the brain, typhous and scarla-
tina ;  lacteal, bilious and helmenthie  irritation, every  vio-
lent febrile  irritation, and finally,  great debilitation of the
brain ; and as  every debilitation  may  augment  irritation
and bring on anomalous action, so will excessus in venere 
140                  BRAIN-FEVER.
 et  onania, hysteria,  hypochondria, nervous  fever  by
 weakness.
   The variety  of character always depends, partly on  the
 quality of the causes, partly  on the existing disposition.
 As for the first, it is noticeable th'at the same cause in pro-
 portion as it operates quickly and concentratedly, or chro-
 nically, may have a quite different effect in regard to cha-
 racter; as when spirituous liquors are taken in large quan-
 tity within a short space of time by persons unaccustomed
 to them will produce inflammatory encephalitis, but  when
 long  continued, and become habitual, create a nervous,
 atonic encephalitis  (delirium tremens, which has been mis-
 taken and considered as a particular disease, but which is
 nothing else than encephalitis nervosa).
   Therapeutics.  The fundamental idea of the treatment is
 to  remove  the irritatio cerebralis.  But to  do so it is most
 important to discriminate its different causes and character,
 by  which  this end may be attained in quite different ways.
 We must  examine and distinguish carefully the following
 cases:
   1. Encephalitis inflammatoria.   The patient  is all the
 time in  a delirious state, stupid or raging ; or lies soporous,
 with reddened eyes, red tumid face, pulsating arteries, dis-
 tended  veins of the head and throat, heat of the head and
 forehead,  full strong frequent pulse (which,  however, may
 sometimes be rather impeded and suppressed), red urine.
 Here  copious  bleeding,   general at  first,  then  local  by
 leeches on the  neck, temples, or behind the ears, cupping
 on the neck (in case of necessity opening of the temporal
 artery); after  proper  abstraction of blood vesicatories in
the neck,  cold fomentation on the shaved head, and if these
do not suffice, cold affusions of the head every  two hours,
 sinapisms on the calves of the legs ; internally nitre, ex-
citing the intestinal canal to frequent evacuations by  anti-
phlogistic purgatives, sulphate of magnesia, tartar, emet.,
calomel every two hours in one or two grains doses.  Re-
gard must be had to the causa remota, as to arthritic me-
tastasis.
  Now, if the  inflammatory  state has disappeared, which
will be  perceived  by  the fever,  redness of the  face and
eyes, pulsation  of tracheal arteries abating, but the deliri-
um and  sopor still continuing, then we have reason to  sup-
pose that the malady has passed into the stadium nervosum
lymphaticum. When this  happens, the cerebral affection
has ceased  to be sanguine, inflammatory, and there only
remains nervous irritation, dependent on debility, perhaps 
BRAIN-FEVER.
141
 already combined  with  incipient exsudation.  Here  the
 mode of cure  must immediately  be changed, and opium
 together with calomel and vesicatories  on the neck must
 be employed; also musk, camphor,  arnica, digitalis;  and
 when sopor continues, the head must be shaved and a large
 vesicatory, even cauteries, applied.
   2. Encephalitis nervosa and adynamica ; ought properly to
 be called phrenitis 7iervosa, since in this case there is no in-
 flammation  present.  The patient is  furious,  often most
 violently so, without the  least signs of sanguineous conges-
 tion to the head,  has a febrile but small pulse,  and most
 frequently trembling and  other spasmodic symptoms. Under
 this head falls the delirium febrile potatorum (tremens), ona-
 niticorum, also hystericum, on which the preceding causes
 throw much light.  Here nothing more  is necessary than
 to remove  the nervous  irritation of  the brain (cerebral
 spasm),  and  opium  is most  useful for this purpose, toge-
 ther with derivatives, contra-stimulants,  tepid  baths;  in
 obstinate cases, musk, camphor, castoreum, liq. c. c suc-
 cin.;  in great debility,   cinchona,  arnica, wine.  Also
 emetics  as strong contra-irritants are often the best seda-
 tives of the brain.  Here,  however, in plethoric persons,
 by accidental exciting influences,  a sanguine,  yea inflam-
 matory complication may be admixed, recognisable by the
 signs of congestion.  The  same must be removed by  ab-
 stractions of blood and other antiphlogistics, but then the
 antispasmodic exciting method must be again  resorted to.
   3.  Encephalitis  gastrica,  biliosa,  verminosa.   The signs
 of a cerebral affection combined with the signs of gastric
 or verminous accumulation.  The  cure consists in cleans-
 ing the prima? via? by emetics, laxatives,  and  vermifuges.
 This consensual  affection  however  produces a  merely
 nervous  as  well as a  really inflammatory irritation of the
 brain, and in the latter case the venesection, and in gene-
 ral a combination  of antiphlogistic  with antigastric reme-
 dies are  necessary.
   In  the  treatment of all cerebral inflammations respect
 must be paid to the exciting cause, e. g. metastasis arthri-
 tica,  psorica, suppressed catamenia,  and  hemorrhoids,
 especially to that  caused by commotion or vulneration of
 the brain, in  which the necessary surgical assistance must
 not be neglected ;  in other cases, however, the entire treat-
 ment for  enceph. inflammatoria is to  be employed. This
 applies also to the encephalitis of lying-in women.   It is to
 be treated in accordance with its character,  either anti-
phlogistically or antispasmodically (especially by camphor, 
 142              MYELITIS,  SPONDILtTIS.

 opium, also by belladonna), but with a  perpetual regard to
 lacteal metastasis to the brain and abstraction of milk from
 the breasts.
   When the stadium acutum is over, and mental derange-
 ment or paralysis remains,  the  treatment for madness or
 paralysis must be resorted to.
   Exsudatory  inflammation  of the  brain, hydrops  cerebri
 acutus infantum, hydrencephalus (vide diseases of children).


   INFLAMMATION  OF THE SPINAL MARROW, INFLAMMATION
               OF THE LORSAL VERTEBRAE.

                  Myelitis,  Spondilitis.

   Diagnosis.   Pain in some  spot of the spine, either per-
 manent or returning always on the same side; to which
 paralysis of the extremities,  commonly of the lower, some-
 times of the upper, associates  sooner or later, and  gene-
 rally beginning at the peripheral termination of the nerves.
 The pain is sometimes very insignificant, or even entirely
 wanting. Therefore, to discover the disease, we must feel
 and press each single vertebra  of the whole spinal column ;
 and  if there be  an inflamed spot, this  pressure will  cause
 the patient to feel sensitive there; more so, when the spine
 is touched  by a sponge and warm water.
   The inflammation  may  be acute and febrile ;  but more
 frequently it is chronic, and then very difficult to be recog-
 nised.   This malady brings on paralysis, which affects not
 only external  but also internal parts,  e. g.  if the disease
 lies at the upper dorsal vertebra?, single cervical and pec-
 toral nerves will be affected, causing dysphagia,  dyspnoe,
 palpitation  ; if at the lower dorsal vertebrae—complaints of
 the stomach and intestinal canal.   Thus inflammation of
 the spinal  marrow can assume the form of the most dif-
 ferent  chronic diseases^ and is  frequently  mistaken for
 such (vide paralysis, tabes dorsalis).
   The issue is, if it is not resolved, exsudation,  hydrops
vertebralis, adhesion, exsiccation, callosity, atrophy of the
 spinal marrow, suppuration, caries.
   The causes are, besides  the  general,  sanguineous con-
 gestion, especially hemorrhoidal ; rheumatism, metastasis,
 mechanical lesions.
   The cure is antiphlogistic, especially leeches on the af-
 fected part and mercurial  embrocations, calomel, purga-
 tives, long continued  vesicatories  on  the  morbid spot;
 treatment of the metastasis. 
ANGINAE.
143
         INFLAMMATION OF THE THROAT, QUINSY.

                       Angina.

  Diagnosis.  Painful, difficult, often impeded swallowing,
or altered voice, difficult, sometimes whistling respiration,
or bothrtogether.
  The variety  is determined by the different seats of the
inflammation, when  it occupies the pharynx (angina pha-
ryngea, pharyngitis), the larynx (angina laryngea, laryngitis,
tracheitis),  the  tonsils (angina tonsillaris)^  the uvula (ang.
uvularis), or the tongue (glossitis).
  The accompanying symptoms are :  Afflux of saliva and
expectoration  (on account  of  the  impeded  swallowing);
exsudation of viscous mucus from the inflamed parts  of
the mouth and  coating of them thereby;  oppression and
hinderance of the circulation of the blood partly of the re-
flux from the head, by the pressure on the tracheal veins,
partly  of the circulation  in the lungs by  the  oppressed
imperfect respiration,  hence in the higher degree  of in-
flammation peripneumonia, sopor, even apoplexy.
  The disease is often one of the slightest and most insig-
nificant complaints, but is  also liable to become  dangerous,
even fatal.   This depends partly  on the intensity of the
disease and the swelling  of the inflamed parts ; partly on
the seat,  and in this respect tracheal  inflammation is the
most perilous.
  It  terminates either in perfect resolution  or passes into
induration, or suppuration (especially  angina tonsillaris);
in chronic  inflammation of the  throat,  or in death.  This
follows either by suffocation or by apoplexy.  The cause
of suffocation is frequently only mechanical, as a swelling
of the internal parts  compressing the trachea and vessels
of the  throat, or sometimes merely a  spasmodic contrac-
tion in consequence  of inflammatory irritation.
  Pathogenesis.   Besides  general, local taking  cold in the
throat, from without,  or  from  within, by cold  drinking
whilst  heated,  or by the  influence of cold and northeast
winds* in the open  mouth.   Some contagia, e. g. scarla-
tina and syphilis, specifically affect  the throat.
  Therapeutics.   The cure of  inflammation according  to
its different degrees.  In lower degrees, general  antiphlo-
gistics, with local dissolvent remedies are sufficient.  Such
are: gargles (the common  elder-tea, with vinegar and
honey, vide No. 39), linctus  No.  40,  or borax  half  a
                      * In Europe. 
144                    ANGINAE.
 drachm, with two ounces of mulberry syrup (syrup, moro-
 rum) ;  still more efficacious is alum, injections of the same,
 vapors.  Externally,—the throat is to be thickly wrapped
 in flannel; embrocated with linitnentum volatile ; sinap-
 isms, general and local abstractions of blood.  Local bleed-
 ing by  leeches or by cups on the neck, is often more benefi-
 cial than general ;  but the latter must precede when there
 is a high degree of inflammatory fever  and plethora.   In a
 lower degree, leeches alone are  sufficient.   The higher
 degree, like peripneumonia, sopor,  oppression of the chest,
 and small, soft pulse, earnestly call  for venesection.  If the
 difficulty of swallowing or breathing does not abate, after all
 the antiphlogistics  have been employed,,continued  spasm
 is to be  considered  as the cause ; in  which  case, opium
 with calomel, a  vesicatory around  the  neck, and  narcotic
 cataplasmata often bring speedy relief;  also an emetic may
 here be  serviceable ; the difficulty of swallowing is  no
 contraindication; the  patient throws  up easier than he
 swallows.
   The  variety of location requires particular  auxiliaries.
 In inflammation of the pharynx, linctus  and gargarisms ; of
 the larynx, vapors ; of the tonsils, which  threaten suffoca-
 tion by the swelling, scarification  of it by means of the
 pharyngoton, by which the most imminent  danger of life
 may instantaneously be rempved; likewise in inflammation
 of the tongue, the  swelling  of  which frequently fills the
 whole cavity of the  mouth,  scarification of the tongue by
 longitudinal incisions on both sides are  necessary.
  Especial attention  is due  to  the variety of  character,
 whether it is purely inflammatory, or catarrhal, or gastric,
 or mixed  of several.
  Inflammation of the throat of a gastric character (angina
gastrica, biliosa).  The signs are those of the inflam'mation of
 the throat, together with the  symptoms of a gastric state,
 coated tongue,  etc.   Here an emetic is the principal rem-
 edy, which often makes a cure by itself; afterwards a pur-
 gative.  In complication with genuine  inflammation,  ab-
 stractions of blood, and the means  necessary on such  an
 occurrence.
  Inflammation  of the throat  of catarrhal character  (an-
gina serosa, catarrhalis, rheumatica).   Signs :  little pain but
more swelling,  more  white, covered with  viscous mucus;
 most frequently seizing  the tonsils (ang. tonsillaris) or the
uvula (ang. uvularis),  but sometimes also  the glottis, with
 or after a  rheumatic affection.  The fever  is slight or en-
tirely absent.  The disease in itself is free from peril, being 
ANGINE.
145
only a rheum of the mucous membrane of these parts;  but
it can even endanger life by the local  swelling of the ton-
sils, or uvula, by a mere mechanical closing up.  The cure
requires:  first, regard to gastric complication, which here
exists very frequently.  In this case,  an  emetic, and then
purgatives afford the best and quickest relief. When there
is no gastric complication, cooling diaphoretics, and above
all sal. ammoniac,  are the  principal remedies; externally,
embrocations of linim. volat. on  the throat,  and wrapping
it  in wadding or  leaven,  emplastrum sinap.  around  the
neck, gargling  with stimulant astringent remedies,  espe-
cially rad. pimpinell.  (vide 41,42,43), alum,  sal. ammo-
niac,  friction, also injections of similar fluids  are here
particularly necessary, in order to  rinse and evacuate  the
gathering tenacious slime. If this  does  not succeed, and
fever and  inflammation increase, then  leeches, even  vene-
section, and calomel must be applied.  Does the swelling
of the tonsils or uvula increase to such a  degree  as to
threaten suffocation, then  incisions  in the uvula (longitu-
dinal)  are the  safest and quickest means for relief and
saving life.
  Inflammation of the parotid glands (ang. parotidea, paro-
titis), mumps, exhibits a swelling of the parotid and sub-
maxillary glands, which sometimes  can attain a  very high
degree, and make even the internal parts swell, even unto
suffocation.  It is of a purely catarrhal character, and pre-
vails commonly epidemically during other catarrhal mala-
dies.  Generally  it yields to  diaphoretic treatment  (by
keeping warm  externally, being wrapped in  worsted) and
to antiphlogistic cathartics ;  when  of a  higher  decree, to
calomel, leeches, and particularly to emetics.  It is notice-
able that  this affection is apt  to produce  consensual  swell-
ing of the testicles, and in general to make metastases;
hence  cold lead,  camphor, or  other repelling remedies
must not be"applied.
  Inflammation  of the throat of a putrid  character (ang.
gangranosa, putrida).   Signs:  inflammation, swelling of
the internal, commonly also  of the external parts of the
throat, exhibiting immediately from the beginning, bluish,
violet-colored spots and putrid  stinking smell ; violent fe-
ver, delirium, difficult breathing ; black  scurfs as  early as
the second  or  third  day, issuing a  very  acrid,  stinking
ichor, which corrodes all  parts, even  the palate and nasal
membrane ; rattling respiration, increase of sopor and suf-
focative symptoms.  Death ensues frequently on the fourth,
at latest on the sixth day.
                          13 
146                   STOMACACE.
   The disease is rare in our climate, and generally a symp-
tom of scarlet fever, often of a concealed  one.   The cure
requires first emetics, and then the most vigorous applica-
tion of antiseptic"roborant and stimulant remedies:  cin-
chona, serpentaria, wine, mineral acids, externally injec-
tions and frictions with the same substances,  calx chlo-
rut., vapors of vinegar mixed with myrrh ; of great efficacy
is also cold,  frequent drinking of ice-water, little bags of
ice put into the  mouth.
   Angina pectoris, vide asthma syncopticum.
   Angina habitualis, angina chronica, is called so, since it
always returns on the least occasion.   It is a very trouble-
some evil, and likely to follow violent inflammations of the
throat.   It is dependent on  continual disposition from re-
maining  local weakness.
   The best cure consists in continued gargling with alum-
water  (two drachms to one pound of water mixed with an
agreeable syrup) ; daily cold washing of the throat, and a
neckcloth of flannel or silk, on the bare skin.   If this treat-
ment is unavailing, we must search  more deeply for  the
root of the disease—metastasis—specific morbific matters,
local derangements.
   The chronic angina is sometimes generated also by mere
weakness, and is removed by the remedies just mentioned.
   But more frequently the cause is a  metastasis, of which
the most frequent are  the rheumatic, arthritic, syphilitic,
scrofulous. Here the only treatment is that of the rheuma-
tism, of arthritis, or syphilis, or scrofulosis. Intermediately,
when it  becomes more phlogistic,  application of leeches.
Careful attention must be paid to hemorrhoidal congestion
and  other abdominal accumulations,  which but  too often
are at the bottom of the malady; in this case, the best
treatment to remove the angina is, derivation of the piles, a
well-conducted dissolving and  evacuating visceral course.
Not unfrequently I succeeded to cure it by trTe use of  the
Carlsbad well, the natural as well as the artificial.  Finally
we must  not neglect  to have regard,  whether there exist
organic disorders, indurations, ulcers and the  like.
  Angina polyposa,  membranacea,  laryngitis  exsudatoria,
quincy, croup  (vide diseases of children).

                      STOMACACE.
                      Stomaitis.
   Diagnosis.  Inflammatory phenomena in  the mouth, ac-
companied by a putrid smell, tongue and  gums  much 
GLOSSITIS.   PULMONARY INFLAMMATIONS.       147
coated.  It occurs most frequently among children, and is
epidemical.
  The cause is catarrhal or gastric.  In grown persons it
is often a symptom of scorbutis.
  The cure consists principally in the  prompt administra-
tion  of an emetic, which alone often removes the whole
evil;  afterwards laxatives, acids.  Locally, gargling and
swabbing with a solution of chloride'of lime in water.
  When it is a symptom of scorbutis, it must be  treated
accordingly.

                       GLOSSITIS.

  Diagnosis.   Inflammation of the tongue exhibits the fol-
lowing signs :  swelling, redness, heat of the tongue, great
difficulty of swallowing, in a high degree total impossibility,
danger of suffocation ; it may swell so as to fill the whole
mouth ; yea, as not to leave room for itself.
  Issue, if not  in  resolution, it terminates in induration,
suppuration, or gangrene.
  Causes are, besides the general, local lesions, acrid sub-
stances, points of decayed teeth, rheumatism, catarrh, me-
tastasis.
  The  treatment is similar  to  that  for  inflammation;  as
general and local abstractions of blood ; in  great swelling,
longitudinal incisions into the tongue, which quickly cause
a subsidence of the swelling and removal of the danger. In
obstinate cases, mercurial embrocations may be used.
         INFLAMMATION OF THE CHEST AND LUNGS.

                Pneumonitis, Pneumonia.

  It appears under various forms—painful and painless,
and accordingly receives various names.  It is called
  Pleuritis, when it is accompanied with stitches  or pain
in drawing  breath, the  pleura, the  costal muscles, or the
surface of the lungs being the seat of the inflammation.
  Peripeneumonia  (inflammation of the  lungs properly so
called), when it  is not accompanied by any pain, but with
oppression, difficulty of respiration and anxiety, the par-
enchyma of the lungs being the seat of inflammation.
  Pleuro-peripneumonia, when  both pain  and  oppression
are present, and in this case, superficial and parenchyma-
tous inflammation are combined. 
148
PULMONARY INFLAMMATION.
   Bronchitis (inflammation of the mucous membrane  of
 the bronchia), when marked by a constant and violent irri-
 tation,  tickling cough and hoarse voice.   It is only a ca-
 tarrhal  inflammatory irritation of the mucous membrane
 (vide catarrhus  pulmonum  inflammatorius).
   The distinction is, however, more anatomical than prac-
 tical ; for the phenomena are  rarely thus  isolated ; at least
 they do not continue* so, and the  treatment is  the  same
 in all cases.  However, parenchymatous inflammation  of
 the lungs  (peripneumony) is particularly noticeable on
 account of the  absence of  pain, and the small pulse, lest
 these negative symptoms lead us into error.
   Diagnosis.  Stitches  or pain in one part of the chest, in-
 creased  by inspiration, and  which frequently prevent full
 breathing, pulse  hard and full.
   Or pressure, oppression of the chest, anxiety ; pulse soft,
 small, sometimes unequal and remittent.
   Cough produced by deep inspiration, or  in violent inflam-
 mation, even by speaking, or the least exertion of the chest,
 is a principal sign and constant accompaniment  of every
 inflammation of the chest.   Where there is no cough there
 is no inflammation, even if pain and other  sigus were pres-
 ent.  The cough may  be either dry or moist, with expec-
 toration.  When dry it indicates either an inflammation of
 the pleura, or in peripneumonia, the highest degree of in-
 flammation.  Expectoration is either serous, mucous, or
 bloody ;  pure blood may be expectorated in the highest
 degrees of the disease.
  Inflammatory fever with  all its  signs,  heat, thirst, red
urine, hard pulse, is present.  The pulse, however, is liable
to deviations, which are apt to create illusions, and  render
diagnosis difficult.  It  may, in spite of the most  violent
inflammation, and on account of it, become small and soft
and lead the tyro to  consider it the pulse of weakness.
The cause  of this is double :  Either the  violent pain  felt
in inspiration (as in pleuritis), prevents the patient from
distending the thorax, and therefore causes imperfect res-
piration, which prevents the free  circulation of the blood
through the lungs, and  thence  only partially into the heart
and the general circulation ;  or the stagnation of the blood
in the substance  of the lungs causes incipient hepatisation
(as in peripneumony).   This also impedes the course of the
blood through the lungs, into the heart, and in the general
circulation.  Hence the pulse is made small and soft, some-
times unequal and remittent, in short, very similar to the
pulse of  weakness.  But this illusion of the pulse, as well 
PULMONARY INFLAMMATION.
149
as that of the oppression, can be easily discriminated from
real  weakness, by  ordering the patient  to  cough or  to
take a deep inspiration.   On doing  so  the pulse will in-
stantly become full and  hard, and its true inflammatory
character apparent.
  The signs afforded through hearing by means of the ste-
thoscope or percussion, have recently been highly recom-
mended for the diagnosis of pulmonary diseases.   But
these signs are very illusory, nor will the existence of an
inflammation ever be discovered  by them alone ;  while the
other signs are sufficient  of themselves for the purpose  of
diagnosis.  At most, they may serve to detect the locality
of disease, but this affords no indication, and  has no influ-
ence on the treatment.  At best, it will aid to define more
accurately the limits of the after-maladies,  induration or
suppuration.
  The disease varies in its severity from slight to most
violent degrees, and  in  the latter case there is delirium
(produced by the violence of the fever), and sopor (by the
impeded  return of the blood from the brain, on account  of
its stagnation  in the lungs).
  Pulmonary  inflammation  is either primary, appearing
simultaneously with the setting-in of the fever, commencing
commonly with a violent chill;  or is secondary, setting  in
only in the course of the fever.
  The course  and duration are very regular,  occupying
seven, fourteen, rarely twenty-one days.
  Of crises, the general, is manifested by sweat  and urine,
often also by epistaxis; the local,  by pulmonary secretion,
and expectoration,  which  are indispensable  to perfect
resolution.   The  wholesome critical sputa is  yellowish
white, similar to a  thick  emulsion ; and in the  beginning
may be mixed with  dark  blood-streaks (the older sanguine-
ous extravasation now becoming loose), and is thrown  up
easily.
  The issue is either :
  A perfect resolution, recognizable  by the general  crisis ;
and the  local one of sputa, cessation  of the cough and
fever ;
  Or is a transition into suppuration, either open or incist-
ed (vomica), marked by abatement of the  pain, but contin-
uance of the feeling of pressure,  especially  in drawing a
deep breath or lying on one side ; a not entirely free respi-
ration, cough when deep inspiration is made, also by speak-
ing and  walking ;  feverish pulse, apparent  good  health,
returning appetite  for three or four  weeks; but  then a 
150             PULMONARY INFLAMMATION.
hectic evening  fever commences,  hot  hands, hot,  red
cheeks after a meal, expectoration of matter; or  in  the
case of vomica, increase of cough  and local  complaints,
phthisis purulenta ;
  Or is a transition into  induration, tubercles, characterized
by  the fever abating, but  respiration  not entirely free ;
short, dry  cough, especially in  drawing a  deep breath ;
sometimes fugitive stitches in the chest ; and as for  the
rest, there  is an apparent restoration of health ;
  Or is a transition into  blennorrhea of the lungs, which is
distinguished by  the fever  abating,  but copious mucous
expectoration continuing, emaciation, finally phthisis pitu-
itosa ;
  Or death from suffocation, complete hepatization  of  the
lungs or gangrene, but rarely the  two last, since the patient
is previously choked.
  Not seldom hydrothorax  is formed during the disease,
and becomes a morbus secundatius
  Pathogenesis.  Besides the general causes of inflamma-
tion, there  are particularly the following :
  1. The  natural inflammatory  disposition  of the  lungs
themselves.  No part of the body is so liable to inflamma-
tion as this ; hence pulmonary inflammations are the most
frequent of all.   This is due to the  abundance of blood it
contains, rendering  it the  most plethoric portion  of  the
body, since  it must  receive the whole mass of blood ;
moreover, the lungs are  subject to the immediate influence
of all nuisances they are exposed  to, and finally to their
own constant creation of warmth, since they are the  hearth
of the vital flame, which is  kindled anew by every  respi-
ration.
  2.  Fever.  Every fever increases  the circulation, hence
congestion in the lungs ; and when violent, is so  far an
inflammatory or morbidly irritated condition, able to bring
on pulmonary inflammation.
  3.  High  standing of the barometer and dry cold; it  there-
fore is more frequent and epidemical in a severe winter,
and its passing into spring.
  4.  Much animal food and ardent beverages.
  Exciting causes are especially taking cold, catarrh, rheu-
matism, suppressed usual hemorrhages, measles, also vio-
lent concussions of the  body,  of the  chest  as well as of
 other parts, particularly  falls and blows on the back.
  Therapeutics.   Venesection, tartar emetic, and vesicato-
ries are the principal remedies.  First a venesection  on the
arm of the affected side as soon as possible, and by a large 
PULMONARY INFLAMMATION.
151
opening, so that the blood may spout arch like, and allow
it  to flow until the hard, full pulse becomes softer  and
smaller; or the small, soft (in oppression of the  chest, or
very violent  stitches) becomes fuller and larger, and  the
stitches or oppression abate or entirely cease ;—but with
constant regard to the pulse, so that the patient appioaches
to syncope, but does not faint quite away, for this is apt to
create  stagnation  and coagulation  of  blood in the lungs,
heart and great vessels.  Accordingly, the patient must lie
down during the  venesection, and  as  soon as the pulse
becomes unequal or  remittent, the  vein must be  closed.
Phlebotomy is to  be repeated according to these principles
should  the same  indications return.   This inflammation
requires and bears most  copious bleeding.  The  earlier
venesection is made, and the more copious the first one is,
the more decisive is its effect for  annihilating the  whole
inflammatory process.  In this way a repetition of vene-
section may be made superfluous, and much blood saved to
the patient.  Weak,  tuberculous lungs, and phthisical  dis-
position strongly  call for abstraction  of blood.  In such
cases,  even  a lower  degree of inflammation, requires at
least a moderate  venesection ;  and in  the violent degrees
of peripneumonia, the veins in both arms should be  opened
simultaneously.   Immediately after  venesection,  tartar
emet., which is the principal and really specific remedy in
this disease,  must be given together with nitre (vide  No.
44), and if the  local affection do not entirely abate, a large
vesicatory must  be  applied  on the  affected  part.   These
remedies will perfectly suffice in most cases.
   But  when, after  a longer  or  shorter space of time,
stitches and oppression  return, or, if they, had  not been
entirely removed, increase,  and  the pulse  becomes fuller
and harder;  or in oppression smaller, then venesection is
to be repeated according to  the rules mentioned  above.
   There  are cases, where  venesection is  salutary  and
necessary, even in the third or fourth  week ;  as  when  the
pneumonic complaints continue, especially if it  has been
neglected at the commencement,  the  abstractions have
not been sufficiently  copious, and in tuberculous lungs.
   But,  should the  pain  increase,  without  fullness  and
hardness of the pulse also increasing, ten or twelve  leeches
ought  to be  applied  on the most suffering  or oppressed
part; after this,  should the  pneumonic  affections  persist,
calomel together with opium (vide No. 4-5)  is to  be admin-
istered. Also senna with sal ammoniac (vide No. 46)  will
prove  very  wholesome, especially in peripneumonic diffi- 
152
PULMONARY INFLAMMATION.
culties, and for promoting the local pulmonary crisis (ex-
pectoration).
  In the stadio erethico of pulmonary as well as  in all other
local  inflammations, the following  mixture has an excel-
lent effect:
Supertart. potass.	3ij.
Nitr. pot.	3i.
Aqua? laurocerasa?	Sij.
Vini. antimonii	3i.
Aqua? fontan.	Svij.
Succi Glycirrh.	3iij.
Syrupi Alth.	5/J-
       M. S.   Two table spoonfuls every 2 hours.


  Drinkinglargely of mucilaginous dissolvent fluids, decoct.
hordei with honey, or oxymel simplex, weak elder tea, spec.
pectoral, must accompany all these remedies. In those vio-
lent pains or great difficulty of breathing, also spasm, which
sometimes continue notwithstanding the loss ofblood, em-
brocations of linim. volat. together with opium and  warm
cataplasms of narcotic herbs, are of excellent use. Expec-
toration must be properly regarded and supported, since it
is a local crisis, indispensable for perfect resolution.  For
that  purpose, lukewarm, dissolvent mucilaginous  bever-
ages, as decoct, of barley, gruel, groats, rad.  althaea}, hb.
tussilag. with honey must be taken in  considerable  quan-
tity; also warm vapors of flor.  sambuc. are to be inhaled,
when  the expectoration is very  viscous and difficult.
Linctus of syrup, liquirit. together  with sulph. antimon.
aur., oxymel sciHit., syrup, senegae, vapors of flor. sambuc.
steeped with water and vinegar ;  when the expectoration is
watery and acrid, and there is a continual irritating cough,
mucilaginosa, salep-decoction ; linctus of oleum amygdal.
one drachm,  mucilag. gumm. arab. q.  s. ad subact.,  aq.
font.,  syrup,  amygd.  aa one  ounce, extract,  hyoscyam.
four grains ; and a vesicatory on the breast, are proper.
  When  the  patient expectorates pure blood, caused by
violent inflammation, a venesection must  be  resorted to;
or, if it be black, dissolved and connected with symptoms of
debility, acid, sulphur, with mucilage.
  In a lower degree of pneumony, the mixture mentioned
above (vide No. 44), together with tart, emetic, may im-
mediately be  administered.  It will often effect the whole
cure.   If it do not suffice, a venesection is to be made. 
PULMONARY INFLAMMATION.
153
   But all pneumonies cannot  be cured  in  that manner;
 there are some  in  which venesection is unavailing, even
 injurious.   Each different character calls for a different
 method of cure, and must be carefully discriminated. The
 following are the varieties, which require difference in the
 treatment:
   1. The gastric, especially bilious inflammation of the
 lungs.
   There are cases, where the  pulmonary affection is not
 real inflammation, but only a consensual affection of conges-
 tion, or merely an erysipelatous  irritation of the pectoral
 viscera, caused by  a gastric accumulation in the stomach,
 or a biliary one in the hepatic system, in which a pure phlo-
 gistic  treatment, especially  abstraction of blood  is  of no
 use, but on the contrary most pernicious.  They are recog-
 nized by the absence  of hardness and fullness of the  pulse,
 which is frequent and soft, and at the same time the signs
 of gastric accumulation which  bear a clear relation to the
 affection of the  chert, notwithstanding the  presence  of
 violent stitches and  oppression  in  the  chest.  Here the
 cure must be directed not to the  pulmonary and vascular,
 but to the gastric system.
   The case can be  double :
   Either  all the signs  of  high gastric  turgescence are
 present, such as a thickly pappy-coated  tongue,  bitter,
 foul taste, nausea, inclination to vomit or actual vomiting,
 headache, often also something yellowish in the face, espe-
 cially about the  mouth.  Here tart. emet. is  to be given,
 so as to cause sufficient vomiting ; the patient will evacu-
 ate a great  quantity of bile ;  this.treatment will frequently
 immediately remove the most violent pleuritic  pain and
 other symptoms of inflammation, and cooling laxatives will
 finish the cure.
   Or the signs of gastric impurities are present (vide gas-
 tric fever), but at the same time hard, full pulse, red  coun-
 tenance, plethoric constitution.  Here a venesection  in the
 arm must first be made, and then tart. emet. is to be given,
 so as to make vomit; afterwards cooling laxatives.   The
 emetic may be repeated on return of indication.   Some-
 times the  inflammatory symptoms  appear  only in  the
 course of the disease.   In such a case, also, are  phlebo-
 tomy and leeches to be  used.
  2  The rheumatic pneumony  (pleuritis rheumatica). The
patient, after taking cold or  previously  existing  rheuma-
tism, is affected by  violent stitches, or pain on one spot of
the chest, which is increased by pressure.  This is the 
154            PULMONARY INFLAMMATION.
distinctive sign of this species.   It may be connected with
cough (by consensual irritation) and difficult breathing,
(since pain prevents the patient  from distending  the tho-
rax).   Here the disease is nothing but rheumatism in the
pectoral  and intercostal muscles, sometimes also of the
pleura itself.  A  vesicatory on the painful  part, covering
it with flannel, and the internal use of tart, emetic, half a
grain every two hours, and a diaphoretic regimen, are the
principal remedies.  In young'plethoric persons, leeches
may be previously  applied.  This rheumatism, however,
partly by increase and communication  of the irritation,
partly by the obstructed respiration, may associate  with
a sanguineous congestion and inflammation of the lungs;
in this  case also venesection  in the arm is not to  be
omitted.
  3.  Putrid  inflammation  of the lungs  (pleuritis putri-
da, gangranosa),  exhibits immediately at  the onset  the
highest vital debility and disposition to putrid dissolution.
The signs are those  of putrid fever with very low pulse,
fetid  breath, dark-colored, dissolved bloody sputa.   The
malady rarely occurs with us, and only epidemically.   The
cure is the same  as that  for putrid fever,—mineral acids,
Peruvian  bark,  alum, balsamic, antiseptic  inhalations of
warm vinegar and myrrh ; also cold fomentations on the
chest. Venesection is fatal.
  4. The adynamic inflammation of the lungs (pleur. no-
tha).  It occurs in aged  people, and  is marked with diffi-
culty of  breathing and weak pulse.   It easily passes into
a complete paralysis of the lungs and catarrhus  suffoca-
tivus.  The chief remedies are: arnica,  senega,  sulphur
antimon. aur., kermes, liquor c.  c.  succin., vesicatories,
sinapisms.   Venesection will be but rarely needed, and
when so, always,  however, with precaution.


                  Pleuritis  Chronica.

  By this name  are  signified chronic pains in the chest
either constant or returning from time to  time, generally
connected with cough and difficulty  of respiration.  They
are of various kind and significance, and therefore require
the most careful examination and discrimination.  They
are commonly due to chronic rheumatisms of the thorax.
Here a vesicatorium  perpetuum on  the spot, covering of
flannel, and anti-rheumatic remedies  are of use.
  Or they are caused by hemorrhoidal congestions to the 
PULMONARY INFLAMMATION.             155
chest, whichmay be recognized by the disposition, or piles
previously existing.  Here leeches on the chest, as well as
at the anus, cooling laxatives, sulphur, in  plethoric persons
even venesection  are  requisite.   In the  female sex, men-
strual congestion  may have the same effect.
  Or the evil originates in the lungs themselves.  This is
an important point  for discrimination and  diagnosis;  for
the two first kinds are not dangerous ; but they may ter-
minate in phthisis.
  This  case is double : either there are tubercles  in  the
lungs, which inflame from time to  time, and then  create
pain, accompanied by  stronger or weaker febrile motions,
dry cough,  sometimes bloody expectoration, and  a little
dyspnoe.  It lasts for several  days, then  abates, and after
a longer or shorter  time the pains return in the same spot.
Such  attacks  deserve the  greatest attention  and  most
speedy removal, for every inflammation  increases the  tu-
bercles or causes them to pass into suppuration.   There-
fore a small venesection, leeches on the painful part, and
antiphlogistic remedies, must  not be delayed, followed by
a vesicatory, which must be kept open for sometime (vide
phthisis tuberculosa).
   Or there  are  vomica, or  inclosed abscesses, which  be-
come inflamed from time to time, causing pain.  Also here
the antiphlogistic treatment is necessary (vide vomica).


      Belated  Assistance,  and  Perilous State of Life.

   The cases are not rare where the physician is called to
the patient after the  seventh day; or  where, in spite of
medical aid, a state endangering life has been developed
within this  period.  Here nothing  less than a proper  and
vigorous assistance can save  the life  of the already des-
paired-of patient;  but for this purpose  the various cases
must be  carefully discriminated.
   1.  The  patient  lies in the highest degree  of  oppres-
sion,  with short, panting, rattling,  hot breath,  orthopnoe,
frequent, short cough, expectorating nothing  But  blood;
dizziness of the  head, or delirium, sopor, hot, red face ;
quick, sometimes full, but most frequently small and weak
pulse ; red urine.   When this is the case, venesection  has
been  either entirely omitted,  or but  imperfectly resorted
to.  This condition is that of the highest degree of inflam-
mation,  over-filling and obstruction of  the lungs.  Here
a venesection alone may yet save the patient, and has done 
156            PULMONARY INFLAMMATION.
 so as late as the tenth or twelfth day. But here a case may
 occur, which is one of the most painful and  anxious in the
 whole course of practice.  It is possible that  hepatization
 of the lungs is already formed, and advanced to such a de-
 gree, that but little blood can penetrate through the lungs
 to the heart.   Venesection can  no further  remove  the
 inflammation, but takes away only that  small quantity of
 blood  which  is left for  circulation,  and the  patient dies
 during or soon after its performance.  The physician can-
 not foresee such an emergency with certainty ; however,
 if the inflammation be still removable, salvation is depend-
 ent on venesection.   Here all must be left to a most accu-
 rate consideration of all the  circumstances,  and  to the
 conscience  of the physician.  It is one of those  cases,
 where he has to sacrifice his reputation to his duty and his
 conscience.  Afterwards a  large  vesicatory to the  chest,
 calomel with  opium, inhalations  of  flor. sambuci, steeped
 in water and vinegar.
   2. The patient labors under  the same difficulties of
 respiration, but all the symptoms exhibit the greatest vital
 debility and a nervous state, as pale  urine, cold extremi-
 ties.  The patient has undergone sufficient, perhaps too
 copious bleeding.—Here a quite opposite condition  exists,
 a  want  of  action  in the  lungs, incipient paralysis; now
 nothing short of the most active excitantia and resolventia
 are capable of saving life ; a large vesicatory on the chest,
 sinapisms on the calves  of  the legs,  continual inhalations
 of the vapors from flor. sambuc. or arnica, with water and
 vinegar ; internally, musk, together with opium and calo-
 mel, kerrnes  mineralis,  ammonium  in  infus.  arnicae.  In
 case of necessity, also an emetic may be given.
   3. Great difficulty of breathing, the  most intense anxiety,
 dizziness of the head, delirium, great prostration, frequently
 to  fainting,  pulse frequent  but not  inflammatory,   urina
jumentosa, and sometimes watery diarrhoea; anxiety and
difficulty of respiration increase and decrease;  very un-
clean tongue, covered with a pappy coat, yellow, brown or
blackish ;  bad taste,  nausea, inclination  to vomit, eructa-
tions ;  and  frequently  the   skin  is  yellowish about the
mouth.  This is a purely gastric state, and the whole op-
pression and anxiety arise from a  consensual irritation by
gastric impurities.  The  necessary evacuants have  either
been neglected in the beginning, or  in the course of the
 disease gastric accumulations have been  engendered.  In
 short, the only remedy for saving life  in this  case is an
 emetic, best  fifteen grains of ipecacuanha given at  once 
CARDITIS.                     157
and then five grains every quarter of an hour, until vomit-
ing succeeds.

                   Subsequent Cure.

  The after-cure of pulmonary inflammation often requires
great attention, partly to remove the remains of inflamma-
tory obstructions in the lungs, and thereby to prevent the
formation of tubercles and consecutive phthisis tuberculosa,
partly to make good the state of debility generated by the
inflammation, and to guard against the  transition into
phthisis pituitosa.  The case is  therefore double: Either
the patient continues to  cough, but the cough is  dry, and
there is but little  expectoration.   Here the best  remedies
are the use of whey,  of Selters water mixed with milk,
hyoscyamus, digitalis  in  small doses, and a vesieatorium
perpetuum on the upper arm.  Or there remains  copious
expectoration of mucus, which in the beginning relieved,
but now, instead  of diminishing,  gradually increases and
weakens the patient.  In such cases, the surest and really
specific remedy is lichen islandicum, given in the form of
gelatina to the extent of two or  three ounces daily ; if it
irritates too much in the beginning, it may be mixed with
dulcamara and liquiritia.
              INFLAMMATION  OF  THE HEART.

                        Carditis.

   Great anxiety but without that cough which is excited by
 inspiration, very violent fever, very quick  but soft, small,
 unequal, remittent pulse ;  fits of fainting, cool  extremities,
 and generally a painful pressure on the left of the sternum,
 in the cardial region.   The symptoms resemble very much
 those of a high degree of peripneumony, for in both cases
 they are due to obstruction of the circulation of the blood,
 here  in the  heart, there in the  lungs.   However, the  ab-
 sence of pulmonary cough, and short respiration ; and the
 presence of oppression, sighing and swooning ; and a hori-
 zontal position,  which is  insupportable in  pulmonary  in-
 flammation, are discriminative of the two  diseases.  But
 high  inflammation  of the heart is always followed  by
 inflammation of the lungs.  This discrimination is of  no
importance as regards the treatment; for in carditis the
same  treatment is to be followed and the same principles
                          14 
158                    GASTRITIS.
observed as in pneumonia.   Frequent and copious  vene-
sections are especially advised, and are the more necessary
the smaller and the more remittent the pulse  is.


               ABDOMINAL INFLAMMATIONS.

  In all inflammations of the abdomen within the perito-
neum, three things are noticeable:
  1. The pulse is small, suppressed, often thread-like, and
is then indicative of the highest inflammation.
  2. The sensibility of the inflamed part is very illusory ;
pain is frequently entirely absent, or is discoverable only
by hard pressure.
  3. It is on these accounts, that inflammationes acuta  are
so likely to  occur in the abdominal region.


             INFLAMMATION  OF THE STOMACH.

                       Gastritis.

  Diagnosis.  A  constant violent burning, stitching pain
in the gastric region, increased by inspiration, by pressure,
and taking any kind of ingesta, bloatedness, tension, swell-
ing, heat, and pain of the  stomachical region, frequently
combined with  pulsation ;  throwing  up all  that is swal-
lowed,  even pure  water;  sobbing, great  anxiety,  small,
thread-like  pulse, cool extremities, violent nervous fits  and
consensual  spasms, prostration,  fits  of fainting;  convul-
sions to tetanusand opisthotonus, sometimes even to hydro-
phobia.  It is a dangerous disease, and very rapid in its
course.  No  inflammation  affects  so  much the nervous
system (on account of the  extreme sympathy of the stom-
ach), and it may prove fatal by this relation alone.   Death
follows, either by gangrene, which is announced by sudden
cessation of all pains, small, scarcely perceptible, remitting
pulse,  and  coldness of  the  extremities  (the pain  abating
and the pulse becoming larger, are here not to be mistaken
for a sign of amelioration); or by nervous paralysis (apo-
plexia nervosa) under spasms or fits of fainting, and  symp-
toms of the  utmost debility.  But  often  it  passes  into
 chronic inflammation, spasm, induration or suppuration of
 the stomach.
    The signs of  danger are found in  the  pulse, which is
 small, becoming  smaller and smaller ;  and  those   of im-
 provement by the pulse becoming larger and broader. 
ENTERITIS.
159
  Special causes are, suddenly stopped  bilious diarrhoea,
the use  of violent remedies, dysentery, cholera, vomiting
of blood, acrid  poisons, hyperemesis, arthritic  metastases
to the stomach, suppressed  menstrua, or hemorrhoids, or
external lesion.
  Therapeutics.   The general cure  of inflammation, with
only two particularities: 1. The  smaller  the  pulse,  the
more urgent and the more copious venesection is required.
2. The antiphlogistic method is here confined to  general
and local abstraction of blood (especially by cupping) ;
and external remedies; for  all  internal ones, particularly
the saline, are  poison,  and increase the  inflammation by
directly irritating the inflamed surface ;  therefore  mucila-
ginous remedies, oily emulsions (vide No. 47), milk with
water, especially buttermilk, are best.
  On account  of the general nervous affection, which is
apt to prove fatal, we must immediately after the necessary
abstractions  of blood,  apply antispasmodic and narcotic
remedies; such as antispasmodic and narcotic embroca-
tions, cataplasms and fomentations along with opium over
the stomach, also  mercurial  ointment with  opium, a vesi-
catory, opiate injections, and most of-all, lukewarm baths.
   In cases of  poisoning with acrid corrosive  substances
(arsenic, sublimate, and other metallic salts), milk drank in
abundance,  oil, and the salt-dissolving  alkalis, kali,  and
soap are to  be used.   In  gastric inflammation owing to
arthritic or podagral metastasis, a large  vesicatory on the
stomachical region is of more use than all  other remedies.
   A chronic inflammatory  state  of the  stomach is  met
with more frequently than acute gastritis.  Recent writers
erroneously call  it gastritis  chronica, for  it is  only a con-
gestive state of the stomach.  It is manifested by chronic
pains and spasms of the stomach, and is treated on as car-
dialgia sanguinea.

                INTESTINAL  INFLAMMATION.

                       Enteritis.

       Ileus Inflammatorius, Colica Inflammatoria.

   Diagnosis.   Violent, pungent,  permanent pain on  one
spot of the abdomen, which is also very sensitive to touch ;
the abdomen is bloated, hot, painful, often so much so as
not to bear the least touch ;  obstinate constipation, vomit-
ing, first of slime and  gall, finally of excrements (ileus,
miserere); sobbing, anxiety, violent thirst, and  the head 
160                   ENTERITIS.
generally free to the last; the pulse is small and contract-
ed, with all the other signs of inflammatory fever.
   The course is very acute.  The issue  is either perfect
resolution or death by gangrene ; the latter being recog-
nizable by the sudden  disappearance of the pain, which
shortly before was increased to its acme, the pulse sinking,
becoming remittent and  imperceptible ; involuntary cada-
verously fetid stools ; to which applies the same remark
that was made in gastritis, not to consider it  as a sign of
improvement ; or  the malady passes into induration (cal-
lositas, scirrhositas intestinorum) ;  or into  suppuration ; in
the  first  case, obstructio alvi habitualis;  in  the  latter,
phthisis intestinalis is the consequence.   But  there are,
even in gangrene, a  few single instances  in which nature
has  removed the gangrenous matter, effected reunion of
the part,  and restoration of the patient.  Also here the
increase of inflammation and  danger is measured by the
pulse becoming smaller.
   Besides the general causes, taking cold in the feet and
the abdomen, suppressed menstrua and hemorrhoids, par-
turition, drastic  purgatives, worms and metastases  bring
on this inflammation.
   The proximate cause of the  constipation and  vomiting
of fa?ces is not so much a mechanical impediment afforded
by the inflammatory  swelling,  but rather a motus antiperi-
staltics created by inflammatory' irritation, which, after the
inflammation has been removed,  may still continue, being
kept up by a remaining nervous irritation  (spasm).
   The treatment is the same as in gastritis; general and
local abstractions of blood ;  and here also, the smaller the
pulse, the more urgent is venesection, and which must be
repeated until the  pulse becomes fuller and broader.  In-
ternally the oily emulsion with hyoscyamus, or fresh  lin-
seed-oil, given by spoonfuls, buttermilk, emollient narcotic
cataplasms, antispasmodic and  mercurial ointments,  cups,
a vesicatory on the abdomen, and oily-mucilaginous injec-
tions every six hours.  No purgatives, no salts as long as
the inflammation is violent.  They only increase the in-
flammation, and do not effect an evacuation.  The removal
of the inflammation opens the bowels.  Preferable to  all
after proper bleeding, is a lukewarm hath, which often best
resolves the spasm and on that account serves to save life.
Generally, in order to remove the spasm  remaining  from
the inflammation, which keeps up the costiveness, vomiting
and  pain, opium, the oily emulsion with extr. opii. aquos.
three grains, or opium together with calomel, and opiate 
HEPATITIS.
161
injections, are proper.   This done we may resort to pur-
gatives, of  which oleum Ricini is the most proper, every
two hours one table spoonful; also in injections, or in lieu
of it oleum  papaveris two ounces, oleum crotonis one drop.
When constipation continues, injections of vinegar or cold
water, also  cold fomentations on the abdomen.
  Particular regard must be paid to the remote cause, es-
pecially if it is owing to a hernia incarcerata.  We must,
therefore,  examine accurately all parts,  where  the like
could arise ;  and if there be hernia, the only cure is reduc-
tion.  Likewise regard  to worms.
  After the disease, the abdomen must be kept  warm  by
flannel vests; all food which is apt to cause flatulency, or
is heavy and indigestible, and ardent drinks are to be
avoided.

              INFLAMMATION OF THE LIVER.

                       Hepatitis.

  Diagnosis.  It is different according to the different seat
of the inflammation.   When it is located more in the sur-
face and  the  convex side, the phenomena are pain in the
right hypochondrium, sometimes stitches, sometimes burn-
ing, sometimes as violent as  in pleuritis, shooting to the
sternum,  the  right scapula, extending sometimes even  to
the right  foot, increased by inspiration ; cough ; frequently
also vomiting, and lying on the right side is impossible.
  When  it  occupies  the concave part of the liver, or the
substance of that organ, then the feeling is more pressing
than painful, but  the biliary system is more affected ; yel-
lowish  color of  the eyes, of the countenance, sometimes
complete jaundice ; bitter  taste, urina crocea, vomiting,
sobbing, lying on the left side impossible, on the right side
alleviating.
  In either  case, on examination, the right hypochondrium
will appear  bloated, painful to pressure, and is hot.
  These  local symptoms are accompanied by the general
signs of an  inflammatory fever.
  The first  species might easily be mistaken for pleuritis ;
as they often offer very  similar  phenomena ; but this mis-
take is without detriment, since the treatment is the same.
  As in general the liver has a chronic character, its  in-
flammation  has a tendency to pass into  a chronic state.  It
is also  apt to affect the  lungs, and to  combine with a pul-
monary inflammation.
                           14* 
162                    HEPATITIS.
  The issue is  either perfect resolution under general and
local crises, especially bleeding at the nose, hemorrhoidal
fluxes, erysipelatous  metastases to external parts, diar-
rhoea; or transition into  chronic  inflammation, adhesion,
induration, and other disorganizations, to  which the liver
is particularly  liable.   Or  it  terminates  in suppuration,
whence phthisis hepatica. The matter forms either a vomica,
which can destroy the whole  substance of the  liver; or
penetrates to without and  engenders a liver-abscess; or
into the lungs, generating expectoration of matter (phthisis
hepatico-pulmonalis); or makes its way into  the intestinal
canal,  whence  arises diarrhoea purulenta, sometimes fol-
lowed by perfect recovery ; finally gangrene.
  Causes,  besides  the general, are  gall-stones,  violent
anger, especially when  accompanied with  drinking ardent
spirits ; too strong emetics, external  lesions, concussion
of the brain, suddenly suppressed diarrhoea or dysentery,
hemorrhoidal congestion.   Summer heat and hot climate
are most predisposing to this disease.
  The cure is as in  pleuritis:  general  and local  abstrac-
tions  of blood, in which  especially  the application of
leeches to the rectum as  a  derivative through the hemor-
rhoidal vessels directly anastomosing with  the  liver, is
recommendable;  antiphlogistic salts,  especial  regard to
the evacuation  of bile by acid laxatives (tamarinds), whey
prepared  with  cremor  tartaris or tamarinds, injections,
which will here operate simultaneously, as internal fomen-
tations of the liver; and if  these remedies do not suffice,
the use of mercury internally and externally, which is par-
ticularly appropriate  to  inflammations of the liver, espe-
cially those of a chronic character.
  Frequently chronic hepatitis  is met with either as a con-
sequence of the  acute, or  is  generated by  local  organic
disorders.   Its  signs  are: a continual or  periodically re-
turning bloatedness in the hepatic region, thirst, complaints
of the stomach, red urine,  febrile motions from  time to
time,  and a yellowish tint.  The cure consists  in the ad-
ministration of calomel, unguent mercur., natr.  and kali
(the carbonic alkaline waters of Fachingen and the Kreuz-
brunnen  in  Germany) ; whey, extract, graminis,  taraxaci,
chelidonii, or the fresh  expressed juices  of  those herbs  ;
cicuta, digitalis, lukewarm baths of soap and alkali;  the
constant wearing of emplastr. sapon. or galban, and in the
intermediate time, as soon as  the pain increases,  applica-
tion of leeches. 
SPLENITIS.   D1APHRAGM1TIS.  MESENTERITIS.     163
             INFLAMMATION  OF THE SPLEEN.

                       Splenitis.

  Diagnosis.  Pains pres^dg and pungent in the region of
the spleen, which is  bloated  and painful under external
pressure ; in a  high  degree  of  it there are consensual
symptoms of the stomach, especially apt to  vomitus cru-
tntus.
  Causes and treatment the same as in hepatitis.
             INFLAMMATION OF THE MIDRIFF.

                    Diaphragmitis.

  Diagnosis.   Pain on one spot within the costal margin
or the  short ribs, which is  increased if the finger presses
below  the  ribs ; the same takes place in inspiration or
stretching of the body, hence the  patient feels alleviated
only with  the  body bent  forwards.   At the same time
there is  cough, and when  the inflammation extends far,
singultus.  If it extends farther, the back is also affected
with pain, which may become extremely formidable.  The
pulse is quick and small, may be also  remittent.   In gen-
eral there is much resemblance to pleuritis, for which it is
often  mistaken.  In the highest  degree risus  sardonius
associates with it.
  Causes, the same as  in pneumonia.
  The treatment is also the same ;  venesection and leeches
are the principal remedies ;  frequent  injections  are very
useful. Against sobbing (singultus) external embrocations,
narcotic  cataplasms,  irritatives of the skin, hyoscyamus
aqua laurocerasi, and musk are the  best.


           INFLAMMATION OF THE  MESENTERY.

                      Mesenteritis.

  Diagnosis.  A deeply seated, dull, pressing pain in  the
lower abdomen, which is  bloated  and painful under any
pressure  ; it is generally connected with constipation; and
there may be also ischuria.   Fever as in all inflammations.
More frequently chronic than acute ;  is met with oftener 
164             PANCREATITIS.   NEPHRITIS.
 in children than in adults, especially in such children as
 labor under scrofula and indurations of the mesentery.
   Treatment the same as in peritonitis.

             INFLAMMATION OF THE PANCREAS.

                       Pancreatitis.

   Diagnosis.   Similar symptoms in the region between the
 pit of the stomach and navel, accompanied with vomiting.
   Treatment the same.

            INFLAMMATION  OF THE PERITONEUM.

                       Peritonitis.

   Diagnosis. Tumefaction and painful tension of the abdo-
 men, with great sensibility to touch,  so much so, that in a
 high degree the patient cannot suffer any thing  on the
 belly.   Constipation or ischury is frequently  connected
 with it;  being  dependent  on the extent of the inflamma-
 tion. In  a high degree all  the accidents of enteritis, as
 vomiting, etc. often occur.   When peritonitis is not cured
 by resolution,  it  runs  into  indurations or  suppurations,
 and  the latter may form an external abscess.
   Causes, besides the general, are, external lesion, preg-
 nancy, parturition, metastases, taking cold in the abdomen.
   The treatment  is the general antiphlogistic, especially
 leeches, mercurial  embrocations, fomentaiions,  lukewarm
 baths.
   Peritonitis exsudatoria puerperalis  (vide  diseases  of fe-
 males).

               INFLAMMATION OF 1HE  CAUL.

                       Omentitis.

  Diagnosis.  The same symptoms as in peritonitis, only
more confined to the  epigastric region, and  accompanied
with vomiting.   More frequently chronic than acute.
  Treatment is also the same.

             INFLAMMATION OF  THE  KIDNEYS.

                       Nephritis.

  Diagnosis.  Pungent, pressing pain  in the renal  region,
shooting  along  the urethra to the bladder; difficulty to 
CYSTITIS.
165
urinate, strangury, or ischury (only when both kidneys are
inflamed, which rarely happens) ; hot, red urine, the testi-
cle drawn near to the abdomen on the affected side, painful
and swollen ; often numbness of the whole  foot, which is
spasmodically affected ; vomiting, colic  pains, tenesmus ;
lying on the affected part and the back, as well as standing
and walking, increase the pains.
  Issue.  Resolution or induration (the kidneys are subject
to the most various disorganizations of substance) ; or sup-
puration (phthisis renalis), in  which either  evacuation of
urine, and thereby also a  complete cure can succeed ; or
the matter works its way to the external  surface (abscessus
renalis), or internally and opens into the intestinal canal.
  Causes.  Nephritic  stones,  especially violent  concus-
sions of the body, or excess in wine, continual riding  on
horseback or in jolting carriages, falls and blows on  the
back ;  long lying on the back, great exertion to lift heavy
loads,  hemorrhoidal  congestion, acrid  diuretics, or can-
tharides.
  Therapeutics.  The cure of this inflammation is  the same
as in the  foregoing,  with  this  additional  remark, that
blister plasters and nitre are to be  avoided ;  oily remedies
and mucilaginous drinks, mild laxatives of manna and tam-
arinds, frequent emollient clysters, cataplasms, and, above
all, after  proper abstraction of blood, a lukewarm bath,
are most beneficial; when the attack is obstinate, calomel
and opium.
  Should  chronic  inflammation or induration remain, the
continued  use of mild, dissolvent  remedies, solutions of
extracts with terra foliat. tart., natrum, lukewarm baths,
and  leeches  occasionally  are recommendable ; in indica-
tions of suppuration, Selters or Spa water with milk.
             INFLAMMATION  OF THE BLADDER.

                        Cystitis.

  Diagnosis.   Burning  pain in  the vesical  region,  with
external  swelling, tension, heat, and pain when touched ;
urine red and hot, strangury, dysury and ischury ;  even
tenesmus and constipation, a hard pulse and fever ;  also in
a high degree  consensual accidents, as vomitus, singultus.
  The issue is either resolution, accompanied with thick
urine, or  suppuration, discharged  with the  urine, or ab-
scesses,  and  finally  urinary fistulas  in  the perina?um, 
166              METRITIS.  OOPHORITIS.
scrotum, or rectum ; or  induration, which,  by repeated
inflammations, may gradually increase the vesical parietes
to the thickness of an inch, a state which causes continual
vesical and urinal difficulties ; or gangrene.
  The causes, besides the general, are external  lesion, he-
morrhoidal congestion; rheumatic, arthritic and syphilitic
metastases ; urinary calculus, pregnancy,  parturition, and
suppressed menstruation.
  The cure is like that  of nephritis.  Should there  be
ischuria, and the  catheter needed,  it must be  cautiously
introduced, and without force as long as its application  is
painful  and difficult; but first,  let  the  inflammation  and
spasm be removed by abstractions of blood, calomel, opi-
um,  lukewarm  baths, emollient injections, embrocations,
and  cataplasms, after which, if necessary, a flexible cathe-
ter may be introduced, and left in as long as circumstances
require.

              INFLAMMATION  OF  THE WOMB.

                       Metritis.

   Diagnosis.  External tension, tumefaction  and pain  in
the hypogastric region, the  pain being increased by pres-
sure ; heat and  pain in the vagina,  and  pain  on touching
the  mouth of the  womb; pain  in urinating,  and defeca-
tion, strangury, ischury, tenesmus and constipation. When
in a  high degree, consensual symptoms as in cystitis.
   Issue. Resolution (frequently accompanied  with  dis-
charge  of blood),  or suppuration, flowing of  matter  from
the vagina, or induration,  or gangrene.
   Causes are difficult paturition, violence  in confinement,
suddenly suppressed menstrua  or lochia, version of the
womb, ill applied pessaries, retained placenta, suppression
of metrorhagias by cold  fomentations or ardent irritants,
ardent abortives.
   The treatment is the same as in cystitis ; and in addition,
emollient injections into the vagina.
             INFLAMMATION OF THE OVARIA.

                      Oophoritis.

  Diagnosis.  Pain in the right or left inguinal region ;  in
a high degree  of inflammation, circumscript swelling  of 
PSOITIS.
167
that region clearly perceptible, and it is painful under pres-
sure ; frequently also consensu&l affections of the neigh-
boring parts, and a febrile state.  In a lower degree of this
inflammation, especially in the beginning or in the chronic
state, the diagnosis is not  so easy, although of great im-
portance, since it can lay the foundation  of multifarious
disorganizations and degenerations^f the ovary, and which
can  only be prevented by early discovery and treatment.
The only sign we have here is pain in  the inguinal region,
which in a quiet position  is  commonly imperceptible, but
sensible by a deep pressure on that region;  little perceiv-
able in standing, without swelling; hot feeling in the vagi-
na, sometimes ardor of urine or pain in the thigh of the side
affected.
   Pathogenesis.  It  originates in pregnancy, especially in
the beginning, but more frequently in parturition; finally,
in unmarried females, in congestions to the ovaries, which
 most frequently  are caused by sexual desire, excited by
physical or moral onania, or imperfect coitus without sat-
 isfaction.
   Therapeutics.  The cure of inflammations ;  especially the
 application of leeches, also venesection if indicated ; cool-
 ing purgatives, calomel and embrocations of volat. liniment
 and unguent mercur.
          INFLAMMATION  OF THE PSOAS-MUSCLE.

                        Psoitis.

  Diagnosis.  Pain in the renal region, hip, and  down-
wards to the leg; the leg  cannot  be  stretched  or  drawn
near to the abdomen without pain ; turning when lying, and
lifting, increases the  pains ; walking is possible only  in
hobbfing, and with the body bent forwards.   Rarely there
is  external swelling along the psoas muscle, and  in the
inguinal  region.   Signs  discriminative of  nephritis,  to
which it has resemblance, are the absence of urinary diffi-
culty and costiveness. It is more  frequently chronic than
acute.  It is not lethal, but very  important  in  its  conse-
quences; for suppuration often exists,  though unperceived,
and the matter breaks through and empties into the abdo-
minal cavity, bringing on a fatal issue ; or (what happens
more frequently), the  matter burrows downward, hence a
phthisis lumbaris, abscessus lumbaris, which  opens in very
remote  parts, as in the  groins, anus, perina?um, thigh, or 
168              OPHTHALMITIS.   OTITIS.
 above the knee.   Not seldom also are the vertebral bones
 or the hip-joint affected by it, and rendered carious.
   The  causes, besides the general, are :  violent exertion
 in lifting and carrying; blows, falls on  the back or the
 nates;  rheumatism and hemorrhoids.
   The  treatment is the  same as in peritonitis;  especially
 leeches,  lukewarm  baths, vesicatories, mercury, applied
 externally and internally.

               INFLAMMATION OF THE EYES.

                      Ophthalmitis.

   Diagnosis.  Redness, heat and pain of the eye in variable
 degrees, either with dryness or increased secretion of tears
 and other ophthalmic humors (ophth. sicca et humida), in the
 highest degree, headache and fever.
   It can be caused by all that is capable of violently irrita-
 ting the eyes from without, as well as from within ; of the lat-
 ter kind are sanguineous congestions, catarrh, rheumatism,
 consensual gastric irritants and  specific morbid matters.
   The treatment must be adapted  to the causes, and to the
 difference of character.  In the acute and high degrees of
 inflammation it is most momentous to resolve it speedily,
 in order  to prevent  suppuration, obscuration  and other
 destructions of this  tender  organ.  The remedies most
 efficacious  for  that purpose, are : venesection,  leeches,
 large doses of  calomel  (three  to six  grains  every four
 hours),  and cool fomentations of weak lead-water to the
 eye.
   In chronic ophthalmitis the treatment varies  according
 to  the  varieties of cause  and character.  The general
 treatment is the same  in any  case, and  in regard  to local
 remedies  we must remark, that dry inflammation  bears
 collyria better ;  the moist only salves, amongst which that
 of red precipitate deserves the palm of all.
  For more accurate information,  I recommend the  study
of writings on ophthalmialogia, which has been raised to
a particular science.

              INFLAMMATION  OF  THE EARS.

                        Otitis.

  Violent,  often insupportable pain in the  ear, with heat
even external sensibility of the meatus auditorius  and
febrile irritation. 
ERYSIPELAS.                   169
  The pain easily communicates to  the whole head,  and
when in  a high degree, brings on even delirium.  Inflam-
mation of the brain  may arise in consequence.  If com-
plete resolution does not succeed, suppuration or otorrhea
ensues, which, however, may be critical.
  The cause is most frequently rheumatic.   Every otalgia,
however, may be increased into otitis.
  The treatment  must be prompt and actively antiphlogis-
tic ;  leeches on the ears, in plethoric persons even general
venesection, are  the principal means.  At the same time,
antiphlogistic remedies and regimen,  cooling laxatives.


                   st. Anthony's  fire.

                       Erysipelas.

  Diagnosis.  Superficial shining redness, which disap-
pears under pressure of the finger ; is of a flying character,
therefore apt to wander from one place'to another.  Some-
times blisters shoot  up on it (erysip, bullosum).
  The inflammation has its seat  in the epidermis; but in
the more violent degrees it affects also the subjacent tissue
(erys. phlegmonodes).
  Generally, previous to, and at the eruption, there exists
a slight fever, which is distinguished by an inclination to
sleep, and  disappears after the  eruption has  broken  out.
Sometimes, however, it is violent and precedes the erup-
tion for several days, together with a soporous state which
continues  afterwards, and by which  the higher degree of
the disease is characterized.  Such a  degree is not decided
before  the seventh or  ninth  day.   Always  also gastric,
especially  bilious symptoms, are  connected with it.
  The issue is either resolution, or induration running into
very chronic callosities ; or suppuration, which may spread
deeply into the cellular tissue, and be followed by chronic
fistulous ulcers ;  or  gangrene. It is  generally a slight dis-
ease and  without danger, but  it  may endanger life by its
seat, as when situated  on the face,  tending to communi-
cate to the brain ; by its character, when it is  putrid ; by
retrocession to noble internal organs.
  We must distinguish the genuine erysipelas from  the
pseudo-erysipelas, associated as a symptom to wounds and
other external lesions.  But  also here we must well re-
member, that a  true erysipelas  can  throw itself on  such
parts by the irritation of external lesion. 
170                   ERYSIPELAS.
   The causes are most frequently bilious or mental affec-
tions,  as  anger, wrath and fright ; or taking cold, vulnera-
tions ; also idiosyncrasies against certain dishes, e. g. crabs,
shell fish,  produce in some individuals erysipelas.  But here
the disposition is of particular importance: females of a ten-
der, white skin, fat, choleric persons, who have  an easily
irritated or morbid liver are most  liable to this malady, and
thereby arises the habitual erysipelas, a very troublesome
evil, excited  by trifling causes.  It appears also often at the
time of menstruation, as its surrogate.
   The treatment must be accommodated to the degree, vio-
lence and character of the fever.   The principal remedies
are gastric evacuations, according to the indicarion, either
by emetics or purgatives, especially with tamarindsand cre-
mor tartari as amelioratives of bile, and in a slight degree,
the same, connected with mild diaphoretics and  an anti-
phlogistic diet, at the same time avoiding to take  cold, are
sufficient  for a cure.  Externally, only moderate, not too
hot covering ; in order  to diminish the pain, farina fabae,
s.  semin. lin. and palvis  flor. sambuci, but without camphor
or lead, may  be  strewed on the inflamed part.  Camphor
and lead,  as well as cold and cold fomentations, are care-
fully to be avoided ; they, it  is true, dispel quickly the
erysipelas, but  can produce  dangerous  metastases unto
internal parts.  It is only in pseudo-erysipelas, which asso-
ciates as a symptom to  wounds, ulcers and other  external
lesions, that  lead-water may be applied.   Warm, wet fo-
mentations are also improper, since they likewise are apt
to produce retrocession, or transition into suppuration.
   In the higher degrees, marked by violence of fever and in-
flammation, and when the individual is young and plethoric,
abstractions of blood may be^iecessary ; precaution, how-
ever, is to be  used, since they are apt to cause a retroces-
sion of the erysipelatous eruption ; in  general, leeches only
are to be applied, and venesection only in extreme neces-
sity, and  in  evident plethora, or truly inflammatory com-
plication,  or  the affection of noble parts  (of the  eyes or
brain).  Purgatives are  more serviceable than bleeding, as
antiphlogistics.
   Especial attention is  due to the erysipelas of the face,
which  is frequently connected with violent cerebral  affec-
tions, sopor and  delirium. Here also, relief is not procured
by abstraction of blood, but by gastric evacuations, espe-
cially by emetics ;  they  remove promptest and most surely
the delirium, and promote the crises.
   Erysipelas  bullosum s. pustulosum is treated according 
ERYSIPELAS.                   171
to the same principles.  The blisters are not to be cut, but
only pierced, so that the water contained in them may ooze
out, and  they remain covered with the epidermis ;  other-
wise very painful and malignant suppurations might  ensue.
When these happen, in order to assuage the burning and to
heal them, it is best to cover them with cream, or in obsti-
nate cases, with ointment of lime (fresh pressed poppy-oil or
linseed-oil with equal parts of lime-water).  Remedies of
lead are to be carefully avoided, as they can produce most
dangerous metastases.
   When  erysipelas  exhibits a disposition to putrescence
and  gangrene, which is discovered by the bluish redness
or the dark spots on the  part, or by a nervous  or  putrid
febrile character, the treatment of the putrid typhus must
be resorted to, and  vigorous roboratives and antiseptics,
externally Peruvian bark  with  sal.  ammoniac,  scordium,
arnica, wine and acids must be applied.
   Retrocession of the erysipelas.  A sudden disappearance
of the erysipelas, caused  by cold, lead-remedies and the
like, can bring on the most violent, even  fatal  internal in-
flammatory affections.   Here prompt  means  to make  it
reappear, or  at least to compensate  it,  are wanted.  In
slighter cases a sinapism on the erysipelatous spot, and in-
ternally spiritus Mindereri, camphor with nitre are of use;
in violent inflammations of internal parts, a venesection,
vesicatories  on the  spot which was previously erysipela-
tous ; likewise sinapisms over the place now affected; in-
ternally nitre with camphor.
   Convalescence.  Erysipelas requires  most careful atten-
tion, after it  is subdued ;  for swelling, induration, and a
disposition to recidives are likely to remain.  The patient,
therefore, must continue  a diaphoretic regimen, and keep
the erysipelatous part warm, and cover it with dissolvent
herbs, until every vestige  of  oedema is gone.
   The chronic habitual erysipelas originates partly in a parti-
cular weakness and secretion  of the skin ; partly in remote
causes,  disorders of the liver  and bilious  acidity, men-
strual disorders,  dyscrasias  of  various kinds, especially
arthritic,  psoric and  syphilitic.  The  cure requires partly
invigoration of the skin by baths, cold washing and rubbing;
partly removal  of abdominal obstructions by  dissolvent,
purgative and roborative remedies;  regulation of the cata-
menia;  cure  of the various  dyscrasias, for  which the
drinking  of Sedlitz-water, continued  for several days,  is
particularly useful,  cupping every eight weeks, also fon-
tanels. 
172               ZONA.   RHEUMATISM.
                     ZONA. ZOSTER.

  Diagnosis.  Red, burning  and itching spots,  occupied
with little pustels, or  stripes in the region of the girdle,
frequently forming a complete belt round the body, accu-
rately  circumscribed and separated from the healthy skin.
  The disease is sometimes acute, combined with  fever,
more frequently chronic, and then of long  duration  and
obstinacy.
  As for its nature it is between erysipelas and herpes ; of-
ten arises from the same cause as erysipelas, but more  fre-
quently from deeper located and general  dyscrasias.
  The treatment is the same as in erysipelas; in the chronic
state like that of herpes.   Particularly recommendable in
the  latter case, is the internal use of a?thiops mineralis,
one half or one scruple daily, together with  res. guaiaci,
and externally sublimate-water ; in obstinate cases a weak
solution of lapis infernalis.
                FOURTH CLASS.


                   RHEUMATOSES.

                      Generalities.

  I understand by this name every affection  which ori-
ginates in suppressed or disturbed function of the skin and
is generated and entertained by an acrid serum (perspirabile
retentum), produced by this impeded secretion.
  It appears in two principal forms, rheumatismus and ca-
tarrhus.  The former is the rheumatic affection in the mus-
cles, ligaments, aponeuroses : the second  in the mucous
membranes, especially the  bronchia, trachea  and nose.
Both are of the same  nature, and one can change into the
other ; the difference  rests only in the location.
  Pathogenesis. The proximate cause of either is a local irri-
tation, created by the antagonistic reflection of the skin and
the acidity thereby generated.  The rheumatic  affection,
therefore has, besides  the dynamic, a material serous char-
acter.  The proof of this is : it is always brought on by sup-
pression of the cutaneous secretion ; it is  cured only by 
RHEUMATISM.
173
serous secretion,  either  general  (perspiration), or local
(local sweat, or artificially excited vesication);  the least
taking cold increases the evil ;  it is generally accompanied
by a serous exsudation in the cellular tissue.
  Therapeutics.  Every rheumatic  affection has two indi-
cations of cure ; in the first place, to restore the cutaneous
function, the crisis by the skin generally as well as locally,
and in its absence to replace it by  artificial serous evacua-
tion (vesicatories) ; secondly, to regard duly the various
dynamic characters, which happen to accompany the rheu-
matic affection, which is by no means inflammatory, but
sometimes of a quite opposite nature.

                      RHEUMATISM.

               Rheumatismus,  Rheumatalgia.

   Diagnosis.   After having previously taken cold, pain in
a muscular, membranous or aponeurotic part, together with
swelling of  the surrounding cellular tissue, light redness
and warmth.
   This is the appearance of rheumatism  in  its  original
form ; but there are many deviations.
   1. The local affection  is not  always accompanied with
redness and heat, hence the division into rheumatismusfri-
gidus and calidus.
   2.  The affection is  not always accompanied by pain, it
may  immediately  affect  the nerves paralytically, and de-
prive  the part of sensation  and motion;  e.  g. surditas,
amaurosis, paralysis rheumatica.
   3.  It is not always located in an external part, for it can
just as well attack all  internal organs;  this, however, gen-
erally happens in a secondary way and  per metastasin ;
sometimes it  can immediately from the beginning seize on
an internal part.
   Thus  rheumatism can exhibit  and generate most vio-
lent and multifarious internal diseases,  of an acute as well
as of a chronic nature, e. g. pleuritis, enteritis, cardialgia,
nervoift  diseases.
   A principal means for  the diagnosis of rheumatism, or
for recognizing the rheumatic character of a disease in
concealed and metamorphosed kinds of rheumatism, is the
close relation which it bears to the atmospheric, especially
the barometrical  condition,  or  so to  say, a barometrical
nature of the  sick, in  which the least change  of weather
immediately aggravates  the evil. 
174                   RHEUMATISM.
   Rheumatism either remains on one spot (rheumat. fixus),
or it wanders from one part to another (rheumat. vagus).
   It is either accompanied by  fever  (rheumat. acutus), or
not (rheumat. chronicus). The first lasts for a definite time;
the latter is of uncertain duration, and may become chro-
nic, even last the whole period of life.
   Rheumatism  and arthritis very  much  resemble each
other in their phenomena, are easily confused, but are very
different in respect to their original character (vide patho-
genesis).  The principal discriminative  signs are :  Rheu-
matism attacks more the muscular and membranous parts,
arthritis  the joints ; rheumatism is not necessarily con-
nected with digestive  difficulties, quite the contrary, with
the best  appetite ; but arthritis  always shows itself con-
nected with or succeeding to digestive difficulties;  arthri-
tis exhibits in the.urine and other secretions more the signs
of a  singular dyscrasia, such as the knotty calcareous
concrements on the joints, and the calcareous sediment in
the urine; rheumatism does not.  Rheumatism sets in after
taking  cold, an external influence operating from without
to within ;  arthritis after, and by disorders  of  digestion
and chylification, from within to without, and appears as a
critical deposite of a qualified morbific matter to the sur-
face.   It  is not rare for rheumatism to assume an  arthritic
form, and vice versa (rheumatismus arthriticus).
   Also several other  diseases can  assume the form of a
rheumatic affection, e. g. syphilis, scorbutic,  psoric, can-
orous dyscrasias.  We distinguish therefore, rheumatismus
verus, which is owing to taking cold, and spurius y a diffe-
rence of great importance for the treatment.
   The effects and consequences  of rheumatism are:  serous
exsudation in the neighboring cellular tissue, induration,
anchylosis,  very  rarely suppuration, paralysis,  exanthe-
mata, blenorrhceas ; and, per metastasin, almost all forms of
diseases, especially nervous, hypochondria, at last in long
duration a particular dyscrasia and cachexia.
   The crises are by sweat and urine, exanthemata,  some-
times also by salivation.
   Pathogenesis. The proximate cause of rheumatism is an
antagonistic  irritation, produced by checked  perspiration,
which irritation is of a double nature,—dynamic, as far as
the  equilibrium  of the system is disturbed,—material, in
regard  to the morbific serous acrid matter (materia rheu-
matica).  It is well, to  remember, that it is owing not only
to suppressed sweat, but far more to the suppression of the
imperceptible gas-like perspiration,  which is  the most  im- 
RHEUMATISM.
175
portant, most general and perpetual emunctory of organic
life, and by which two thirds of all corrupt matters are dis-
charged from the system, the retention of which, must of
necessity,  engender a very nuisible morbific matter, that,
in course of time will injure the integrity and mixture of
the humors.  Rheumatism, therefore, is only irritation, but
by  no means a genuine (phlogistic) inflammation ; is an
irritation  approaehing to inflammation, located not in the
vessels, but in the serous membranes; inflammatio serosa,
not  sanguinea.  Thereby  the  rheumatismus verus differs
from the  rheumatismus spurius, which  may arise in many
other ways.  The notion of suppressed cutaneous action,
taking cold, must here be taken in its widest sense.   Not
only the  suddenly  suppressed perspiration (taking cold
properly speaking, which gives occasion to acute rheuma-
tisms), but much more, the chronic, gradual, frequently im-
perceptible,  diminution  and suppression of cutaneous per-
spiration, which generates the chronic (often so obstinate)
rheumatisms and rheumatic  maladies, is here to be count-
 ed.  The latter kind  is caused by living in moist dwellings,
 moist and  changeable climate; hence it occurs most fre-
quently in the middle climates and middle seasons (spring,
fall).  It  is  farther caused  by too liglit clothing,  which
often  unknowingly  brings on rheumatism in females; and
 by neglected cultivation of the skin, uncleanliness.
   The  predisposing causes are:  too  warm regimen, by
 which  the sensibility  of the  skin is morbidly increased ;
 disuse of air, living in closed rooms, want of exercise, ge-
 neral and local weakness, cold, pituitous, lymphatic, phleg-
 matic constitution.  But  rheumatism  can  also arise with-
 out any predisposition,  and there  is no disease, which can
 be generated so certainly.  A  person needs only to expose
 himself with an  overheated  sweating body, to  a great
 draught of air, and  rheumatism will follow.
   " Rheuma" itself may give  rise  to various diseases, that
 is,  to all kinds of acute fevers and inflammations ; and as
 regards every kind of chronic diseases, the rheumatic dia-
 thesis is  one of the most prolific sources, a fact, which we
 cannot too strongly promulgate.
    Therapeutics.  In the treatment of all rheumatic diseases
 we must adhere to  the idea, that the skin is their source,
 and that retained perspirable matter,  a serous acrimony is
 their matter morbific.  The original indication is therefore
 double :  to restore  or replace the  cutaneous function, and
 to  remove  the serous  acrimony  either by a natural crisis 
176
RHEUMATISM.
 (especially  of  the  skin)  or  by an artificial one (drawing
 blisters, suppuration).
   The special treatment is determined on by the two prin-
 cipal species, the febrile rheumatism (vide rheumatic fever),
 and the non-febrile rheumatism (rheumatismus chronicus).
   1. Apply  internal remedies, which unitedly fulfill the
 above-stated indications,  and are termed on  that account
 specifica antirheumatica. The  most efficacious  are: spiritus
 Mindereri, guaiacum (vide No. 27, 28, 29 a), aconite, cam-
 phor, dulcamara, nitre (a great remedy especially when
 there is a phlogistic state, but in large doses up to one half
 ounce within 24 hours), avntimoniurn and  all its  prepara-
 tions, sulphur,  warm baths,  especially soap and  culinary
 salt-baths.
  2. Apply  external means,  which fulfill locally the same
 indication, i. e. effect a local crisis.  For we must remem-
 ber that rheumatism  can be treated locally  in a double
manner,  namely,  by means which support  the local reac-
tion necessary for a complete crisis (radical method),  and
by such means as suppress reaction, and thereby take away
the pain and irritation for  a moment,  but which are apt to
cause rheumatism to shift  to another, perhaps internal no-
ble  part;  or effect an  incomplete crisis and its  conse-
quences, i. e. retain the rheumatic  matter  in the affected
part, and bring on  stiffness, swelling, or frequent returns of
rheumatism, even  paralysis.
  Of the first class, the radical, the sure external means
are : warmth, oiled silk, flannel,  greasy wool, fur,  espe-
cially of the wild cat, embrocations of liniment, ammon.,
but without camphor, since this is apt to operate suppres-
singly ;  in order to do away with the  pains emplastr. de
hyoscyamo with opium ; in very violent pains  narcotic ca-
taplasms,  but only  for a few hours, since too long an ap-
plication might produce chronic  exsudation and suppura-
tion. But vesicatories, applied until they draw blisters, on
 or next the  affected part,  are the principal means; they
 remove the pain promptly,  and render the crisis complete
 by serous evacuation.  If  one does not suffice, another is
 to be applied the following day near the first.
  Of the second class, the suppressive, are :  cold and lead,
 of which especially  saturnine  plasters are favorites. Both,
 it is true,  are able to dispel the pain quickly, but are very
 apt to  generate a dangerous metastasis of the  rheumatism
 to  some internal organ,  and  pjoduce  chronic  distempers.
 Also local abstractions  of blood may be included in that 
RHEUMATISM.
177
 class,  since  they likewise  quickly remove the active in-
 ternal reaction of nature,  thereby removing the pain and
 irritation (so that the ignorant are impressed with the be-
 lief that they really cure), but they never annihilate rheu-
 matism itself, a disease that never calls for evacuation of
 blood  but only of serous matter; on  the contrary,  they
 have like the above-mentioned, a tendency to  produce me-
 tastases and  chronic local evils, even obstinacy of rheuma-
 tism itself.   An  exception  to this statement is found in
 rheumatismus calidus,  when rheumatism is combined with
 true  inflammation, exhibited  by heat and redness of the
 part  affected.   Here  leeches or cups are salutary, not to
 remove  rheumatism,  but only to do away with the  inflam-
 mation connected with it.
   Regard must be paid to constitution and complication.
 Three varieties under  this  head deserve particular atten-
 tion:  1. The phlogistic,  when rheumatism occurs in a ple-
 thoric youthful person, or exhibits  all the symptoms of an
 inflammatory disposition.   Here,  a strict antiphlogistic
 diet and treatment must be employed, consisting of local
 and general  blood-letting, nitre, anddiaphoretica frigida.
 2.  The nervous, in sensitive individuals.  Here antispas-
 modic remedies, even opium must be used along with the
 first.  3. Finally,  the gastric, especially the bilious, which
 can render  the rheumatism violent and obstinate.  Here
 emetics and purgatives frequently  effect the cure more
 quickly  than all other antirheumatics.

          Cure of Obstinate  Chronic Rheumatism.

   Sometimes,  however, the afore-mentioned treatment is
 not sufficient.  The case does  not yield, or if it abates
 a little, it returns with renewed vigor.  Rheumatism  may
 become  one  of the most obstinate maladies,  and its cure
 one of the most difficult tasks in the whole round of prac-
 tice, requiring a deeper penetration into the organism and
 the multifarious sources of the complaint. I here give the
 following rules:
  The use of the above-mentioned antirheumatic remedies
 may be increased  and  prolonged; for the want of success
is often owing to the irregularity and short time of employ-
 ing them, and to the impatience of the sick, who does not
allow time for their operation.
  A stronger preparation of the  same remedies may be ad-
ministered ;   or such  other more vigorously penetrating
means  as experience  confirms.   Of that number are, ac- 
178
RHEUMATISM.
cording to my experience, the tinct. guaiaci volat., tincture
of guaracum, arnica, tinct. fulig., oleum jecoris aselli (one
or two ounces several times a day), petroleum, tinct. anti-
mon. acris (30 drops several times daily), ammonium sul-
phuret. (two or three drops daily several times), calx anti-
mon. sulphuret., and the  sulph. water prepared of it (vide
No. 29 b),  the  mercurials, especially sublimate,  which I
consider one of the  most efficient means of this class,
either as an addition  to  the decoct, of guaiac. (vide No.
30), or in the form of pills (vide No. 31), or as a?ther mer-
curialis.
  Finally emetics may be resorted to, repeated every se-
cond day.   They are  of  great use.   We must, however,
never forget, that they attack the system violently and are
apt to injure the stomach  and digestive power ; hence they
are recommended only in cases of necessity, when other
means have been tried without benefit.
  Externally, embrocations of mercurial ointment, of strong
etherial oils, oleum  cajeput., petroleum, may be applied ;
for assuaging the pain, emplastr. hyoscyam. with opium;
also decoction of tobacco  (one ounce in sixteen ounces of
water reduced to eight ounces), used as  lukewarm fomen-
tations  constantly continued are most efficacious.   More-
over, emplastr. de galbano one  ounce, camphor, petroleum,
carb. ammonia? opium aa £ drachm, malax.; scarification,
electricity, and galvanism  are advised.
  This  treatment must be connected with baths, general
and local, in which are mixed  seasalt, alkali, sulphur, par-
ticularly sublimate (-V or 1 ounce for one bath).  The most
efficacious  are  the hot thermal baths at Wiesbaden, Top-
litz, Aachen, Baden (near Vienna), Warmbrunn.  As local
baths, the douche (shower-bath) and sprinkling are of exi-
mious power.  In a  state of  great  debility  cold  baths are
also serviceable.
  Great  is  the effect of artificial ulcers, strong cutaneous
irritation and suppuration  entertained for a long time; yea
they are often indispensable in  obstinate rheumatisms. Of
this description are fontanels,  mezereum, antimonial oint-
ment, moxa, actual cautery.
  Finally,  it is  necessary to inquire  accurately  into the
diet and mode of living of the patient, in order to discover
whether  the unperceived  cause may not be found  in the
moist,  draughty dwelling, too  light clothing, etc.;  and  if
so, must be remedied.
  Besides this mode of directly attacking rheumatism, we
must  take  the  constitution  of the patient into considera- 
                      RHEUMATIISM.                  179

tion.  Frequently, a constitutional disorder is the sole root
of the disease ; and a cure is impossible without remedying
it, which alone is often sufficient to effect the cure.
  Of this  description the principal one is debility, general
as well  as local,  often  produced  solely by the  malady.
Here roborants are beneficial,  and in  the first  rank stands
quassia; then strengthening baths, cold baths, sea-baths.
The nervous constitution calls for a nervous  treatment.  In
the  succulent, lax, phlegmatic constitution,  warming pti-
sanes, such as excite all the secretions and irritate the vas-
cular system, especially the use of drastic purgatives, since
the cutaneous  action is here  less  to  be relied on, are of
excellent  effect.  This is the case, where the Zittmann's
decoction  (vide No. 204),  even inunction and fasting are
serviceable.  The plethoric constitution, inclined  to san-
guineous  congestion,  of which character is the  hemorr-
hoidal disposition, is often at the bottom of the most  obsti-
nate rheumatisms ; when  this is  the  case,  abstraction  of
blood, leeches applied to the rectum, and the cure  of piles
are required.  In the gastric, especially the atrabilious con-
stitution, the dissolving evacuating visceral treatment con-
tributes most towards curing rheumatism.
  Finally,  in obstinate rheumatisms  a  complication with
other diseases is  to be considered and well ascertained;
and  here a syphilitic or psoric dyscrasy is most suspected,
for they often originate the evil and its obstinacy.
  A regard to the  periodical character of rheumatism is  of
great importance.   When it returns typically, at  certain
definite periods, cinchona or quinine, also iron, especially
the carbonate, are the principal remedies.

                  Cure of Rheumatosis.

  The rheumatic  constitution,  the disposition to rheuma-
tisms, returning constantly,  and from the slightest cause,
requires the following treatment.   The chief indication is
to remedy  the excessive sensitiveness  and debility of the
skih, in which  that constitution  is founded.   Therefore
cultivation of the skin  by strengthening,   vivifying and
hardening it, is advised.  This is effected by  daily washing
the  whole  body with cold water  (for which purpose also
the Schneiderian apparatus may be used), combined with
frictions, a lukewarm  bath once or twice a week, cleanli-
ness, frequent  changes of linen, pure air, muscular  exer-
cise.  In effeminate and sensitive persons,  or patients
highly disposed to rheumatisms, flannel clothing near the 
180
SCIATICA.
  skin, a Russian steam-bath every 14 days. In order to pre-
  vent rheumatism, and remove the accumulated rheumatic
  matter, it will  also be very useful to take every three or
  four  weeks  for a few days  resina guaiaci together with
  sulphur (vide No. 32),  so that  two or three evacuations
  occur every  day.
    Some local diseases deserve to be particularly mention-
  ed, since they are frequently of a rheumatic nature.

                           HIPS.

                    Ischias,  Coxagra.

    Diagnosis.  Pain in the region of the hip-joint,  which
 often extends to the knee, even to the foot, accurately fol-
 lowing the course of the sciatic  nerve.   Its severity may
 impede the motion of the foot, and bring on stiffness and
 contraction ;  finally, by its long continuance and violence,
 disturbing  nightly rest,  it may induce general marasmus
 and emaciation.
   By coxagra an inflammatory affection of the hip-joint  it-
 self is understood, recognisable  by  pain in stepping and
 moving, but not  felt during rest—a character which dis-
 tinguishes it  from sciatica.  The pain in this  case is pro-
 pagated to the front of the knee  (while in  sciatica it is only
 to  the external side), and the leg  is protruded and length-
 ened.
   Pathogenesis.   It is most frequently a rheumatic  affec-
 tion of the hip-joint, sometimes only of the ischiatic nerve
 in its whole extent.  After death exsudation is discovered
 in the nervous sheath.   This affection, however, can in-
 crease even  into  inflammation and attack the  joint (cox-
 agra), causing an exsudation sometimes within  eight days
 and protruding the head of the femur.  Psoric,  scrofulous^
 and other metastases may act as remote causes, especially  -
 in children, in whom it often occurs  under the name of
 claudicatio spontanea.
  Therapeutics.  In common cases and in  the beginning it
is sufficient to prescribe  resina guaiaci £ to 1 drachm  a
day, together with aconite; wrap  the joint in wool  make
embrocations  of liniment, volat., put a vesicatory on the
hip-joint (by which the exsudation there  is most  surely
prevented)  and sweat for a few days.  In  obstinate cases
in plethoric persons, and  when there is suspicion  of he'
morrhoidal congestions, leeches must be applied.  In ner-
vous sciatica a vesicatory  is to be applied  in the course of 
LUMBAGO.  CATARRH.
181
the nerve on the external side of the hip-joint, the follow-
ing  day another on the external side,  immediately above
the  knee,  and on  the third day one towards the external
part of the leg, above the malleolus. The case proving still
obstinate,  it will call for antirheumatics and mercurials,
especially sublimate,  drastic purgatives,  the use of liver-
oil, and all the remedies already recommended for chronic
rheumatism. A combination of tinct. antimonii acris, gua-
 iac. volat., 30 to 40 drops three times a day, with an addi-
tion of some drops of laudanum liquidum is of great use.
Externally, baths,  with the addition of soap, culinary  salt,
sulphur, and sublimate are serviceable, also those of Wies-
baden, Teplitz, Aix la  Chapelle,  steam-baths;  perpetual
vesicatories, fontanels, moxes, cauteries.

                        LUMBAGO.

   Diagnosis. Violent pain in the region of the loins, some-
times  periodica], sometimes  permanent.   An  important
variety of lumbago is  one which follows any quick motion
of the back, as in rising from a stooping position. The pa-
tient is suddenly seized  with a violent pain as if produced
by an  arrow shot into  the part; it  pins him, as  it were,
into a fixed attitude, from which he cannot stir without
suffering torture, and  so confines him for many days.
   It is caused like sciatica frequently by  rheumatism, but
more  frequently by a hemorrhoidal congestion  of blood,
which may even pass  into inflammation (myelitis).
   The cure, therefore, requires:—"first, leeches, in pletho-
ric subjects and in a feverish state even venesection,  and
cooling  laxative  remedies,  lukewarm baths,  especially
steam-baths on the affected part; then sulphurous remedies,
guaiac,  vesicatories; in short, the cure of sciatica  and
rheumatism.
   In cases of chronic  pain in the sacrum, and when meta-
static  (scrofulous,  psoric, syphilitic)  causes are present,
caries  of the vertebral  bones may imperceptibly arise,  and
thereby engender an abscessus lumbaris, which breaks at
remote places, as the groin or leg.

     RHEUMATIC AFFECTION OF THE MUCOUS MEMBRANE.

                       Catarrhus.

  Diagnosis.  Rheumatic affection  of  the  mucous mem-
brane,  most commonly that of the  nose (coryza,  gravedo).
                           16 
182
CATARRHUS.
Its signs are: sneezing, running of acrid serum and mucus,
or the contrary, dryness, stopping in the nose, with irrita-
tion  and swelling of the membrane ; in a high degree also
lachrymation and irritation of the eyes; tension, pressing
headache above the eyes, with or  without fever  (on the
first, vide febris catarrhalis).
  Or it  affects  the cavity of the mouth and the throat.
Signs: redness of the internal parts, palate, uvula, tonsils,
accompanied with pain in swallowing (vide angina catarr-
halis).
  Or it  affects the windpipe and bronchia.  Signs: cough,
dry  at first, or  expectoration of acrid serum or mucus;
hoarseness,  in severe  cases  a  painful  sensation  in the
trachea  and the  lungs (catarrhus pulmonum).
  But a catarrhal affection can  seize every other  part of
the body, and generate all kinds of blenorrhoea, which then
are nothing but  catarrhs, such as  catarrhus intestinorum
(diarrhaa, dysenterxa),  aurium (ottorrhaa), oculorum  (oph-
thalmia humida), vagina? et uteri (fluor albus), vesica? (cys-
torrhaa), and must be  treated according to the principles
already  mentioned.
  Course.  Every catarrh runs  through two  stages; the
first, stadium cruditatis s. irritationis, when irritation of the
mucous membrane, accompanied with secretion of a watery
acrid serous matter is the prevailing character ;  the se-
cond, stadium coctionis s. secundarium, when the irritation
abates and  the  matter appears cocted,  mild,  and thick.
This period  is of indefinite duration,  sometimes very short,
sometimes  very long;  and not unfrequently passes into
tussis chronica, even phthisis. Thus this disease, though in-
significant in itself, may become  fatal  in a double way:
either by transition into inflammation of the lungs,  or into
phthisis, and we may rightly presume, that it  has brought
on the greatest number of consumptions.
  The causes  are the same as in rheumatism  ; living and
sleeping in a warm atmosphere are  especially  noticeable.
  The treatment is fundamentally  the same as in rheuma-
tism. We have chiefly to consider whether the catarrh is
accompanied by  fever, or not.   The  treatment  of the
febrile variety is like that of catarrhal fever.
  The cure of the non-febrile is generally performed by
nature herself through coction and crises, local as  well as
cutaneous, to support which, drinking freely of gruel, elder
tea, species pectoral., and remedies promotive of expectora-
tion, as  licorice and syrup,  is proper. In high degrees, and
when nature's healing power is not sufficient,  the best re- 
CATARRHUS.
183
medies are sulphur (vide No. 33),  dulcamara, sal ammon.,
spirit. Mindereri, antimonials, ammonium anisat., rad. se-
nega?,  extract, helenii;  in  tickling cough, tinct.  pjmpi-
nella? is of specific efficacy ; also vesicatories on the chest
and arm.  In gastric complication emetics are advised.   In
every obstinate cough we must not neglect to wear flannel
on the chest next to the skin, which often is sufficient of
itself to cure.  But good care, avoiding to take cold, and
antiphlogistic diet are always necessary; for it must never
be  forgotten, that in every catarrh there exists a sub-in-
flammatory irritation of the mucous  membranes, which -
may be increased to real inflammation by cold, overheat-
ing, wine and the like ;  or may pass into a chronic  stao-e,
altering the substance of the lungs itself in a morbid man-
ner, giving rise to either tubercles, atony, or relaxation of
the mucous membranes.  The utmost precaution and care
is to be  observed by persons of a hectic disposition,  or
having morbid, tuberculous, or weakened lungs.  As soon
as fixed  pains in the  chest associate with the  catarrh, a
vesicatory must he put  over the affected spot; when fever
sets in and the cough becomes dry, antiphlogistics are to
be administered internally, even leeches or a moderate  ve-
nesection may be needed (vide catarrhal fever).
  The treatment of a lingering protracted cough is of great
moment; for this  is  one of the most common though  im-
perceptible ways of transition into consumption.   The pa-
tient may feel comfortable, but  continues coughing, and
finds himself after six or eight weeks in the first stage of
phthisis.  Either, by the continued catarrhal irritation of
the bronchia, tubercles are  formed, phthisis sicca, tubercu-
losa ; or relaxation, atony of the lungs is the consequence,
and blenorrhaa pulmonum,  phthisis  pituitosa  succeeds.
The cure  resides in  a proper discrimination of the case,
especially  as  regards the cough,  whether it be dry or pi-
tuitous.   In  the  first case it is either a continuance of ca-
tarrhal irritation, or a disturbed local crisis of the catarrh,
a fixed chronic cough.   Here a decoction of dulcamara is
the principal remedy (vide No. 34),  next  senega, antimo-
nials, carduus benedictus (a remedy of prompt efficacy is
the elixir cardui benedicti, as stated in No. 72, b),  marru-
bium (vide No. 35), solution of the extract (vide No. 36),
vesicatorium perpetuum on the upper arm or chest (on the
spot, which the patient  complains of as sore), entertained
in suppuration for several weeks, flannel,  best on the bare
skin; Setters water, mixed with milk; I can  recommend
from my own experience also the Eger salt-well. 
184
GASTROSES.
   Or it is due to weakness of the lungs with copious ex-
pectoration  of  mucus.   Here  the principal  remedy is
lichen  islandicus, in the beginning  with dulcamara (vidfc
No. 37), afterwards alone as gelatine, 2 ounces daily.
   Or it is due to nervous irritability, only spasm, which is
recognised by the  dry spasmodic cough  and  the  other
symptoms of nervousness; here extract, hyoscyami, 2 to
4*grains daily, liquor ammonii anisat.,  spiritus Mindereri,
■liquor  c. c. succin.,  aqua laurocerasi, and in obstinate cases
opium  (1 scruple of Dover's powder every evening).

                       Catarrhosis.

   The habitual disposition  to catarrhs is best overcome by
daily cold washing  of the chest; in spring and fall the  use
of lichen  islandicus for 3 or 4 weeks,  daily enjoyment of
the free air, exercise, and wearing of flannel on  the chest,
where  there is great sensibility of the skin, a moist climate,
and suspicion of pulmonary disorders.
                 FIFTH  CLASS.

                    GASTROSES.

          GASTRIC DISEASE, GASTRIC IMPURITIES.

          Sordes Primarum  Viarum, Infarctus.
 - Gastrosis  exhibits a particular form of disease, since it
has symptoms peculiar to itself, and indications which call
for a particular mode of cure—the evacuant ;  hence,  it is
rightly denominated a malady curable by purgatives, as
rheumatism is one curable by serous and cutaneous  eva-
cuations, and inflammation by bleeding.   This malady de-
serves the best attention of the physician for three reasons :
  First, on account of the great  importance of the system
in which it  is  situated;  for the digestive system is the
source of assimilation and growth,  the  representative of
reproduction, as the nervous is that of nervous life, the ir-
ritable system that of sanguineous life,—therefore,  it must
not be considered, as frequently happens, in  the light of a
local, but as the third principal system of the body.
  Secondly, on account of the vast pathogenetic influence 
GASTRIC DISEASES.                185
which it exercises, whether healthy  or diseased, over the
whole body, by arresting or alienating reproduction, or af-
fecting  the humors; as well as by its  extensive connection
with  all parts of the body  through the medium of the
ganglionic nervous system, and by which it is possible that
gastric  disturbance  can  produce almost  any kind of dis-
ease, and may form the object of cure in all,  especially in
chronic maladies. Hence we derive the gastric method of
cleansing the  intestinal canal and abdominal  system, a fun-
damental practice, which has resisted the changes of theory
and the course of time from the  ancients  until  now,   con-
firming according to  my  own experience the old adage :
Qui bene purgat, bene curat.
   Thirdly, because this system is a principal seat of crisis
and critical secretion,  especially  in these  climates. It per-
forms not only the purification of the  liver, so important to
the whole organism, but it sometimes  replaces cutaneous
functions, and it secretes and is the receptacle of injurious
morbid substances, wherefore we say :  the intestinal canal
is a scene of action, on which the most important maladies
are decided.
   Diagnosis.  The tongue is generally unclean, want of ap-
petite,  corrupt taste ;  the seat of the impurities, however,
makes  a difference.   When they are in the stomach, the
tongue is unclean, white, yellow, or brown-coated, want of
appetite, pressure, tension, sometimes painful sensatio'ns in
the region of the stomach, eructation, nausea, or vomitinc,
consensual symptoms, of which headache is  particularly to
be mentioned. When seated in the intestines, the abdomen
is tumid, tense, and rumbling, feels as if pressed and heavy;
colic, pains in the back, fetid flatus, sometimes diarrhoea.
At the  same time  more or less consensual  symptoms,
which  have  this peculiarity, that  they are in causal con-
nection with the gastric  sisns, augment with their increase
and diminish  with their decline.  All gastric diseases are
marked  by a lassitude disproportioned to the rest of the
symptoms.
   The  gastric signs are either combined with fever  (vide
gastric fever),  or  without it (gastrosis chronica).  The spe-
cial diagnosis  is mentioned in the various species.
   The  chief kinds  of gastric matter are : saburra,  bile,
phlegm, acidity,  infarcts, accumulated or formed in the in-
testinal canal.
  Pathogenesis.   Accumulation  of  impurities in the stom-
ach and intestinal canal may take  place in a double manner :
either by imperfect  digestion, owing to an excess, or the
                          16* 
186                GASTRIC DISEASES.
 indigestible nature of food, and its  imperfect evacuation;
 or by disordered secretion from  the organs lining or con-
 nected with the stomach and  intestinal canal, as regards
 quantity or quality, and effusion into it of noxious matters,
 such as chyle, phlegm and bile.  From the extensive sym-
 pathetic nervous connections of the stomach and intestinal
 canal, it is very likely that gastric impurities are generated,
 either by sympathy and  consensual communication with
 general and local irritation of remote parts, such as of men-
 tal affections, pains and even febrile irritation ; or by anta-
 gonismus, as in consequence of taking cold and suppressed
 cutaneous function.   Even  a crisis may produce a meta-
 static secretion in the intestinal canal, and thus engender a
 secondary gastrosis oragastiic febrile complication in the
 course of a fever.
  For special  causes, see under the species.  Disposition
 to gastrosis is due to weakness of the digestive organs,
 habitual costiveness, faulty diet, abuse of emetics and pur-
 gatives, irritability and consensual sensibility  of the diges-
 tive  organs and the gangliary system relating  to it, hyster-
 icism of the stomach, liver, etc., whereby  it happens that
 the least nervous  irritation  or  morbid affection influences
 this  system ;  also  to  atmospheric and climatic  influences
 (thence the epidemic and endemic  character),  especially
 moist or very changeable weather.
  But most important is the pathogenetic influence which
 crudities  can exercise over the  organism, and by  which
 they can become the source of  innumerable diseases. This
 deserves the greatest attention of the practitioner as an
 object of cure in many cases.
  Next  they affect the intestinal canal itself, creating  im-
 peded as well as morbidly increased activity of it; irritation
 and spasm, which frequently attain an inflammatory degree.
 They also operate  sympathetically on the brain, the  lungs,
the  skin, the abdominal viscera, the whole nervous system;
 produce delirium,  pectoral and  tracheal affections, cutane-
 ous eruptions, especially erysipelas,  congestions, local in-
flammations in remote parts, general febrile excitement—
 evils, which may be removed by a single emetic or purga-
tive.
  Therapeutics.   The  general indication is,  to evacuate the
 offensive matter, after having previously prepared the  pa-
 tient ; to remove their injurious effects and to prevent their
 regeneration.
  For the precautionary measures proper to be observed in
 the  administration of emetics and purgatives, see gastric 
GASTRIC DISEASES.                 187
fever.  I need only remark, that they are to be repeated
 when gastric accumulations  continue; emetics in tumes-
 cence upwards, purgatives, when the fa?ces continue bad
 and morbid, to ascertain which due  attention and examin-
 ation of the stools are necessary.


          1. Saburral Accumulation,  Indigestion.

   In this case an emetic or a purgative is generally needed,
 according to the seat of turgescence, and afterwards elixir
 viscerale Hofmanni.  Gormandizers, who frequently over-
 load the  stomach,  will do well to keep on hand  what is
 called a digestive powder (vide No.  48), in order to be im-
 mediately able to give themselves relief.


                2. Accumulation of Bile,

   Occurs frequently after violent angry mental emotions,
 likewise in an  epidemically prevailing bilious constitution
 after hot  summers.  Those  whose  liver is irritable  and
 easily excitable by mental or physical causes, are  subject
 to effusions of bile into the stomach.
   The siims are :  the preceding  mental affection, the pre-
 vailing constitution, the temperament, the yellow or brown
 coated tongue, the bitter  taste,  generally also nausea or
 bilious vomiting, headache, or bilious diarrhoea, with pains
 in the abdomen.  The bile sometimes may acquire  such an
 acridity as to affect the throat and cause violent spasmodic
 reactions, which  may increase  to an  inflammatory state,
 similar to the effects of poison.
   Also here evacuations by emetics and purgatives, accor-
 ding to the respective indications, are called for. Regarding
 emetics, precaution is to be used, since the stomach is al-
 ready much irritated ; therefore the dose must be  divided
 if there is already bilious vomiting, otherwise hyperemesis,
 even inflammation might be created. The purgatives, also,
 must be selected from the cooling and acetous class, bile-
 correctives, neutral salts,  tamarinds and cream of tartar
 water.   In a high degree of irritation, pain in the stomach
 and intestines, mucilaginous  beverages in large quantity
 and clysters, also warm  fomentations are to be used ; and
 in plethoric persons,  a moderate venesection  previous to
 the emetic, are the proper remedies. 
188  -
GASTRIC DISEASES.
               3. Mucosity of the Stomach.

   Signs: No desire for food  or drink, feeling of pressure
and fullness in the prsecordia, especially after taking food,
white mucous fur on the tongue, phlegmy taste, much flat-
ulency ;  in the morning nausea, even vomiturition, slimy
stools, constipation, deficiency of warmth, particularly a
cold sensation in the stomach, pallor,  lassitude, insensibili-
ty, slow pulse, emetics and purgatives have little  effect;
subject to worms.
   The special causes of mucosity are : infant age, phleg-
matic  temperament, sedentary  life,   excesses  in  eating
heavy, farinaceous, fatty food.
   The cure always  requires, previous to evacuation,  the
use of strongly dissolvent, stimulant and incisive remedies;
the mucous coating must be dissolved, before operating on
the membranes of the  stomach and intestinal canal, and on
account  of the  insensibility,  all the  remedies must  be
strongly irritative.   For that purpose are serviceable :  sal
ammoniac, sulphate  of potash, natr., soap, sulphur, sulphu-
ret. of antimony, kermes mineralis, rad. pimpinell, ari, sen-
ega?, squills,  gummi ammoniac, asa foetida.   The disposi-
tion being duly affected, vomits (tartar emetic), and pur-
gatives (salts combined with senna, jalap.,  alces) may be
resorted to.
   This done, in order  to  remove the  chronic state, much
exercise is to be taken, aliments which tend to create mu-
cosity must be avoided, and strengthening remedies used
(vide weakness of the stomach).

          4.  Acidity, Acrimony of the Stomach.

   Signs: Hunger,  sometimes a canine  appetite,  but  no
thirst; sour eructations, and sour breath,  colic, pallor, foul
teeth,  symptoms increased by taking vegetables,  which
create acidity,  especially milk,  on  the  contrary,  meat
agrees well.
  The special causes are  the  infantile age, which has  al-
ways a tendency to create  acrimony ;  weak  bile ; a hypo-
chondriacal and  hysterical  state, also plethor#, particularly
of the stomach, and anomalous hemorrhoids.
  The treatment is double : palliative, neutralizing the acids
by absorbents, such as  magnesia, lapis  cancrorum, concha
pra?par., aqua calcis viv.and clay (bolus alba), the most effi-
cacious of all, but not in excess or for too long a time, since 
GASTRIC DISEASES.
189
 it  is apt to produce  obstruction  of the vessels,  also  lac
 sulph.   The alkalines, soap, carbonate of  soda, potash,
 ammonia and bitters  similar to  bile : beef's gall, quassia,
 absinth., aloes.   Radical cure is effected by remedying the
 generation of acidity, much muscular exercise, flesh meats,
 strengthening the digestive  organs by bitters and tonics,
 as well as by martials (vide weakness of the stomach).
                                                        i
   5. Saburral  Accumulations in the Intestines (Infarcts).

    Signs:  Tumid abdomen,  in which are frequently felt
 knots and indurations, changing from place to place, hard,
 knotty stools, alternating sometimes  with diarrhoea, con-
 taining  gelatinous  matter, or pitnita vitrea, or real mem-
 braneous  concrements,  bilious and  atrabilious infarcts,
 pressure and  heaviness in the abdomen,  sallow counte-
 nance, chilliness ; slow, but sometimes uncommonly full
 pulse, hemorrhoidal complaints.
    Causes are: sometimes only retention and gradual accu-
 mulation and induration of excrements in the great intes-
 tines, particularly in constipated habits, sedentary persons,
 and strictures of the rectum, or they are owing to deposites
 in  the intestinal canal of  atrabilious concretions from the
 liver, or concretions formed  in  the intestinal canal itself,
 or generated by a special  secretive product, similar to the
 membraneous formations  generated in  the uterus.  Gen-
 erally they are connected with obstructions of the abdomi-
 nal viscera.  They are of  great  moment, as frequently
 causing  most obstinate chronic maladies, for the  cure of
 which their removal is the only means.  Their effects may
 be  local, causing  obstinate colics,  cramps of  the stomach,
 difficulties of digestion, hemorrhoids ;  or consensually gen-
 eral, giving  rise  to all kinds of diseases, hypochondria,
 hysterics,  epilepsy, melancholy,  paralysis, hemorrhages,
 blenorrhoeas.  Therefore the cure  of these  maladies re-
 quires the removal of such accumulations.
  Therapeutics.  The principal means are one  or two injec-
 tions a-day, especially the  visceral clysters of rad. tarax.,
 saponar.  and similar resolvents, which have become re-
 nowned through Koempf.  It is essential that they should be
 retained  some time,  therefore they are to be given in small
quantity  (six ounces), after which the  patient must  rest
quietly on the left side for half an hour.  In more obstinate
infarcts or very viscous  phlegmosity, stronger dissolvents
are admixed  with the enema, such as soap, a table-spoonful
of fresh ox-gall or lime-water. 
190                NERVOUS  DISEASES.
                 SIXTH  CLASS.


            NERVOUS  DISEASES.

                       NEUROSES.

                      Generalities.

  Diagnosis.  Every morbid action of sensation or motion,
or thinking, if primarily and idiopathically founded in the
nervous  system,  and not  merely a symptom  of another
malady, or if dependent on another disease, exhibiting itself
purely as an anomaly of the nervous system, belongs to
this class.
  The anomaly may be : either increased action (erethis-
mus) or  diminished (adynamia, paralysis), or altered  (ab-
normitas, alienatio), which is true in regard to the functions
of sensation as well  as of motion (muscular action)  and
mental action.
  Their  course and duration are very indefinite, sometimes
transient, sometimes rapidly fatal, sometimes  lingering
through  life, sometimes interrupted by long intervals, pass-
ing from one form into another form, frequently connected
with the periods of development, appearing and disappear-
ing with them.
  They may spontaneously cease with their causes, changes
in the mode of life, or the periods of growth,  since old age,
by a gradual decrease of sensibility often cures the most
obstinate nervous diseases;  or may attack other systems
by a transmutation into material diseases, crises, metasta-
ses, new formations.
  In general they are not fatal, but may rapidly become so
by paralysing an  organ  indispensable  to  life, as the brain
(apoplexy), the heart (asphyxia), the lungs (catarrhus suf-
focativus), or slowly, by affecting nutrition (tabes nervosa,
or dropsy, phthisis).
   Pathogenesis.   The proximate  cause is an abnormal con-
dition of the internal  nervous life.  It  is manifested partly
by a disturbance in its functions, partly in an unusual con-
sensus, partly in a morbid affection of organic life. 
NERVOUS  DISEASES.
191
  The remote  causes are best divided into four principal
classes.
  1. Disposition, hereditariness, relaxed/fibre, infantile age,
female sex, female education, periods of development, that
of the teeth and speech, of puberty ; moist climate, city
life and sedentary life, epidemic constitution, low state of
the barometer, west wind [in Europe].
  2.  Debility.  It can be brought on
  Either by withholding the excitants and necessary sup-
port  of life, deficiency or bad quality of  food, bad air, cold,
especially damps, loss  of blood, menstrua nimia (often a
hidden cause), too great loss of semen  by venery or  mas-
turbation, too frequent parturition, long  continued lacta-
tion, chronic, serous  and  mucous  profluvia, diarrhoea,
fluor albus, gonorrhoea,  salivation, sweats.
   Or by over-irritation and exhaustion  of the powers, ex-
cessive mental exertion, acute and chronic diseases, exces-
sive  heat, intemperance in spirituous  liquors, coffee and
tea.
   Or by want of exercise, of use ; hence idleness is one of
the richest  sources of nervous diseases.
   Or by influence of potences, which directly weaken the
nerves, such as: sorrow,  grief, sadness, longing, envy,
weariness, passiveness of the mind, indulging the feelings,
abuse of directly weakening narcotic substances.
   3.  Disturbed equilibrium (antagonismus),  sanguineous
 plenitude (disproportion between  power and weight), sup-
 pression  of muscular action, of cutaneous secretion,  the
 action  of the abdominal  system,  sexual functions, men-
 strual and hemorrhoidal discharges.
   4. Local and specific irritations.   Of this kind the first to
 be mentioned are  abdominal  irritatives, worms,  gastric
 matter, saburra, obstructions of the viscera.  Secondly: san-
 guineous congestion, especially of the brain and the abdo-
 men, plethora abdominalis; hemorrhoidal disease is one of
 the most frequent causes of numerous  nervous disorders.
 Thirdly.; metastases of morbid matters, as the arthritic,
 rheumatic, scrofulous,  syphilitic,  psoric.   Fourthly:  me-
 chanical  irritations,  foreign bodies, inserted from  without
 (splinters), as well  as local disorganizations  generated in
 the body itself,indurations,stones, ganglia (which cause fre-
 quently extremely tormenting and obstinate  local neural-
 gias), hydropic accumulations, exostoses, caries.   Finally,
 morbid affections of the  mind, fixed ideas,  exaltation of
 imagination.—The  secondary  causes, generated  by the
 disease itself, and on which its continuance depends; tre- 
192
NERVOUS  DISEASES.
 quently without any other cause co-oparating,  are habit
 and weakness.   The worst is habit,  when it becomes typi-
 cal, and the worst and most  obstinate of all is, when this
 type is complicated with organic  functions, which  are in-
 dispensable to life, e. g. the catamenia, sleep ;  hence  the
 menstrual spasms, mental diseases and  nocturnal epilepsy
 are so difficult to cure.
   On that is founded  the practical division of nervous dis-
 eases, which points out  simultaneously  the object of cure
 and  the  indication :  neurosis simplex s. nervosa, neurosis
 adynamica, neurosis sanguinea., neurosis metastatica, neurosis
 abdominalis, gastrica, neurosis organica.
   Therapeutics.  The treatment is double : of the disease
 itself (radical cure) ; of its phenomena, symptoms (pallia-
 tive cure).
   Radical cure.  In  treating a nervous disease  our first
 question must be :  is the cause material or not,  i. e. is  it
 purely nervous, or is it  nothing but  the product of other
 material disorders %  In the first case we direct the cure to
 the nervous system (direct nervous cure), and thereby re-
 move the disturbances obvious in  it. In the second case,
 we are to take away the material disorders and maladies,
 on which  the  nervous disease depends, which  done, the
 disease disappears  by  itself, and the  cure is finished (indi-
 rect nervous cure).   If it persists notwithstanding, it is to
 be regarded as purely nervous, and to be treoted  as such.
   The fundamental  indication, therefore, always  remains,
 to regulate the anomalous action of the nervous system, be
 it excessively increased, or debilitated, or alienated.
   For accomplishing this end, it is necessary to seek for the
 various causes of the disturbance, and  accordingly the treat-
 ment of nervous diseases is manifold.  When it  proceeds
 from debility (after great loss of blood, of semen,  extrava-
 gant corporeal or mental exertions),  invigoration  and res-
 toration by roborantia and nutrientia is most called for and
 often sufficient for the cure.  When  there is plenitude or
 local congestion of blood, repose is necessary, for muscu-
 lar action  tends to augment it; also general and  local
 derivation of blood  are of greatest use.   We have then to
look particularly to concealed congestion, caused  by  hem-
 orrhoids  and menstrua.  When abdominal  irritatives in-
farcts, worms, visceral obstructions exist, then the resolv-
ing, evacuating, anthelminthic method  is often the best treat-
ment of the nervous disease. Particular attention  must be
paid to dyscrasias and metastases to the  nerves.   Thus it
often happens that a nervous disease is nothing but a rheu- 
NERVOUS DISEASES.                193
matic or chronic  affection, an  antagonistic reflex of the
disturbed cutaneous function to the nervous system, and
here merely covering the skin with flannel, likewise baths,
cutaneous irritatives, internal antirheumatica  are service-
able. The affection may also  be arthritic ; here the cure of
gout is to be pursued.  Thus also psoric, especially scabi-
ous  and herpetic acrimony is frequently the sole  cause of
chronic nervous irritation.   Every lurking syphilitic dys-
crasias, also an imperfect mercurial treatment may be the
cause, and the cure is to be made by mercurials.  Finally,
the psychical influence deserves essential regard, and the
discovery and removal of a secret grief, of a secret longing
(particularly  in females), are  often the  only  remedies
needed.
   But if a remote cause cannot be discovered, or the dis-
temper continues after its removal, then the direct ner-
vous cure must take  its place, i. e. the internal  abnormity
of the nervous  life and its organization, which  is at the
bottom of the nervous disease, must be operated upon and
annihilated.  If the direct  method is used whilst the remote
cause is present, it will prove entirely inefficacious ; or if
it assuage the evil for  a  time, it will soon reappear, and
frequently with increased violence.
   The direct or specific cure is effected by the following
remedies: first, the application of such means as have a
specific relation to the  nervous system (nervina, antispas-
modica).   Of that number are  all etheric vegetables and
animal  substances, the  narcotica, balsamica and  gummata
ferulacea, the ethers and mineral acids, the acria metallica,
the  alkalies and earths, the  imponderable natural agents,
electricity, galvanism, magnetism, mineral  as well as ani-
mal. In order to find  out the  proper nervine, it is very
useful and important to look for those remedies which, in
a  healthy state, would specifically affect the laboring part,
or are capable  of producing attacks similar to the  actual
one.
   In the administration of these remedies, especially of
the stronger and narcotic kinds, the following rules are to
be observed :
   1. We must always begin  by small and cautious  doses,
since we can  never determine beforehand the  degree of
irritability  present.   Then  gradually increase  to such a
dose, as would produce  a  slight attack of narcosis (glitter-
ing of the eyes,  drowsiness, slight vertigo), by the metallic
nausea,  and then decrease the doses in the same manner,
as they  were increased.  Then  a small  pause is to  be  al-
                          17 
194
NERVOUS  DISEASES.
lowed, during which, if the evil does not yield, the remedy
is to be repeated in the same manner, and may be continued
for months, in obstinate cases.  This alternating augmen-
tation, and diminution, and entire pausing is the  safest, and
at the same time the most efficacious, manner of using the
stronger and more offensive nervines, since it allows time
to the organism to recover its irritability, thereby rendering
the remedy a new one, and avoiding the  risk of  injuring
the system by a too long continuance of large doses, a danger
always to be feared, as debilitation of the  mental and sensual
faculties is likely to follow the use of narcotics.   Moreover,
it is also important in lingering nervous  diseases, to change
the remedies, in order to create a new impression.  Finally,
when single remedies  are inefficacious, we must combine
several together.   As  for the weaker nervines,  which are
of an animating, roborating and permanent efficacy, their
use must be continued for a considerable time, sometimes
for years, in order to gradually attain the intended amelio-
ration of the morbid condition.
  2. By  contrastimulants  and derivatives.  This purpose
is fulfilled by baths, cutaneous irritatives, artificial  ulcers,
abdominal irritatives (especially when the cerebral system
is affected).
  3. By restoring the organic balance in the action of the
nerves, especially in the relation of the irritable to the sen-
sitive system, the  disturbance of which is frequently the
sole cause of nervous disease ; for which end muscular
exercise and lukewarm baths are useful.
  4. By strengthening.  Every nervous disease, although
it may not have originated in  weakness, finally creates de-
bility of the nervous  system, and  is entertained  by this
very state.  Therefore the use of roborants (amara, amara
adstringentia, astringentia, acida mineralia, martialia, cold,
cold baths), and restaurantia (nourishing diet, living in free
salubrious  air} in  the  country, travelling, exhilaration of
mind) are salutary.
  5. Change of habitual mode of living, of situation, envi-
rons of the residence. Often a mere change of climate will
effect  a  cure. Especially  low,  moist   regions must be
changed for high dry ones.
  6. Sometimes, particularly in very tender, irritable sub-
jects, who have used an abundance of irritative means, the
best cure consists  in withholding all heterogeneous, medi-
cinal and  dietetic  irritants, especially  such as strongly
affect the nerves,—abstraction of irritation ; at  the same
time, milk diet, quiet country-life, lukewarm baths, avoid- 
MENTAL  DISEASES.                 195
ing tea, coffee, spices, etc.   Here the homoeopathic cure
and the application of the remedies in homoeopathic doses
can also prove very useful.
  Finally, in very obstinate diseases it is advised to excite
artificial crises, or to shift the malady to  other systems.
  The greatest and most general  roborative for the brain
and the whole nervous system is the daily affusion of  the
head with cold water.
  Of great moment in the treatment, is a regard to period-
icity of the nervous attacks, whether they be spasms, pains
or other alienations, even paralyses.   When they return at
definite intervals, cinchona given in the absence of  the at-
tacks,  is the sole and certain remedy.
  Palliative cure.  It only assuages  the phenomena,  the
symptoms of the disease ; it is, however, of great import-
ance,  in the first place, as relieving the patient; secondly,
since  even the symptoms can bring on danger ; and thirdly,
because  by the outbreaking  (e. g.  epilepsy) the morbid
character is more and more impressed on the nerves, there-
fore a  palliative  treatment becomes an  important part
of the cure.  The remedies fulfilling that end are the anti-
spasmodica and contrastimulants.
                1. MENTAL DISEASES.

                    INSANITY, INSANIA.

         Mania, Melancholia, Amentia, Fatuitas.

   Diagnosis. Disturbance of the normal action of the mind.
 It is called melancholia, when connected with timidity, un-
 sociability, sadness,  listlessness, debility ; madness (mania)
 when accompanied with rage, vigor and pugnaciousness;
frenzy (moria,  amentia), with fixed ideas, partial disturb-
 ance of the imagination (conceptions), or of discrimination
 (conclusions) ;  imbecility (fatuitas), when marked by weak-
 ness or total loss of  the faculty of thinking; somnambulis-
 mus, a continuous action  of the mind, fancy,  or volition
 during sleep.
   The diagnosis is often very difficult, since the alienation
 frequently has  reference to only one object (fixed ideas),
 while the  individual is of  sound mind towards all others ;
 diagnosis is also difficult in slight degrees, and when the
 disease is periodical.  We must exclude those mental dis- 
196                MENTAL DISEASES.
 turbances which are symptoms of diseases, and which pass
 away  with them,  as  those caused  by  fever, hysterics,
 violent passions ; for  every violent affection  makes  man
 temporarily insane.
   Delirium must be carefully distinguished from  insanity.
 In  hysterical and  hypochondriacal persons, delirium often
 lasts long, and may be accompanied with fixed ideas, which,
 however, are only symptomatica!, and not  a mental disease.
 The same is true  of febrile deliria, for they are  not  only
 symptoms of acute, but also of chronic nervous fevers, and
 may continue  for  months, and wholly disappear with the
 febrile excitement.  Therefore, we should  never call a men-
 tal  disturbance  connected with  fe.ver,  insanity.   Young
 practitioners cannot be too cautious in the diagnostics of
 mental symptoms,  and in  pronouncing the word insanity,
 for to  declare a person insane, is morally  to kill him.
  Insanity is permanent or periodical, is of long duration,
 the cure difficult, and amelioration uncertain, and apt to be
 interrupted by  relapses.  Sometimes it passes into other
 nervous maladies, as catalepsy, epilepsy, paralysis (transi-
 tion from the mental to the  material nervous  system), or
 into still  more  material  diseases  (corporification of the
 mental disease, transition from the mental  to the vegetative
 sphere), as gout, cutaneous eruptions, ulcere, hemorrhoids,
 phthisis.  It may terminate fatally by apoplexy, consump-
 tion, or dropsy.                             m
  Pathogenesis.   The immortal  spirit, as  such, cannot be-
 come sick in the common earthly sense of the word. Mind
belongs to another  world.   There  is only one disease to
which  it is liable—moral corruptness, sinfulness.   Spirit—
thought, is not  matter, nor the product of  matter ;  for that
 which  can view and contemplate both itself and  matter,
must be superior to, and independent of,  matter;  what is
free cannot be the  product of necessity.   This immortal
 spirit during its earthly existence, is inseparably interwo-
ven and combined with the body, most intimately with the
nervous  system, and  particularly  with  its  most  refined
part, the brain.   By this connection its earthly limit and
manner of action is confined.  Hence it becomes,  like all
things  which  enter  into organization, subject to the laws
of life.  It is only by this means  that it can manifest exter-
nal  phenomena and  its  internal actions (hence the  brain is
properly called  the  organ of the mind), and  through this
it may  be affected and  altered by the organism, as  well as
the organism by it ;  and only in this way can it be impaired,
disturbed, or totally impeded in  its functions.   All mental 
MENTAL DISEASES.                 197
 diseases, therefore, belong to the category of nervous dis-
 eases.*
   The proximate  cause of a mental  disease, therefore, lies
 in an abnormal state of this material organ, either its ac-
 tivity being excessively enhanced or diminished, or altered
 in modo (in its normal laws and proportions).  This is made
 evident by the  fact, that mere corporeal causes (intoxica-
 tion, fever, narcotics) can  produce  a  mental disturbance,
 and that insanity may cease on transferring the affection to
 other organs of  the body,  as it were, to corporify it, as
 when it gives rise to phthisis, epilepsy, dropsy.
   The disturbance can be created in two ways,—by spirit-
 ual as well as by corporeal influences.
   The remote causes are :
   1. Spiritual or mental: violent passions, rapidly working,
 as fright, joy, anger, as well as concealed and lingering, as
 continual grief, sorrow, chagrin, envy, jealousy, especially
 egotism, hatred,  melancholy, unrequited love,  ambition,
 disappointed hope, deep continuous mortification, exces-
 sive  mental exertion,  especially when combined with  a
 sedentary life  and  solitude, reflection on subjects which
 surpass human  capacity or that of the individual  (mystic
 religion, transcendental philosophical meditation) ; exertion
 of the mind, particularly  involuntary, enforced  by stimu-
 lants, wine, coffee and the  like, scruples  of conscience,
 every kind  of  enthusiasm,  political as  well as  religious,
 wrong cultivation  of the  mind, unequal  exercise of the
 mental  faculties, especially imagination  excessively  en-
 hanced  by the  reading of novels, attending theatres  and
 the  like, persisting in a  fixed  idea, instinct, or  passion,
 which must be  considered a transient insanity, and if not
 combatted,  may pass into  real  insanity ; finally,  lucubra-
 tions, sleeplessness ; for daily interruption of mental activ-
 ity is essential to  the preservation of mind, i. e. sound
 reason.
  2. Corporeal.  Such,  especially,  are  influences which
 excite and change directly  the  brain  and  its  action, as
 excess of spirituous liquors, particularly of brandy.   The
 excessive use of narcotic substances, as opium, belladonna,
 (both even given as remedies, especially in children), ope-
 rates in a  similar  manner.   Stimulants  consensually or

  * The most appropriate likeness is that of the relation of a musi-
cian to a stringed  instrument.  Without it the best player is unable
to utter a tone, and only when it is well tuned (in good healthy order),
a pure tone. If the instrument is not well tuned, disharmonious tones
are heard, though  the player be the same.
                           17* 
198                 MENTAL DISEASES.
antagonistically operating on the brain, particularly such
as affect the gangliary system of the abdomen, a system
closely in connection, partly consensual, partly antagonis-
tic, with  the brain ; abdominal  irritants, accumulations,
infarcts, stoppages  in the portal  system,  obstructions,
physconias of the viscera, worms.  Here, particularly, the
remarkable  antagonism of the abdominal nervous system
against the cerebral one is to be  regarded ;  for a sup-
pressed or debilitated action of the first is capable of pro-
ducing increased and abnormal action of the latter.  San-
guineous  congestions of the  brain, passive  as well  as
active, an inflammatory  state, especially  from suppressed
piles, menstruation,  bleeding at the nose.  Debility of the
brain from general causes, exhaustion of power (here  in-
sanity is  often only a symptom of general nervousness,
hysterics, etc.), frequently by excesses in venery, still more
in onany  in both sexes, since the generative system and
the brain  are in particular relation,  and  mutually operate
on each other.—Metastases to the brain, especially arthri-
tic and psoric.—Mechanical lesion, a fall,  stroke or wound.
These may produce insanity by mere  eommotion of the
brain, by  bloody and serous extravasations,  or by depres-
sion of the skull,  thickening and exostosis of the bones of
the head, or by pseudo-organization.—Organic disorders,
indurations,  callosities,  scrofula,  hydatids,  excrescences,
softening, suppuration, or atrophy of the brain ; exostoses,
ossification, hydropic accumulations.
  Frequently several causes simultaneously  exist, render-
ing the disease more difficult of cure and dangerous; thus,
when mental exertions frequently recur, are combined with
a sedentary life, sorrow, heavy indigestible food.
  Particular regard is due to predisposition  (predisposing
cause) of mental maladies.   Hereditariness  is first to  be
mentioned, which, alas !  experience too well  confirms, may
be handed down from parent to offspring, and become pecu-
liar to families.
  The  temperament.—The  melancholic and  choleric are
most liable to insanity.
  Further, irascibility.  The more passionate a man is, the
more is he disposed to mental diseases.  Every passion is
a  temporary  insanity, a  suppression of reason ;  if it be-
comes prevalent, it may  induce permanent insanity.
   Mode of living,  when accompanied by the foregoing
causes, that is, sedentary life, solitude, partial exertion of
the mind.  Therefore weavers and shoemakers are partic-
ularly disposed to it. 
MENTAL  DISEASES.                 199
  Finally, generally prevalent mental dispositions, excite-
ments, mental confusions, particularly false  ideas of reli-
gion, immorality, irreligiousness and mysticism.
  Wherefore insanity may become endemic, epidemic, or
climatic.  We find it prevalent at one time, rare at another ;
more" frequent  in certain regions, nations,  or classes of
people  than  in  others.  Thus it  rarely  occurred in the
nations of antiquity, and is scarce even now among uncivi-
lized nations (in England 1 in 80t,  in France 1 in 1200);
it is likewise more frequent in great, luxurious  and im-
moral cities, than among country people.
   The best practical division  of insanity is into: vesania
nervosa, sanguinea, adynamica, metastatica, abdominalis, or-
ganica.
   Therapeutics.  The  object of cure is to restore the mental
action to  its normal state.   This may be effected, partly by
removing the remote cause, partly by a direct operation on
the mind.
   The first step is to discover the remote  cause, and to  *
act accordingly (the indirect mode of curing). If  it is san-
guineous, or inflammatory, or there is great  determination
to the brain, general  and local bloodletting  is called for;
and in violent  rage,  arteriotomy, antiphlogistics, purga-
tives, tartar emetic, calomel,  cold fomentations  and  affu-
sions on the  head are the remedies.  If it is  nervous, from
weakness of the brain and nervous system, then  nervines,
excitantia, valerian, arnica, serpentaria,'wine, ether, opium,
rubefacientia, warm baths, cold fomentations on the head,
are the proper remedies.  This treatment applies to deliri-
um  tremens s. potatorum and to  insanity, arising  from
excesses  in venery and masturbation.
   We are not to forget that this species  often arises  from
over-irritation  of the  first, and the insania nervosabecomes
the second stage of the phlogistic  one, according to which
the mode of treatment has to be modified ; whereas on the
contrary, the nervosa may associate with transitory con-
gestions of blood to  the brain, and render abstractions of
blood, at least local,  necessary. If the cause is abdominal,
owing  to gastric accumulations,  infarcts, especially  atra-
bilious,  stoppages of the viscera,  worms,  the  resolvent
method is required, removing the abdominal irritatives.   If
it is metastatic, then the metastasis must be treated.  If it
is psychical, longing, unsatisfied  passion, then the same, if
possible,  must be done away with.
   The second  indication  is  to  operate directly on the
proximate cause, that is to say, to operate immediately on 
200                 MENTAL  DISEASES.
 the  mind and its organ, in order to restore the thinking
 faculty (direct cure of insanity).
   There are two ways by which we may reach the mind,
 the  corporeal and the spiritual.  The corporeal is the most
 essential in mental  diseases.   Of all insanities cured, cer-
 tainly two thirds have been healed by physical mean's.  It
 is, however,  proper and  most  efficacious, to unite both
 modes.
   The physical treatment has two indications.
   The first is to  produce, by contrastimulants, a derivation
 from the sensorium, and thereby to restore its balance and
 normal action.   The most important counter-point of the
 brain  is the abdominal nervous system (whence the inac-
 tivity of the intestines and abdominal viscera in every vio-
 lent insanity). To bring these viscera into greater activity
 must, therefore,  be our first endeavor;  by this proceeding
 the  cure is most  frequently successful^  and the balance of
 the  nervous action is restored.   In  addition  to this, the
 continued  use of cream of tartar, soluble tartar, and emetic
 tartar, in divided doses, with dissolvent extracts; in greater
 degrees of inactivity, rad. and extract of hellebor. nigr., rad.
 veratri albi, herba gratiolsa, tinct. colocynth., calomel.  The
 nauseating treatment  and hunger must  also be mentioned
 here, since they operate strongly on the nerves.  Next to
 them,  the  contrastimulants by cutaneous irritatives, sus-
 tains an important place ; the application of vesicatories
 artificial ulcers (especially a seton in the neck), antimonial
 ointment,  artificial  creation  of  exanthematous maladies
 (infection  of the itch has cured insanity), application of
 moxa, actual  cautery on the  neck and  head (accidental
 burning cured insanity) ; generally, creation of  corporeal
 pains and complaints.
   The second is  to produce an alteration of the brain by
 remedies acting directly and specifically on it.  The most
 valuable and confirmed by experience are : herba digitalis,
 in large doses, thirty to forty  grains  daily in infusion, hy-
 oscyamus,  herb,  and rad.  belladonna?,  aqua laurocerasi,
 stramonium, camphor; a  combination of belladonna with
 aq. laurocerasi (liquor, belladonna? cyanicus, vide No. 50),
 I have found particularly efficacious.  If the vascular sys-
tem  is  simultaneously excited, digitalis combined  with
nitre (vide  No. 51), cannot be  sufficiently recommended ;
 and in intervals, small doses of tartar emetic ; cold water,
externally in affusions, and taken internally to the amount
of sixteen to twenty pounds daily.   In the use of narcotics
precaution  is necessary, lest excess and  too long  continu- 
MENTAL  DISEASES.
201
ance might change insanity into imbecility.   Opium is less
appropriate, on  account of its constipating quality,  and
causing congestions to the  head ; it  is salutary only in
very debilitated  individuals, after  sanguineous excitement
has abated, or in cases which are  due  to nervous debility,
e. g. in delirium  potatorum.
  The psychical treatment may be divided into two classes ;
the first embracing that which is  common to all kinds of
insanity, and the second relating  to the special and indi-
vidual particularity  of the  patient, which is  to  be  sought
from the first, and must be adapted to it.


            The General Psychical Treatment.

  Psychical treatment has for its end to make reason pre-
dominate over irrationality.   This end is attained by edu-
cation ; for ill-bred children resemble the insane ; caprice,
ill-nature, irrationality prevail over reason.  The psychical
cure is nothing but the art of education applied to insanity,
and the  rules and means of every kind of education  are
applicable to  insanity.  Therefore, the first consideration
is obedience.  It is the ^foundation of education.  Obedi-
ence is the habit to subordinate one's own will to  that of
another, and  thereby  learn to  subject it to the supreme
will of reason.  The insane, like obstinate, capricious chil-
dren, are first to be accustomed to discipline. In all things,
even  in trifles, he must learn to obey.   They  must fre-
quently  be commanded to do that which is contrary to
their will.
   The second means is work, occupation, partly  mental,
partly corporeal, but  mostly the latter, connected with ex-
ercise and the enjoyment of free air.   By this the  mind is
withdrawn from  indulging too much  in its own thoughts,
attracted elsewhere, and placed again in connection with
the external  world.   Idleness  is  the mother  of all evil.
The choice of occupation must be suited to  the education
of the person, and the species of insanity.
  The third is exact order,  strict distribution of time, and
subjection to authority.
  The fourth  is, to exhilarate by agreeable impressions on
the senses, especially by music, the power of which on the
mind is far greater than is generally imagined.
  The fifth is punishments  and rewards, as with children.
With this view, strait jackets, cold shower-bath, tread-mill, 
202                 MENTAL DISEASES.
in extreme cases, even  corporeal  chastisement, but  only
when the patient is strong and obstinate.
  The sixth, belief and confidence in one person, especially
in the physician.  The insane must be brought to the full
conviction that he is his friend, and thinks and does his
best  for  him,  therefore  the  physician must  be without
defects.
  The seventh,  crowning the  whole  mental  cure,  is  to
awaken and fortify the moral and religious principle of the
patient.  Religion is the  best thing  in man ; it is that which
properly  constitutes him such  a one; it is the essential
part of his life ; therefore it is religion, when all other
means fail, that the patient's thoughts and actions must be
referred  to. On this account, going to church and conver-
sation with a sensible clergyman are advised.
  Finally, change of place, habitual attendants and objects
are mighty auxiliaries.
  In violently excited, raging individuals, mental irritation
and exercise must be withdrawn, and compulsory measures
must  be  taken, of which the strait  jacket, convincing the
patient of his impotency, and the darkness of a cushioned
room are of great effect.


                 The Special Treatment.

  Besides these general rules, the individuality of the mind
affected, and the various species of insanity must  be con-
sidered.   The proud must be humbled, the timid  and de-
jected raised ; the monomania, illusion of the senses, or of
the imagination, are to be treated according to their nature,
and the patient will be best undeceived by entering into his
hallucination and annihilating it by itself.
  The psychical treatment can,  it is true, do much, some-
times all, towards curing ; but cases merely psychical are
rare ; for the  body always partakes more or less of the
disease.   Therefore, it is best to unite both methods, the
corporeal and the mental, as the surest means to attain the
end.
  The curability of insanity is  in  the average  of one to
five, at highest four. 
HYPOCHONDRIASIS.
203
               HYPOCHONDRIA.   HYSTERIA.

                   Male,       Female

                   Hypochondriasis.

  Diagnosis.   Great disposition to spasms and nervous at-
tacks of many forms, great variation and contrariety in the
natural  phenomena of the system, remarkable idiosyncras-
ies and sympathies, disorders of the digestive system, and
great consequent sympathetic influence on the whole body,
disposition to flatulency, constipation, inclination to solitude
and sadness, mind continually occupied about  imaginary
diseases, which belief becomes a fixed idea and predomi-
nates over reason ; singular  fancies, incessant meditation.
In general, there is anxiety,  pusillanimity, sadness, or ex-
travagant  mirth  without  cause, rapidly alternating with
each other ;  inclination  to weep.  Pale, watery urine and
frequent urgency  to pass it (a sure indication of threaten-
ing spasms), globus hystericus.
   The symptoms  are spasmodic sensations, and fits of all
kinds, which in slight cases are of a  light character ; but
in  hio-h degrees  of hypochondria they  are violent,  dan-
gerous and even fatal, e. g. catalepsy, asphyxia, hydropho-
bia,  epilepsy,  deliria, violent frenzy, somnambulism;  in
which cases we must carefully  distinguish between  deli-
rium, true insanity and epilepsy.
   Hypochondria  and hysteria are but sexually, not essen-
 tially different.   Hypochondria  is  the male, hysteria the
 female form of the same malady. The difference between a
 phlogistic and a nervous hypochondriasis is very important.
    The duration is indefinite ;  it may  last years or for life,
 interrupted by long intervals.
    It is not a fatal disease, but is very troublesome to the
 sufferer as well as to others ; on  this account, two methods
 of treatment are required: to encourage the patient while
 he suffers under  the apparently dangerous  attacks of suf-
 focation, epileptic fits, swoons, lasting for hours, asphyxia,
 (as long as they are  of hysteric nature,  they  are not
 perilous) ; and to inculcate patience, and particularly to ad-
 monish against the deception of hallucinations.
    Pathogenesis.  The proximate cause is morbidly exalted
 and unnatural sensibility of the nervous system ; especially
 of the digestive  organs, which may  create extraordinary
 reactions, novel and uncommon sympathies. 
 204            HYPOCHONDRIA.  HYSTERIA.

   The remote causes may be divided into the following
 chief classes.
   1. Debility of the nerves, especially  from excesses in
 venery and onanism in both sexes ;  immoderate exertion of
 the faculty of thinking, also  of feeling, perpetual physical
 or moral  sufferings, as pains, sorrow, excessive corporeal
 exertion,  continuous  debilitating  evacuations, especially
 loss of blood by too frequent venesections, menstrua, hem-
 orrhoids,  chronic diarrhoea  (also hypercatharsis);  gonor-
 rhoea, in the female sex (often as secret cause) fluor albus.
  2. Irritation, especially that caused by suppressions, ac-
 cumulations  in the abdomen, plethora abdominalis (anom-
 alous or  suppressed piles, dysmenorrhoea),  worms, gout
 (atonic,  irregular, suppressed).   Hypochondria is often
 nothing but a gouty affection—arthritic matter thrown on
 the nerves,  and disappears as soon  as local podagra  ap-
 pears, leaving the patient gay and free from spasms.  In the
 female sex, increased and unsatisfied  sexual desire is a fre-
 quent cause of hysterics, therefore it  is common in such as
 exalt their imagination  by reading novels, plays and  ro-
 mances ;  in  young  widows.  Also  psoric or  rheumatic
 irritation (from light dress, by antagonism) and metastases
 of other morbid matters, lurking syphilis.   Of all this, the
 physician must carefully inquire.   Several causes united,
 frequently conspire to produce the  disease.
  Therapeutics.  The fundamental idea of treatment is to
 diminish the  morbidly increased sensibility of the nervous
 system, especially of the  gangliary  portion  of it, and to
 restore the balance of its action, by removing the morbid
 irritating and debilitating causes which  affect and disturb
 it, or by immediately altering and invigorating the nervous
 system.
  1. The  first question  is :  does the disease arise  from
material  causes  or not 1   Most frequently accumulations
and obstructions in the abdomen, constipation and hemor-
rhoidal plenitude  are at the  bottom, as is implied in the
name morbus ex hypochondriis, and claim the first and most
momentous consideration.
  The symptoms are as  follows : regarding the causes—
sedentary life, compression of the abdomen by lacing, long
continuance of sorrow, indigestible food,  sallow complex-
ion, and conjunctiva, the same around  the mouth and nose,
belly tumid, and  also on  accurate examination an enlarge-
ment or hardness of single viscera ; appetite  bad or very
unequal; tension in the stomach after eating ; stools gen-
erally tardy, hard, sometimes also constipation for several 
HYPOCHONDRIA.  HYSTERIA.            205
days, then sudden diarrhoea ; piles, or at least hemorrhoidal
disposition ; finally, the long duration of the disease, which
always produces abdominal obstructions, so that roborantia
are injurious, but solvents are beneficial.
  The method  of cure is the solvent, the visceral  cure.
Succi recens expressi, or extr. taraxaci, gramin., fumar.,
millefol, centaur,  min.,  marrub, chelidon.,  serum  lactis,
terra foliata  tart., tartar tartarisat, antimonials,  alkalines,
especially nitre, medicated soap, lime water, sulphur, gum-
mi  ammoniac,  guaiac,  asa  foetida.  Drinking largely of
water,  the  solvent mineral  waters, Selters, Fachinger,
Sedlitz  waters.  In obstinate constipations, mercury, in-
ternally and externally,  pulv.  Plummeri, baryt. muriat.,
cicuta,  belladonna, aloe, tr. colocynth., pil. balsam.,  elixir
aperit. pharm.  Pruss., tr. antimonii acris, Carlsbad,  Mari-
enbad, clysters, tepid baths, especially soap and salt baths.
This treatment is  often  alone sufficient  for  a cure, for
freeing  and restoring the abdominal functions and the bal-
ance of the nervous system.
  It is of consequence to observe the following rules: For
irritable, plethoric, phlogistic, atrabilious  individuals, dis-
posed to hemorrhoids, we are to give cooling dissolvents,
juices  of herbs, extracts, saline solutions (vide  No. 52),
alkaline  mineral waters; for relaxed,  cold,  phlegmatic,
mucous  subjects the  stronger (vide No. 53), and  more
ardent are only to  be used, as aloetica (vide No. 54) ; in
sanguineous accumulations in the abdomen, sulphurica, and
from time to time, leeches ad anum.
  To purge is not to  resolve, but on the contrary, to im-
pede a  solvent effect.  Therefore  we  ought to prescribe
the resolventia only in such doses as will  produce one or
two stools a day.   This is  often sufficient for the whole
cure.  But  when  signs of turgescence, loss  of appetite,
tumefaction of the abdomen,  tension and colic set in, pur-
gatives must be resorted to (especially Saidschutz or Pill-
na bitter water), or also  emetics, according to indication.
  In obstinate  constipation and infarcts, clysters are the
principal remedy.
  In individuals very liable to  spasms we must combine
the  resolvents with  antispasmodics; in great debility,
with roborants, bitters and saline remedies ; and towards
the end of the  malady, where  weakness keeps up the ob-
structions, chalybeate waters.
  Corporeal exercise, especially on horseback, is indispen-
sable to the cure.   It is often alone sufficient to effectuate
the solution and to free the abdomen;  likewise  friction of
                           18 
206            HYPOCHONDRIA.   HYSTERIA.
the abdomen, which is more efficacious if performed in the
morning, when in a jejune state.
  Moreover, we must not neglect to take into consideration
other material causes of the disease which lie latent, as the
arthritic, scrofulous, rheumatic, psoric, syphilitic dyscrasia
and worms,  and to remove them.
  2. When  debility is the only cause (merely nervous hy-
pochondria), recognizable by the pre-existing  debilitating
circumstances, as fluor albus,  chronic diarrhoea,  loss of
blood, especially menstrua nimia, frequent waste of semen,
gonorrhoea  chronica, even  the  evacuating  and resolvent
method carried too far, as shown by the signs  of general
weakness, weak pulse, being easily fatigued, deficiency of
animal warmth, etc., and by the absence of  other material
causes : its removal is the principal object of cure, and this
alone is sufficient;  for no cure can be effected while these
causes of debility are  suffered  to exist.   Therefore, the
diarrhoea, gonorrhoea, ha?morrhagia, fluor albus, particularly
pollutions, which are frequent causes of nervous hypochon-
dria must be remedied.  The cure of the latter is not easy,
since weakness of the genitals is always combined with in-
creased irritability, and the usual strengthening and restora-
tive remedies would  simultaneously increase the irritation
and afflux of humors,  and thereby their  discharge. On this
account we give only cooling, strengthening, astringent and
nutritive remedies,  such as the elixir acidum Halleri (vide
No. 55), alum, terra catechu (vide No. 56), kino ; and the
maxim, " fast  and work," is to be  observed  ; stimulant ali-
ments avoided, and  much muscular exercise performed.
When the irritability  has been diminished, quinine,quassia,
columbo, iron, gelatin of lichen island., cold baths, general
and local—douches on  the genitals, the perina?um, or sa-
crum, strengthening embrocations on the  lower part of the
spine, finally sea bathing, the baths of Pyrmont and Dry-
burg are useful.
  3. The third point of treatment consists in changing and
invigorating nervous life ; a  treatment which, in  purely
nervous hypochondria, may be pursued from  the beginning,
and is all that is requisite.   In the material  hypochondria
the nervous treatment must be combined with a material
one.  The modifying, antispasmodic method is intended to
improve the internal  anomalous state of  nervous life, the
morbidly increased sensitiveness of the  whole economy,
and particularly of the  digestive system.  It is to  be ob-
served, that the diminishing of this increased  sensibility and
of the constantly irritated state connected with it, amounts 
HYPOCHONDRIA.  HYSTERIA.             207
to invigoration, and is even the best treatment for irritable
individuals.  It is  effected by the  use of antispasmodic
nervines: rad. Valeriana, fol.  and cort. aurant., rad. cary-
ophyllat., castoreum, galbanum, asa foet., elix. acid. Halleri
and Mynsicht., liquor anodyn. Hofmanni, phosphoric acid.,
and tepid baths, either simple  or mixed with  herbs, which
strengthen the nerves.   The  use of these  mild remedies
continued for a long time (several months), can prove very
beneficial.  Even an infusion  of a few green orange leaves,
taken cold morning and evening, can be most serviceable.
The tea No. 57 1 can recommend from my own experience,
as often  sufficient for a cure.
  A principal part of this treatment, which must never be
neglected in the cure of hypochondria and  hysterics, is to
restore the disturbed  balance  of  the nervous action (espe-
cially between the irritable  and sensitive systems),  by
much muscular exercise and tepid  baths ;  and to animate
the nerves by  the  universal, subtile, invisible  and impon-
derable vital substance of the atmosphere by daily exercise
in the free air,  living in the country, travelling.  Daily air-
ing is, in nervous weakness, the  most invigorating means
of all, not  to be replaced by  any other, more efficacious
than all others, and has no contraindication.
  The properly strengthening  method may sometimes be
of use in unison with the modifying, but it must always be
had recourse to at the end of the cure ; for weakness arises
in every  kind of hypochondria by the disease itself, and in-
vigoration is necessary for the confirmation  of the cure,
and preventing a recurrence of the  disease.  The degree
of irritability and the state of the digestive organs must be
carefully regarded, in order to succeed.
  The fixed astringent roborantia,  given  immediately in
the beginning, or  while great irritability  exists,  do not
digest, but  create  complaints of the  stomach,  anxiety,
spasms,  diminish the appetite and fail to strengthen.  If
the  same are given while the digestive ways are  embar-
rassed, they will create  the same troubles.  We must there-
fore  distinguish the various degrees of irritability.  The
greater it is, the more  caution is to be  used in selecting
the  degree of irritative and roborative remedies, especially
when there is great irritability of the vascular system and
a disposition  to congestions.   Here the continued  use of
elixir acid. Halleri,  and if that be too strong, of acid, phos-
phor, in connection with valerian, fol. aurant., herb,  millef.
and tepid medicated (herb) baths are often the  best robora-
tives, and it is only by degrees that we may pass to stronger 
208             HYPOCHONDRIA.   HYSTERIA.
bitters and roborantia.   Likewise, when  the  digestive or-
gans are not entirely free of impurities (which cannot be
obtained in some hypochondriacs on account of weakness),
the pure bitters, and in the first place  the resolvent,  infus.
and extract, taraxac, millefol., centaur, minor, trifol. fibr.,
marrub. ate to be used, after which absinth., then rad.  co-
lumbo, lign. quass. (this  especially as  a cold infusion); in
such cases, also a combination of rhubarb or tart. emet. is re-
commendable.  Gradually we may  proceed, prescribing the
stronger astringent roborantia, Peruvian bark, cort. aurant.,
cascarill., iron, chalybeate waters, Pyrmont, Dryburg, Spa,
Schwalbach, Cudowa.   But also  here it is important to
remark,  that it will  be  well to commence with volatile
forms of these  remedies, e.  g. with the tincture  cinchona?
Whytii, tinctura ferri setherea  (vide  No. 58), or flor. sal.
ammon.  martial, or mineral water, and to pass but gradu-
ally to  the  fixed forms.  Baths, first strengthening  herb-
baths, then chalybeate baths (green vitriol,  three drachms
for one bath), cold bathing  in the river, still better in the
sea, are here indispensable, even frequently more strength-
ening than internal remedies.
  There are cases,  where  the nervous  irritability and
irritation  are so great, that every thing,  even the mildest
medicament creates  excitement.   In  these cases the best
roborative treatment will be negative invigoration by rest
of the body and  mind,  by  withdrawing irritations,  espe-
cially all substances  which have a tendency to the nerves,
tranquil life in the country,  milk diet vvide general cure of
nervous disease).
  In the general treatment, but especially in the strength-
ening,  a strict  diet  is  essential.   It  consists in avoiding
warm beverages, coffee,  tea, all flatulent indigestive  vege-
tables, especially onions, pulse, cabbage, and all excess in
food.   For the  hypochondriacal are very liable to indiges-
tion, which requires gastric evacuants, and these always
lessen the roborative treatment.
  The  palliative  treatment  is  of great moment to  hypo-
chondriacs and hysterical persons, since it is not only in-
dispensable for alleviating life, but also composes apart of
the general  treatment, inasmuch as to appease the nerves
is essentially to cure.  Such patients must have always a
palliative on hand. Their principal complaints are spasms,
constipation of  the bowels,  acidity in the primee vise and
flatulency,  for  these  are the principal causes and com-
plaints.  Thence antispasmodica,  antacida,  carminativa
and open bowels are  the  best palliative remedies.  On this 
                 HYPOCHONDRIA.  HYSTERIA.            209

 principle rests the solamen.hypochondriacorum (a compound
 powder of  magnesia carb.,  tartar,  vitriol.,  rhubarb,  rad.
 Valeriana? together with semen foeniculi), which every hy-
 pochondriac ought to have by him.  Besides, injections (of
 asa foetida 1 to 2 drachms triturated with gummi arabic
 for hysterical persons) and footbaths are of great relief;
 for frequently the  whole attack passes away, when the pa-
 tient gets rid of flatus. Farther, all kinds of antispasmodics
 especially liquor anodyn. Hofmanni, tinct. Valeriana?,  cas-
 torei, liq. c. c. succin., asa foetida,  embrocations of anti-.
 spasmodic ointment on the pit of the  stomach and spine ; in
 swoonings the forehead and temples are to be washed with
 aromatic water, burning feathers, cut onion to be held to the
 nose.  It may be well to remark that, in order to meet the va-
 rious sensibilities that exist in a case of hypochondria, it will
 be proper to  combine several antispasmodics together ;  that
 the odoriferous, as musk, are to be avoided, also opium, be-
 cause this last constipates, and easily becomes a habit diffi-
 cult to be dispensed with, for which reason it ought to be
 seldom prescribed.  The most general and the  safest anti-
 spasmodic for such patients is hyoscyamus, in  preference
 to opium.  It does not constipate, nor heat as opium does,
 but operates assuagingly on the mental disposition of  the
 patient, which is very important in this malady.
   In all nervous attacks it is important to distinguish  the
 constitutio calida phlogistica from the constitutio frigida ner-
 vosa, i. e. the combination of nervous  weakness with ple-
 thora and irritability  of the vascular system, or its absence.
 In  the  first  case  all ardent antispasmodics and irritatives
 are to be avoided, and cooling ones, as flor. zinci,  hyoscy-
 amus,  aqua laurocerasi,  spirit, nitric. a?th., antistimuli,  de-
 rivations by foot-baths,  sinapisms,  injections  are to be
 used in preference.
  Generally, abstraction of  blood, especially by venesec-
 tion, is injurious in all purely nervous, particularly hyste-
 rical cases;  it can  even make them extremely  violent  and
 dangerous.
  The hypochondriacal and  hysterical attacks, it  is true,
 may attain a  degree of violence, which is apt to create anx-
iety, especially in inexperienced young practitioners, and
to misguide them.  Of that number are the swoonings, in-
creased to asphyxia, which may last for hours, even days;
the  strangulatio and suffocatio hysterica,  in which  the  pa-
tients lie for hours in constant danger of suffocation, with-
out breathing, exhibiting convulsions apparently  epileptical
and violent fixed pains in the chest and the abdomen, might
                          18* 
210               SPASMODIC DISEASES.
easily be taken for local inflammations. Here a right diag-
nosis is most important to distinguish those fits from the
hypochondriacal  and hysterical,  that  is, the merely spas-
modic, and to discern them from inflammatory ones.   The
signs are, pale, limpid urine, with frequent urgency to pass
it; globus hystericus, inclination to weep, previous know-
ledge of  the hysterical character,  the trifling occasion of
those attacks, and the absence of fever.
   As soon as  their nature is recognised as such, the dan-
ger of the attack  ceases, and the remedies above-mention-
ed suffice to  remove it.  We except the only case, when
the patient is  young and  plethoric, or suppression  of a
preceding hemorrhage has preceded.  Here, a long dura-
tion and  violence  may  of course  cause a dangerous ac-
cumulation of blood in  noble parts, as apoplexy and the
like ; in such a case abstraction  of blood, which elsewhere
would be  injurious and  even dangerous, is necessary  as a
symptomatic means.

                 2.  SPASMODIC DISEASES.

           Anomalies of Motion and Sensation.

   We comprise under the word spasm in its most extended
sense, all anomalies of nervous action, not only of motion
(spasmi tonici et clonici, convulsiones),  but also of sensation
(pseudasthesia), in its increased as well as in its alienated
form.  They are variously modified, according to the di-
versity of the organ, in which they are located, but are all
one and  the  same in character.   The same is true in re-
gard to  their  fundamental indication, which is variously
modified  by variety of locality.


                    FALLING SICKNESS.

                        Epilepsia.

   Diagnosis.   Convulsive  motions with loss of conscious-
 ness.  Falling down with cries, foam at the  month, the
thumbs flexed into the palms (the only  muscles which,
 while  all others  are convulsively  moved, remain tetani-
 cally stiff).  The consciousness is the most essential pa-
 thognomic symptom, and  not the violency of convulsions.
 The weakest convulsion with unconsciousness is epilepsy;
 the most violent, consciousness existing, are not epileptic.
   The attacks occur by paroxysms.  Every paroxysm has 
EPILEPSY.                    211
two stages,  the convulsive, lasting for some minutes up to
two or three hours, and the soporous apoplectic.  Presages
are sometimes entirely wanting, and the patient uttering a
cry, falls suddenly, as thunderstruck, to the floor.  Some-
times signs  precede, anxiety, headache, nausea ; the most
remarkable is the aura epileptica, the feeling of a cool breath
or wind, which commences at the point of a finger or a toe,
raises upwards, and then, as soon as it reaches the brain,
produces the fit.  Sometimes the aura proceeds from an
organ of the senses, and exhibits itself as a foreign smell,
taste, color, double sight, and the like.
   The attacks occur sometimes typically, at certain periods
and days, sometimes every night (epilepsia nocturna) ; but
more frequently at indefinite times, weekly, monthly, even
yearly once or twice.
   Duration most indefinite, often through life.   The  prog-
nosis is  unfavorable, the disease is difficult to  cure, not
fatal,  but dangerous on  account of falling and accidental
lesions, troublesome and horrible to behold, perilous even
by possibly communicating itself by  infection ; ending in
weakness of the mental faculties, even in stupidity.
   Curability in  proportion  of 1 to  20; a fatal issue rare.
Transition into imbecility, fatuitas, also into insanity (some-
times alternating), hydrops, tabes.
   Pathogenesis.   The proximate  cause is a great anorma-
lity of nervous action, always seated in the brain, probably
in the cerebral organ of motion,  medulla oblongata.  This
forms the most essential difference between epilepsia and
chorea and other convulsions. There are no organic faults ;
for many epileptical individuals have  been dissected, with-
out  discovering them.   They can operate only as remote
causes.
   The remote causes,  besides  the general, are: hereditary
disposition, debilitation  of the nervous system,  especially
by onanism and  excessive venery, violent fright, infection
by the sight of it, worms, particularly tape-worms, gastric
accumulations,  infarcts,  obstructions of the viscera,  meta-
stases to the nerves, especially  scabious  and  herpetic, le-
sions of the head,  local and mechanical irritations, splint-
ers of bone, caries occulta, suppressed hemorrhages, espe-
cially epistaxis.
   To this must be added, when epilepsy has lasted for a
considerable time, habitus, the  disposition of the nervous
 system to this anomalous action having become a habit.
   Therapeutics.   The  radical cure has the following indi-
 cations : 
 212                   EPILEPSY.

   1. Look for the remote cause and  remove it.  This is
 often  alone sufficient to perform a cure, and  such a causal
 cure is always more permanent than the specific. The most
 frequent causes are three, to which I would lead attention  ;
 the  abdominal irritants, such as worms, infarcts, obstruc-
 tion of the viscera.  Here  resolventia  must be used  and
 continued for a long time ; at the same time emetics every
 eight days, in obstinate cases drastics in small doses (scatn-
 monium,  aloe, calomel, tinct. colocynth.), clysters (I saw
 a case, in which a cure was effected by persisting in them
 for a year).   Debility  from onanism.  Here the treatment
 of tabes nervosa and dorsalis, especially cinchona  in sub-
 stance and  chalybeates.  Psoric acrimony shifted to  the
 nerves.  Here sulphur,  antimonium,  guaiac,  sarsaparilla,
 dulcamara, mercury, sulphur-baths, artificial ulcers enter-
 tained for a long time in suppuration.
  2. Examine whether a constitutional fault originated and
 keeps  up the disease.  Here must be considered especially
 the  disproportion between  the vascular and nervous sys-
 tem, youthful plethoric individuality^  suppressed hemorr-
 hoids, and menstrua.  In such cases food and sleep are to
 be diminished, watery vegetable diet, much  corporeal la-
 bor,  venesection every six or eight  weeks, a purgative or a
 bottle  of bitter water every fortnight,  fontanels, are advis-
 ed,  the hemorrhoids and menstruation must  be restored
 or compensated.  I have succeeded to  perform some cures
 by this treatment.—On the contrary, when there is exhaus-
 tion  of the humors and vital  powers, the restaurant and  ro-
 borant method is necessary.
  3.  If the disease, in spite of this indirect treatment, does
 not  cease, or if none of the  above-stated indications is
 present, then  the  direct or specific treatment of epilepsy
 takes place,  which  consists in  operating immediately  on
 the nervous system, to change and annihilate its anomalous
 action.
  Specifica anti-epileptica.  Of  the  great number only six
 have proved to me most serviceable : zinc, cuprum, vale-
 rian, folia aurantiorum, cinchona,  cold  affusions of the
head, sea-bath.  The most valuable of all, most frequently
confirmed in my experience,  is zinc,  in large doses and con-
tinued for a good while.  The patient may commence with
 taking^ 1 grain morning and  evening,  best in the form  of
 pills  (vide No. 59),  and increase the dose every other day
 one half grain, until nausea succeeds ; when the dose is not
to be augmented, but diminished.  Thus, gradually rising
 up to 10, even 20 grains may be given  without detriment, 
EPILEPSY.                    213
 and must be continued in a high degree of the disease for
 months, yea for years; in a lower degree at least 14 days
 in  every month.  Very efficacious is a combination of se-
 veral of the above-named remedies (vide No. 60).  I have
 found the use*of valerian to be made more  efficacious,  by
 adding to it oleum Valeriana? (vide No. 61).  The folia au-
 rantiorum (1 dram of the powder taken three times a-day,
 and a tea of orange-leaves  after every dose),  have proved
 in  my  experience alone sufficient to cure epilepsy  arising
 from onanism. I can also confirm the rad. artemis. vulgar.,
 1 drachm taken every evening in warm beer and waiting for
 a sweat,  as useful.   The same  may be  said of Ragolo's
 powder.*   In  the most obstinate  cases argentum nitric.
 used with great precaution (vide No.  62) is  of service,
 but it has a bad  consequence,—the patients turn black
 after its use.
  Besides these,  the  narcotics (with  the exception  of
 opium, which  is not proper on account of its power  of
 creating congestions to the  head,  even is dangerous, since
 it is apt to change  epilepsy into  apoplexy), stramonium,
 belladonna,  hyoscyamus, aconite, digitalis;  but I must not
 forbear to caution against strong doses, and for tooilong a
 time ; for, though they  may cure epilepsy, they may cause
 a transition into fatuitas; likewise oleum animale Dippelii,
 cajeputi, mercury, vomits, phosphorus, sedum acre, galeum
 luteum, cardamine pratensis, electricity, setaceum nucha?,
 moxa, or the actual cautery to  the  cranium.
  The  principal rule, to the neglect of which it is certainly
 owing, that  the cure of epilepsy has been so rarely lasting,
 consists in  continuing  the  remedies for a time sufficient,
 not only to  prevent the actual paroxysms, but also to anni-
 hilate the habit, the peculiar  disposition to it residing in
 the nerves.  It will therefore be proper to continue the re-
 medies for several months;  and, the fits having ceased, to
 persist in the same means with cinchona  added, which have
 proved  serviceable a fortnight  in  each month for several
 years.
  4. Should this method of  cure be ineffective, try to cre-
ate  an artificial crisis, especially cutaneous diseases (ino-
culation of the itch), flowing hemorrhoids.
  Thepalliatlbe treatment consists in preventing the fit. It
is only  possible, when the attack is foreboded.   The most
efficient remedies are :  a vomit,  liquor c. c. succin. 60
  *  According to Gmelin and Feuerlein this remedy may be com-
posed as  follows : rad. valerian, half a drachm, magnes. alb. and sal
ammoniac of each 3 grains, oleum cajeput. 2 drops. 
214                     CHOREA.
drops, oleum animale, particularly pulv. rad. artemis. vul-
gar., 1 drachm in warm beer, and to retire immediately after
takino- it.  In the epilepsia manu-symptomatica and pedi-symp-
tomatica, the joint of the hand or foot may be tied up, by
which the nerves  are, so to say, tied up, tfnd the aura is
prevented from propagating to the brain.   Such men do
best to wear a leathein band with a tourniquet on the part,
and lighten it as  soon as the aura is felt.  During the fit
itself, the patient being unable  to  swallow, and injection
inapplicable, since the  anus is closed, or it is  imme-
diately evacuated, nothing can be done but to put him on
a  soft bed, and let his spasms work off, taking care only
that he may not injure himself; for any force or fastening
increases the spasms.


                    st. Vitus'  dance.

                         Chorea.

   Diagnosis.   Involuntary motions of single  members or
the whole body, which have this peculiarity, that they re-
present the kinds of motions most common to the  patient,
and wander from one part to  another, consciousness re-
maining,  which is a distinctive feature of the latter from
epilepsy.
   It varies very much both in  degree  and form.   Some-
 times the involuntary motions seize only  single parts,  as
 the arm, the  facial  muscles,  the tongue (even periodical
 stammering comes  under this  head), sometimes only one
 half  of the body  (chorea dimidiaia), sometimes it is perio-
 dical, sometimes permanent;  sleep alone procures  rest.
 Sometimes it produces the most violent muscular exertions
 s     contortions,  such as dancing for  hours  until falling
 down from fatigue, turning on one leg, the most singular
 leaps and violent jerks of the  body upwards and to a dis-
 tance.   Also the  running spasm,  when the feet run away
 with the patient, and he is obliged to run for hours irre-
 sistibly, until he falls down, is here to be counted.
    The disease occurs most  frequently at the time of the
 development of puberty, from  the seventh  to the sixteenth
 year of age, more among the female than anfong the male,
 oftener in  moist  coastward regions, than  in places situat-
 ed higher.  It may occur also  epidemical, even communi-
 catively, especially  in great assemblages.
    It is not accompanied  with any danger to life, and is ge-
  nerally curable, but partial contortions, e. g. of the facial 
CATALEPSY.                   215
muscles,  may remain a  grievous  inheritance  through
life.
  Pathogenesis. The proximate cause is anormality of ner-
vous life and  its action, excepting  the brain,  hence it is
probably an affection of the spinal marrow.
  Remote causes are, besides the general: all nervous dis-
eases, the developing process of puberty, irritation  from
worms, moist  climate.
  Therupeutia.  The treatment is the same as in epilepsy.
The most efficacious remedy,  by which the end is almost
ever obtained, is zinc ; then valerian,  copper,  asa foetida,
baths,  first tepid, then cold river baths.  Worms and  other
remote causes must be removed.

                      CATALEPSY.

                      Catalepsis.

  Diagnosis.  Mutual influence of soul and body annihilat-
ed,  insensibility  to external impressions, immovability, but
at the same time no spasmodic stiffness of the muscles, but
flexibility,  so  that  the limbs  assume and retain any posi-
tion which is given to them ; body and soul continue in the
very situation in which the attack has befallen them; the
body persisting in the same position, the soul in the  same
series of thoughts, even words.   The internal sense  is re-
tired and  sunk  into itself, without clear  consciousness,
often accompanied with dreams and visions ; organic life
is  undisturbed.   The fit lasts for  minutes,  hours, even
days;  after it the  patient awakes as  from  a deep  sleep.
Sometimes during the fit  novel and  singular consensus
and senses are  formed,  as hearing and perceiving by the
pit of the stomach or sole of the foot.
  This accident has been the  foundation of many religious
reveries and  superstition,  e.  g. Mahomet's inspirations,
which he pretended to receive in that way; the belief of
bewitching, demoniac  possessions, a  fate   which  it  has
shared with epilepsia, chorea, vesania.  Medicine has bene-
fited  and may still benefit mankind in explaining  these
phenomena as natural effects of a nervous disease, not ow-
ing to spiritual influences,  and teaching how to heal them
by  natural means. Thus  it has done  away with witch-suits
and funeral piles.
  Pathogenesis.  The proximate  cause, a most singular
mental and nervous state, similar  to sleep,  when also the
mutual influence of the soul  on the body  is annihilated, 
216
SOMNAMBULISM.
therefore  greatly approximating to somnambulism.  The
gangliary  system seems here to  take the principal part.
  The remote causes are the same as those of epilepsy and
chorea.  Most frequently it is owing to hysterics, exagge-
rated fancy,  and sensibility in  the female sex, masturba-
tion,  over-excited and unsatisfied sexual desire,  worms,
metastases.
  Therapeutics.  The treatment  of nervous diseases in ge-
neral; searching after and  doing away  with the remote
cause.  The  direct cure is effected by zinc,  valerian, cin-
chona, orange leaves in powder and infusion, besides cold
baths, enjoyment of free air, strong corporeal exercise and
activity are, according  to  my experience the  best;  also
magnetism has proved beneficial.
                     SOMNAMBULISM.

                    Somnambulismus.

  Diagnosis.  To hear, speak, walk, or perform other ac-
tions while asleep, as if awake, but without being conscious
of them, and without remembering them when awoke.
  A lower degree is dreaming; the higher speaking dur-
ing sleep; still higher to hear and answer; higher yet,  to
rise, walk about, and do business; the highest is  clair-
voyance ,external and internal sensibility increased above
the common limits  (as in catalepsy).
  Both states, somnambulism and catalepsy, resemble and
pass into each other.
  This distemper happens most  frequently during child-
hood and youth, and wears away with advancing age;  to
some individuals, however, it is attached for life. The full-
moon often exercises an influence on the patients, thence
they are also called lunatics.
  It is  without, danger, but is troublesome, and is dangerous"
on account of the accidents to which such persons may be
exposed in walking  about during the night.
  Pathogenesis.  The cause of it  is too  lively an imagina-
tion and senses during sleep.
  The  gangliary system, it cannot be denied, plays a prin-
cipal part, and this  state  seems to reside in a preponder-
ance of the action of this  system over  the cerebral; the
perception and representation of that system (the animal
soul) predominating over the intellectual faculties of the
mind, the latter entirely retiring.  The sexual system is of 
NIGHTMARE.                   217
great influence on  this malady, and this state is met with
more frequently among females than males.
  The  remote causes are the same as in chorea, especially
the development of puberty, sanguineous congestion to the
head, and worms.
  Recently  it has been discovered that this state may be
excited by the manipulations of magnetizing, and  we now-
a-days distinguish somnambulismus naturalis and artificialis.
  Therapeutics. The causes are similar to those of nervous
diseases  in general, especially of chorea and catalepsis. In
order  to prevent walking while  asleep  during night, be-
sides tying  the individual,  a tub may be placed before
the bed  of the patient, containing cold water, into which
he  is obliged to  step,  when  rising,  and which  awakens
him.
                       NIGHTMARE.

                   Ephialtes, Incubus.

   Diagnosis. During sleep the feeling of a heavy pressure
on the precordial region, which impedes breathing; great
anxiety, and many images of fancy (phantasmas, visions),
created by  the  causes  of the  pressure, e. g. flying men,
dogs, bears, monsters, also robbers, murderers ;  in which
the sufferer strives often for a long time in vain to raise
and move himself,  or to cry  for assistance, until he finally
succeeds to utter  a cry of anguish, by which he generally
awakes, and the painful state terminates.  This commonly
happens in the first hours of sleep, with some rarely, with
others almost every night, disturbing the sleep and injur-
ing the general state of health.
   The accident? depends  on  a particular cramp-like affec-
tion  of the pra?cordial nerves, and their consensual opera-
tion  on the brain.   The causes may be triple: either me-
chanical pressure of an overloaded distended stomach (too
rich supper of indigestible meals, accumulation of winds),
or plethora of the abdomen, general or local; or lying on
the back, by which likewise accumulation of blood or winds
to the precordial region is favored.
   The  treatment  consists in  removing  the occasional
causes,  remedying the general or local plenitude of blood,
accumulation of winds, constipation, avoiding supper and
lying  on the back.
                          19 
218               AGRYPNIA.   RAPHANIA.
                     SLEEPLESSNESS.

                       Agrypnia.

  Diagnosis.  Impossibility to  get  asleep,  without  any
other disease,  or any externaP or internal  cause  which
might disturb rest.  It may become a very tormenting evil
lasting for months, even years, finally causing great weak-
ness,  emaciation, and disturbance of all the functions.   It
may also be periodical, that is, return every other night.
  The causes  are either morbidly  increased excitability
and mobility of the nerves;  hence agrypnia is often a con-
sequence of nervous fever and other nervous diseases; or
a deeply seated nervous  irritation,  either mental  (secret
grief, sorrow,  suppressed passion),  or corporeal,  located
most frequently in the abdomen, in the gangliary system.
  The cure  must relate  to the various causes, especially
the abdominal  irritations; therefore removal of the stag-
nations of the abdominal plethora and infarcts gives the best
relief.  Besides the means which directly  soporify the ner-
vous system, tepid foot-baths before retiring, general luke-
warm baths, the  use of herb,  or extr. hyoscyami,  which
is a sqrer  and  safer  remedy than opium, 1 to 2 grains be-
fore retiring, are recommendable ; also emplastr. or extract
hyoscyami  applied to both temples  are advised.  In non-
plethoric, especially  in  debilitated  old  persons,  a small
glass of old Malaga wine is  the  best means to promote
sleep.

                       RAPHANIA.

  Diagnosis. Violent convulsions and spasms with rigidity
of the limbs, accompanied  by a feeling  of crawling, or a
violent pain.
  The disease is rarely fatal, but it may pass into a chronic
nervous one, in insanity and emaciation.
  Pathogenesis.  It is always caused by  living on bread
mixed with  spurred rye (secale cornutum); hence this dis-
ease occurs in  moist years, when this degeneration of corn
is prevalent, and becomes endemical and epidemical.
  Therapeutics. The cure is easy, and surely effected by the
following remedies; first  a vomit, then a purgative, after
this opium  £ grain,  along with sulphate  of potash every
three hours.
  The spasms, and  often very painful contractions of the
limbs are best relieved by contre-pressure and tying.  • 
TREMOR.  TETANUS.   TRISMUS.           219
                      TREMBLING.

                        Tremor.

  Diagnosis. May be local and general, of various degrees,
from the lowest to the most violent, passing into real con-
vulsions and forcible involuntary motions of single limbs,
as a forcible continued striking  with one arm or foot, so
that the patients  hit themselves involuntarily;  in some,
continual shocks  and shakings  of all  limbs, even  of the
head ;  a state  which appears similar to chorea, but is dis-
tinguished from it by the convulsiveness of the shocks and
the absence of gesticulations.
  It is very difficult of cure, when it is idiopathic and arises
from nervous weakness.
  Pathogenesis. The most common  causes are:  weakness
or plethora, excessive  use of ardent drinks, especially of
brandy and coffee, metastasis, particularly arthritic.  Most
frequently a symptom  or consequence of other diseases,
especially after apoplectic fits, nervous fevers, and poison-
ing with mercury, arsenic, and lead (particularly mercurial
vapors and fumigations), but can finally become idiopathic
and continue so.
   Therapeutics as in all spasms ;  particular regard must be
paid to the causes, such as metallic  poisoning, metastases.
In the idiopathic  and purely nervous species,  attention is
due to the spinal marrow as being the original seat of the
evil; therefore recourse must be had to remedies which
have a specific tendency to this organ, as nux vomica, zinc,
stramonium, chalybeate-baths (Pyrmont), cold baths, elec-
tricity with strong shocks, moxa to the spine, and leeches
on the same part, when there is suspicion of sanguineous
congestion.

                   TETANUS.   TRISMUS.

   Diagnosis.  Constant spasmodic contraction of one mus-
cle (tetanus localis), or of all the muscles (tetanus univer-
salis).   Of the first  kind is tetanus lingua,  penis (priapis-
v us).   The universal has received different names, accord-
i> g to the form which it gives to the body,  which may be
straight,  rigid, and immovable;  or bent  forwards  (em-
pi osthotonus), or bent backwards (opisthotonus).
   The malady  may be continuous, or periodical; acute, or
chronic.
   The duration is variable.   The acute is  generally very 
220               TETANUS.   TRISMUS.
short, lasting 3 to 7 days.   The  spasm  finally seizes the
chest,  lungs, and heart,  and kills in this manner by suffo-
cation  or apoplexy.   The  brain  remains often  free  from
disturbance to  the end of the malady.   The chronic form
lasts much longer,  especially if  it be periodical.  I have
seen it continue for years, and in one case it would always
return  at the same period,  and last eight hours each  time.
Constant trismus also may last for months, especially when
it is of rheumatic or organic origin.
  The prognosis depends on the cause and the character.
The disease is very dangerous, almost always fatal, in the
idiopathic (tetanus neonatorum, and traumaticus); less  so,
when symptomatic of other maladies; least so, when it is
a symptom of chronic nervous weakness and hysteria.
  Pathogenesis.  The proximate cause is a particular affec-
tion of the spinal marrow (not of the brain, as in epilepsy,
for consciousness is not disturbed), and" of the intercostal
nerves.  Remote causes are bilious and other gastric irri-
tants (especially in trismus), rheumatisms, typhous, putrid,
and miasmatic  fevers, small  pox,  scarlatina, metastases,
suppressed exanthemata; even suppressed gonorrhoea has
created it; local irritation of external parts, wounds,  espe-
cially of tendinous and aponeurotic structures, punctured
wounds, foreign bodies, as splinters, especially when thrust
into the feet and hands, hysteria.
  Therapeutics.   We must carefully discriminate whether
tetanus or trismus is symptomatica! or idiopathic.  In the
first case,  the  disease of which  it is a symptom is  to be
treated. In the  gastric vomits and purgatives (even trismus
yields  promptly to emetics).  In the inflammatory fevers,
abstractions of  blood and antiphlogistics; in the adynamic
the most vigorous  excitantia, antispasmodica, opium and
warm baths; in the putrid,  musk, camphor, but no  opium,
for fear of increasing putrescency and colliquation ; in the
rheumatic, camphor, liquor c. c. succin., warm baths, tar-
tar, emetic, opium ;  in hypochondriacal and hysterical per-
sons,  these diseases are  to be cured and  the  nerves
strengthened ; in the metastatic,  derivation and antistimu-
lants; in that which is due to suppressed gonorrhoea, the flux
must be regenerated.
  Among the idiopathic  are numbered those species, the
cause of which  is a primary irritation, idiopathically  ope-
rating  on the nerves, especially foreign  bodies.  Their
prompt removal, and then opium  and warm baths perform
the cure.  Of special importance are two kinds, the tetanus
neonatorum (vide diseases  of children),  and 
TETANUS.  TRISMUS.
221
             Tetanus Traumaticus, Trismus.

  It arises either immediately after a wound, in consequence
of the violent  pain or affection,  nervous irritation, and
kills instantaneously (as soldiers are found with spasmodi-
cally  rigid limbs on the field of battle), or in the first few
days after the wound, during its inflammatory stage, or 8 to
14 days afterwards, whilst the wound is in the best process
of healing and suppuration,  without any inflammation and
pain.  Here the wound is apparently a predisposing cause,
imparting increased sensibility to the nervous system. The
exciting causes are mental affections, taking cold, corrupt
air, or foreign bodies, also tension  and  distraction of single
fibres in the wound, which are due to suppuration.   The
most perilous are punctured wounds in tendinous and apo-
neurotic parts, as in the sole  of the foot and the palm of
the hand.  Also glass and other splinters, sticking in for
weeks, and leaving no visible wound, can cause this evil;
the presence of which must be ascertained by a close ex-
amination.—The pulse frequently remains normal, and the
head is also free, but there is great anxiety  and oppressed
respiration.
   Duration is two, three,  four days ; death by suffocation
or apoplexy.
   The prognosis is most unfavorable ; mortality 20 to 1.
   Therapeutics.   The foreign bodies must be removed, the
wound enlarged, opiate ointment  and  cataplasms of hyos-
cyamus  and  opium  applied.   The  principal remedy is
opium, internally administered by clysters,  and  rubbed on
the spine and pit of the stomach.   -Internally half a grain
every half hour  is to be taken ;  if that does not relieve
after six hours,  the  dose  is to  be  increased to one grain;
and  then to one and a half grains, if it produce  no effect;
and  so on gradually increasing ; between these doses give
carbonate of potass half a scruple, warm baths, mixed with
hyoscyamus and soda.  In plethora and inflammatory dia-
thesis, first venesection, and leeches on the spine ;  calomel,
mercurial  embrocations,  so  as to  create salivation  ; cold
affusions. As soon  as the spasm abates, the doses of  opium
must be decreased.   Should these remedies prove unavail-
ing, belladonna  may be given and  a moxa applied on the
spine.  Finally, amputation of  the wounded limb ; which,
although it might not immediately remove the spasm, will
be preparatory to rendering the opium efficacious. 
222                     ASTHMA.
                        ASTHMA.

  Diagnosis.   Dyspnoea without fever ;  when the disease
is slight, the  difficulty of breathing is perceptible only on
motion ; in the higher degrees it is constant and accompa-
nied with gasping.  By the  absence of fever we distinguish
it from the short  breathing which is a  symptom of nearly
all  acute fevers,  especially  the inflammatory, and  from
phthisis  pulmonalis, which in some  respects  this malady
resembles.  There are kinds of asthma in which the patient
labors under  the same short breath, cough, and expectora-
tion, as in phthisis, but the absence  of chronic fever and
emaciation are discriminative.
  Asthma is nearly always accompanied by cough, either
dry (asthma siccum), or with  expectoration (asthma humid-
urn, mucosum).  It is  either constant (continuum), or  only
attacks  by paroxysms (periodicum).
  The consequences are partly local, partly general.  The
local ones are : impeded circulation of the blood  through
the lungs, hence congestion,  accumulation  of mucus,  stag-
nations, thickening, tubercles, bloody cough, inflammation
of the lungs, suffocation.  The general are : imperfect san-
guification, cachexia, cyanotic as well as serous, diminished
resorption, watery extravasation, first  in the  extremities,
then in  the internal cavities, especially of the chest.
  Pathogenesis.  Proximate cause:  disturbance and  diffi-
culty of the respirative action.   The causes may be  idio-
pathic (seated in  the lungs and organs of respiration them-
selves), or consensual (asthmaidiopathicum and consensuale).
They may, however, vary  greatly; and  for practical  pur-
poses may be comprised under the principal classes of all
nervous diseases, the divisions of which  will point out the
treatment of different asthmas.  They are the following :
  1. Asthma nervosum s. spasticum.   Mere spasm of the
respiratory organs. It is generally periodical.  Frequently
a product  and symptom of  hypochondria and hysteria
(suffocatio s.strangulatio, a. hystericum), affecting the patient
with  apparent  suffocation, for several minutes,  even for
hours;  but this state of horror is  without danger ; for, as
soon as it is over, the patient can breathe as freely as be-
fore.  The asthma acutum  infantile ; the asthma spasticum
et convulsivum belong to  the same class.
  2. Asthma sa?iguineum, is a consequence either of  gen-
eral plethora  or of local congestion in the lungs, especTally
of suppressed hemorrhoids, menstrua, epistaxis.
  3. Asthma metastaticum, owing to a  morbid matter shifted 
ASTHMA.
223
to the lungs and respiratory organs ; most frequently from
gout (a. arthriticum), or syphilis (a. venereum), or scrofuli
(a. scrophulosum), under which head also a. strumosum, aris-
ing from swelling of the cervical glands, must be classed, or
to a metastasis of cutaneous diseases and inveterate ulcers
(a. psoricum); or  it  is caused by suppression  of  serous
secretions  (a. serosum).  This species is double:  either
rheumaticum, due to suppressed  action of the skin, espe-
cially to chronic influence of moist air, or dwelling ;  and
urinosum, owing to  diminished secretion of  urine ; which
often occurs in aged  persons.
   4. Asthma abdominale, arising from some cause which im-
pedes the free motion of the diaphragm, as flatus (a. flatulen-
tum), from acidity in the  stomach (a. saburrale), from ob-
struction, enlargement of the liver and other  abdominal
viscera.
   5. Asthma atonicum s. adynamicum, owing to weakness
of the respiratory organs, either  a product of general de-
bility (as after great  loss of blood, in scurvy and chlorosis),
or of local weakness  of the lungs (a. humidum).
   6. Asthma idiopalhicum et organicum,  due to a local me-
chanical,  chemical or organic cause, which disturbs the
free action of the respiratory organs.   Of that kind  are a.
metallicum caused by depositions of  poisonous metallic
matters  (as  a. saturninum, arsenicale, mercuriale),  a. pul-
verulentum, calculosum, pannificum, brought on by  dust,
stony  concretions,  as in the cases of millers  and wool-
manufacturers ; a. aereum, when air  penetrates into the
parenchyma (emphysemapulmonale), or into the pectoral ca-
vity externally  closed (tympanitis thoracis) ;  a. hydropicum,
owing to an accumulation of water either in the parenchyma
of the lungs (adema pulmonum), or in the pectoral cavity ;
a. mechanicum, such as when caused by ossification  of the
costal cartilage, (a.  senile), curvations of the spine (a. gib-
bosum) ;  a.  syncopticum s. cardiacum s.  stenocardia ;  also
angina pectoris, due  to enlargement, aneurisms, or other
organic diseases of the heart; a. humidum, owing to atony
and blerinorrhoea of the lungs.
   Therapeutics.   The treatment is divided into the general
and special.
   The general treatment looks upon the asthma, without
regard to a remote cause.  It is often  the only one which
may be  applicable,  and therefore of  great  value in  those
cases in which the remote cause  is not discoverable, and in
those where, though known, it is not  removable,  which
happens, alas ! but too often in this malady. 
224
ASTHMA.
   It has the following indications :
   Free expectoration and  solution  of  the  obstruction  in
 the chest as well as in the  abdominal viscera, which very
 frequently accompanies it; for this purpose, extr. gramin.,
 tarax., gummi ammoniac, tartras potassae, acetas potassae,
 tartar emetic in small doses, sulphur aurat.  antimouii, are
 particularly recommendable.
   Promotion of all secretions, especially that of the kid-
 neys, partly  in  order to derivate the irritation, partly  to
 prevent  dropsy of the  chest, which is to be suspected  in
 every chronic asthma, either as already existing or  at least
 as threatening ;  flannel is to  be worn on the chest,  next to the
 skin ; antimonials, sulphur, particularly diuretics, squills and
 digitalis are  recommendable.  Finally, continued antistim-
 uli by issues on  the upper arm, foot-baths of  mustard, wear-
 ing of oil-cloth  socks.
   The special treatment must be appropriated to the causes
 and character of the disease.
   1. Asthma  nervosum  s. spasticum  is recognized  by the
 general signs of a nervous  state.  The cure requires the
 application of antispasmodic, derivative and antistimulant
 remedies ; of the first, particularly recommendable are zinc,
 copper, hyoscyamus and smoking of the leaves of stramo-
 nium ; attention must be also paid to material and metasta-
 tic causes, which may possibly lie concealed.
   Asthma periodicum, noclurnum is most promptly removed
 by a cup of one ounce of fresh roasted  coffee, which may
 be repeated in obstinate cases. If a material  cause does not
 exist, cinchona may be  given in the intervals.
   Asthma hystericum (suffocatio, strangulatio hysterica)  is
 best met by  asa foetida,  taken as a medicine, or by injec-
 tions.
   2.  Asthma sanguineum  is recognized by the general
 symptoms of plethora, or by a suppressed habitual hemor-
 rhage.  The  plethora  must be  remedied by venesection,
 frugal diet, exercise ; or by restoration and  compensation
 of local sanguineous evacuations.
   3. Asthma  metastaticum requires for its cure, that of the
 disease, of which it is  a symptom  or metastasis* and to
create and entertain artificial ulcers on the upper arms and
feet.
   4. Asthma  adynamicum calls for  active  roborant  and
restorant remedies;  in asth. scorbuticum  scorbutis is to be
cured.
   5. Asthma abdominale,  if there  exists indigestion,  wants
emetics and purgatives;  if flatulency, recognizable by the 
ASTHMA.                    225
distention of thepra?cordia, frequent eructations, and feeling
easy after every eructation, carminativa,  cumin,  pepper-
mint (vide No. 63) ; injections (vide flatulency).  In con-
stipation  of the abdominal  viscera  the  resolving method
must  be-  used ; also Carlsbad,  Ems,  Geilnau, Fachingen,
Selters waters.
  6. Asthma idiopathicum, mechanicum.
  Asthma  saturninum,  mercuriale, arsenicale.  Treatment
of these cases of poisoning, especially by sulphur (aqua cal-
cis, antimon. sulphur, sulphur baths), opium.
  Asthma pulverulentum,pannificum, calculosum. The treat-
ment requires dissolvent remedies, moist, warm  vapors,
oxymel scilliticum, between them emetics, but especially in
the calculosum ; respect must also be had  to local inflam-
mation, which may possibly be present ;  therefore as soon
as pain and anxiety in the chest is manifest, venesection or
leeches are to be used.
  Asthma strumosum, tuberculosum.  The  treatment of stru-
ma ; by acetate of soda, half a drachm dissolved in  water
taken daily, I effected a perfect cure.  In tubercles of the
lungs, riding on horseback and milk  diet are advised (vide
phthisis tuberc).
  Asthma  gibbosum.  Nearly all hump-backed, ill-grown
persons labor  more or less under oppression of the  chest.
The cure  of the hump-back, the proper cause, is not  possi-
ble ; nothing therefore remains but relief and prevention of
the bad consequences, such as hemoptysis, phthisis. Regard
must chiefly be had to  the disturbed circulation of blood,
plethora ad spatium, and  the impeded growth ; therefore
abstractions of blood repeated from time to time are indis-
pensable,  and afford the  best relief;  likewise issues and
other derivatives.
  Asthma syncopticum (a. cardiacum, angina pectoris, s '<mo-
cardia) ; that species which  is due to an organic disease of
the heart  or of the great vessels (enlargement, aneurisma-
tic  ampliation, ossification of the valves, polypus  and the
like).  It  is marked by  the following symptoms :  The pa-
tient in motions of the body is suddenly seized with violent
oppression at the chest, sometimes with, sometimes with-
out pain ;  palpitation of the  heart, anxiety; and cloudiness
of the head, which passes  into vertigo, and, when in a high
degree, into a fit of fainting ; irregularity of the  pulse,  a
feeling of painful drawing, even numbness in one arm.
Horizontal position relieves and appeases the  attack ;
which is peculiar to the asthma cardiacum,  whereas,  in the
asthma pulmonale the upright, forwards  bent position re- 
226
ASTHMA.
lieves.  In the  higher  degree of the  disease, the cardiac
region is  also  found tumid.   The  diagnosis is,  however,
often  very difficult, and a consideration of the preceding
cause is important, learning that the evil  has  set in after
violent exertion or exercise of the body, accompanied by
anxiety, or after an inflammation of the heart, or by a me-
chanical  lesion.  Also the stethoscope  may be used for
making out the diagnosis.  It is noticeable, that frequently
arthritic metastases to the heart can give occasion to the
malady.  The treatment, which however rarely procures a
radical cure,  consists in diminishing the action of the heart
and preventing too strong congestion of blood to it, which
may cause an increasing extension, and finally  bursting, in
consequence of which  the disease proves fatal.  The prin-
cipal  remedies  are small venesections frequently repeated,
leeches on the  cardial  region, the use of nitre, digitalis and
aqua laurocerasi;  the  application of cold to  the  region of
the heart, and cold bathings, repeated several times a day;
avoiding all strong exercise ; antiphlogistic vegetable diet;
also artificial ulcers on the arm or in the  cardiac region.
I can assure  that I have seen gradual decrease, even cures
of that evil  effected by these  means applied for months,
continued even for half a year.  It would  seem,  that even
hypertropic and aneurismatic dilatation of the heart can be
confined and  reformed (absorbed).  The recognition of the
«ingle faults  of the heart is scarcely possible, and does not
contribute any  thing towards curing.
  Asthma mucosum (humidum), distinguished by constant
accumulation of mucus and mucouscough, is a blennorrhoea
pulmonum, and must be treated according to the principles
laid down for  blennorrhoea and phthisis pituitosa.  Very
frequently arthritic metastases and obstructions of the ab-
dominal  viscera are the causes, and  determine the  treat-
ment.  The  continued use of mild, solvent remedies is
exceedingly  serviceable, especially mellago and extract.
graminis.  In the first place  expectoration and freeing
the lungs  of mucus, must  be attended to.  If the mucus
is very tenacious  and  the  expectoration thrown up  with
difficulty, gummi ammoniac (No 64), sulph. antimon. aur.,
kermes, oxymel scilliticum, liquorammon. anisat., sulphur
are very  valuable.  Commonly, in order to  moderately
strengthen the lungs in too  great a secretion of mucus,
herba marrubii, rad. helenii, arnica?, senega?  (vide No. -65,
66, 67, 68), the elixir pectoral. (No. 69), are of use.   Pre-
caution, however, is to be used in the application  of strong
roborant  and astringent  remedies,  as  cinchona,  lichen 
PALPITATION  OF THE HEART.           227
islandicum ; for they are apt to suddenly stop expectora-
tion  and  to bring  on attacks of suffocation.  The only
advisable means are pure amara, quassia, cort. or extract.
cascarilla?, but always mixed with expectorants.
  Asthma senile is  generally a consequence  of weakness
created by old age, often also of ossification  of the costal
cartilage.   The first case is to be  treated as asthma ady-
namicum  and mucosum ; the latter is incurable, but relief
may be expected from palliatives.
  Asthma  emphysematicum  (pneumaticum, asreum)  arises
either from an aerial cellula of the lungs bursting by  exces-
sive  distention  and  exertions of the lungs in lifting a load,
blowing an instrument,  after violent external  commotions,
as falls and the like, by which the air is forced  into the
cellular tissue of the lungs (emphysema pulmon.) at each in-
spiration; or from the external surface of the lungs being
torn through by fractured ribs, corrosion of matter,  which
affords issue of the air into the pectoral cavity.
  The diagnosis of either case is difficult, and rests onlyj
on one sign, the appearance of an emphysematic  swelling*
above the clavicula.  The first case calls for venesection,
and  rest of the  whole body and the lungs, in order that the
lunjs may be distended as little as possible, permitting the
little wound to  heal by itself, and the issued  air  to  be ab-
sorbed ; at the  same  time, the inspiration of cold air may
do  good.   In the second case, the  emphysema  must be
operated  on.
   Asthma acutum infantile (Millari)  and asthma thymicum,
vide diseases of children.
               PALPITATION OF THE HEART.

                       Palpitatio.

  Diagnosis.   Irregular, forced  motion of the heart, or of
single  vessels.  The  palpitation  increases  frequently to
such a degree of violence as to become visible and audible
(the sounding heart) ;  in the  more violent degrees by im-
peded  circulation,  it  becomes dyspnoea,  fainting  (vide
asthma syncorticum).
  Also single vessels can undergo such an abnormal pul-
sation, especially in the abdomen (pulsatio abdominalis),
sometimes by aneurismatic extension, often also merely
by local  spasm, as  it happens in hypochondriac and hys-
terical persons. 
   228                     coughs.

     Pathogenesis.  In most cases it  is symptomatic, consen-
   sual, the  effect of  another disease, most frequently of hy-
   pochondria and hysterics,  or it  is caused by abdominal
   irritation, flatulency, obstructions, distentions of abdominal
   viscera, worms, hemorrhoidal congestions ;  or it is also
   due to  general  plethora or metastasis of arthritic, psoric,
   morbific  matters.   Sometimes,  but   much  more rarely
   (about  one in six cases), it  is an idiopathic disease of the
   heart. Even then it is not always organic ; but we must well
   distinguish  the idiopathic dynamic from the organic.   Also
   the idiopathic disease of the heart may be purely dynamic,
   a spasmodic state of this muscle,  as of any other muscle ;
   but by  long continuance and  violence, the dynamic disor-
   der may change into an organic derangement of the heart,
   distention and the  like.   The organic disease of the heart
   consists either in an aneurismatic  distention of single parts
   of the heart and large vessels, or  in a  general enlargement
   of it, or in ossification,  failure of the valves,  induration,
flkilcers,  etc.  The  stethoscope may serve  the  purpose  of
^liagnosis.
     Therapeutics.   The chief  rule is to consider every irreg-
   ular action of the heart first as symptomatic, and to search
   for the  disease of which  it is  a symptom or consequence.
   By doing so, we shall often  effect a  cure, in which we
   would fail, were we to look upon  it as a disorganization of
   the heart.   Consequently the  remote cause, hypochondria,
   hysteria, flatulency, plethora, hemorrhoidal  congestion, the
   metastases must be treated.   If it originates in hemorrhoi-
   dal congestion, the application of leeches  to the rectum,
   and sulphur powder will bring relief.
    If it be idiopathic, a method of cure, directed to the dy-
   namic affection  of the  heart may be serviceable ; and I can
   recommend by my own experience, digitalis (No. 70), the
   external application of cold (cold bathings four  times a
   day, or  applying ice for a quarter or half an hour); riding
   on horseback.
    If the evil is an organic disease  of the heart, then this is
  to be ascertained; which, however, as well  as the cure, is
  very difficult (vide  asthma syncopticum).


                           cough.

                           Tussis.

    Diagnosis.  Forced,  audible  respiration   without fever,
  which is discriminative of cough,  as a symptom of acute 
COUGHS.
229
 fevers and pulmonary inflammation and phthisis pulmona-
 lis.   It may be dry or accompanied by expectoration.
   Duration  is  indefinite;  it  can last for days,  weeks,
 months, years, even through life.
   It is not  dangerous in itself, but may^become so by its
 consequences.  For it is apt to create inflammation of the
 lungs, hemoptysis, and  finally phthisis;  and by the latter
 it becomes one of the most perilous  maladies.  For it is
 proved,  that  two thirds of all  pulmonary consumptions
 have arisen from neglected cough.  Every cough, if it lasts
 long, may  terminate  in that  destructive  malady, and is
 more likely to do so if the patient is of  a  phthisical con-
 stitution.
   Pathogenesis.   The proximate  cause  of every act of
 coughing is a convulsive contraction of the lungs and  res-
 piratory organs.  It may originate from increased  irrita-
 bility of the lungs, or from a morbid irritant matter.  The
 first may be a consequence of sanguineous  congestion, of
 inflammability (tussis sanguinea, plethorica, phlogislica), or
 of increased  nervous  sensibility  (tussis  nervosa, spastica,
 erethica).  The morbid irritation may  be seated within the
 lungs and respiratory organs themselves (idiopathic cough),
 or without them (sympathetic cough), and may vary in  its
 nature.  Catarrhal irritation, rheumatic, gastric, abdominal
 irritants ; morbific matters, as arthritic, psoric, scrofulous
 metastases  to the lungs ; organic  disorders of the lungs,
 tubercles, blennorrhoea,  ulcers.  Henee result the following
 varieties of cough, the  knowledge of which is important
 in practice, since  they  call for as many different methods
 of treatment: tussis  catarrhalis, abdominalis, nervosa, san-
guinea, metastatica, pulmonalis, phthisica.
   Therapeutics.  Above all, examine the species, the respec-
tive  character,  and determine  accordingly on the  treat-
ment.
   1. The catarrhal or rheumatic cough, acute  or chronic,
is a  consequence  of  taking  cold.  This  suppresses  the
action of the skin, and  alters the pulmonary  secretion ;
consequently the distemper is antagonistic, a reflex, a trans-
lation of the cutaneous function to the lungs.   The treat-
ment must conform with the indications of the a?tiology,
that  is: to increase the  cutaneous action, to alter that of
the lungs, and to restore the equilibrium  and their normal
action (vide catarrh).  If the malady is recent, antimonials,
sulphur, glycyrrhfza, extract helenii, elixir pectorale, extr.
cardamom,  benedict.,  sal. ammoniac, supertart. potassae
(vide No. 21, 33, 34, 71 72 a), constant respect,  however,
                           20 
230                     coughs.
being paid to the gastric complication, which is  apt to be
connected with it. The mixture No. 72 b I can particularly
recommend as one of the most prompt curatives.  Does
the cough  become obstinate, or is it already inveterate,
the principal remedies are stipites dulcamara?, flannel vest
next to the skin, and a vesicatorium perpetuum on the up-
per arm.  If this  should not suffice, I have seen mezereum
on one arm, or in a more difficult case, on both upper arms,
entertained  for weeks, even  months, prove efficacious.
When dulcamara  alone is not sufficient, it  may  be com-
bined with  lichen Islandicum (vide  73) and Selters water.
If all this is unavailing, it is because the catarrhal  irritation
has passed  to a tuberculous state, or a blennorrhoea pulmo-
num has succeeded, and the treatment of phthisis, tubercu-
losa or pituitosa,  is to  be pursued (vide phthisis).
  The chronic  catarrhal state is to  be treated and carried
through with the utmost  care, and in this way it may  be
prevented from passing into pulmonary consumption.
  2. The gastric and abdominal cough (stomach, liver, worm
cough).  It is  very important  to  distinguish this from
the pulmonary  cough,  since  its treatment is entirely dif-
ferent.  The discriminative  signs  are :  the  respiration is
free, the patient can walk, run, speak, take a deep breath
wfthout coughing or panting.   In general, affections of the
stomach but not of the lungs  produce cough, which there-
fore is greater after  meals.   At the  same time  there is
imperfect  digestion.   If  the  case  is recent, it  requires
nothing but sal ammoniac, or tart, potassa? for some days,
and  then, according to circumstances, emetics or purga-
tives  (especially  manna and  folia senna? are recommend-
able).   When the case is older, and  there are indications
of infarcts  or  visceral obstructions, associated  very fre-
quently with incipient  cachexy, then active resolventia are
to be used  for a considerable time (vide treatment of abdo-
minal obstructions  in  hypochondriasis),  intermixed with
emetics and purgatives.  I have seen such coughs, appa-
rently phthisical, which had continued for months, disappear
by  a single  emetic.   Millefoil-tea  is also  useful,  taken
morning and evening for some time ;  not less so is marrub.
alb., quassia lign.  In irritation  from worms, these must be
removed.
   3.  Nervous, spasmodic cough.  It is recognized by  the
absence of other causes, by the nervous habit and concom-
itant symptoms ;  that it is not increased but rather dimin-
ished by running, speaking, motion, even over-heating ;  on
the contrary, it is excited by all things that operate on the 
coughs.                    231
nerves, especially mental emotion.  The treatment is that
for nervous  weakness, varying, however, according to its
different forms.  In great irritability, asses' milk, free air,
exercise on  horseback, viscum quernum, hyoscyamus, opi-
um, Valeriana, tepid baths, Ems baths ;  in the atonic state,
cinchona, liquor c. c. succin., quassia (vide phthisis nervosa)
are advised.
  A particular kind of spasmodic cough is the tussis matu-
tina vomitoria, a disease which attacks hard drinkers, espe-
cially brandy drinkers. They are tormented every morning
by violent throwing up.  The cure is performed by mode-
rating the excess in spirituous liquors, by the use of quassia
and other remedies which tend to  strengthen the stomach,
as well as of belladonna and aqua laurocerasi.
  4. The sanguineous and phlogistic cough is often a con-
sequence and effect of general plethora, frequently occur-
ring in young  persons.   The  distinctive  signs  are :  the
general symptoms of plethora, the full, strong pulse, cough
is excited and increased by exercise ; there are other con-
gestions of  blood ; generally also, dyspnoea or pains  in the
chest.  It may run into hemoptysis and pulmonary inflam-
mation. The treatment must tend to diminish and derivate
the plenitude of blood, which may be attained by venesec-
tion, antiphlogistics,low vegetable diet,  corporeal exercise.
Or  it is owing to a local congestion of blood, hemorrhoidal,
menstrual, either by suppression of previously existing evac-
uations of blood or first wrongly directed impulse (hemor-
rhoides anomala?, incongrua?,  menstrua  anomala).   The
latter is of particular importance in practice, and more
difficult of recognition when no hemorrhoidal or menstrual
flux has preceded.   I have seen persons laboring for years
under cough, accompanied with pains in the chest, so that
their state was considered incipient  phthisis, which, how-
ever, was nothing but molimina hemorrhoidalia, taking a
direction towards the lungs.   The diagnosis rests on the
symptoms of the hemorrhoidal disposition, of the plethora
abdominalis (vide hemorrhoidal disease), or the signs of fe-
male puberty and  molimina menstrua.  This cough also
occurs at the cessation of the menses.   The cure consists
in derivating the blood from the lungs; in the hemorrhoi-
dal  cough,  to cure  the abdominal plethora by dissolvent
extracts, neutral salts and sulphur (vide hemorrhoids), and
 when these do not suffice, leeches must  be  applied to the
 rectum ;  in the  menstrual cough the  catamenia must be
 brought on ; in cessation of the catamenia  the  flux must
be  compensated  by other  abstractions  and evacuations  of 
232
HOOPING COUGH.
 blood.  Or finally,  the cause is a chronic inflammatory
 state of the lungs.   The signs of this are frequent  febrile
 motions, always  irritable pulse, frequently stitches  in  the
 chest, dyspnoea.   The cough is  dry.   This is already the
 commencement  of  phthisis florida or  tuberculosa (vide
 those diseases).  In  every sanguineous cough whey, either
 serum lactis simplex, or prepared with cremor tartari, Sel-
 ters water mixed with a little milk, Egers  salt spring, the
 Kesselbrunnen in Ems are of great value.
   5. The  metastatic cough, caused by deposites of arthritic,
 rheumatic, psoric, scrofulous, syphilitic or other morbific
 matters, on the lungs and  respiratory organs. ' The treat-
 ment consists in  a proper treatment of the original disease
 (gout, scabies, scrofula), and derivation by cutaneous irri-
 tants, flannel dress and artificial ulcers ; respect  must also
 be paid to the dynamic character, whether it be phlogistic,
 or nervous, or atonic.
   Cough by poisoni g (vide asthma).
   6. The idiopathic  or pulmonary cough, which originates
 in a disorder that has become peculiar to the lungs.  It is
 a phthisical cough ;  for it is either a consequence of blen-
 norrhoea of the lungs, which is classed under phthisis pitui-
 tosa; or of a tuberculous state of the lungs, a symptom of
 phthisis tuberculosa ; or of a chronic  inflammation  of  the
 lungs, which belongs to phthisis florida, or of a suppuration
 of the lungs, which is placed  under phthisis purulenta (vide
phthisis pulmonalis).
  One  more organic  local disorder must be mentioned,
 which is often an unknown cause of obstinate cough, that
 might lead even"to phthisis.  It is a prolongation or swell-
 ing of the uvula,  which  irritates  the glottis and  produces
 coughing.   In this case the easy and harmless operation of
 cutting off the elongated uvula is a sure and prompt remedy.
                     HOOPING COUGH.

                   Tussis  Convulsiva.

  Diagnosis.  Paroxysms of incessant expirations, occa-
sionally interrupted by a long drawn whistling inspiration,
similar to the cry of a hen.  It lasts from a few minutes to
a quarter of an hour, and generally terminates in vomiting.
If the case  is violent, .the patient's face turns dark  and
blue, blood escapes from the nose  and mouth ; the spas-
modic motions of the  lungs sometimes pass from a pulmo- 
HOOPING COUGH.
233
nary tetanus into complete  cessation  of respiration  and
apparent  suffocation,  a state that may last for several
minutes.  Such attacks may return every three or four
hours, in  severe  cases more  frequently ; and in all cases
the attacks are more frequent and violent in the night; the
least mental affection, weeping or laughing can bring them
on.   They are commonly more violent  every  other  day
(typus tertianus).   In the  intervals the  chest  and respira-
tion are entirely free, and  the patient, except  being  weak,
is healthy in other respects.
   It attacks children in preference, and only once during
life (like small  pox and measles).
   Course, duration.  We distinguish three stadia.
   1st Stage  (stadium febrile, irritationis).  The commence-
ment is generally similar to a catarrhal  cough with febrile
motions.  It is apt to be associated with an inflammatory
state of the lungs. Gradually the cough assumes more and
more the  character of hooping cough.
   2d Stage (stadium nervosum, spasticum).  The cough is
merely a spasmodic  affection, without fever, and lasts for
several weeks.
   3d Stage (stadium  adynamicum). The  paroxysms of
cough continue for  three  or four weeks, with  prominent
intermissions and increasing weakness.
   The duration is five, eight, or twelve weeks, even lon-
ger.  Sometimes it ends in a natural crisis, by  cutaneous
eruptions, or aphthae.   The consequences when  it has con-
tinued violent and for a long time, are :  tabes and atrophia,
due to great exhaustion and deficient nutrition, since the
cough causes the food to be ejected from the stomach, and
on account of debilitation  of  the lungs, phthisis pituitosa.
Also pneumony may join it and  prove fatal.
   Pathogenesis.   The  proximate cause  is a nervous  irrita-
tion, especially of the nervus phrenicus and vagus, produced
by a particular contagion  originating in  the  atmosphere,
but propagated from individual to individual;  this is made
evident by the circumstance that even old nurses may be
infected by the children on whom they  attend.  The ner-
vous irritation produces simultaneously the convulsive, as
it were, epileptic  motions,  and also  increased mucous se-
cretion in the stomach and lungs, even increased secretion
of bile ; and, when the  disease is very  violent,  and  there
exists the disposition, an inflammatory  state of  the lungs.
The disease, therefore, is nervous in its  nature, but may
assume an inflammatory character.   The morbid process
                          20* 
234
HOOPING COUGH.
generated by the contagion has, like small pox and measles,
its definite duration.
  Therapeutics.  It  calls for cleansing of the stomach  and
the prima? via?, assuaging of the spasm by  specific  reme-
dies and antistimuli ;  and a regard  to complication.  The
different stages constitute an essential difference in respect
to treatment.
  The first  stage is of a gastro-catarrhal character, often
inflammatory ; the  treatment therefore must be resolving,
cooling, purging; in addition to this, emetics and the linc-
tus No. 74.  As soon as  the fever increases, and the diffi-
culty of breathing becomes greater, with irritative cough
and pains in the chest, leeches are to be  applied  on the
chest, and small doses of calomel given.
  In the second stage the spasm must be soothed partly by
antispasmodic and  narcotic remedies, especially by hyos-
cyamus ;  asa  foetida  in  linctus and clysters,  belladonna
(vide No. 75)  ; in  extreme degrees of cough, opium, but
not long continued  on account  of its constipativ'e and con-
gestive power (vide No. 76) ; extract, lactuca? virosa?,  dul-
camara, cicuta, musk, ledum palustre,—the relieving effect,
however, varies according to the epidemic ;  partly by anti-
stimuli, cutaneous  irritation, embrocation of the ointment
or tincture of  cantharides, ointment of tartar emetic (vide
No. 77), on the pit  of the stomach and sides; irritatingthe
kidneys (scilla, digitalis, tr. of cantharid), injections. These
remedies are often  sufficient to effect a cure.
  In  the  third stage, when the remedies  mentioned do
not suffice to remove the cough, which has already lasted
for several weeks, and the  fever is gone, it is probable that
the spasm is entertained by weakness, and  then  cinchona
in connection  with  antispasmodics, is the principal remedy
for finishing the cure (sulphas quinini one half or one grain
twice a day).  It is  particularly  appropriate,  when the case
manifests a periodical character, as an increase of the vio-
lence of the paroxysm on every second day.
  If the  cough continue, accompanied  with frequent  ex-
pectoration of  mucus, gelatina lichen. Islandici is the best
remedy, and by which it may be prevented from changing
into phthisis pituitosa (vide No. 78).
  The subsequent treatment in  a very debilitated state re-
quires tepid strengthening baths (malt baths), cinchona,
acorn-coffee, gelatina lichen. Island. 
CHRONIC VOMITING.
235
                   CHRONIC VOMITING.

                        Vomitus.

  Diagnosis.  Vomiting, which, without being a symptom of
an acute febrile state, appears as a chronic distemper.  It
is  either permanent or periodical, either  before  or  after
taking food.
  Every violent and permanent vomition is to be consid-
ered as an important  and a perilous attack; it may prove
fatal by inanition, or  create inflammation of the  stomach.
Every chronic vomiting claims our greatest attention, since
it may be a sign of other important, even organic disorders.
I shall here give only a few hints.
  When it always follows a meal, throwing up the food, an
organic disorder of the  stomach may be suspected.
  When it is accompanied with violent pains and spasms in
the ventricular region and in the abdomen, and the patient
turns yellow, gall-stones ; when  in the renal region, gravel
are supposed to exist.
  When it seizes children,  the  head being affected, and
drowsiness, squinting,  costiveness accompanying it,  it is
a sign of incipient hydrops cerebri.
   VVhen it attacks children in  the morning, in a jejune
state, and is followed by bulimy, it points to worms.
   When it is chronic, obstinate in children, accompanied
with constant thirst, diarrhoea, distended precordia, disfig-
uration of countenance, coldness of hands and feet, drawing
the legs towards the belly, and emaciation, gastromalakia
is threatened.
  Pathogenesis.   The proximate cause is a convulsive con-
traction of the  stomach and  the neighboring muscles,—
entirely analogous to cough.  It may originate in too great
an irritability of  the stomach  itself, so  that even the  most
common and innoxious stimuli, as aliments, even water,
can excite these convulsive contractions ; or be due to san-
guineous congestion and  inflammability, or increased ner-
vous sensibility (sanguine  or nervous character),  or to an
unusual morbid irritant matter.  This can be located either
in the stomach itself (idiopathic vomition) either within  it
(contentum ventriculi),  as indigestives,  bile, mucus,  acid,
worms ; or in the substance of  the stomach, such as organic
disorders, callosities, scirrhosities, ulcers, polypus, carcin-
omata, metastases, of  which the  most frequent are the
arthritic, psoric, rheumatic ; or without the stomach (sym- 
236
CHRONIC VOMITING.
 pathetic irritation), swelling and  indurations of the liver,
 spleen, pancreas, kidneys, nephritic stones, gall-stones, the
 gravid  uterus, cerebral  affections, violent  headache,  con-
 cussion of the brain by falls or blows, even psychical irri-
 tation, squeamishness.
   Therapeutics.   Investigate the different remote  causes,
 and remove them (the indirect treatment), and if it persist,
 operate  directly on the  proximate cause,  the  convulsive
 state  of the stomach, and calm  this by remedies which
 have a direct or a derivative tendency (direct treatment).
   Consequently,
   1. When gastric impurities are  the cause (vomitus gas-
 tricus, saburralis), which is recognized by the known signa
 sordium, and by the quality of the matter thrown up, bilious
 or saburral, then emetics and purgatives are the only true
 means of cure : vomitus vomitu curatur.  There is, however,
 a difference, when the evil is not a consequence of a tran-
 sient  indigestion, but of a chronic mucosity and acidity of
 the stomach.   Such cases require  a long course of treat-
 ment,  intermixed with repeated emetics and purgatives,
 and finally roborants (vide indigestion, anorexia, apepsia).
   2. When rheumatic, arthritic, psoric or any other metas-
 tasis isthe cause (vomitus chronicus,rheumaticus, arthriticus,
 etc. metastaticus).  Particularly frequent is  the rheumatic
 It is  recognized by a preceding chronic cold (especially
 moist, draughty  dwelling) ;  by  the rheumatisms  and  ca-
 tarrhs previously existing, which  now have disappeared;
 by the generally concomitant pains in  the  stomach (vide
 cardialgia) ; the arthritic by the gout, especially podagra,
 previously existing, and the urina rubra ;  the psoric by the
 cutaneous  diseases or chronic ulcers, which existed previ-
 ously and have been suddenly suppressed. In the treatment
 of all these species, we must consider above  all, whether
 an inflammatory state of the stomach has been  generated
 by the metastasis (vide No. 3), and commence with reme-
 dying  that.  Then a vesicatory to the  epigastric  region,
 in retroceded (re-entered) podagra, sinapisms on the feet,
 in exsiccated ulcers, exutories on  the previously affected
 spots, embrocation with antimonial ointment, mezereum.
 Besides the remedies and method  of treatment which the
 various species of disease calls for, in gout, guaiac, aconite,
 in scabious metastasis, sulphur.
  4. When mere nervousness of the stomach is the cause
 (vomitus nervosus, spasticus, hystericus).  Tlje signs are the
absence of other causes and the symptoms of a spasmodic
hysteric  state.   Vomiting takes place  generally in the 
CHRONIC VOMITING.
237
morning, in a jejune condition, or after  mental  emotions,
or as a symptom of hemicrania hysterica.  The treatment
must  be that of hysteria and  nervous  weakness ; in the
paroxysm  direct treatment  of vomiting (vide  cardialgia
nervosa).                                *
  In  the troublesome  and frequently returning cephalaea
vomitoria hysterica the  recipe No. 79, used in the intervals
free of paroxysms, is an excellent remedy.
  5.  When organic  disorders, either in the stomach, as:
callosities, scirrhosities, carcinoma,  softening ; or in the
neighboring parts, as physconias, obstruction, induration of
the liver, pancreas or spleen  are the cause : the stagnations
are to be resolved and the spasm is to be soothed by direct
treatment.

   The Direct Treatment of Vomiting, Anti-emetic Method,

  Is called for, when no material or remote  cause can be
discovered (v.nervosus), or when it continues after  their
removal.   It  is momentous as indicatio vitalis, since every
constant vomiting can endanger life, and  requires stopping.
The remedies are : potio Riveri, the surest and safest anti-
emetic (vide  No. 1), invigorated in  obstinate  cases by anti-
spasmodics (vide No. 80),  external means, which  here
prove often of more  service than the  internal ones, fomen-
tation of  the  epigastric region by  spirit,  matrical.  and
tinct. opii  (No. 81), little bags  with mentha crispa, steeped
in wine, sinapisms, finally, dry cups,  one of  the most  effi-
cient means, by which I often  succeeded to  stop the  most
obstinate vomiting ; injections ; at last opium, musk. Small
pieces of ice and ice cream have often proved most useful.
In children chronic vomiting requires our whole attention.
We must carefully examine whether it is caused by worms,
or  is symptomatic of  hydrocephalus; or  of softening of
the stomach; vide diseases of children.

     Special Treatment of Particular Species of Vomiting.

  Vomitus  chronicus Ingestorum.  The   patient  throws up
the aliments  two or three hours, even as soon as one hour
after  taking them ;  there is constant hunger, costiveness;
in some patients pain is felt  in the epigastrium, especially
when  pressed; and in some cases a  hardness may be dis-
covered on examination.  As  the  case advances, it goes
through the degrees of emaciation, tabes, vomiting of dark
green, blackish matter, death. 
238                CHRONIC VOMITING.
  The cause of this afflicting disease is scirrhus, or carci-
noma of the stomach.   The cure is rare, although some-
times possible, when  the evil has  not  advanced  too  far,
callosity only and not true scirrhus existing.   A principal
sign is pain.   As long as this  is wanting, there is hope.
But  if pain  is  present, then scirrhus  or even carcinoma
exists and medication is useless.  The following remedies,
according to my experience, have sometimes succeeded in
conquering it: liquor  belladonna? cyanicus (No. 50), mer-
curial  embrocations, extract, cicuta? and calendulae,  the
Carlsbad water, bi-carbonate of soda, perpetual cataplasms
of cicuta over the stomach,  the application of moxa on the
epigastrium (by which I  once  succeeded  in immediately
curing, and  for ever, a kind of vomiting, accompanied by
abdominal pains which had  lasted for several months,  and
had  resisted all other means), clysters;  leeches  on  the
scorbiculus  cordis from time to time, especially when pains
set in.   Milk  as exclusive food, is salutary.  By this  diet
and  milk injections, some patients have had their life  pro-
longed, have even been cured.
  Akin to the preceding is that chronic vomiting which is
owing to induration, enlargement or other  disorganization
of the pancreas.  It is distinguished from the former by
not always taking place after eating, and that it is not food
but acid and salivary matters that are thrown up,  and  the
patient has often a  sensation of violent, deep seated pains
in the umbilical region, sometimes extending to the back,
and  frequently an induration or swelling deeply seated can
be discovered by pressure.  In  this case the cure is  diffi-
cult, but possible, particularly at the commencement.   The
treatment is the same  as in the previously mentioned  dis-
ease ;  more active resolventia, especially  the  Carlsbad
water,  however, may  be  used,  since  the  stomach  bears
more.   The application of leeches is not to  be omitted in
a painful state.
   Different  from either of the preceding is ruminatio hu-
mana.   The ingesta are likewise thrown up, but with ease,
and  without any emetic exertion, and they are not altered
ly incipient digestion.  The cause of it is an enlargement
of the oesophagus and  saccus coecus, in which  the aliment
is collected and retained for a while.
   Vomitus matutinus, vomiting every morning under  tor-
turing cough and choking, a quantity of viscous slime. It
is the  lot of old drinkers.  The means for  remedying it
are : abstinence from drinking, regular and digestive meals,
magnesia and rhubarb (vide No. 83),  in the morning a 
HICCOUGH.
239
glass of cold water, pills of asa foetida, fel tauri, cushions
of menthacrispa on the abdominal region,columbo,quassia.
  Vomitui marinus (sea-sickness).   The most tormenting
nausea with vomiting, also purging and general indisposi-
tion, even to fainting, and a feeling of universal destruction.
It can last for two, three, or four days, and longer, caused
only by a sea-voyage in high wind, which  gives great mo-
tion to the vessel ; it does not happen on lakes and rivers,
and ceases as soon as we land.  It occurs, as a rule, only
once, and disappears by habit and repeated voyages. Every
one is seized by it, but not in an equal degre?.  It resem-
bles most the state of nausea and fainting  to which  some
persons are  liable when riding  in a wagon and swinging.
The only cause is the rocking motion of the ship.
   The means which, though they do not entirely prevent,
at least alleviate, even sometimes prevent it, are horizontal
position, staying on the deck near the mast, light digestible
 food, and the plaster  No. 84  spread on  leather, of the
 size of the hand, applied to the epigastric region.
   Vomitus calculosus.  Vomiting may  be a symptom of
gall-stone as well as  of gravel, and is either acute or  chro-
nic.  In the first case it is a symptom of stone colic ("vide
colica  calculosa).  The  diagnosis depends on  the  other
signs of  stone  (vide calculus), and  the  treatment is the
 cure of calculus, which  see ;  therefore, in chronic cases,
 Carlsbad spring and  similar alkaline remedies.
    Vomitus gravidarum, vide diseases of females.
    In all chronic vomiting, milk, taken one cup every two
 hours, has been observed to be the best and only remedy;
 even when it is  owing to internal indurations and  strait-
 enings, it is conservative, even curative.   In general, how-
 ever, the  malady must be considered as arising from an
 organic disorder, and consequently incurable. Frequently,
 indurated excrements in the  colon  are  its cause,  which
 may be removed by  injections and drastic purgatives.
                   HICCOUGH, HICKUP.

                       Singultus.

  A short, convulsive contraction of the stomach  and dia-
phragm,  generally periodical, arising from  insignificant
causes,  overloading of the  stomach, acidity, taking cold
(especially in  little children), and  then insignificant and
wearing away of itself; but sometimes a.true permanent 
240                   NEURALGIAS.
 spasm in  these organs, which may continue for hours,
 days, and become offensive and dangerous ;  in fever it  is
 sometimes a  fatal symptom ;  concomitant  with internal
 inflammations.
   The cure of ordinary hickup is very easy ; slow drink-
 ing, or still better, a piece of sugar slowly melted in the
 mouth, removes it quickly.  When it is nervous, a  symptom
 of spasm, as well as present in nervous fever, hyoscyamus,
 musk, opiate embrocations over the stomach ; an antispas-
 modic cataplasm, dry cups on the same, especially a warm
 bath are serviceable.  When it  is inflammatory, the inflam-
 mation is to be treated.

                        NEURALGIA.

   Diagnosis.   Chronic,  permanent, or periodical pain of  a
 single nerve, or of a plexus  of  nerves, especially  in  mem-
 branous or aponeurotic parts.   It may affect any part of
 the  body, and receives different names according to its
 location.  When it arises in the  head, it is termed cephalaa,
 hemicrania, clavus y  when  it seizes  the  face, prosopalgia  ;
 when the ischiatic nerves, ischias ; when the back, notalgia;
 when the lumbal region, lumbago ; when the hip, coxalgia,
 coxagra; when the stomach, gastrodynia ;  when the intes-
 tines, colic a.
   The origin and treatment is the same as in all nervous dis-
 eases, varying only as regards location, whence are derived
 specific names.  I  will only remark  in  general, that  nar-
 cotics, especially liquor  belladonnae cyanicus, aqua lauro-
 cerasi and  stramonium (one eighth to one  half of a grain
 of the extract, and of the tinctura serrrinum up to ten drops),
 douches, cold baths and moxa are of  particular efficacy  ;
 in periodical attacks,  Peruvian  bark and iron, especially
 ferrum carbonic, half a scruple twice a day.   In neuralgias
 of external  parts we are carefully to  examine whether a
 mechanical irritation, as  induration,  a ganglion, a  splinter
 of a bone, an excrescence and the like are not the  original
 cause.

                       PRURITUS.

  Itching is a particular  sensation of the skin, which gen-
 erally exists only as  a symptom of cutaneous eruptions
 and is to be  treated  as such ; it may, however, appear also
independently  as an  isolated nervous affection, and even
assume such a degree  of violence and obstinacy as to allow 
HEADACHE.                   241
no rest day and night, to become a real disease, and if it
be general, even to endanger life.  I have seen an old man,
who had been a hussar, labor more than a year under such
a  dreadful general itching, without exanthema, that it  de-
prived him of rest day and night.   In this  desperate state
he had to use the hardest scraping instruments, as curry-
combs and the like, until blood would come, in order to  get
relief;  finally he died of emaciation.
   The causes may be the same as are common to nervous
diseases,  but are particularly chronic suppressed perspira-
tion, atrabilious and psoric acrimony.
   The treatment must be adapted to these causes.  As local
means, baths, especially Russian steam-baths, frequent cup-
ping and artificial ulcers are  most  serviceable.  Also a so-
lution  of two drachms of borax in  six ounces of rosewater
is often of excellent service.
   A very troublesome  and frequent evil is the itching of
the genitals, especially in the female sex (pruritus vulva).
It is more common to old maids and widows, owing to
disturbances of menstruation and hemorrhoidal conges-
tions,  is very tormenting and difficult of cure.
   The treatment must  first tend to the removal of hemor-
rhoidal and  menstrual congestions or other  dyscrasias,
also ascarides, which sometimes creep into the~vulva;  re-
peated application of leeches is recommended.  As a local
means, I can advise from expeiience as most efficacious to
wash the genital organs with  soap water, composed of gen-
uine cocoa-oil soap and a weak solution of sublimate in
rosewater.

                       HEADACHE.

                 Cephalaa, Cephalalgia.

   Diagnosis.  A  very  common complaint, frequently a
symptom of other diseases, especially of fevers ; but is here
considered only as an isolated affection.  It is either per-
manent (cephalaa), or periodical (cephalalgia), either gen-
eral, or occupying  only single  parts  of the  head, as one
side (hemicrania), or a small circumscribed  spot like a nail
driven  in there (clavus).   Also the degree and species  va-
ries very much, as burning, tearing, pungent, boring.  In
the highest degree consensual symptoms associate with it,
especially of the  stomach, as nausea, vomiting (cephalaa
vomitoria).  It  may become  an extremely  obstinate and
tormenting complaint.
                          21 
242
PROSOPALGIA.
  The origin and treatment coincides with that of general
nervous diseases.  We must carefully distinguish ceph. ner-
vosa, sanguinea, gastrica, metastatica, organica.
  Of the specialities, the most frequent is the hysterical and
hypochondriacal headache, for which, as a palliative, hyoscy-
amus, aqua laurocerasi, liquor anodyn. Hofman. are useful;
in headache accompanied by vomiting, pulvis  aerophorus or
potio Riveri together with hyoscyamus, sinapisms, mustard
foot baths; to eradicate it, a cold infusion of  quassia, cin-
chona, particularly iron (vide No. 85, 79), ferrum carboni-
cum, sea baths, chalybeate baths, Pyrmont spring are very
salutary.  It  is very important, however, to  have regard to
local sanguineous congestions ; these call for the applica-
tion of leeches.   Of the metastatic, the most frequent and
obstinate is the  arthritic (gout in the head)  and rheuma-
tic ; when  perpetual derivatives (fontanels,  cort.  mezerei,
repeated  cupping  in  the  neck), and arthritic  remedies
(guaiac, aconite); in the rheumatic, calomel, drastic pur-
gatives, bitter water, foot baths of mustard, mustard-meal
in the stockings,  oil-cloth soles, smoking of tobacco are
most serviceable.   After fruitless use of the most active
remedies, even of the  Russian baths, I have seen perfect
cures effected by  No.  86, continued for a fortnight (vide
arthritis, rheumatismus).  In very obstinate headache in the
forehead,  we must never omit to inquire whether foreign
bodies, as worms, insects, larva?, have not entered the frontal
sinuses.  In such cases, warm vapors drawn into the nose,
smoke of tobacco, and between them  sternutatories (vide
No. 87), have remedied the evil by sneezing and throwing
it off.

                      PROSOPALGIA.

                    Tic Douloureux.

  Diagnosis.  Very tormenting pains in the face, especially
in the region of the processus zygomaticus,  in the nervous
plexus, termed  pes anserinus,  from  whence the  pain
spreads to all parts of the  face.  In the highest  degree
they resemble violent  electric shocks, and create  spasmo-
dic distortions of  the  face.  They  appear periodically,
sooner or later, sometimes typical.  The complaint is one
of the  most obstinate.
   Causes and treatment are the same as in cephala?a. In the
first place, therefore, the remote causes, congestions, ab-
dominal stoppages and the like are to be remedied.  Most 
ODONTALGIA.
243
frequently  there is a rheumatic, arthritic cause, combined
with a  very tender sensitive nervous system ; hence it is
met with most frequently in the female sex, and aconite
and guaiac are very useful, especially in the mixture men-
tioned under  cephala?a, likewise sublimate, together with
decoction  of  guaiac, sarsaparilla, and extract, hyoscyami,
also oleum jecoris aselli.
  Finally, the disorder is to be looked upon as idiopathic,
and must be treated accordingly.  Lotions and  fomenta-
tions of aqua laurocerasi, of liquor anterethicus (vide No.
176), opiate and  saturnine plasters, frequently  repeated
cupping on the neck, a seton and moxa are very useful;
lastly, more than all, douches of cold water, continued and
repeated in every attack  up to the ceasing of pain, by
means of a small clyster pipe.  Electricity and magnetism
have sometimes proved beneficial.  The proposal to divide
the nerve is an unsafe  remedy.

                      TOOTHACHE.

                      Odontalgia.

  One of the most frequent and  painful neuralgias is odon-
talgia, toothache.  It can attain  a degree bordering on tic
douloureux, even surpassing it.
  The cause  is either a carious tooth, or rheumatic irrita-
tion, which is more frequent, and, associated with carious
teeth, produces  the periodical  pains.  Besides, there  are
two causes, sanguineous  congestion  (especially in young
plethoric persons and in pregnant women), and nervous-
ness.  In obstinate, ever  and  anon returning toothache,
deeper  seated dyscrasias,  such  as arthritic, psoric, syphi-
litic, may be the remote cause.
  The treatment must  correspond to the causes ; removal
of the carious tooth,  rheumatism, plethora,  nervousness.
For a  palliative cure,  the removal of sanguineous con-
gestion, which commonly exists here, by applying  some
leeches on the gum, derivation'by sinapisms or horse-rad-
ish  on the arm or neck, and local antispasmodic remedies,
embrocation of ol. cajeputi or spirit, camph. with opium on
the  cheek where the pain  is, a pill of hyoscyamus or opium
laid into the  aching tooth, a mouth bath  of decoct, flor.
sambuci and herb, hyoscyami,  a small piece of rad.  py-
rethrii or armorac, or  a few drops of tinct. cantharidis on
the  gum, will be found serviceable ;  but the most efficient
is to wet the tooth with tincture of Para-cresses. 
244   OTALGIA.  COXALGIA.   CARDIALGIA, GASTRODYNIA.
                        EARACHE.

                        Otalgia.

  Otalgia occurs also  as a pure  neuralgia, and is  treated
like  odontalgia ;  the most beneficial remedies  are:  cata-
plasmata emollientia, narcotica of flor. sambuci, herb, hy-
oscyami steeped in  milk, applied to the ears.   But it  is
most frequently of a rheumatic character, and when violent
and constant, an inflammatory state is to be  feared, which
is to be treated antiphlogistically by local abstractions  of
blood (vide otitis).

                 r     COXALGIA.

  Vide coxagra, ischias (hips).
          SPASM OF THE  STOMACH, STOMACHACHE.

                 Cardialgia, Gastrodynia.

  Diagnosis.   Spasmodic  pains  and  contractions in the
epigastrium, sometimes periodical (cardialgia in  a limited
sense), sometimes constant (gastrodynia).  They vary in
intensity, being sometimes slight, sometimes of insupport-
able violence,  spreading by consensus to the chest and
back ;  exciting nausea and vomiting, anguish,  coldness of
the extremities, and even syncope.  It may become chronic
and very obstinate.   It is more  common  to females than
to men.  When it occurs in women after  the cessation of
the menses, and is associated with fits of fainting, it is apt
to pass into vomiting of blood.
  Besides the general causes of nervous diseases, hysteria
is one of the most common ; also acute and still more so
chronic colds  (owing to light clothing, moist  dwelling,
business  of washing), wherefore  the disease is often no-
thing but rheumatism of  the stomach;  and disturbance of
menstruation, wherefore it appears frequently at the times
of puberty, still more after its cessation.
  The treatment, aside of that for nervous diseases in gen-
eral, requires particular consideration, whether there is san-
guineous congestion and  chronic inflammation,  in which
case abstractions of blood, general as well as local, are not
to be neglected ; gastric  impurities  must be removed by 
PYROSIS.  COLICA.                245
 evacuants, even emetics, which give immediate  relief;  in
 rheumatic, arthritic, and  other metastases, mustard plas-
 ters, vesicatories  over the  stomach.  In purely nervous
 spasms of the stomach, the principal and specific  remedy is
 subnitrate of bismuth, two  grains daily three times,  tritu-
 rated with sugar ; magnes. carbon, with extract hyoscyami,
 and cortex Winter., pulvis aerophorus, ol. cajeputi.  In ob-
 stinate cases the mixture No. 88 has not forsaken me.
   Of particular efficacy are external remedies, embrocation
 of antispasmodic liniment (No. 89), warm cataplasms of hy-
 oscyamus and chamomile ;  the  mere  application  of a
 warm body, dry aromatic herbs, mustard plasters, and dry
 cups to the  epigastrium.  In chronic spasms of  the stom-
. ach,  I can recommend douches  of cold  water (or still  bet-
 ter, mineral water) by my own  experience.
   If  the  disease resists all these means, and the food  is
 rejected,  there is reason to suspect an organic disorder.
                        PYROSIS.

   A very distressing sensation of burning, rising from the
 stomach, especially  after taking fatty food. The complaint
 is more  frequent in youth than in advanced age.
   The cause of it is  a generation of acidity in the stomach,
 and a disposition of the stomach liable to it.   Especially
 the acrimony of grease seems to have a tendency to pro-
 duce this disorder ;  hence fat aliments are injurious.
   The treatment is that of acrimony of the stomach (vide
 gastrosis), and avoiding grease.  For temporary relief, one
 teaspoonful of carbonas magnesia? or lapis cancrorum is
 serviceable ; still more efficient is ammonium carbon., three
 grains, dissolved in  one ounce of melissa; likewise char-
 coal powder.

                         COLIC

                        Colica.'

  Diagnosis.   More  or less violent pains in the intestines,
of a  contracting, pinching, tearing, or  burning nature ;
which, when severe,  are accompanied by anxiety and cold
sweat; bowels open or  costive.   The pain may be spread
over the  abdomen, or confined to one place.   The  com-
plaint may be periodical or permanent; when the latter, it
may last  through life.  In every violent colic there is dan-
                          21* 
24fi
 *u                    C0L1CA.
 ger of inflammation, especially if the pain is seated in one
 place and becomes burning, or when costiveness and vom-
 iting accompany it.
  Pathogenesis.  The  causes are innumerable ;  however,
 they can all be reduced  either to injurious matters in the
 intestines, to  cramps,  sanguineous  congestions, or to me-
 tastases and antagonisms or organic disorders.

  Therapeutics.

         General Rules of Treatment for any Colic.

  In every colic  the first thing to be done is to cleanse the
intestinal canal by a mild laxative ; for impurities are ever
present, partly as cause, partly as effect, and their removal »
always produces great  relief, even o'.'ten complete cure.
Further,  in every colic,  mucilaginous  and oily remedies,
such as  water-gruel,  linseed tea, a  spoonful  of  almond,
poppy or linseed oil, spermaceti, half an ounce dissolved in
a cup of warm water, promptly mitigate the pains ; the best
form of administering these  remedies is the combination
No. 90 ;  opium must be  avoided, because it constipates the
bowels.   Externally, antispasmodic ointments, cataplasms,
and oily  injections.  Further, in every violent colic there
is danger of inflammation ; therefore, as soon as the pain
becomes fixed, violent, and burning, when the abdomen  is
distended and painful  to the touch, and there is fever, a
venesection must immediately be made ;  and in young,
plethoric persons, when  the pain is violent and permanent,
it is advised even as a prophylactic.—Finally, we must
examine in every colic,  whether there be hernia.
  In every chronic colic it is an indispensable condition,
indeed often the only  means of cure, to wear flannel round
the abdomen  and back.
  The special treatment depends on the causes, which are
 numerous.  All kinds  of colic, however, may be reduced to
 the following principal classes :
  Colica sanguinea (blood colic). Signs of general or local
 (abdominal) plethora or  inflammability.  Of that character
 is also the menstrual and hemorrhoidal colic (vide menstrua
 and hemorrhoides).  It is either molimina menstruorum and
 hemorrhoidum, or a consequence of their suppression. The
 treatment consists  in general and local abstractions of
 blood,  cooling purgatives.   In  the  hemorrhoidal colic,
 sulphur.
   Colica nervosa.  Of this class are  the spasmodic and
 hysterical  colic.  The signs of which, see under  the res- 
COLICA.
247
pective heads.   It calls for  oily emulsions with hyoscya-
mus,  antispasmodics,  inunctions  and  cataplasms.   In
stubborn cases, laudanum may be added to the emulsion ;
warm baths and  injections  of asa foetida one  drachm, re-
sorted to.  See cure of hysteria and hypochondria.
   Colica gastrica.  Under this head falls the colica biliosa,
which is often epidemic, especially in the heat of summer.
It has  for signs gastric impurities, bitter taste, foul, yellow-
coated tongue, etc.  For the cure, give emulsions first, also
potio Riveri, a  spoonful  of  orange juice and injections ;
then mild laxatives, as tamarinds, manna, soluble tartar are
required.
   Colica saburralis calls for purgatives, or an emetic, ac-
cording to the indication of its locality.  Sometimes chronic
colic is owing to very hard and  ancient sordes, especially
of a tenacious mucous character, atrabilis, true  infarcts,
(colica  stercoracea).  Here a continued  use of resolvents,
and  particularly of injections, also purgatives, are neces-
sasy.
   Colica verminosa.   The symptoms are those of worms
(vide worms).  The disease is remedied by oily emulsions,
calomel, flores  zinci, afterwards  santonicum; the cure of
worms.
   Colica flatulenta, owing to accumulation of winds  (vide
flatulency).
   Colica metastatica, is known by the disappearance or sup-
pression of a preceding  disease, on which the colic  has
followed.  The treatment must be that of the metastases,
and of the malady which originated it; as such, particularly
fequent are chronic, rheumatic, and arthritic colic.   The
disease is nothing but a rheumatismus  or arthritis intestino-
rum, and must be treated as  such, by sulphur, guaiac, aco-
nite, antimonials, mercury (vide  No. 91).  In the arthritic
species, soda with bitters, warm  baths, vesicatories on the
abdomen, fontanels, woollen clothing, are chiefly to be re-
lied upon.
   The syphilitic colic, a consequence of an imperfect cure
of the  venereal virus, which has thrown itself on the intes-
tinal canal, is not a rare occurrence.   In  this case mer-
cury must be given, the same by inunction when it cannot
be borne internally.
   The psoric colic,  a  consequence  of receded cutaneous
eruption, scabies or  herpes, calls for sulphur, antimonials,
vesicatoria perpetua, warm baths, especially sulphur baths ;
the most efficacious are the natural, such as those of Aix-
la-Chapelle, Nenndorf, Warmbrunn. 
248                     colica.
   Colica adynamica has for signs the symptoms of weak-
 ness and its antecedents, particularly excesses in wine and
 women.  Frequently it is a remnant of other species of
 colic,  especially when strong evacuants have been  used
 for a  long  time.   The only  curative means  are internal
 and external  roborantia, amara, cinchona, especially  iron,
 Pyrmont spring and bath,  cold washing, and  steaming of
 the abdomen.
   Colica calculosas. consensualis, in consequence of gall or
 nephritic stones.   The signs are : sudden and very violent
 pain, with forced  vomiting.   In  the  gall-stone colic, the
 pains  are situated  in  the  region  of the liver  and epigas-
 trium, and are followed by a yellow color of  the skin; in
 the gravel colic (colica nephritica), the pains occupy the
 whole  abdomen, especially the  course  of the  urethra;
 cramp in the loins and calf of the leg, also retraction of the
 testicle on the side affected (vide lithiasis).
   The treatment consists in an abundant use of fat oils and
 emulsions, hyoscyamus, antispasmodic embrocations, cata-
 plasms,  oily injections, but chiefly of warm baths,  which
 alone  often promptly  relieve.  In nephritic colic, opium
 also is to be used;  but must be avoided in gall-stone colic,
 because it stops the intestinal discharge, which is here  so
 necessary.  In every stone colic, the  possible occurrence
 of inflammation is to be regarded, which in  strong, ple-
 thoric persons, or in a febrile state, requires venesection.
   Colica visceralis et organica arises from obstructions,
 physconias, indurations, and other organic disorders of the
 liver, pancreas, spleen, and other abdominal viscera, or
 from  newly generated pseudo-organizations.  The signs
 are those of the existence of visceral obstructions (vide
 obstructio).  The cure requires strong resolvent remedies
 (methodus resolvens, hypochondria), especially  gummi  am-
 moniac, soda,  soap, taraxacum, mercury,pillula? resolventes
 (vide No. 92).  The most efficacious of all is the Carlsbad
 spring.
   Colica metallica (arsenicalis, saturnina, mercurialis), owing
 to metallic poisoning, not acute but  chronic.   It is recog-
 nized by the preceding internal or external communication
 of the  poison ; and  the treatment is that which is usual for
 metallic poisoning,  in which sulphur, taken as a medicine
 internally and in baths, is the principal remedy.  Particu-
 larly remarkable and frequent is the colica saturnina (colica
pictonum).   It is distinguished by obstinate constipation of
 the bowels, paralysis of the extremities,  emaciation,  and
 exsiccation of the body. 
HYDROPHOBIA.   POLYDIPSIA.             249
  The treatment must commence with opening the bowels,
especially by castor-oil, rhubarb, aloes, sulphur, sulphur
baths ; then opium and  alum must  be given.  Colica or-
thritica often creates very similar paroxysms.
                      HYDROPHOBIA.

  Diagnosis.  Aversion to and impossibility of swallowing
any thing fluid, whilst solid food may possibly be taken.
  It is a mere spasmodic nervous affection of a particular
character, even the highest degree of idiosyncrasy.
  It arises either by being poisoned with the hydrophobic
virus (hydrophobia miasmatica s. contagiosa), and is a  symp-
tom of rabies "(vide rabies), and is dangerous to life.   Or it
is a symptom of nervous diseases (hydrophobia spontanea
s. symptomatica) in hysteria, by excited imagination (fancy-
ing to have been bitten by a mad dog—hydrophobia imagi-
naria), also in and after inflammatory  affections of the
throat, angina, gastritis.  Here it is a pure symptom of
spasm, without any danger, and is to  be treated as such.
A mustard plaster or vesicatory around the neck, narcotic
cataplasms, injections of asa foetida and opium ; aqua lau-
rocerasi, liquor belladonna? cyanicus are generally sufficient
to remove it.
                       POLYDIPSIA.

   Diagnosis.  Insatiable thirst.  Thirst, like hunger, is re-
 lative and varies according to individuality ; strong in some,
 weak in other men; also depends  very  much on habit.
   Morbid thirst arises either from internal heat (thence a
 symptom of every fever,  especially the inflammatory), or
 from increase of  watery evacuations  (thence present in
 diarrhoea, sweat, diabetes), or from spasmodic suppression
 of the internal exhalation of the  mouth and throat (as in
 hysteria, hypochondria, and other nervous diseases) ; it can
 also  be produced by obstructions of the liver.
  The treatment must comply  with the various causes.
 Particular attention is  due to  it as a symptom of obscure
diabetes mellitus,  of which it is often the only sign;  it  de-
serves particular  attention,  and therefore the urine must
be tested.   The same  applies to  diseases of the liver.  I
 have cured a  case,  the patient of  which was obliged to
drink 30 and more pounds of water a day, by the  Carhbad 
250         DISORDERS OF  HEARING  AND SIGHT.
spring, also by the use of the pills No. 93.—Nervous poly-
dipsia I have seen perfectly cured by sea-bathing.
  The thirst for  spirituous liquors, especially brandy, is
important and destructive.   It is always the consequence
of a bad habit, leads to dropsy, delirium tremens, indura-
tion of the stomach,  emaciation,  and admits of cure  with
great difficulty.                                .        f
  The remedies are:  gradual weaning off, substitution ol
another less injurious, even  salutary stimulus, tinct. ab-
sinthii, rendering brandy  disgusting by admixtion of nau-
seating  substances, as tartar, emetic, mineral acid (elix.
Halleri, 10, 20 drops three times a  day), and quassia (pills
of extract, quassia?, absinth., cascarilla aa) have been of use.


             polyphagia,  pica, vide Apepsia.

                 PSEUDACUSIS, PARACUSIS.

  Diagnosis. To  hear something where there is no sound,
or to perceive wrong what is audible.  Of this kind is the
tinkling and humming of the ears (susurrus aurium), the
hearing of unusual foreign sounds and voices.
  The  most troublesome, and distressing of these evils is
buzzing in  the ears.  By its violence and uninterrupted
continuance, it may attain a degree which  deprives the
sufferer of all mental tranquillity, and brings him to despe-
ration.  Besides the general treatment, I have found most
efficacious  a  daily embrocation with unguentum epipasti-
cum behind the  ear,  repeated cupping on the neck, foot-
baths of mustard, and laxatives.

                       PSEUDOPIA.

   To see something where there is no object, or to per-
ceive wrong what is visible.  Here must be ranged the see-
ing of flocks and sparks before the eyes (scotomia), seeing
colors and  various apparitions, seeing half (visus duplex),
seeing double (diplopia).
   This illusion of the senses may increase  unto an exhi-
bition of real images and aparitions (as when the sense of
hearing is struck with sounds, voices, words) ; which  the
patient does not  believe to be sensations originated within
 himself, but thinks them phenomena communicated from
 without.  This accounts for people becoming visionary. 
           NYMPHOMANIA, SATYRIASIS, ONANISMUS.       251

  All these delusions of the senses, as well as those of
smell, taste, and feeling, originate in an altered tone of the
nerves,  either of the external or the internal sense; for
every sense has a double organ, an external and an internal
one; and  this alteration has  been  bro'ught on by local or
by sympathetic irritation, and is to be treated accordingly.
  The sympathetic is most frequently abdominal, especially
in disorders of the sight, and therefore occurs often to  hy-
pochondriacal persons. I knew a man who, when suffering
under an accumulation of wind would suddenly become af-
fected  with half-sight.  He saw  all objects only half;  as
soon as he discharged flatus, he could see them whole again.
Besides local plethora, congestions, metastases or pure
nervousness, are the most  common causes, to which the
treatment must be adapted.
           DISORDERS OF THE  SEXUAL INSTINCT.

          Nymphomania, Satyriasis,  Onanismus.

   Diagnosis.  Excessively increased, insatiable sexual in-
 stinct.  It is called satyriasis in men, when it is accompa-
 nied with continual erections, priapismus ; in women, nym-
 phomania, furor uterinus ; with unnatural gratification, self-
 pollution, onanismus ;  in the highest degree, when instinct
 or passion overpowers reason, especially in females,  de-
 generating into true rage and  insanity, erotomania.
   The  causes can be corporeal  as well as mental.   Over-
 heated imagination directed to voluptuousness, too frequent
 habit of gratifying the sexual desire, and irritation  of the
 genitals in the  absence of true satisfaction, passionate love
 for a person, occurring more frequently in the female sex,
 in unmarried women, widows. Deficiency of coition rarely
 produces  such  a state, if no excitement and corruption of
 imagination, or habit of immoderate gratification, or  irrita-
 tions of the sexual organs have preceded, therefore  grati-
 fication does not always remove the evil.   An idle,  luxu-
 rious mode of living, and absence of care and trouble,  are
most  apt  to predispose to this state, whereas it is rarely
found in the country among laborious people.  However,
 there may  exist  mere corporeal  irritatives,  especially
 worms  (ascarides), plethora abdominalis and indurations
 in the abdomen,  which irritate the sexual nerves by their
 location.  Thus I have seen a very respectable old  woman,
 in her 70th year of age labor under this disease, the  cause 
252
PARALYTIC DISEASES.
 of which, on dissection, proved to  be a scirrhous indura-
 tion near to the ovarium.
  The principal signs of nymphomania are : violent, burn-
 ing, piercing,  itching pain  on the  clitoris and  bladder,
 vesical  spasms, strangury, ischury,  discharge  of  mucus,
 frequent fits of fainting, hysterical spasms.  They serve to
 discover the often concealed evil.
  It is not out  of place, but  is worthy of remark, to men-
 tion how frequent premature development of the sexual in-
 stinct has become. It is the consequence of too rich food,
 especially too  stimulant  aliments  and beverages  (meat,
 wine, coffee, spices), of too much rest and sitting, and too
 premature excitement of the imagination.
  The principal means  to banish this demon are  fasting
 and labor. As it is chiefly owing to idleness, too rich food,
 luxury,  and indulgence in imagination ; therefore, lower-
 ing the diet to  a few vegetable aliments,  much corporeal
 labor, and exertion,  until fatigue be  produced, which will
 consume and translate the power ; occupation of the mind
 with serious abstract topics,  cold  regimen, cold lotions,
 and  baths, cooling laxatives, and the use of camphor are
 the best preventive and  curative means.  The latter is
 really a specific antiphrodisiac ; I have seen its long con-
 tinued external and internal  use produce atrophy of the
testicles.   It  must be applied internally and externally in
 little bags, and lotions to the genitals.  The same is true
 of the external use of lead remedies.  Galen says :  Plum-
 bum est  domitor veneris.
  In the  highest degree  of nymphomania, and when it is
 incurable  by  the usual means,  cauterizing the clitoris and
 nympha? by lapis  infernalis,  or extirpation of the clitoris
 are  most serviceable.
  Priapism may appear also purely symptomatica], as a
 mere local spasm (tetanuspenis) in hypochondriacal indivi-
 duals. Immersing the yard in cold water,  or narcotic-oily,
 warm fomentations applied to the same, remove it promptly.
                 3.  PARALYTIC DISEASES.

  Annihilation or diminution of the two fundamental func-
tions of the nervous system,  sensation and motion,  or of
one of them.
  Proximate cause is impeded action of the nerves, which
may be produced by  real deficiency of power (true debi-
lity),  or by  an external  cause suppressing its energy, as 
APOPLEXY.                   253
 plethora of the vessels,  extravasation, foreign  bodies, tu-
 mors, sprains, ligatures; or  by spasmodic affections, me-
 tastases, specific stimuli, consensual, especially gastric ir-
 ritatives,  worms;  hence  paralysis may alternate  with
 spasms, even  be combined with spasms and pain.
   The  paralysis may proceed from the peripherical as well
 as from the central termination of the nerves.

                 PARALYSIS  OF THE BRAIN.

                        Apoplexia.

   Diagnosis.  Sudden annihilation of consciousness, of the
 sensitive and motive power, while  the vital functions, as
 pulse and  respiration, continue undebilitated, even are in-
 creased.
   This state  is to be distinguished  from other  states  very
 similar as to their phenomena  ; from epilepsy, by spasmodic
 motions; from syncope, by the absence or great weakness
 of the  pulse and respiration ; from  the highest degree of
 drunkenness,  by the cause preceding, the smell of spirit-
 uous liquors,  and  motion not being  entirely suspended.
   The case may be different.  Sometimes an apoplectic fit
 strikes as if lightning, and like it kills in a moment.  Some-
 times it does  not kill instantaneously ; in this case the pa-
 tient lies as if in  a deep sleep,  with snoring respiration,
 slow, frequently full, strong pulse, without consciousness,
 without perceptibility, without any power of motion (some-
 times with intermixed spasmodic motions),  foam at the
 mouth, dilated pupil, eyelids  and jaw hang down, impossi-
 bility  of swallo ving,  involuntary stools,  and emission of
 urine.  This is termed apoplexia cornpleta.—But sometimes
 apoplexy is incomplete, the patient retains consciousness,
 and only single parts are seized by paralysis.   Here again
 the following  cases must ba discriminated.  The patient is
 paralyzed on all parts below the head (paraplegia), or  only
 one half of the body is paralyzed (hemiphle^ia).  Sometimes
 only sensation or  motion is  paralyzed.  The slightest at-
 tacks of apoplexy, which therefore are not at all noticed,
 are those,  wlien  only single  nuscles are paralyzed,  as in
 the face, one eye is smaller than the other, the mouth awry.
  Complete apoplexy takes the  following  course.   Either
 the patient does not  recover consciousness, but di?s in
 the fit, or he recovers consciousness, which is followed by
fever, generally remittent with daily  exacerbation?, which
 either  saves the  patient  by coction  and crisis (on the 7th
                           22 
254                    APOPLEXY.
 or 14th day), or in an exacerbation, generally on 3d or 7th
 day, brings on a new fit and kills him.  The fever is some-
 times an intermittent, the apoplectic fit is nothing but the
 first paroxysm of the fever and ague, and the patient feels
 perfectly well after the paroxysm is over;  but  the follow-
 ing day the apoplectic paroxysm returns and then proves
 fatal; if this do not happen, the third attack certainly will
 terminate  that  way  (vide febris intermittens perniciosa).
 Generally, after the attack, local paralyses remain either in
 external parts, or in internal organs, as loss of memory,
 speech.   The worst  of all is  the  paralysis of the gullet,
 swallowing being  thereby impeded; in  such a case the pa-
 tient lies often 5 or 6 weeks, before he dies.
   Apoplexy is one of the most dangerous diseases; the
 complete is in most cases fatal,  rarely perfectly curable,
 subject to relapses within  longer or shorter intervals.  In-
 complete apoplexy is frequently succeeded by a more vio-
 lent attack.
   The forerunners of apoplexy are :  uncommon sleepiness,
 nauseating  vertigo, humming  in the head, partial loss of
 memory,  hanging down of the eyelids,  lower lip or jaw;
 thence frequent chewing with nothing in the mouth to chew
 on,  involuntary flux of saliva during sleep,  easy distortion
 of the countenance, especially of the angle of the mouth,
 old age.
   Pathogenesis. The proximate cause of apoplexy is a sud-
 den stoppage of the cerebral action.  This can be created
 by active  as  well as  passive, and  in general  by various
 causes.  They may be divided for practical purposes into
 the following classes.
   1. Sanguineous  congestion to the brain, the  most common.
 It is created by plethora,  stoppage of the reflux (by pres-
 sure  on the cervical vessels from tight cravats, clothing,
 swelling on the throat, disorders of the heart, also the pres-
 sure of an overloaded stomach—thence apoplexy frequent-
 ly occurs after  a hearty meal—hanging position  of the
head, angina, pneumonia); by too great an  afflux (by vio-
 lent motions, passions, keeping the head loo warm, insola-
 tion, and equally violent degrees of cold forcing the blood
 into the vessels, spirituosa, drunkenness, metastases, mor-
 bid irritations, idiopathic as well as consensual, lesions of
the head, inflammation of the brain).
  2. Erethismus,  nervous affections, spasm  of the brain in
 nervous not plethoric individuals, by all violent irritations
 of the brain, passions,  violent convulsions and spasms, as
 tetanus, metastases, consensual irritations. 
APOPLEXY.
253
  3. Adynamia, real  exhaustion  of the vital power of the
brain, as in old age, after great loss of blood, excesses in
venery, nervous fevers.
  Of the  pathological cerebral irritations, which are able
to produce apoplexy, two are of particular importance to
the practitioner, the  metastatic, and most frequently shift-
ing of arthritic matter to the brain, as the shifting of the
scarlatine matter to the brain ; thence the sudden fatal apo-
plexy of this disease ; and consensual gastric, where the ir-
ritant matter is located in the pra?cordia; thence  apoplexia
biliosa, which may become even epidemic.—The  discrimi-
nation of the ancients between apoplexia sanguinea and se-
rosa is perfectly correct, save that there were no accumu-
lation of serum, but as apoplexy without sanguineous con-
gestion, which  is not found in the brain during life nor
after death, it is the  same which we now term  apoplexia
spastica, nervosa, adynamica.
  Predisposition deserves great consideration.  The same
occasional causes which operate on some persons with im-
punity,  will induce apoplexy in  others,  merely because
they are predisposed to it.  The predisposition consists
chiefly in  the corporeal structure, short thick neck, head
sunk between the shoulders, short stout frame (architectura
apoplectica); old age, the seasons, as the equinox,  transit
from winter into spring, or from autumn into winter, is fa-
vorable to apoplexy, especially the month of December ;
finally,  rapid change in the barometric state of the atmos-
phere.
  Every fit of apoplexy leaves a predisposition to another.
   Therapeutics.   The  fundamental indication is to  restore
the action of the brain.  I must, however,  remark that the
disease does not always depend on a passive state, a weak-
ness of the brain, for the cause  of cerebral inactivity can
often be of a very active character, and the brain  may be
unimpaired in  its power, but only oppressed by  pressure;
and secondly, that  the cause of every apoplexy is not to
be sought for  in a congestion of blood, which likewise is
not always the case.
  The treatment of apoplexy, therefore, consists  merely in
taking away the cause,  which disturbs  the  action of the
brain, and, if this do not  suffice,  to restore its  action by
endeavoring  to arouse it directly.  It is best to look upon
the internal state as  a suspension of the cerebral activity,
not as a loss of it.
  The first and most important investigation in every apo-
plexy must be, whether there is a sanguineous  accumula- 
256                    APOPLEXY.
tion in the brain.  As in hanging, the first thing to be done
is  removal of the rope,  so the  removal  of the sanguin-
eous  pressure is the first  condition of cure, often suffi-
cient in itself to effect it. This accumulation is recognised
by a full hard pulse, red bloated face, reddened (often pro-
truded) eyes, increased warmth, besides the causal circum-
stances, as suppressed hemorrhage, and drinking of spiri-
tuous liquors, etc.  In such a  case a venesection in the
arm, in suppressed hemorrhages on the foot, must imme-
diately be instituted.  The opening must be made large;
for it  is essential that the evacuation of blood be quick and
copious.  Let the blood flow,  until the stcrtor abates, or
consciousness  and speech  return,  and the pulse loses its
fulness and hardness.  If the blood cease to fiow and the
symptoms persist, a second vein is  instantly to be opened.
If the pulse becomes small, without alleviating the symp-
toms, the vein is to be  closed, and local  abstractions of
blood  substituted.  Twelve cups on the throat and neck,
twenty  leeches  on the head, in urgent cases; if all this is
unavailing, and the sanguineous congestion continues, the
jugular vein  or the temporal artery must be opened.  In
suppressed hemorrhoids or menses,  leeches are to be ap-
plied  ad anum or labia vulva?.  When no amelioration suc-
ceeds, and the pulse grows again  fuller, the venesection
may be repeated after six or eight hours. In hemiplegia it
must  be made on the sound side.  Simultaneously we  must
employ every thin^that  can by derivation or contrastimu-
lation  draw the blood away from the head.  This may be
accomplished  particularly  by clysters (of 3 or 4 ounces of
vinegar, salt, mustard, tartar emetic 4 grains), sinapisms
on the calves of the legs, foot and arm, mustard-baths, cold
fomentations on the head.  When the patient is able to
swallow, cooling purgatives, as sulphate of soda and senna,
tartar emetic (vide No. 94).  The head must be elevated,
tight clothing  removed, and the room be warm.  If the pa-
tient is unable to swallow,  the remedies must be conveyed
into the stomach by means of a flexible tube.   As long as
signs  of congestion are present, all  irritatives must be ab-
stained from,  even emetics so much cherished, since they
are apt to increase the congestion  to the brain ; also  the
aromatic lotions and olfactory remedies are to be avoided.
If  after this treatment no  improvement appears, there is
little hope.  Generally on  the  third day  a relapse  takes
place  and  kills the patient.   If by this treatment ameliora-
tion succeeds, no alteration is to be  made,  but  the  use of
cooling purgatives and clysters is to be continued.  It is 
APOPLEXY.
257
 only after a proper application of these means have failed
 that an emetic is admissible, and then it is a most excellent
 remedy,  especially when the stomach has been overloaded.
 A  large  vesicatory on the neck is also proper.  And now
 appropriate nervines and stimulants maybe resorted to, but
 always with  precaution to avoid all such  as create strong
 sanguineous excitement, and therefore cooling and purga-
 tive remedies may be admixed.   The best are valerian,
 arnica  (vide  No. 95), pyrethrum, tinctura ambra?, liquor
 c. c succin.  At the same time regard must be had to the
 possibility of effusion, for which calomel and digitalis may
 be given intermediately.  If, after the removal of the san-
 guineous congestion, the symptoms do not abate, the treat-
 ment for  apoplexia nervosa is to be entered upon.
   The second case is a purely nervous, spasmodic and ady-
 namic apoplexy.  It is recognised  by the absence of the
 above-mentioned signs of sanguineous congestion  and ex-
 citement.   The  patient looks  pale, is rather cool than
 warm, his  pulse  small,  easily compressible;  debilitating
 causes, exhausting  evacuations or exertions, or a chronic,
 weakly, nervous  state, or old age have preceded. Here, of
 course, a stimulant nervous treatment must be prosecuted;
 Valeriana, arnica, liquor c. c. succin.,  castoreum,  ambra,
 oleum cajeputi,  and similar a?therea, but  particularly sti-
 mulant clysters (of vinegar, mustard, and pyrethrum), and
 cutaneous irritatives,. vesicatories on the neck, sinapisms
 renewed  every 12 hours on the extremities, aromatic lo-
 tions and embrocations are to be used. Should the above-
 named  remedies  prove inefficacious,  an addition of opium
 to  the  other  nervines may  be  of  great service.  If this
 treatment is fruitless, a moxa is to be applied to the head;
 of the successful application of which I know one instance.
 We are, however, not to forget, that sometimes latent con-
 gestions of blood, at least local ones, hemorrhoidal, do co-
 exist, and require the application of leeches.
  The third case is the gastric and bilious apoplexy. It is
 recognised by an overloaded stomach or anger having pre-
 ceded, by the prevailing bilious epidemy, and by  the fol-
 lowing  signs: the patient has  eructations, disposition  to
 vomit, coated tongue, a wry face, the white of the  eyes is
•yellowish, he carries his hand frequently to the epigastric
 region,  which is distended.  Here  an emetic is the only
 salvative ; but previous to its administration examine well
 whether congestions and a plethoric state do not coexist,
 which is frequently the case.  As a vomit tartar emetic  is
 the best;  after vomiting irritative injections and purgatives 
258                    APOPLEXY.
 must be administered.  This is often sufficient to accom-
 plish a cure. If amelioration does not succeed, or it stops,
 we are to ascertain whether there is still an indication lor
 an emetic, and repeat it.  If this is not the case, and gas-
 tric accumulation is no longer present, the treatment must
 be to operate on the dynamic state, and when  signs of san-
 guineous congestions continue, the treatment of the apo-
 plexia sanguinea, or where the nervous state predominates,
 that of the apoplexia nervosa is to be pursued.
   The fourth case, which is of frequent occurrence, is me-
 tastatic apoplexy, especially  that which arises from gout.
 It  is discovered  by  knowing that  this morbid  state pre-
 existed.  We  must first  inquire into the dynamic relation
 of the malady  and remove it.  Most frequently, especially
 in gout, it is sanguino-inflammatory.  Consequently, we
 begin by abstraction of blood, as in apoplexia sanguinea,
 but afterwards the morbid  matter  must  be translated by
 antistimuli  (in retroceded podagra,  sinapisms on the feet,
 foot-baths of mustard, dry bran-baths mixed with salt), and
 specifics  corresponding to  the morbific matter, such as
 guaiac and aconite, given. But if the vital condition  is ady-
 namico-nervous,  the  treatment of  apoplexia nervosa is to
 be combined with the specific and derivative.
   When apoplexy is a symptom of intermittent fever, the
 patient will  be free from apoplectic symptoms as soon as
 the  paroxysm  is  over; and  the treatment will consist in
 merely preventing another attack by the most active febri-
 fuges, among  which cinchona and opium rank first (vide
febris intermittens perniciosa).
   If apoplexy  is a consequence of mechanical  pressure on
 the brain,  produced from without by lesions of the head,
 or from within by organic  formations  in  the cranial ca-
 vity,  or on the neck, when the cause of the pressure can-
 not be removed,  the effect,  the sanguineous congestion
 may be diminished by abstractions of blood and derivatives
 but never entirely removed.
   Paralysis remaining after apoplexy is treated as such.

   Every one,  who has' sustained an apoplectic fit, must
 carefully try to prevent its  recurrence.  The preventive
 rules are: to  lie with a high pillow, to keep the feet warm,
 to avoid overloading the stomach  and  spirituous liquors,
 violent passions,   suppers,  and costiveness ; and  to take
 mild laxatives from time to time, especially Saidschiitz bit-
terwater ; also  a  moderate abstraction of blood in spring
and previous to the winter setting in is proper. 
SUFFOCATIVE CATARRH.  SYNCOPE.         259
     SUFFOCATIVE CATARRH, PARALYSIS OF THE LUNGS.

      Catarrhus Suffocativus,  Apoplexia Pulmonum.

  Diagnosis.  Sudden attack of suffocation, orthopnoe, rat-
tling in the throat,  cold sweat, agony, sometimes loss of
consciousness, sometimes it is retained.
  Pathogenesis, is the same as in apoplexy, with this diffe-
rence,  that there is here  a paralysis of the pectoral nerves,
while  in apoplexy it is  a paralysis of the cerebral nerves.
The occasional causes may be the same as those of apo-
plexy; but a material local accumulation and extravasation
in the bronchia, as excessive accumulation of mucus in
asthma mucosum, sanguineous extravasation,  effusion of
matter in  suddenly burst vomica, may give rise to it.
  Therapeutics.  The principal indication is promptly to
free the lungs from their accumulation, and to  rouse their
action.   The chief remedies are :  immediately  a  vene-
section in the arm,  and directly after it an emetic, sina-
pisms to the chest and upper arms, arm-baths; then decoc-
tion of senega, or arnica root, and tart, emetic, liquor ano-
dyn. Hofmanni, liquor c. c. succin., musk, vesicatories, re-
gard being paid to remote causes, as in apoplexy.
                       FAINTING.

                 Lypothymia, Syncope.

                       ASPHYXIA.

                    Suspensio Vita.

  Diagnosis.  Loss of consciousness,  sensation, and mo-
tion;  pulse  and respiration diminished or entirely annihi-
lated.
  There are different degrees of it:  the lesser, hpothymia,
when the pulse and respiration are but moderately weak-
ened ; syncope, when those functions are scarcely percep-
tible; asphyxia, when they are entirely abolished.
  The forebodings of fainting are: buzzing  in the ears,
sparkling before the eyes, and dimness of sight.
  The duration varies very much, from a few minutes up
to several hours, even days. Recovery is generally accom-
panied with a deep sigh.
  The prognosis differs according to  the causes.  Hyste- 
260
SYNCOPE.
 rical fainting is without danger, however long it may  last.
 It is more dangerous when due to plethora, or stoppages
 of the  circulation in the heart and to high degrees of ex-
 haustion.   Syncope  at  the commencement of or during
 fever augurs bad.  There is reason for fear in every faint-
 ing fit  of long duration, on account of the  stoppage of the
 circulation, stagnations and coagulations'of blood, espe-
 cially when an inflammatory state of the blood exists.
   Pathogenesis.  The proximate cause of syncope is debi-
 lity, or a complete  cessation of the action of the central
 organs, the heart and lungs, and consequent cessation of
 nervous action ; this  forms an essential difference between
 syncope and apoplexia.  In  the first there  is impeded san-
 guine  life, in the latter impeded nervous life.  Fainting
 proceeds from the heart, apoplexy from the  brain ; there-
 fore, in the first the  pulse is weakened and annihilated, in
 the latter unaltered, even increased. There is then, no pa-
 ralysis after syncope ; but paralysis is usual after apoplexy.
   The  remote causes are:  nervous affections (great mental
 emotion, as fright, joy), nervous fevers, but especially hys-
 teria, and is therefore of frequent occurrence in this state,
 corrupt air, strong odors, especially the fragrance  of flow-
 ers on hysterical persons, narcotic poisons, consensual ir-
 ritations, irritation by worms ; plethora  of the  heart,  by
 which its contraction is  impeded,  and the  motory power
 suppressed for some time  (sanguineous  plenitude, youth,
 violent  motions, suppressed or imminent  hemorrhages,
 tight lacing, diseases of the heart) ;  weakness, after violent
 corporeal exertions, loss of blood, exhausting evacuations,
 as violent diarrhoea, cholera, or artificial, as in paracente-
 sis abdominis for ascites.
   Therapeutics.  The action of the heart is to be roused,
 and for this purpose there is a great variety of resuscita-
 tive  means, corresponding with the variety of causes. The
 only general and innocuous resuscitative is a sprinkling of
 cold water; in hysterical  persons the  fumes of burning
 feathers, cut onion, vinegar, acidum aceticum aromaticum
 to the nose, washing with aromatic spirit, rubbing the ex-
 tremities,  injections,  fresh  air.   In the adynamic form,  a
 horizontal  position, to promote the reflux of blood to the
 heart, is one of the best restoratives;  volatile  odors,  as
ammonium, rubbing  the  face, the scrobiculus, the  spine
with aromatic  spirit,  strong wine  given as  soon  as it can
be swallowed.   In  the sanguineous syncope  place the feet
pendent, and raise the head and chest; foot and arm-baths
removing  every pressure and tight clothing, cold water 
ASPHYXIA.                    261
dashed into the face (avoid aromatic or volatile odoratives
and lotions), in obstinate duration venesection.
  If all these means are unavailing, the treatment of as-
phyxia must be resorted to.
                       ASPHYXIA.

   Diagnosis.  Suspension of pulse and respiration, of sen-
 sation and  the power of motion, consequently it is a per-
 fect image of death, for which it may be mistaken, as  all
 the ordinary signs of death are here  fallacious, and none
 to be relied upon excepting incipient putrescency, and its
 adjunct the soft doughy cornea, which retains any impres-
 sion that is made upon it.  Internal consciousness is pos-
 sible,  so  that it  sometimes  happens that a person appa-
 rently dead, hears what passes around him, without being
 able to utter a single sign of life.
   Pathogenesis.  The causes are : either a sudden mecha-
 nical stoppage of the action of the heart and lungs, (suffo-
 cation by  hanging,  being drowned,  stopping the mouth,
 vapors and mephitic air), or the abstraction of elements
 indispensable  to life, as warmth, oxygen,  or  influences
 which directly exhaust vitality, as lightning, intense emo-
 tions  of the mind,  paralyzing poisons,  malignant nervous
 fever,  plague).  Every fit of fainting may  pass into  as-
 phyxia.  In lying-in  and hysterical women it may occur as
 a symptom, and in the latter case be only a spasmodic at-
 tack, which will last a certain time and cease of itself.
   Therapeutics. The fundamental indication is to rouse  the
 latent  vital  power,  especially that of the heart and lungs;
 and  next  to  remove the impediments to  their action.
 Therefore,  we must first awaken the  vital  power which is
the source of excitability ; for, unless there is excitability,
stimulants will be unavailing ; but excitability requires  for
its support pure air and warmth.  Therefore, the apparently
dead body must  be placed in pure air,  and furnished with
warmth,  by means of hot sand  or ashes, or what is still
better  by  the contact of a living  person, and  this caloric
retained  by proper  bed clothing; also, hot applications
must be made,  and frequently renewed, to the scrobiculus
cordis, behind the  shoulders  and to the soles of the feet.
A warm bath,  strengthened  with salt, ashes' or spirits, is
not to  be neglected.  By this  process alone, persons appa-
rently  dead have been restored.  It  is more  important of
itself thau all other means besides;  is the principal thi ig 
262                    ASPHYXIA.
to be done, and not to be interrupted to give place for other
remedies.  Insufflation into the lungs through the mouth,
the nose being closed, is requisite. This will be more effi-
cacious  if immediately performed  by   an  assistant,  for  ,
warmth and vital breath are great vivifiers of the lungs
and heart. Pure, or oxygenated air, may also be employed
by  means of Gorcy's bellows; but,  in  using this  instru-
ment much care is required, lest it over-distend the lungs.
It will be proper to  inclose the chest with a  towel,  and by
alternately drawing and relaxing it imitate respiration.
  The second  indication  is to apply  active  stimulants,
which excite directly through the medium of the nerves, or
indirectly through  sympathy  the action of  the  heart and
lungs.   The direct stimulants  are insufflation and  disten-
tion of the lungs, artificial respiration,  an electric  or gal-
vanic shock passed through the heart (by the application
of one conductor to the pit of the stomach,  and the other
to the spine);  also,  transfusion  of living blood.  The in-
direct  are : frictions to the soles of the feet and palms of
the hands; dropping cold water and wine on the scrobicu-
lus ; spirit of ammonia approached to the nose and dropped
on  the  tongue,  tickling  the fauces  with a feather, irri-
tative  injections, cups on  the pit of the stomach, and ex-
citement of the nerves of hearing by loud sounds.
  As regards  obstructions, besides  removing  that of the
rope from the  neck of persons hung, mephitic air from the
suffocated, the water from the  lungs by an inclined posi-
tion in  the case of drowned persons, venesection must be
mentioned,  as proper to relieve the  surcharged lungs and
heart, and is never to be omitted in cases of suffocation.
  Time  deserves great consideration,  because a certain
lapse is  necessary before  life can return, as is shown by
some cases of asphyxia, which required an interval of seve-
ral days.  Therefore, after having employed every resus-
citative means, we must leave the individual in repose, but
keep him  warm,  and repeat the stimulants  every few
hours for a space of twenty.four,  waiting the signs of pu-
trefaction.
  There remain to be mentioned a few particular rules re-
garding some species of asphyxia.
  In frozen persons,  while warmth is necessary for resus-
citation, it must be of a low degree, approaching to the
freezing point; for a higher one would instantaneously an-
nihilate the remaining vital power,  and produce a transi-
tion into putrid dissolution.  The body or the part affected
is to be placed in snow or  ice-water,  which will suffice for 
VERTIGO.   LETHARGY.
263
recovery if there is a sufficiency of life remaining.  Every
warm application is injurious, even warm injections.
  Those struck by lightning,  are  to be affused with cold
water, buried up to the neck in fresh dug earth, bled,  and
have opium administered.
  In suffocation by carbonic vapors or other mephitics, the
body must be exposed to a current of fresh air, and be as-
persed with cold water ; venesection must be practised,
and injections of vinegar administered.
  Diagnosis.  All objects, even  the  patient's  own body,
appear to him as turning round ;  when the case is severe,
he staggers and wavers ; when the case is still more severe,
his sig°ht is obscured (vertigo tenebricosa) and consciousness
suspended (vertiga caduca).
  In youth it signifies little; but in advanced age it is the
forerunner of apoplexy.
  Pathogenesis.   Its causes are  the  same  as  those of all
other nervous diseases; but the  most frequent are gastric
sympathies, from overloaded stomach, worms and infarcts.
Besides  these  it may be produced by a sanguineous  cere-
bral congestion, organic disorders in it,  plethora, or de-
bility.
   Therapeutics,  consist of gastric evacuants,  abstractions
of blood, and nervines, according to particular indications.
Direct cure: cold bathing of the  head, cold affusions, mus-
tard foot-baths,  cupping  in the neck  frequently repeated,
washing the temples, forehead,  behind the ears,  and the
neck with spirits and balsamics.  Internally, bitterwater
continued for some days,  valerian,  mustard, elixir acid.
Halleri,  issues on the neck  and on the arm, worsted stock-
ings  and socks  of oilcloth.  I have found guaiacum with
cream of tartar (No. 96)  a true specific


                        LETHARGY.

                       Lethargus.

   Diagnosis.   A sleep continued beyond  the natural time,
 it may extend to weeks,  months, even years.*  The funda-
 mental functions of organic life,  as pulsation, circulation
   * An instance of 4 years' duration is stated in Hufeland's "Journal
 der praktischen Heilkunde,"  vol. 59, piece  3, page 127. 
264                 LOCAL PARALYSIS.
of the blood and  respiration, remain undisturbed.  Nutri-
tion is possible only by the injection of fluid aliments;  se-
cretions  and excretions are trifling.  In some cases  short
intervals of awaking  intervene, to pass again soon into

  This complaint is rarely fatal, unless it is a symptom of
some dangerous  affections of the brain ;  it  may even be
critical in'chronic, nervous, and mental diseases, and lead
to a restoration of health.
  In a lesser degree it is drowsiness,  a perpetual inclina-
tion to sleep.
  Chronic lethargy most  frequently occurs in the female
sex.  The causes are:  disturbances of menstruation, espe-
cially at the development of puberty,  general nervous  dis-
eases, intense mental affections,  mental diseases, and  me-
tastases to the brain (irhas been observed after measles),
exsudation into the cranial cavity, and  organic  disorders.
Temporary lethargy and drowsiness in children generally
forebode hydrops cerebri, and in  aged persons, apoplexy.
   Therapeutics.  The treatment must be accommodated to
the causes, and nutrition must at  the same time be attend-
ed to; external irritative and excitative means, baths,  cu-
taneous stimuli,  irritant clysters, the endermatic method,
and moxa are to be used.  I once applied galvanism (one
pole to the pit of the  stomach, the other to the ear) with
perfect  success.   In  metastatic lethargy  the internal  and
external use of mercury has proved most  serviceable.
                     LOCAL PARALYSIS.

                    Paralysis Localis.

   Diagnosis.  Impaired or totally annihilated sensation or
motion,  or  both.   In  a higher  degree,  the nervous  in-
fluence of organic life and  reproduction is annihilated.
   There are consequently different degrees :  1, diminished
sensation, or motory power;  2, entire annihilation of one
or the other; 3, of both;  4, weak pulse and diminished
warmth in the paralyzed  part  ; 5,  emaciation; 6, disorga-
nization, withering, complete drying up,  gangrene or dry
mortification, necrosis, mummification.
   It  can attack  any part  of the body, external as well as
internal,  and according to the part or the organ it affects,
the number of which  is great, it has  received different
names; as in the organs of senses amaurosis, cophosis ; of 
LOCAL PARALYSIS.
265
 the intestinal canal,  dysphagia, apepsia, of the pectoral or-
 gans, asthma.
   It frequently follows apoplexy;  but often it has only a
 local origin, and may be quickly or gradually formed. It is
 sometimes connected with spasmodic  affections, or alter-
 nates with them.
   The cure  is always difficult.  Its curability depends on
   1.  Duration: the older  the complaint, the more difficult
 the cure ;
   2. Seat:   cure  is  most difficult,  when the disease is lo-
 cated in the organs of the senses ;
   3. Cause: when it is owing to  metastases, the cure is
 easier;  more difficult when owing to real debility ; incur-
 able  when caused by a  mechanical pressure which cannot
 be removed, as that of exostoses;
   4.  Degree :  easier to be remedied, when only sensation
 or motion is lost, but spasms and pains continue in the part;
 more difficult,  when either  are  wanting; still more so,
 when the organic  life of the part is  impaired.
   Pathogenesis. The  proximate cause is an affection of the
 nerve itself, annihilating  its action entirely or partially.
 Here is the place to make a remark of practical import-
 ance, which is, that the impeded action may be seated  in
 the place of paralysis itself, as well  as in the origin and
 course  of the nerve relating to this part, as in the brain,
 spinal marrow, or ganglia.  Some kinds of paralysis evi-
 dently proceed from   the centre ; as  those which accom-
 pany apoplexy and diseases of the spinal cord ; some from
 the peripherial terminations of  the  nerves and are propa-
 gated to the centre.
   A deficiency of action must not be ascribed to deficiency
 of power, as is too often done ; for  power may remain un-
 impaired, being only obstructed in its transmission.  We
 therefore distinguish paralysis a defectu virium and paraly-
 sis ab oppressione virium. The latter is more frequent  than
 the former.
   1. Paralysis by oppression.
   Sanguineous congestions produce pressure on the nerves,
by general  as well  as  by local plethora (paralysis san-
guinea).
   Metastases—by  a  morbid matter  transmitted  to  the
nerves, wh.ch,  by  a peculiar operation on the internal ner-
vous life, obstructs or confines its activity.
   Consensual abdominal irritatives—abdominal stimuli may,
by conseiisuality through  the sympathic nerve, produce a
 spasmodic obstruction in remote parts.
                           23 
266
LOCAL PARALYSIS.
  Mechanical pressure—caused by a ligature, the compres-
 sion of tumors and indurations, extravasations in the brain
 or on the nerves themselves, luxations and fractures.
  To this head also belongs spasmodic paralysis, which is
 an active and not a passive condition of the nerve,  and is
 often mistaken for spasms in the  part affected.
  2. Paralysis from weakness.
  Is due to any cause which can  rapidly or slowly annihi-
 late or impair  the nervous power of a part.   Apoplexy,
 lightning, violent passion, especially fright may produce it
 suddenly; and it may be brought on slowly by abstraction
 of power, over-irritation, exhaustion, immoderate exertion,
 particularly excess in venery ; as  a consequence of fevers,
 especially  nervous ones  and other debilitating diseases,
 also by want of use and deficient exercise of a  part.
  Therapeutics.   The first thing we  have to investigate into
 is,  whether  it is vis oppressa or deficiens,  since the treat-
 ment will not only differ but be opposite, according as one
 or the other of these  causes prevail ;  in the first it will be
 to impart, in the latter to abstract prwer; and a confusion
 of either of these modes may lead to great injury. A great
 prejudice,  which has caused unutterable mischief,  is the
 idea that every  paralysis is a weakness,  and ought to be
 combatted by stimulants and roborants.
  When paralysis is owing to oppression of nervous power,
 the treatment  must  commence  by removing  the cause,
 which oppresses and  binds up the power, liberating which
 will often perform a cure.
  When there is sanguineous congestion or inflammation,
 bloodletting and  antiphlogistics are  of  service.   When
 there is metastasis, vesicatories, artificial ulcers, and reme-  •
 dies opposite to the respective morbific matter are to be
 used ;  when it depends upon a consensual abdominal irri-
 tation, the gastric solvent method,  even drastic remedies,
 often the most successful, are to be resorted to. When there
 is mechanical pressure,  the same  must be removed by me-
 chanical or surgical means.
  It is only when the paralysis  continues after the use of
 all these remedies, that  the  nerve-animating method is to
be adopted.
  When, on the contrary, the  cause is  real debility, ex-
 haustion of power, vigorous roborative and restaurative
 remedies must be prescribed, from the beginning, in com-
bination  with the nerve-animating method.
  The general rules recommended for the treatment of pa-
 ralysis are: 
LOCAL PARALYSIS.
267
   1. The alternating increase and diminution of doses;
even pausing once and a while intermediately, in order to
allow nature time to collect excitability, is of great import-
ance ;  likewise an alteration of remedies.
  2. Patience is here a virtue indispensable  to the physi-
cian.  Nature wants time for a process like the gradual re-
animation of a part; a physician who cannot wait, will have
no success in paralysis.  Not weeks, but months and years
may be needed for such a cure ; favorable changes external
as well as internal may happen, and what is not possible in
this, will be practicable in a future year.

                Nerve-animative Method.

  We are always  to look upon the nerves as  enlivened by
a peculiar matter ; or contemplate life  as something similar
to galvanism, as  is apparent in the electrical eel,  whose
shocks on btfjng touched are not the  result of a  physical
necessity, but voluntary functions of its nervous  system, a
spiritual matter, which can be transferred, attracted, accu-
mulated, impeded, interrupted.
  Vivification, resuscitation of a debilitated, half dead ner-
vous life can therefore be effected :
 '  1. By local irritation, which creates an excitement, and,
in consequence of this an increased vital process and afflux
of blood, producing an increased  development of the ner-
vous power.  The irritation may be excited idiopathically
as well as consensually. The latter is often more efficacious
than the first, especially when proceeding from the stomach
and intestinal canal, on account of the  large consensus ner-
vorum of these parts.
   2. By an internal animating influence, particularly the
mental one  proceeding from the brain, and the increased
sanguineous influence from the heart.
  The remedies to attain  these ends are:
  1. Pharmaceutical: emetics, Schmucker's pills (vide No.
97),  a nauseating  treatment,  drastics, in  small doses  (as
tinct. colocynthidis  10 to  15 drops three times a day) ;  all
the ethers, nervines, balsams, particularly ammonium, liquor
c.  c.  succin.,  arnica,  valerian, cantharides,  and several
other insects, such as millepedes, ants, vespa aurata ; oleum
aether, cajeputi,  Valeriana?  (vide No. 98, 99),  roris marini,
animale Dippelii, camphor, a?ther, a?ther mercurialis (vide
No. 104, especially  in paralysis syphilitica and in general
metastatica), phosphorus, some narcotics, as belladonna, di-
gitalis,  where there is  suspicion of  effusion;  rhus tox- 
268
LOCAL PARALYSIS.
icodendron, capsicum, opium ; the most valuable is nux vo-
mica (vide No. 100).
  All these means may be simultaneously applied extern-
ally for bathing, anointing,  or fomenting (vide  101, 102,
103).
  Cutaneous irritations  of all kinds, as frictions, sinapisms,
mustard-cataplasms, and mustard-baths, vesicatories, sca-
rification, urtication, moxa.
  Mechanical  shocks,  by friction, riding in  a  carriage,
shaking-machine.
  Specific irritatives,  peculiar to every organ,  as light to
the eye, sound to the ear, hot spices to the tongue.
  Baths, above all the hot  thermal, as  those  of Teplitz,
Gastein, Wiesbaden, Aix la Chapelle, Baden, WTarmbrunn:
the chalybeate, such as Pyrmont and Driburg; the natural
and artificial saline, sulphurous, and chalybeate; also baths
of fermenting matters, as of malt, wort, brandy-lees, and
shower baths..                             *r
  2. General powers of nature.  The ordinary vivifying na-
tural agents, warmth and electricity,  are of great  value, in
order to revive a half or apparently dead part.
  Warmth, woollen clothing, lambskin,  or  wild  cat fur,
warm baths; in severe cases  steam and  sweating baths, ge-
neral  as well  as local; and  in worse ones, cauterization.
Vital warmth  is particularly efficacious, therefore the ap-
plication of a living creature, or placing the paralyzed part
in a fresh killed animal, also terrestrial warmth, as the
volcanic heat in thermal springs.
  Cold, used only momentarily as a sensitive irritant,  drop-
ping, sprinkling, or immersion baths.
  Electricity, which is important on account of its affinity
to the nervous system, may be  used in variable  degrees
of tension from the lowest to  the highest,  in  insulation,
by streams of aura, or  sparks and  shocks, the latter with
caution. Galvanism is less safe,  and apt to disorganize the
tender organs of sense.  Magnetism, animal as well as min-
eral, in all cases where known remedies fail.
  The endermic method also deserves  attention.  For this
purpose a small portion of skin is to be denuded by means
of an epispastic, and extract of nux vomica, morphine, bel-
ladonna, or the like, applied on the raw surface; but  great
caution  is to  be observed  in regard to quantity, since re-
medies frequently operate more violently in this way than
when given internally.   The best place for this operation
is near the origin of the nerves affected.
  Psychical stimuli are of great importance, as mental in- 
                     LOCAL PARALYSIS.                 269

 fluence, fixed volition, exertion to move, exercise, raising
 the imagination, firm confidence in one's own or a superior
 power, faith,  which can here perform wonders.
   In  my experience I have found the  following  remedies
 most efficacious: emetics,  nauseating pills,  ajther mercu-
 rialis, arnica, nux vomica, tincture of colocynth (particu-
 larly  in paralysis atrabilaria), electricity,  thermal baths of
 Teplitz, Aix  la Chapelle,  Wiesbaden,  Gastein,  ant-baths,
 malt-baths, (6 to 12 pounds of malt, 2 pounds of hops, 6 to
 12 pound  of  distiller's grains),  baths  of wort, of brandy-
 dregs, Russian baths, mire-baths.
   Particular notice is due to paralysis dorsalis s. medulla-
 rs, or as it is generally termed, paralysis of the lower ex-
 tremities,  although it  may sometimes seize the upper ex-
 tremities.   It generally commences with lameness of one
 or  both the lower extremities, sometimes with lameness of
 a hand and foot, and continues to extend. It is characte-
 terized in  the beginning by a kind of staggering or waver-
 ing of the feet;  or sensations of pressure, pain, and crawl-
 ing in the  back.   In  order to ascertain, whether it origi-
 nates in the back and in what part it is located, pass a hot
 sponge along  the spine, which will increase the sensibility
 of the affected spot, and thus point it out.  This  affection
 may  continue so for  years,  even remain fixed  in  an ex-
 ternal part through life, without extending further.  But
 sometimes it is  increased unto perfect immobility, spread-
 ing to vital organs, giving  rise to inactivity of the rectum
 and the urinary bladder, and terminating in  incontinence
 of their functions; finally difficulty of breathing, weakness
 of  sight and of  the lungs, of the intellectual faculties and
 the brain,  apoplexia nervosa.
   The cause  is always to be sought for in the spinal  mar-
 row.   Sometimes  it  is purely  mechanical, owing to  inci-
 pient curvation  of the column ;  but more frequently it is a
 consequence of debilitation of the spinal marrow brought
 on  by venereal and onanitic excesses, or  by rheumatic, ar-
thritic,  scrofulous, or other  morbific  metastases, sangui-
neous congestion, and chronic inflammation.
  The treatment must be directed particularly to the spinal
marrow; and, besides the remedies already recommended
against paralysis from congestion, the application of leeches
to the suspected  part of the back ; and cold fomentation^; a
moxa, frequently repeated on the spine and long-contihtTed
 suppuration of it the chief  means.   Among the excitants
oleum terebinthina?, 30 drops four times a day, has proved
particularly efficacious.
                          23* 
270                   DYSPHAGIA.

  When \
be the sar
a kindred.
  When venereal debility is the cause, the treatment must
be the same as for tabes dorsalis, to which  the  disease 13
                      DYSPHAGIA.

  Diagnosis.   Difficulty of swallowing, without pain and
without signs of inflammation.   Swallowing becomes im-
possible, and the patient dies from starvation.
  The causes discriminative of the various species are the
following:
  Spasm.   It is a symptom of hysteria, globus hystericus,
and  commonly met  with periodically, but  may  become
permanent.
  Atony and paralysis.  Whence met with after apoplexia
and hemiplegia.
  Metastasis.  Most  frequently  venerea,  arthritica, and
scrophulosa.
  Finally, mechanical impediments, as swellings and indu-
rations of the glands in  the oesophagus or fauces, dilata-
tions, by which a second bag is formed in the gullet, where
the aliments accumulate.  Thence ruminatio humana.
  A moist  climate  and abuse of tea,  too  hot  or  too cold
beverage,  and  that of ardent  spirits seem most to predis-
pose to it,  hence it frequently occurs in Holland.
  Therapeutics. The treatment must conform to the causes.
  Spasmodic dysphagia. The cause of spasm, most frequent-
ly  obstructions in the abdominal viscera,  must  be re-
moved ;  the treatment of hypochondria and  hysteria  is
therefore  requisite.  External  fomentations of theriac, hy-
oscyamus,  cicuta, emplastrum de Galbano crocat. c sal.
vol. c. c. and  opium.—Internally extract, hyoscyami, opium,
aqua laurocerasi, belladonna may be  given; and sinapisms
and vesicatories applied  to the  throat.   Also ol.  cajeputi
on sugar is particularly recommendable in spasms of the
gullet and stomach.
  The atonic and paralytic.  Rough  and  solid things are
often more easily swallowed  than fluids.  Here the best
excitantia are vesicatories, ol. cajeputi, mentha piperita on
sugar, ground mustard, tinct. cantharidum are recommend-
ed ; externally spirituous  fomentations, electricity.
 ^j^p metastatic.  Here two  things are to be effected, de-
rrTanon of the matter and assuaging of the cramp, which
is due to  irritation ;  which may be  accomplished by the
afore-mentioned  antispasmodics, especially   vesicatoria
nucha?, and at the same time vesicatories and issues on re- 
APHONIA,  DYSPHON1A, DYSLOGIA.           271
mote parts, particularly  where the matter has been pre-
viously seated.  Also  foot-baths of mustard,  socks of oil-
cloth, sulphur-baths are advised. Simultaneously we must
use the remedies, which are appropriate to the dyscrasia in
question.  In  such cases salivation may prove beneficial,
especially when a suppressed salivation, as sometimes ap-
pens, gave rise to the disease.
  The mechanical. Most frequently depends upon swelling
of the  glands;  therefore met  with particularly in  scrofu-
lous individuals. The  best remedies  are cicuta, antiscro-
phulosa : as spongia tosta, iodine, internally and externally,
barytes (vide No. 105), mercury ; at the same time  mercu-
rial ointment externally, and a continued use of emplastrum
de cicuta; also mezereum on the arms; trochisci e  pulvere
spongia? usta?,  extract, cicuta?  et  arnica?,  placed  beneath
the tongue, and allowed to dissolve slowly.
  In  incurable  dysphagia life  may'be prolonged by milk,
which even in injections  and clysters  does a great deal of
good.
            APHONIA. 'DYSPHONIA.  DYSLOGIA.

  Diagnosis.   We must distinguish  faults of speech and
faults of voice.
  1. Speech  is  either entirely wanting (aphonia completa^
dumbness), or is only imperfect (dysphonia, dyslogia).
  Perfect  dumbness is  either permanent or periodical.  In
the first case it is congenital, or is a  consequence of a pa-
ralysis, commonly of apoplexy.  In the latter case it is the
effect of a spasm.
  Congenital dumbness is always combined with deficiency
of hearing and is ovving to that ; generally it  is the effect
of an internal  disorganization, and  is  therefore remediable
only by the substitution of the visible and tangible means
of language for that of the absent audition ; by these means
it is possible,  not  only to acquire the faculty of recogniz-
ing linguistical impressions, but also  that of pronouncing
letters and words;—such  is the recent art of instructing
the deaf and dumb, an admirable discovery of modern times
and now brought to great perfection.  Sometimes it is pos-
sible by the  use of antiparalytic remedies to procure to
some children at least a certain  degree of hearing.  I once
saw good effect  from belladonna.   I have met  with a case
of congenital dumbness,  while the faculty of hearing ex- 
272           APHONIA,  DYSPHON1A, DYSLOGIA.

isted, dumbness was  congenite,  consequently it  was due
merely to a disorder of the cerebral organ of language.
  Paralytic  aphony is  treated like paralysis; chewing of
mustard or cubebs; oleum cajeputi applied to the tongue,
electricity and galvanism are here of use.
  Periodical  dumbness  is always a spasmodic affection,
and  appears in  children, sometimes  typically ; it  is fre-
quently caused by verminous irritation ; in grown persons it
is a symptom of hysteria, catalepsy, or insanity, and is to
be treated according to the causes.
  An imperfection of  speech, a difficulty of utterance  can
be of various character : it is either an incapacity  to find a
word, or making use of a wrong one (amnesia of language).
Here, the  disorder is mental, and is a deficiency of memo-
ry.   Or it is an incapacity to pronounce  clearly (stammer-
ing,  stuttering,  balbuties), the indistinct pronunciation of
single letters, stuttering.  Here also the defect lies in the
mind, in its linguistical  operation : the ideas anticipate the
words;  hence there is no stuttering in singing, where the
mind is obliged to go by measure.  It may, however, origin-
ate also in  an organic disorder of the tongue (as from the fre-
num not being cut), or in a bad habit. Besides the removal of
the organic disorder,  the treatment consists in accustom-
ing the tongue, to pronounce slowly and distinctly by fre-
quent exercises in reading loud, or when it is inveterate
and very bad, by the method lately invented by Lee, which
is founded on a particular upright position of the tongue.
  2. The  voice  may  be entirely  lost, or is rough, hoarse
(raucitas,  hoarseness).   The cause of this resides either in
the mucous membrane lining the organ  of voice, a com-
mon case  ; or in a morbid affection of the  nerves  pertain-
ing to that organ.   In the first case it is a common  symp-
tom  of catarrh, and is to  be treated as such (especially by
sulphur and antimony);  or it arises from a scrofulous«ffec-
tion  of the tracheal glands, or from a metastasis (most fre-
quently syphilitic), to which the treatment must be adapt-
ed by specific derivative remedies.  Not unfrequently  it is
the  commencement and first symptom of phthisis trachea-
lis, which  see. In the second case it is often  only  a symp-
torn of general debility; it may, however,  be also  a  perio-
dical  spasmodic disorder;  sometimes owing to deeper
seated affections of the. cardial  and pulmonary  nerves.
Here, general tonics  and antispasmodics are the  best re-
medies. 
DYSPEPSIA.
273
                   APEPSIA.  DYSPEPSIA.

   Diagnosis.   Absence of appetite, or one which is weak
 and irregular ; pressure, tension  in the epigastrium  after
 eating ;  eructations which taste of the aliments, flatulency,
 morosity,  drowsiness;  aptness  to indigestion,  acidity,
 mucosity.
   Pathogenesis.  Weakness of the stomach hs caused by:
 irregular or bad diet, gluttony, warm beverages,  especially
 tea, drink in  excess, a sedentary  life, great  mental exer-
 tion, sorrow,  immoderate venery.
   Therapeutics.  Before  commencing the treatment, we
 must first ascertain  whether the debility is real or  only
 apparent, as when  produced by substances which  fret the
 nerves of the  stomach. If tonics be used in the latter case,
 they will not  only fail to strengthen, but will make the dis-
 ease worse, and localize the morbid cause.  The material
 causes of  weakness  of the stomach  and  indigestion,  to
 which the  physician must particularly direct his  attention,
 are : gastric impurities, saburra, bile, or morbid metastases,
 as the rheumatic, arthritic,  psoric, or local plethora.   The
 treatment must be  adapted  to  the  respective causes : and
 consists of cleansing the stomach  (vide gastrosis), or trans-
 lating the  metastases  and local plethora.   Many cases  of
 weakness of the stomach will require nothing else. There-
 fore, the application of leeches, or the hemorrhoidal treat-
 ment will often be the best means for  strengthening the
 stomach and  restoring the  digestive powers.  But when
 the  disease originates in mere weakness, or  debility re-
 mains after the material causes have been removed, stom-
 achics may be used.  The  best are bitters, especially
 columbo, gentian, absinth., quassia, hops, beer, and aloes in
 proper doses ; also aromatics, or six to nine corns of white
 pepper, swallowed  every morning, fasting, are, according
 to my experience, very efficacious, when continued for a
 long  time ; orange-peel,  ginger,  nutmeg,  caraway,  and,
 above all, generous old wine, as Madeira, Xeres, Malaga.
 In great atony : mineral acids and aromatics combined, as
 elix. acid. Halleriacum tinct. c. aurant, tr. cinchona? Why-
 tii, elixir vitriolatum  Mynsichtii,  chalybeates, combined
with aromatic bitters, chalybeate wine (vide No. 106),  Pyr-
 mont or similar chalybeate waters, one glassful every morn-
 ing fasting ; also a complete course of the Pyrmont spring.
 Externally, frictions of balsamic remedies on the epigastric
 region are exceedingly beneficial, often  more  so  than the 
274           PICA, MALA CIA.  1MP0TENCY.

internal remedies ;  tonic  ointments and stomach-plasters,
bathing with spirit of matrical., thyme, balsamum vita, wear-
ing a little bag filled with spices, repeatedly moistened with
French brandy, on  the epigastric region;  strengthening
baths; finally cold, used  in  two ways, as  cold food, ice-
cream internally, and  externally  bathing  the epigastric
region, and cold douches on the same, have  often removed
the most obstinate complaints  of the stomach.
  In all this .treatment, the following rules  are to  be ob-
served: weakness from  irritability or from torpidity must
be attended to.  The first case calls only for the volatile,
easily digestible remedies, for  the tonic are  too heavy.  If
it is only a  nervous disease, a nervous  weakness  of the
stomach, a disharmony  of the gastric nerves, whence it
derives periodicity ; nervines,  antispasmodics, as valerian,
orange-peel, elixir acid, aromat., and ethers are  the best
stomachics.
  Further, without a proper regimen, no roborant  treat-
ment  will be availing.   All warm beverages,  especially tea,
much  milkj  flatulent  vegetables,  grease, cheese,  cakes,
spirits, and, above all, overloading of the  stomach must be
avoided ; the best nutriment is roast meats.
  Finally, exercise is indispensable, and frequently is the
best of all tonics.
                     PICA,  MALACIA.

  Appetite for unusual food.  Sometimes  it is a salutary
instinct in diseases ;  as the desire for acids in putrid mal-
adies,  for  earthy substances in acidity of the stomach;
sometimes it is  merely a  morbid symptom, especially that
for lime in chlorosis, and is present in hysteria, melan-
choly,  worms.
  It is to be  treated as a  symptom of the  respective dis-
eases.

                       IMPOTENCY.

                       Impotentia.

  Diagnosis.   Inability  of the male to fecundate.
  Its character varies, and has  different degrees.   Impo-
tency may be absolute or  relative, existing at all times and
under all circumstances;  or only at  certain  times, under
certain conditions, and  in relation to particular persons. 
IMPOTENCY.
275
    It may be perfect and imperfect, in which latter case, if
  there exists great susceptibility in the other sex, fructifi-
  cation is practicable.
    Impotency consists either in an entire want of erection,
  or in a  too quick, or total want of emission  of semen in
  coition.
    Pathogenesis.  That coition may be fecund, three things
  are necessary : the semen must reach  the place of its des-
  tination, it must be possessed of an enlivening power, it
  must be communicated  and received by both  parties with
  that degree of stimulation and excitement which is  requi-
  site for engendering a new living being.
    The obstacles, therefore, are various : 1. Phymosis,  ex-
  crements and tumors,  urinary fistulae,  lateral openings of
  the urethra (hypospadias).  2. Dynamic: a deficiency or a
  too watery and inactive quality of the  sperma, deficient or
  bad food, over-feeding, atrophy or diseases of  the testicles,
  deficient nervous and muscular power, such as old age,  se-
  vere maladies, excessive corporeal fatigues, excessive men-
  tal exertions, sorrow, grief, but particularly over-irritation
  and exhaustion by excesses in venery, still  more in onan-
  ism ; which is now-a-days the most frequent  cause of  im-
  potence.  Another remarkable but rare cause is dys-sper-
  matism, due to excess of irritation, a continual tetanus penis
  in coition, which shuts up spasmodically the  emunctories
  of semen, and renders ejaculation impossible.
    The cause, however, may only be relative and temporary,
  as a  physical or moral dislike, antipathy to an individual,
  unequal temper and irritability.  Thus a man may be impo-
  tent with one  person, and  not so with another ; thus he may
  be so during the  influence of debilitating physical or moral
  causes, afterwards not.
    Therapeutics.   The cure consists in general and local in-
*  vigoration  and vivification ; roborants, cinchona, especially
  quassia,  columbo,  chalybeates,  a?ther  sulphuric, martial
  (vide  No.  110, 111,  112),  and generous old  wine, spices,
  especially  vanilla,chalybeate  baths (particularly Pyrmont
  and Driburg), sea bath,  cold water, and * team baths, espe-
  cially on the  lower part  of  the  spine  and the  perina?um,
  washing the  genitals  with decoction  of mustard, liquor
  anodyn. Hofmanni, spirit of ants (vide No.  113),  electri-
  city ;  in  very atonic subjects a cautious use of the tincture
  of cantharides (three or four  drops), also phosphorus,  dis-
  solved in sulphuric a?ther in doses of a quarter of a grain.
  At the same  time a nutritious  regimen, gelatinous  sub-
  stances, eggs, strong broths, animal food, oysters, snails, 
276              STERILITAS.   AMAUROSIS.
chocolate, salep, hartshorn  jelly.   The  most difficult im-
potence to  cure, is that which is  caused by onanism  and
continuing pollutions.   But it is not hopeless.  I have seen
such individuals cured by  abstaiiung from all unnatural
stimulants, including that of mind, by early rising, airing,
and corpoieal exercise, and the internal and external  use
of Pyrmont water, taken at  the well, and become fathers of
healthy children.
  Finally, in judging and treating  impotency, the influence
and disposition of the mind is to be considered.  Want of
self-confidence,  as well as  too ardent desire,  may  hinder
the accomplishment of the  act.  Hunter relates the case of
a man  who, after a long expectation, and in spite of all his
exertions in the marital bed, was unable to accomplish his
desires, until, by the advice of his physician, he resolved
to abstain from  coition for several nights ; after  that he
succeeded.
  Nor is it to be forgotten,  that even  in considerable weak-
ness of the man, a youthful, very sensitive, susceptible and
vigorous female may make up the deficiency, and  render
conception possible.
 BARRENNESS OF FEMALES.

        Sterilitas.

(Vide Diseases of Women.)
                       AMAUROSIS.

                   Nervous  Blindness.

  Diagnosis.  Abolition of sight, without  obscuration  of
the humors or membranes of the  eye ; contractility  of
the iris in obedience to light, being diminished or entirely
annihilated.
  Weakness ofjsight  (amblyopia), is its lowest degree.   It
has for concomitant symptoms and forebodings generally,
sparks and luminous phenomena in the eye.  In rare cases
the iris may be contracted.
  The causes are the same as in all paralyses, particularly
over-irritation and excessive exertion of the eyes now so
prevalent, and metastasis. It is difficult to cure, and rarely
perfect.  It is undertaken  according to the same  indica- 
DEAFNESS.                    277
 tions as the treatment of paralysis in general; particular
 regard being paid to the delicacy o^he organ.  Therefore
 we are to consider whether there exists a congestive state
 which must be translated, the metastasis removed, the ab-
 domen stirred up and freed (for which purpose tart, emet.,
 the  nauseating treatment and Schmucker's pills often an-
 swer well) ; and nervines,  internally as well as externally,
 which latter application, on account of great delicacy and
 sensibility of the organ, must be very cautiously used, since
 the  stronger applications are apt to injure more than to do
 good.  Valerian, pulsatilla, arnica, belladonna, electricity,
 and mineral magnetism have proved the most useful reme-
 dies.

                        DEAFNESS.

                        Cophosis.

   The causes are : most frequently metastases, of which
 the most common are catarrhal-rheumatism, sanguineous
 congestion, abdominal obstructions, nervous  debilitation,
 local over-irritation by too strong a sound, organic dis-
 orders.
   The treatment  must always begin with cleansing and
 rinsing the external  ear, since the cause of deafness is
 often merely an accumulation and thickening of ear-wax, a
 common occurrence, by the removal of which I have cured
 the evil. But derivation, in sanguineous congestions, local
 and general abstractions of blood, especially cupping on
 the  neck, in catarrho-rheumatic metastasis, exutories be-
 hind the ears (most efficacious is cantharid-ointment behind
 the flap of the ear, on the mastoid process), and strong mer-
 curial purgatives.   In general, the consensus of the abdo-
 men with the organ of hearing is very noticeable and im-
 portant ;  commonly the patients hear better  a few days
 after having taken a purgative.   In cases of catarrho-rheu-
 matic deafness,  I  cannot sufficiently recommend  guaiac,
 combined with calomel, and sulphuret of antimony (vide
 No. 114).  At the same time we must not neglect to stim-
 ulate the mucous membrane of the nose, by which, not only
its derivative secretion,  here so important, is increased,
but also the auditory nerves and the Eustachian tube be-
 come excited, possibly resulting  in great benefit. For that
 end, the errhine (No. 87) is of service.  In specific metas-
 tases, as the syphilitic, the proper specifics are to be used.
 As local means, etherial oils, injections, vapors into the
                           24 
278          ANOSMIA, AGUSTIA.  ANESTHESIA.
external ear are recommended ; but here I advise the great-
est caution, since inflammation of the external and even of
the  internal organ of hearing,  is likely  to follow strong
stimulants.  It will be well  to distinguish those  cases, m
which hearing is better in moist or dry weather. In the lat-
ter case, a relaxation of the internal membrane is presumed,
and stimuli  are  proper.  In the first case, more dryness
and tension exists, and relaxants are of use.  In such cases
I have seen the best effects from a little almond oil on cot-
ton put into the ear; the oil may be mixed with ox-gall.
Combined with this, small doses of oleum cajeputi, cam-
phor and petroleum may be applied, or  the  mixture No.
115, which I can recommend from my own experience.
  Injections  into the Eustachian tube may become very
useful, especially when there is reason to suspect obstruc-
tion in it.  This may be presumed when the patient cannot
hear better with his open mouth, and through the medium
of the teeth. Electricity is of particular efficacy, and ought
never to be neglected.  In order to cure those  cases of
cophosis which resist all other modes, two operations have
been resorted to : the perforation of the  mastoid  process,
or of the tympanum.   The first is always accompanied
with peril, even danger to life, on  account of the inflam-
mation propagating to  the  brain, and ought  never to be
undertaken.  The latter may be serviceable, but generally
so only for a time ; it is, however, without danger.   As a
means of relief, the use of acoustic tubes is advised.
                   ANOSMIA,  AGUSTIA.

  The senses of smell  and taste may be lost, generally
both, but not always; this happens most frequently from
catarrh, and is a  common symptom of coryza, and  disap-
pears with that indisposition.   It may, however, also be a
symptom of spasm and paralysis. As such, I have observed
anosmia of periodical character.
                     ANESTHESIA.

  Loss of the feeling of the skin, either in single parts or
of the whole.  It is generally the consequence of an inter-
nal paralysis of the part, in which the sensitive and not the
motory portion of the nerve is affected.  Sometimes, how-
ever, it  is  only a  spasmodic affection of the cutaneous 
ANOREXIA.   ANAPHRODISIA.             279
nerves; often it is purely local, and  confined to a small
spot, which is numb.  Then it is often a sign of latent
arthritis.  I have seen in paralysis dorsalis, the whole skin
of the patient become numb and without feeling.
                       ANOREXIA.

  We  are  to  discriminate between  hunger and appetite.
One may have hunger, that is, the feeling of emptiness and
a want of nourishment, and may lack appetite, which  is a
particular sensation.
  Want of appetite  (anorexia) is owing most frequently
to the presence  of  gastric  impurities,  and is cured by
evacuants.   It  is farther  an  essential symptom of fever,
and deserves,  as such, particular attention.   Sometimes,
however, it is  a  peculiar affection  of the nerves of the
stomach, a disharmony, or ana?sthesis of them (as well as
is deficiency  of  sexual desire), and may continue for
months, even  years,  in  hypochondria,  hysteria, melan-
cho!,r SP.d sometimes as a consequence of nervous exhaus-
tion by continuous exertion  of the mind.  It  is also fre-
quently due to great  torpidity, or weakness of the stomach,
by habitual excess in eating, but never in drinking.
  The treatment is either that of the diseases  from which
it arises, or the administration of stimulants which directly
operate on the stomach and increase its sensibility, among
which, bitters, aromatics, salts (particularly culinary salt),
and corporeal exercise and exhilaration are to be  classed.
                     ANAPHRODISIA.

  Loss of sexual desire is analogous to the loss of the nu-
tritive instinct.  It may originate in  the same way as ano-
rexia, either by a deficiency of the necessary organic and
material  conditions, deficient  or inactive quality  of the
sperma, disorders of the requisite organs in either sex ; or
by a disharmony in the nerves which belong  to them, and
here the cause can be purely psychical: as a sad disposi-
tion of the mind, occupation with serious abstract subjects.
It can be  the  consequence of impotency, but exists also
without it, and may on the other hand, become a cause of
impotence, but not  always, and here the remarkable in-
stance especially in the female sex, takes place, that with- 
280                   EMACIATIONS.
out any sexual instinct or desire, even without sensation,
even in spite of it, conception is possible.
  The cure consists in that of impotency, or, if this is not
the cause,  in exciting a specific  sensuality by internal and
external stimulants, of which cantharides are the best, and
in directing the imagination to sensual pursuits.
               SEVENTH  CLASS.

                   EMACIATIONES.

                      Generalities.

   We class under this head all diseases in which deficient
nutrition  of the body  forms' the principle of the  disease,
and is the object of cure ; and which is  not, as in  many
other maladies, a mere accessory symptom.
   The proximate cause of every emaciation is a condition
of the system, in which consumption exceeds restoration.
   Emaciation may happen in four different ways :
   1. By impeded admission of the nutritive matter, or ob-
struction  and disorganization of viscera  essential to life,
atrophia ;
   2. By excessive loss, or consumption of humors and
powers (without suppuration), tabes ;
   3. By chronic irritation, hectica ;
   4. By suppuration, phthisis.
   Its importance,  duration, and danger vary very much,
and depend on the cause, the  nature of the individual, and
external relations.  The most dangerous kind of emaciation
is that which arises from  suppuration, most  so  when this
is seated in an organ  indispensable to life.  That which
originates  in weakness, and continues for years,  as atro-
phy and hectic, is  less dangerous.  The principal sign of
danger is  the lingering fever with which  it is associated,
early in some, later in others, and which greatlyvcontributes
to self-consumption and emaciation.  In emaciation owing
to suppuration, fever is associated from the beginning, and
is the principal symptom for detecting its existence. Ema-
ciation, like dropsy,  is frequently no  more  than the last 
PULMONARY CONSUMPTION.
281
stage of another disease, leading unto death, atrium mortis.
Death ensues, either from a complete consumption of all
humors and powers, and is inamediately preceded by colli-
quation ;  or from the destruction of some noble organ in-
dispensable to life.
  The treatment, in general, has to answer three ends :
  1. Removal.of the causes, general as well as local, as
dyscrasias, which keep  up the disease.
  2. Diminution of self-consumption (the fever).
  3. Promotion of  restauration, of  the humors as well as
of the powers, by vigorous restoratives, aliments and  air,,
also roborants, commensurate  with the state of irritabil-
ity,  lest, by too  strong excitement, they might  consume
more than restore.
                PULMONARY CONSUMPTION.

                 Phthisis Pulmonalis.

  Diagnosis.   Cough,  oppression  of the chest, lingering
fever, emaciation.   These are the essential symptoms, and
are sufficient for diagnosis.  The consumptive fever, which
accompanies  this  disease, distinguishes it from asthma,
which, as regards  cough,  oppression  and  expectoration,
may agree with  phthisis.   Besides fever, we must  notice
as a sign characteristic of consumptive persons: the great
carelessness they show in regard to health,  the little atten-
tion they  pay to attacks of sickness (in this respect con-
trasting with the hypochondriac),  and their inclination  to
seek for the seat of the disease not in the chest, but in the
abdomen,  also  their  cheerful  hope,  which  increases  as
danger approaches.  The  signs which auscultation, per-
cussion and the stethoscope afford, may serve as auxilia-
ries, especially to ascertain the location of a vomica, but
never to give the general diagnosis ; since by hearing alone
we cannot even distinguish the difference between the rat-
tle of mucus  and that of pus.
  Cough can exist with and without expectoration.  In the
first case  the disease is phthisis  sicca s. tuberculosa, and
expectoration may be absent from the beginning until
death. The expectoration  may be  pituitous (phthisispitu-
itosa), or purulent (phthisis purulenta).
  Generally, pains in the chest  are  combined  with the
oppression, but not always ;  and they are not essential to
diagnosis.
                          24* 
282
PULMONARY CONSUMPTION.
   This disease occurs more frequently, and is more dan-
 gerous than all others.   The  sixth  part  of mankind  (at
 least in large cities), die of,i(t.
   It varies very much  induration ; lasting  only  a  few
 months, sometimes years, sometimes through life.
   The curability is difficult, and is dependent  on the con-
 stitution.   Constitutional, hereditary consumption is never
 perfectly  curable.  The germ of this disease lies  in the
 organization itself, and  the whole life is a continual en-
 deavor to develop it; all other, even the slightest diseases
.tend towards it.  In the  female it may last for  a long time
 without danger to  life, as  long as menstruation endures;
 as soon as this ceases, the patient is  lost.


                        Course.

    Phthisis Incipiens, Fiens.   Incipient  Consumption.

   This is the most important period of the disease, and  is
 the stage  most necessary to be discovered ; since redress
 can  be had only by preventing its complete de'velopment.
 The modes of transition into pulmonary consumption are
 different, and they exhibit as many signs of this stage.
   1. Atony of the lungs.   Weakness,  relaxation  of  the
 lungs creates a morbidly increased secretion of mucus, a
 blennorrhoea, which gradually passes into  a purulent cor-
 ruption, and seizes upon the lungs.  The signs  are: fre-
 quent recurrence of catarrhs,which are always accompanied
 with copious and protracted expectoration of mucus.
   2. Phlogosis of the lungs.  Chronic, sanguineous conges-
 tions and  inflammability of the  lungs (phthisis florida).
 This is either  a general chronic congestive state of the
 lungs, or is confined to the mucous membrane of the bron-
 chia (bronchitis chronica). It gradually engenders tubercles
 or suppuration  of  the lungs,  ending in  pulmonary con-
 sumption.
   The signs are : a frequent, dry cough, and recurrence of
 flying  stitches and pungent pains in the  chest, oppressed
 respiration, pulse always irritated, and exceedingly accele-
 rated by the least motion.  Cough, stitches, and oppression
 increase by every strong over-heating, and violent exer-
 cise of the body, or by exertion of the lungs in speaking,
 laughing, etc.;  also after  passion and spirituous  bever-
 ages.  Jt  is apt to hemoptysis.
   3. Pulmonary tubercles.   They gradually pass into in- 
                PULMONARY CONSUMPTION.             ^°d

flammation and suppuration, and thus produce pulmonary
consumption.  The signs of this stage are similar to those
of the former, only the'complaints of the chest are aug-
mented in certain  situations and positions, and a peculiar
expectoration sets in from time to time (vide phthisis tu-
berculosa).
   4. Nervosity of the lungs, and of the whole system.  The
nervous character and nervous disturbance predominate
over the general and pulmonary reproduction to such a de-
gree as to prevent nutrition, and cause disorganizations of
the lungs.  Its signs are: the nervous symptoms, phthisical
disposition, uncommon emaciation without a definite cause,
frequent, dry cough, which often  assumes  a spasmodic,
even  convulsive  character, flying pains in the chest, not
unfrequently a sanguinolent cough of a spasmodic charac-
ter ; all without signs of inflammation and fever.   Some-
times it is preceded by a real tabes nervosa, later it seizes
the lungs, and ends in pulmonary consumption.
   5. Abdominal consensus (phthisis abdominalis ex hypochon-
driis.  Chronic abdominal complaints, especially disorders
of digestion, a glairy state  of the stomach, obstructions of
the liver and bilious accumulations, infarcts, glandular ob-
structions and hemorrhoidal accumulations may keep  up
a continual sympathetic  irritation and  congestion in pre-
disposed lungs—disorders which  at last affect the organ
itself, and  create, first apparent, finally, a real pulmonary
consumption.  The signs are : faulty digestion, mucosity,
hepatic diseases, and other abdominal disorders, combined
with  chronic cough,  which may be dry  or moist,  with
dyspnoea, even  with emaciation and febrile  motions  and
nightly sweats.   The  principal sign is: the  pectoral diffi-
culties are increased  or  diminished in proportion as the
abdominal disorders increase or decrease, but are not influ-
enced by potences which operate directly on the lungs; such
as strong exercise, over-heating, speaking, laughing, etc.
   6.  Pulmonary  metastasis.  Suppressed  piles, menstrua-
tion,  gout,  scurvy, herpes, syphilis, scrofula, old ulcers,
fontanels,  fluor albus and other  secretions, which  have
become habitual; the imperfect crisis of acute, especially
exanthematic fevers, may mutate to the lungs; by which
their functions are disturbed, their irritability is increased,
the organ impaired, reproduction itself rendered abnormal,
and reproductive  disorders generated ; thus a disposition
to all kinds of pulmonary consumption is laid.  The  signs
 are : after suppression of another malady, cough and  dys-
pnoea, perhaps also pains in the chest. 
284             PULMONARY CONSUMPTION.
                      Second Period.

                   Phthisis Manifesto.

   The principal sign is:  a lingering fever  associated with
 the difficulties in the chest.   The febris lentais character-
 ized by its type, which  is  that of a continued remittent
 (sometimes, especially in the  beginning, an intermittent),
 wherefore, the pulse remains  accelerated  after the remis-
 sion in the morning ;  in the  evening there is chilliness,
 towards morning, sweat; as the disease increases, there is
 also an exacerbation  at  noon, hot  hands,  cheeks  circum-
 scribed with red, particularly after eating ; emaciation,
 muscular weakness, appetite good, even increased  as ema-
 ciation augments,  good  digestion,  cheerfulness, levity in
 all that concerns health,  underrating the danger, and dis-
 belief of a pulmonary disease.  The  expectoration becomes
 purulent;  but, when the  ulcer is closed, the cough is dry.

                      Third Period.

                   Phthisis  Consumata.

   The  principal signs are:  the accidents of colliquation:
 dripping and exceedingly debilitating morning sweats, diar-
 rhoea, turbid urine, which is greasy on the surface; duplica-
 tion of the fever, that is, two exacerbations appear, one in the
 morning, the other in the  evening ; extreme prostration and
 emaciation rapidly running into exhaustion, tenacious ex-
 pectoration, increasing dyspnoea, appetite remains, even in-
 creases, hope likewise. In the female menstruation  ceases.
   At last, as forerunners  of death appear :  swelling of the
 feet, hoarseness,  anginous  attacks,  aphtha?, colliquative
 diarrhoea  increasing,  extreme  dyspnoea, rattling  in  the
 throat, stoppage of expectoration ; finally death ensues by
 quick or slow suffocation, sometimes by hemorrhage.
   Pathogenesis.  The proximate cause of consumption  is a
 dynamic or organic disordered state of the lungs, which
 disables them from performing  their  function of preparing
and  animating the  blood.  The fundamental cause of it
and  particularly of its frequent occurrence and  danger, is
the nature, situation and function  of these  organs  them-
selves.  They are the most sanguineous of all organs; they
receive all the blood of the body, and therefore are the most
disposed to sanguineous congestions and  inflammations.
Moreover, the lungs are of an extremely delicate, relaxed  • 
PULMONARY CONSUMPTION.             285
vascular, secerning and absorbing structure, never resting,
incessantly collapsing and expanding themselves, and there-
fore are liable to stagnations, effusions, vitiation of secretion
and reproduction ; and  wounds and ulcers, etc do  not
readily heal.   Finally, their  position  is  superficial,  and
exposes  them to lesions, to all the injurious  influences of
the atmosphere and the substances contained  in it.
   The pulmonary disease, which  originates phthisis, may
be either a chronic inflammation or  an adynamy, or a tu-
berculous, or a suppurative state of the organ.
   The remote causes are  partly predisposing, partly  ex-
citing.
   The predisposing are the following:
   1. Disposition.   There  is  a consumptive disposition,
which renders  an individual liable  to contract  phthisis
from  slight causes, as a catarrh, which, in a person  free
from the disposition, is innocuous, and who can even re-
cover  from wounds in the  lungs;  a  disposition that may
be so strong that the very life of the individual is a contin-
ual tendency to  create  phthisis—all tends to it, and he
cannot  escape  it.  This disposition constitutes  what is
termed a phthisical  constitution  and  structure.   It is
marked by a flat thorax, narrow towards the side and back,
shoulderblades protruding wing-like, long neck, slender
body, and very  white  teeth;  but  above all, by a peculiar
irritability of the vascular system and  lungs ; thence  cir-
cumscribed red cheeks (called phthisical roses), appearing
especially after eating ;  easily  excited, over-heating  and
redness of the face on  rising,  hot hands after meals, cough
easily excited, irritable, sanguine temper, but particularly
by an indifference and a  carelessness of their own health,
especially concerning that  of the lungs, so that they entire-
ly overlook, in reporting their case,  the  difficulties  in the
lungs, or pass over them intentionally,  and attribute their
disease generally to some  other part, especially to the ab-
domen.  The phthisical disposition in this respect forms a
striking contrast to the hypochondriacal.
   2. Hereditariness.  In no malady is the transmission of
disposition so great as in this.  But  the parents must ne-
cessarily have already  had the disease before procreating
the offspring.  There are  whole families, in which this dis-
ease is inbred.
   3. Age.  The period of youth, from  puberty  up to the
age of twenty-five or thirty years.  It is most prevalent at
this time, when sanguine  life predominates,  and passion
urges  the blood to the heart  and lungs ; hence  the  fre- 
286             PULMONARY CONSUMPTION.
quency of phthisis in youth ; later in life these causes much
more rarely create phthisis, in advanced age, asthma.
  4. Quick growth.   It  is incredible how  much quick
growth renders a person liable to consumption ;  this is
due to the disproportionate growth of the thorax  to  the
rest of the body.  It is, therefore, particularly necessary
at this period, to avoid all the occasional causes.  All tall
and slender bodies are much more liable to consumption
than short, stout ones.
  5. The atmospherical condition,  of residence, climate.
In a disease of the respiratory organs, these  are certainly
of the greatest importance.  Living in corrupt, moist, con-
fined, particularly  animalized  air, predisposes to  phthisis.
This is made evident  by its frequent occurrence in popu-
Ions cities, by the different influence of salubrious animal
air  in the  country,  the influence of  pure, vegetable air.
The proportion is that of one  to ten.   Also a moist, north-
ern climate predisposes  more to  consumption than  the
southern.  It  is a  decided fact, that the northern regions
favor more the pulmonary, the  southern, the hepatic  and
abdominal maladies.
  6. Mode of living, occupation.  All occupations in con-
fined rooms predispose to it more than those in open air;
likewise the luxurious, gluttonous, dissipated life in large
cities.
  7. Habitual over-heating  of the lungs, exertion  of the
lungs.  Immoderate dancing,  running, singing (especially.
when combined with exertion in females at the  period of
development, during menstruation), and ardent spirits.
  8. Premature and immoderate coition, frequent pregnan-
cies, too long lactation.
  9. Catarrhal disposition of the lungs, which is manifested
by frequent and long continued catarrhs.
  10. Local  weakness  of the lungs,  which  is  indicated
partly by what is  already mentioned,  partly  by this, that
the person  cannot retain breath for a long time, and  is  apt,
in running  and ascending stairs  or  mountains, to stop
short from  impeded respiration.
  11.  Scrofulous disposition, which is  very apt to produce
tubercles in the lungs.
  12.  Malformations, curvatures of the spine, rachitic de-
formities of the thorax, by which the lungs  are  prevented
from expanding and acting freely.
  These causes will of themselves, by merely increasing
in force, produce consumption.  The following  occasional
causes  will frequently  make  it break   out when  already 
PULMONARY CONSUMPTION.             287
lurking in the system, and are even capable of themselves
to generate it, though not so easily in persons who are free
from a phthisical disposition.
   1. The most frequent of  all is a neglected catarrh.   In-
numerable instances of consumption originate in a common
catarrhal cough, or rather from one which is unceasingly
renewed by slight causes, which in this way leads imper-
ceptibly into this destructive malady.  Tissot was right in
maintaining that  more individuals die in this way by ca«
tarrh, than by the plague.   According to my experience,
one third  of all consumptions result from catarrh.
   2. Ha?moptysis.  A person laboring under a  phthisical
disposition, becoming affected with bloody cough, is on the
road to consumption ; it being the signal of transition.
   3. Pneumonia. It can give rise to  chronic inflammation
of the lungs, pulmonic  blennorrhoea, or tubercles, or sup-
puration, also to  every kind of phthisis.
   4. Violent sanguineous congestions to the lungs by great
over-heating of the body, by violent exertions of the lungs
in singing, crying, playing on  wind instruments, ardent
beverages, excess in smoking tobacco.
   5. Inspiration of irritant or acrid substances, as dust and
metallic vapors.
   6. Wounds and contusions of the chest.
   7. Metastases  to the  lungs.  All morbific humors, as
those of gout, rheumatism,  scrofula, syphilis, and psora,
when  shifted to the lungs,  may  produce consumption.
Suppressed habitual evacuations of blood, hemorrhoids,
menstrua, and obstruction  to the development of the first
catamenia.  Also too rapidly suppressed habitual discharge
of mucus, fluor  albus,  dysentery,  diarrhoea;  even  inter-
mittent fever.  A remarkable metaschematismus is that of
chronic insanity, which terminates very frequently in con-
sumption.
   8.  Measles, which, next to catarrh, is a  most frequent
cause  of pulmonary  consumption.  It is very apt to en-
gender tubercles.
   9. Finally, contagium phthisicum must be  mentioned.
It cannot be denied, that a high degree of phthisis ulcerosa
generates  an  infective matter which may communicate
the disease, but only to persons predisposed to  it ;  it may
infect  even beds and  clothing, which phthisical persons
have used for a long time ; this, however, happens more in
southern than in  northern climates.
   On the pathogeny of consumption a difference is founded, 
288
PULMONARY CONSUMPTION.
  which is of the greatest importance in prognosis and the-
  rapeutics: the division  into phthisis constitutionalis  and
 phthisis accidentalis.  The constitutional consumption, in-
 nate in the organism by structure, hereditariness, and the
 corporeal disposition, endeavors through the whole period
 of life to develop itself; it can be delayed, but never en-
 tirely annihilated, and once developed, is incurable.   Ac-
 cidental consumption, on  the   contrary, in an  otherwise
 healthy disposition, may be cured  ; such an individual may
 be shot through the lungs, and no consumption follow.
  For practical  purposes, the  most important division is
 that into : phthisis florida, phthisis purulenta, phthisis tuber-
culosa, and phthisis pituitosa.
  Therapeutics.  A distinction  must be made in the treat-
ment, between incipient and confirmed consumption.
  As certain as it is, that confirmed consumption can sel-
dom be cured,  it is equally certain that it may be prevented.
       DISPOSITION TO, AND INCIPIENT CONSUMPTION.

                      Phthisiosis.

  The general  signs  of  this period are : short breath on
the least exercise; want of breath in ascending  stairs or
mountains, inability to hold  breath for a long time, or to
draw a deep inspiration without exciting cough;  this hap-
pens on every exertion of the lungs, as in running,  speak-
ing for a long time, affections of the mind;  after a meal,
hot hands and face, circumscribed redness on the cheeks;
rapid, easily excitable pulse,  uncommonly red tongue ; in-
difference to diseases,  especially pulmonary complaints,
phthisical formation, hereditary disposition.
  The treatment of this period is prophylactic, the principal
treatment for consumption.   Here art is yet of some avail,
and may prevent  the  disease from passing into confirmed
phthisis.  A number of instances have satisfied me  in this
respect.  The whole period of life, of a constant phthisical
disposition, may thus  be steered  clear of destruction, the
more so, as the phthisical disposition decreases as age ad-
vances.  The main object of cure is to make it pass the
thirtieth year  of age without accident, which  requires
 great  attention on the  part  of the physician,  and  strict
 resignation on the part of the patient. 
PULMONARY CONSUMPTION.            289
        General Rules of the Prophylaxis Phthisica.

   The fundamental principle of treatment is to avoid all
that can tend to an increase of  sanguineous congestion  in
the  lungs, to strengthen  them  by appropriate means, and
to protect  t'.iem against, as well as to deviate from them
all fnjurious  influences.  This  end  is attained  by avoid-
ing  all violent, over-heating exercise, especially dancing,
running, great exertion of the arms (fighting), great efforts
in singing and speaking, all ardent and  spirituous bever-
ages,  enjoyment  of pure  air,  taking precaution  against
sharp cold (northeast) wind, living in the country on milk,
in general, more  a vegetable than  animal  diet, wearing
woollen  flannel next to the skin, and worsted stockings.
Sexual cohabitation ought to be abstained from, or enjoyed
only moderately ; all  violent mental affections avoided ;
moderate exercise on horseback; in the least indication of
inflammation of the chest, a small venesection, and a fon-
tanel on  the upper arm continued for years.
   In regard to the special treatment, the  following cases
must be  carefully distinguished :
   1. The patient is seized with flying stitches through the
chest, a  burning feeling  in  one  spot, dry, irritable cough,
pulse always excited, red cheeks, and sometimes bloody
expectoration.  Such symptoms are evidence of a disposi-
tion to phthisis florida or tuberculosa.  There is always a
disposition to little pulmonary inflammations, which ought
to be arrested as soon as formed, in  order to prevent the
increase of tubercles, and their transition  into suppuration.
Therefore, on the slightest attack of pain in the chest or
increase of dyspna?a, a small venesection of four to  six
ounces is to be made in the arm, order the patient  to keep
very quiet for several days, observe a cooling diet and take
antiphlogistic remedies (nitre, tartar, potassa?, aqua lauro-
cerasi and  digitalis (vide No.  116).  At the  same time,
whey and milk diet, particularly asses'  milk, juice of cu-
cumbers; in the spring, the fresh expressed juice of herba
tussilago, cerfoil, borrage, Sellers waters mixed with milk,
Egers salt spring ;  but in a very phlogistic constitution,
mineral waters containing iron are dangerous. Following
this course, and making a small  venesection  every four or
six weeks (from the sixteenth to the twentieth year of age,
thirty bleedings in a case), I have succeeded in saving per-
sons, and preventing consumption.  In a tuberculous dis-
position,  the  use  of Ems  springs  (the  Kesselbrunnen),
combined with whey, is recommended at  this period.
                           25 
290
PULMONARY CONSUMPTION.
  2. The  patient  has a  disposition to  atonic  pituitous
phthisis (vide the symptoms above).  Here the long con-
tinued use of gelatina lichenis Island., made in water or in
milk, is the principal remedy.   At the same time, warm
air, confinement, warm drinks, and sleeping in warm rooms •
is to be shunned.   It is in this  case that  riding on horse-
back is  of a wonderful effect, likewise daily exercise of the
lungs by reading aloud.   In a high degree, even cold drinks
and washing the chest with water is salutary.
  3. The metastatic.   The most frequent is the catarrhal
and rheumatic ;  and  here dulcamara alone is  a true spe-
cific (No. 34) in a phlogistic  disposition ;  in  one that is
atonic, it may be combined with lichen  Island.  (No. 37),
and a vesicatory entertained for a long time on the chest;
and in an  inflammatory disposition, leeches  and venesec-
tion.  If this is unavailing, cortex  mezerei on  both arms,
entertained  in drawing for several months, is the best de-
rivative.  In the  same  manner,  other  metastases, as the
arthritic, psoric, scrofulous, etc, ought to be treated, but
paying due  regard to their specific character (in the pso-
ric, a combination with  sulphur,  in the  scrofulous,  with
baryta muriatica), and to the respective dynamic character,
whether it be more phlogistic or atonic. Suppressed men-
strua and piles are to  be regenerated or compensated.
  4. Nervous phthisis (see the  signs).   Milk diet, country
life, tepid baths, riding on horseback, asses' milk; in very
debilitated  nervous persons, cold infusion of cinchona, in
great emaciation, gelatinosa, restaurantia, hordeum pra?pa-
ratum, salep, arrow-root, broth of shell-snails,  oysters ; in
very great irritability and frequent irritative cough, hyos-
cyamus, aqua laurocesasi (which is here  particularly suit-
able), even  small doses  of opium, given for a short time in
order to assuage the cough.
   5.  Abdominal phthisis (see the signs).  Injections, mild
resolvents,  extractum taraxaci, marrubii, gramin., tartras
potassa?, the fresh expressed juice of these plants, Marien-
bad Kreuzbrunnen, Egers, Selters  and Ems springs  (vide
abdominal treatment in hypochondria) are of service.


             Phthisis Formata s. Manifesto.

   The  symptoms of confirmed pulmonary consumption
may  be seen above.   Its principal signs are the setting in
 of a lingering fever and morning sweats.
   The  fundamental indications in any kind of phthisis are. 
PHTHISIS PULMONALIS PURULENTA.         291
1,  amelioration and  cure of  the  local  disorder  in the
lungs,  be  it  induration,  suppuration  or blennorrhoea ;  2,
diminution and proper treatment of the fever ;  3, repa-
ration  of the  loss of humors by suitable restoration and nu-
trition.
  In undertaking the treatment of phthisis, we must not,
as is usually  done, doubt the possibility.of a cure ; for this
deprives us of courage, circumspection, and an enterprising
spirit,  but act as if diseases of the lungs,  even  purulent
ones were curable ; for this is proved  by numerous facts.
On dissection, considerable portions of a lung, previously
consumed by suppuration, and healed up, have been discov-
ered in persons who had recovered and afterwards enjoyed
the free use  of this organ, as I have  myself seen  an in-
stance  of  in  a public  teacher.  Never give  up courage  or
hope, but  call to your assistance all that can tend  to  attain
  '«end.
  In the first  place, therefore, we have to investigate the
character  and condition of the lungs ; that is, under what
species of phthisis the case in  question is  to be classed.
            PHTHISIS PULMONALIS PURULENTA.

  The only distinctive sign is the expectoration of purulent
matter.  But this diagnosis is very difficult, especially in
the first  stage, and when the pus comes from a superficial
surface.   A chemical examination of the sputa by alkalies
and  acids has been  recommended  as proper to point  out
the difference between pus and mucus, but it is fallacious:
1, since the former is never obtained pure, but mixed with
mucus ; and 2, because the secretion of all inflamed linings
yields this mixture.  The most sure are those discriminative
marks which  strike the senses, as the sweet and saltish
taste of the sputa, its bad smell, and its  sinking  in water,
especially salt water, if purulent ; whilst  mucus will swim,
and is stringy between the fingers.
  The principal remedies  called for are gelatinous restau-
rants, but not those  obtained from  warm-blooded animals,
for these heat the blood too much, and increase the fever;
but  obtained from vegetables and cold-blooded ; above  all,
milk and  whey  diet, particularly new milk, better if it is
that of asses  or women; a teaspoonful of prepared bar-
ley  boiled in a few cups of milk, gelatin of Island, moss,
two or three ounces daily, boiled in milk and sweetened ; 
292          PHTHISIS PULMONALIS PURULENTA.
salep and oat-water* and the lately recommended jelly of
Carrageen moss ; broth of snails, oysters.  These remedies
will not only make up the loss of power and humors, espe-
cially that of the nutritive lymph which is consumed by
suppuration, but also serve to heal the ulcer, since they act
in this way  on external ulcers.
   The second indication, healing of  the pulmonary ulcer,
is accomplished partly by the means  just stated,  partly by
remedies which have a direct  influence  on the lungs, the
antiphthisica, properly so called.   But the greatest precau-
tion is  needed  in carefully  discriminating  the different
characters of the disease, whether it is phlogistic  or atonic,
so  that suitable antiphthisics  may be selected, according
to  its  nature.   In phlogistic consumption, which is  the
most frequent form of the disease, only antiphlogistic anti-
phthisics are to  be used, that is to say, remedies  which do
not excite inflammation either in the  lungs or in the vascu-
lar system in  general.  It  is only in  the atonic form  that
irritant, ardent ones may be prescribed.
   Of the first class, the most valuable, and confirmed by
experience in  single cases, are  the following : semen phel-
landriiaquatici, one scruple up to two drachms of the pow-
der, or half  an ounce in decoction, a day,  herba digitalis
purpurea?, Selters water, mixed with  milk or whey, Ems,
Kesselbrunnen, Egers salt spring, Obersaltsbrunnen in  Si-
lesia with whey, lime-water with milk, chlorate of lime (vide
No. 117), one half up to one  drachm daily, dissolved in
water, aqua laurocerasi, juice of cucumbers, two or three
ounces four times a day (a great remedy!) ; likewise  the
fresh expressed juice of herb, chervil, and tussilage, stipi-
tes dulcamara?,  mineral acids, plumbum acetatum (vide
No. 118).
   Of the second or heating class, the most confirmed  are
the following : myrrh (undoubtedly the best and most  ap-
proved, Hofmann's myrrh-sugar; vide No. 119), balsam de
Mecca, copaiva,  balsam. Peruvian., asphaltum (ol. asphalti,
one or three drops, triturated with sugar, daily),  kreosote
similar to the foregoing (two or three grains), arnica, fer-
rum (Griffith's mixture).
  But, in  the  use  of  all these  remedies, we  ought to be
cautious in observing, whether they create stitches, pains,


  ' One handful of oats, boiled  three times  in a quart of water,  and
poured off, then again boiled until the grains burst,  then percolate it
and mix it with two teaspoonfuls of milk and a teaspoonful of honey. 
PHTHISIS PULMONALIS PURULENTA.         293
 and oppression in the chest, or  increase the fever; if so,
 they must be abandoned, lest they augment the inflamma-
 tion of the lungs, and accelerate death.
   Besides these medicines, the following means are  ad-
 vised to promote the healing of the pulmonary ulceration:
   Local applications to the internal surface of the lungs and
 the ulcer.  These are inhalations of vapors, balsamic fumi-
 gations,  gasses, those of  hyoscyamus,  majorum, fennel
 seed, myrrh steeped  in water, living constantly in a room
 where  tar is boiled  from time to  time, the usefulness of
 which I am  convinced of by my own experience), inhala-
 tion of carbonic acid and chlorine gas, the atmosphere of
 cow-stables, sea air (especially a sea voyage), and residence
 in warm, uniform climates, as Nizza, Hieres, Pisa, Madeira ;
 but care is required in the  selection.  Purulent consump-
 tion calls more  for low regions, as Pisa and Rome ; tuber-
 culous consumption, bronchitis chronica, blennorrhoea pul-
 monum, for a dry air, as Nice.
   That position of the body,  in which the pus can most
 easily escape.  It is found out by  observing which side
 the lying on  gives most cough and expectoration.  On this
 side, which is generally avoided, the patient ought to lie
 several times a day for as long a time as it can be borne.
   Passive exercise, as riding on horseback, swinging, motion
 of a vessel, sea voyage.
   Promotion of free expectoration.   This, for two  reasons,
 is an  essential condition for effecting a cure.  1. Because
 it favors the cleansing and healing of ihe ulcer.   2. Be-
 cause the fever is thereby diminished and  colliquation
 prevented.   When  expectoration is easy, nothing  is more
 needed than  to order much diluting, mildly dissolving bev-
 erages, as barley-water, gruel, decoction of dog's-grass
 root,  Selters water  with milk,  and  to avoid colds and
 heats.   But when it stops, the cause must be inquired into
 and acted on accordingly.   The obstruction may be owing
 either to a great tenacity in the mucus, which is recognized
 by the nature of the sputa.   Here inhalation of warm emol-
 lient vapors, kermes mineralis, oxymel scillitic cum syrupo
 althea? and liquor ammonii anisat., emulsio gummi ammo-
 niaci, drinking largely.  Or it may be suppressed by an
 accidental irritation, most frequently a gastric one ; here
 mild laxatives, such as manna, soluble tartar, also emetics,
 if indicated, are  advised.   If the irritation  is of a catarrho-
 rheumatic character,  which  may be  recognized  by the
 presence of catarrhal or rheumatic symptoms and frequent
cough, with  expectoration of an acrid, watery serum, in
                          25* 
294          PHTHISIS PULMONALIS PURULENTA.
 which case it must be treated like  catarrh, by water gruel
 with liquorice, dulcamara, and vesicatories  on the chest.
 If it is due to spasm and  nervosity, which is discoverable
 by the frequent,  violent and  spasmodic  cough, without
 signs  of inflammation, hyoscyamus, aqua  laurocerasi, and
 opium are of  use.  When it is caused by  inflammation,
 recognizable  by increased  fever, anxiety,  dyspnoea and
 pungent pain  in the chest, antiphlogistics,  leeches, even
 small  venesections are indicated. When due to weakness,
 the signs of which are the absence of other causes, weak-
 ness of the pulse and the other functions,  gummi  ammoni-
 ac, arnica, ammonium anisat., flores benzoesare the reme-
 dies.
   Further, issues are often of wonderful benefit, especially in
 the beginning and in the metastatic forms of consumption,
 rheumatic, psoric, and are capable of translating the inter-
 nal disease to the surface.  There are instances of con-
 sumptive persons accidentally injured by  fire, who, by the
 long  continued suppuration of the burns, have recovered
 from consumption.  The best imitation  of this accident is
 the establishment of a large issue or seton on that part of
 the chest where pain is most felt; but if, however, the pa-
 tient is  already debilitated, or it is observed that artificial
 suppuration  weakens him, the substitute must be avoided.
   Finally, if the ulcer draws to  the surface, and  a disten-
 tion  or fluctuation between the ribs is apparent (vide vom-
 ica), it must be opened.
    The third indication  is to  diminish  the fever, and  the
 local as well as general inflammatory state of the lungs
 connected with it.  The fundamental causes of consump-
 tive fever are loss of humors, the  irritation produced by
 absorbed pus, and the  inflammatory irritation of the pul-
 monary ulcer.  These,  however, cannot  be removed but
 by annihilation, cure of  the disease, and with it the fever.
 But the fever may be prevented from increasing, and there-
x by debility and emaciation may be avoided.  This depends
 on finding out the causes.  The  most common is  the aug-
 mentation of a phlogistic state of the blood.  Therefore
 generally cooling, but not weakening remedies are  most
 beneficial, such as tartar, potassa?, saturations of carbonate
 of potass, or still  better, of lapis cancrorum, with lemon
 juice  (vide No. 120).  Sometimes an increase of the local
 inflammation in the sphere of the ulcer is the cause, which
 is recognized by pains, stitches in the part, and  oppressed
 respiration.  In such  a  case, leeches  on  that spot,  or a
 small  venesection in the  arm give most relief; indeed a 
PHTHISIS PULMONALIS PURULENTA.          295
teacupful of blood, taken away every four weeks, is recom-
mendable to diminish the hectic fever,  to preserve  life,
even to sometimes cure the disease.  In  order to remove
the general  phlogosis, mineral acids, especially elixir acid.
Halleri,  largely diluted with water and mixed with  gruel,
may be used ; we must, however, be careful,  that the acid
does not increase the cough or create diarrhoea.  Or a gas-
tric complication  has  taken place, which is  a common
occurrence in consumption.  The signs  of this are  com-
mon, and the  proper remedies are mild  laxatives;  or, if
there is  any indication for them, also slight emetics, which
give great relief in such states.   Finally, increase of  fever
may be owing to an increase of weakness and colliquation.
Here elixir acidum and gelatins are proper (vide last stage).
   Besides the general treatment, we must not neglect and
disregard the specific character of the disease.  Thus, in
a psoric  diathesis, sulphur and artificial ulcers;  in a syphi-
litic one, mercury ;  in a scrofulous  one, cicuta, baryta?
murias may be administered at once.
   Of great importance in  phthisis is a palliative treatment;
calming  of the most tedious and dangerous symptoms, es-
pecially as this is often the only method which is left to us.
   1. The most  troublesome symptom  is cough.  It  is in-
separable from the disease, but deserves particular regard,
since its violence can give rise to additional inflammation
of the pulmonary ulcer, and  to hemorrhage,  besides tor-
turing the patient.  The mode of assuaging it depends on
the various causes which  increase it (vide expectoration).
   2. The morning sweats. They too are  inseparable from
the disease ; but their immoderate  augmentation calls for
relief, which may be  obtained by light covering, frequent
airing, and  keeping out  of  bed.   Besides laxatives and
mineral acids (elix. acid), sage tea, alum, boletus laricis,
four to thirty grains a day, are of use.
  3. Diarrhoea  is a principal sign of incipient  colliquation,
weakens very much, and  therefore must be stopped.   For
this purpose, all fermentable and acid food must be avoided,
and cortex simaruba?, rad. arnica?, ratanhia, lime-water may
be administered; but opium is more sure, and  best given
in  clysters with milk, since, by the  mouth it  may operate
disadvantageously.   Diarrhcea may, however,  also be due
to  taking cold and  to indigestion, and  is to be treated ac-
cordingly.
  Ha?moptysis, is to be treated according to its causes; as
inflammation, gastric stimuli, purulent corrosion of the ves-
sels, colliquation (vide hemoptysis). 
296                     vomica.
  5. Finally, aphtha?, a very tedious symptom, appears in
the last stage. The principal remedy for this is borax with
syrup, mororum ; if this does no good, we may try sulphate
of zinc, combined with catechu and syrup, althea? (vide No.
121), as a gargle.

                    The Last Stage.

  Signs, see above.
  The treatment of the last stage is, properly speaking,
nothing more than smoothing the  road to  the tomb;  for
cure is impossible ; but alleviation is wanted, especially of
the aphtha? and of the want of breath.
  Besides assuaging  the symptoms just mentioned, the
only means  which can take away from the patient the feel-
ing of his  physical sufferings,  and raise his  spirit to a
higher and to a more agreeable world, to  one free from
pains, is opium.   Who would be the physician of such a
patient, without this remedy !  It is  necessary to both phy-
sician and patient.  It is inestimable—nothing else can
replace it—it is a gift from heaven to a miserable sufferer
to entrance him before death.
                        VOMICA.

  Pulmonary  ulceration  does  not  always  present  an
open surface, but is often a collection of pus enclosed in
more or less firm membranes. It is either the consequence
of pneumonia, or of a tubercle which has suffered gradual
transmutations ;  in the latter case, several exist at the
same  time.  These may be  borne through life, with no
other knowledge of their existence than is given by a little
irritative  cough  and trifling difficulties of  respiration.
They, however, most frequently break, and  a person who
did not suspect their presence, expectorates pus.  This
may happen in a double  way.
  1. Either a great qnantity of pus escapes  into the bron-
chia, almost suffocating the  patient; suddenly giving the
symptoms of suffocative catarrh.  The treatment consists
in ridding the bronchia as quickly as possible from pus and
preventing suffocation by venesection, emetics, warm va-
pors, and a suitable position.
  2. Or the expectoration of pus gradually follows.  The
result of this is quadruple : Either the vomica is perfectly
evacuated, contracts gradually, and cicatrizes, followed by 
VOMICA.
297
 perfect recovery. Or matter continues to be expectorated,
 and the vomica, surrounded by a firm membrane, ceases to
 affect the substance of  the lungs, farther, does not trouble
 the system, and remains as an isolated imposthumous cav-
 ity like a fontanel, in which a quantity of matter is  daily
 separated.  Or the patient daily throws  up a certain quan-
 tity of matter, often  very fetid, and may live  in other
 respects in a perfect state of health from ten  to twenty
 years.
   3. Or an open, corrosive ulcer is formed.  In this case
 the patient expectorates pus continually, and all the symp-
 toms of phthisis purulenta manifesto  set in.
   4. Or the vomica at first forms between the pleura and
 the lungs; or the matter has  gradually worked  its way to
 the surface, and  by inflammation has formed adhesions of
 the pleura.  The diagnosis of  such a case is difficult at
 first; for the patient often feels  but  very little  pain or op-
 pression of the chest, and has little  or no cough.  But  a
 lurking fever, emaciation, red urine,  and  difficulty of lying
 on the opposite side lead to  a suspicion, and an examina-
 tion by the stethoscope may here procure some light.  But
 if the gathering increases, this side of the thorax enlarges,
 grows  hot, points somewhere between the ribs, the part
 fluctuates and  finally bursts of itself, or  is opened by art
 (operation  of empyema); when  the discharge is perfect,
 healing may ensue.
   Or finally, he throws up a vomica, and a short stoppage
 of expectoration succeeds; but  soon a second one opens,
 and so on until the lungs are entirely destroyed.  This is
 the case in tuberculous consumption, in which new ones con-
 tinue to pass into suppuration.  In these cases, absorption
 of matter and wonderful metastases and evacuations of pus
 by urine  or by stool may take  place,  and thus a perfect
 cure be effected.
   A similar process takes place  in all suppurations of (in-
 ternal) viscera.  There  also  a closed  vomica  may  form,
which  the  person may bear  for life,  without  becoming
phthisical.  But it may burst and kill by  a sudden internal
effusion of matter one  who  previously  seemed healthy,
e. g. vomica?  of the liver, kidneys,  by effusion  of matter
into the abdominal cavity ; cerebral abscesses, by effusion
into the cavum cranii. 
298           PHTHISIS FLORIDA, LARYNG1TES.
                   PHTHISIS  FLORIDA.

  Diagnosis.   The sigps of the  disposition to florid con-
sumption (which see above), but in a more intense degree,
particularly the circumscribed redness of the cheeks (which
gave occasion to the term), the heat of them, and of the
hands after a meal, associated with a lingering fever; the
cough  is commonly dry, or accompanied only with  little
expectoration, frequently more or less hsemoptysis (bloody
cough).
  Pathogenesis.  This disease is essentially a  chronic in-
flammatory state, generally  connected with tubercles or
passing into  them, finally leading to suppuration,  when
associated  with ha?moptysis.
  Therapeutics.  The treatment is the  same that has  been
recommended in the florid disposition. Frequently repeated
small venesections, leeches on  the chest, milk and whey
diet, digitalis, aqua laurocerasi,  country air and fontanels
are the  principal means.  Connected with this course of
treatment, are mild, cooling jellies, prepared barley, salep,
arrow-root, Carrageen moss  and the oat-water described
above.  Respect must at the  same time be paid to phthisis
tuberculosa, which generally  is coexistent.
            PHTHISIS TRACHEALIS ET LARYNGEA.

  Diagnosis.  Hoarseness and cough; at the commence-
ment of the disease the  cough is only irritative, subse-
quently purulent expectoration comes on, and a feeling of
soreness, or heat and pricking in the trachea ; sometimes
there is no pain at all, but merely a sensation of external
pressure on the wind-pipe ; speaking, laughing, every ex-
ertion of the throat creates cough; swallowing, at least in
the beginning, is free and  without pain.   No pain is felt in
the lungs,  nor any difficulties of  respiration.  Lingering
fever is long absent, and generally sets in  about the time
of suppuration.
  The course  of this disease is very chronic, often lasting
for years before it  proves  fatal,  l'eath is due to the total
destruction of the  larynx by suppuration, and the commu-
nication of the former to the lungs.
  Pathogenesis.  The proximate cause is chronic inflam-
mation, and finally ulceration of the mucous membrane of
the larynx.  The most frequent occasional cause is a neg- 
PHTHISIS HEP.,  REN., VESIC, MESENT.       299
lected catarrh ;  scrofulous and syphilitic  metastases, and
immoderate efforts in singing, speaking, and crying also
produce it.  The bronchial glands are frequently the seat
of this disease, thence the gray, dark colored, cloddy sputa.
   Therapeutics.  The treatment must be  adapted to the
various causes, and to the general principles of the anti-
phthisic method, respect being paid  to the location of the
disease ; but it must be persevered in for a long  time.  A
long continued exutory on the neck, cortex mezer. on the
upper arms, strict antiphlogistic diet, avoiding all kinds of
exertion of the throat, leeches on the neck whenever pains
come  on ; when  the  origin is catarrhal, hepar sulphuris,
calc  two grains three times a day,  formed into pills with
liquorice;  Plummer's powder with digitalis;  dulcamara in
decoction  and extract, serum lactis, the fresh  expressed
juice  of chervil, tussilage, hoarhound, and chloride of lime,
dissolved in  aqua laurocerasi  (vide No. 125), Egers  salt
spring, which is here really  specific, Ems, Kesselbrunnen
and bath ; in great atony these means must be combinated
with roborants, and particularly myrrh (vide No. 126) have
proved to me most efficacious.  In scrofula or a suspicion
of a syphilitic diathesis, calomel unto incipient salivation.
In the commencement of the disease, the sperm  of her-
rings, taken fasting, has been of use.  Inhalations of miti-
gating, moist  vapors (of decoct, malv.,  sambucus, cicuta,
hyoscyamus), also dry balsams (as decoct, of myrrh, boiled
tar) are very  beneficial;  they must, however, be adapted
to the degree of irritability, and ought  never to  increase
cough.  I  have also seen good effect from emplastr. cicuta?
cum  hyosciamo, cicuta et hyoscyamus, worn around the
neck.

 PHTHISIS  HEPATICA, RENALIS, VESICALIS, MESENTERICA, ETC.

   Diagnosis.  Existence  and course of a lingering fever
(vide phth. pur. pulm.), combined with the  symptoms of
the various local suppuration peculiar to every species.
   In phthisis hepatica, pain and pressure in the hepatic re-
gion, spreading to the right arm or leg, inability to lie on
the left side, yellowish colored countenance and sputa, vom-
iting  and  other disorders of the stomach, constipation of
the bowels alternating with diarrhoea, and turbid red urine.
   In phthisis renalis, pain and  pressure in the renal region,
increased  by lying on  the back, drawings in the leg and
lower foot of the side affected, purulent discharge in the
urine. 
300                      TABES.
   In phthisis intestinalis, pain and tension in the abdomen,
 discharge of pus and blood by stool.
   In phthisis vesicalis, discharge of matter  from the blad-
 der ; in phthisis uterina, from the uterus.
   The  diagnosis  of internal suppurations  which are not
 connected with the external suiface is more difficult, be-
 cause they are not  manifested  by purulent discharges, as
 in phthisis mesenterica, abdominalis, vomica clausa.  Here, a
 lingering fever is often  the only  sign, accompanied  by
 pain, pressure, swelling of the suppurating part.
   On the other hand, all  external chronic suppuration of
 wounds, ulcers, caries, accompanied with great discharges,
 may produce phthisis.  I will mention here only abscessus
 lumbalis.
   Pathogenesis.  The existence  of suppuration  in these
 organs, which  is either the  consequence of inflammation,
 or  of a metastasis of morbific matters,  or a shifting of
 pus from other parts, which is not a rare occurrence, par-
 ticularly in phthisis renalis.
   Therapeutics.  Ths loss of humors and power must be
 made good, and the lingering fever be properly treated,
 as  in phthisis purulenta pulmonalis.  Besides local  treat-
 ment of the ulcer  ; in phthisis vesicalis and  uterina,  injec-
 tions must be used.   At the same time, attention is  to be
 paid to  the tendency, which the matter has to the surface,
 a common occurrence in hepatic and  renal suppurations,
 which is manifested  by an external swelling  and fluctua-
 tion, and may be cured by opening the  abscess.

                        TABES.

  Besides the  natural wear and consumption of the body
 by the continual operation of life itself (marasmus senilis)',
 the  following causes also produce tabes, as is seen in the
 emaciation which follows  severe acute or chronic diseases,
 or exhausting methods of cure;  as by mercury, salivation,
 and abstinence ; or strong corporeal  fatigues, likewise con-
tinued  excessive  mental exertions,  especially when  com-
bined with lucubrations, lingering sadness and grief  me-
 lancholies; but particularly  in continual loss  of  humors
 as chronic  hemorrhages,  blennorrhoeas, diarrhoeas, loss of
 semen,  saliva, sweat,  and too long continued lactation ;
 most so when to the loss  of these is added  that of power
as excesses in venery and  masturbation, in both sexes too
frequent parturitions, the abuse of spirituous liquors, opium
 and purgatives. 
PHTHISIS PITUITOSA.               301
  In all these cases the treatment must tend :
  1. To remove the debilitating cause. The hemorrhages,
and blennorrhoeas, and other chronic evacuations are there-
fore to be restrained, and the"weakening exertions  both of
body and mind must be abstained from.
  2. To restore to the system its lost powers and humors.
This is effected by easily digestible and concentrated ali-
ments, tonics and nervines ; free salubrious air, rest of body
and mind, moderate exercise commensurate to the circum-
stances.  In the selection of food and  medicines we ought
to be careful, that  their stimulant power correspond to the
patient's irritability, because a too energetic action might
exhaust  the vital powers, and thereby annihilate the mate-
rial effect of the restaurant.
  I take this opportunity to admonish  the practitioner that
chronic  debilitating evacuations often exist unknown to
physician and patient until the hour of death, and not to ne-
glect their investigation.  Of this class are too frequent or
too copious menstruation, hemorrhoids, fluor albus, pol-
lutions, and masturbation,  but above all diabetes meilitus,
from which  many a person has died without the physician
or patient being aware of its existence.   For this species
of diabetes is not  so remarkable for the quantit}' of urine
discharged, as for its peculiar quality, abstracting from the
blood its most nutritive substance.   Therefore it is advis-
able when we cannot discover the cause of emaciation,  to
make a chemical examination of the urine.
                 PITUITOUS  CONSUMPTION.

                    Tabes Pulmonalis.

       Phthisis Pituitosa, Blennorrhea Pulmonum.

  Diagnosis.  Cough with copious expectoration of mucus
of different colors and quality, but commonly white and in-
sipid, sometimes  milkwhite and sweetish, similar to chyle ;
sometimes yellowish and greenish, acrid, salty,  puslike,
sometimes mixed with blood ; simultaneously there is ema-
ciation and lingering fever.
  The expectoration may continue for years, before  fever
sets in, or becomes phthisis.  Generally suppuration  of the
lungs at  length takes place, and leads to death.  The dis-
ease,  however, may prove  fatal  without suppuration and
destruction of the lungs by a mere loss of humors, as dis-
sections  have proved.
                          26 
302                  TABES NERVOSA.
  Pathogenesis. It is often a mere atony of the lungs ; an inhe-
rited pulmonary weakness; or owing to excesses in venery
and masturbation, living in confined air charged with animal
exhalations, neglected catarrh, hemoptysis, a former pneu-
monia, particularly one which has been treated too long a
time by relaxing  expectorants, warm vapors, and the like ;
immoderate  smoking  of tobacco, asthma pituitosum, old
age ; but also irritation of the lungs, and thereby increased
secretion of mucus; above  all  a chronic suppression of
perspiration ;  psoric, arthritic, scrofulous metastases, sup-
pression of other blennorrhoeas, suppressed fluor albus, go-
norrhoea, diarrhoea, gastric accumulations, obstructions of
the abdominal viscera.  Tubercles are  not unfrequently
connected with it,  partly as cause,  partly as consequence.
   Therapeutics.  The first thing to be done is to invigorate
the lungs; at  the  same time regard must be paid to the
possibility of metastasis, and morbid irritations to the lungs.
Tonics may  be used,  but with precaution,  lest strong as-
tringents might  too rapidly suppress the expectoration.
Therefore Island, moss, mixed  with dulcamara  (vide No.
122) is best given in the.beginning ;  and if this do not help,
myrrh may be added (vide No. 123); besides cortex casca-
rilla?, cinchona, quassia.  At the same time a flannel vest and
a fontanel on the arm ;  after these,  if the violent  expecto-
ration do not abate, and respiration  become free, make  use
of the strongest astringents,  as terra catechu, alum, ratan-
hia (vide No. 124), cort. quercus, vitriol, martial., inhala-
tions of balsamic vapors, oxygen gas, strengthening baths,
particularly sea-baths,  exercise, and riding on horseback.
There are also  cases, when strong  exercise  carried  to
sweating and fatigue, combined with living in the open  air,
have cured pulmonary consumption.  I have seen it cured
by military service in the field.
  But when metastases lie at  the bottom of the disease,
recognisable by former  diseases ; and when the expectora-
tion is of bad color and acrid, the treatment of these various
acrimonies, the arthritic and  syphilitic, must be combined
with the tonic course.
                 NERVOUS CONSUMPTION.

         Tabes  Nervosa.   Febris  Nervosa Lenta.

  Diagnosis.  Emaciation without any apparent local affec-
tion  or visceral disorganization ; but a nervous weakness 
TABES NERVOSA.                 303
prevails, with perverted or increased sensibility and spas-
modic affections.  A lingering fever gradually sets in, and
the disease passes into nervous phthisis, or terminates in
general debility and total abolition of nutrition.
  The disease has two degrees.  The first is without fever,
but it is recognised by the following  symptoms:  In the
morning the patient is weak and  listless, the  pulse small;
in the evening he is brisk, even vivacious, with a full pulse ;
he  has a constant desire  for restoratives, and  to enjoy •
fresh air; but  eating  causes  pressure in the  stomach and
sleepiness; giddiness, megrim,  weak sight, vertigo; chil-
liness  and sudden alternations  of heat and cold, redness
and pallor; hypochondriacal and hysterical complaints.
  This  malady may last for a long while, before it becomes
fatal.  It kills  either  by a total cessation of nutrition, a
true exsiccation of the body, or by a transition into phthisis
pulmonalis (vide phthisis).
  Pathogenesis.  The proximate  cause is : a nervous weak-
ness, carried to a degree which  is insufficient for the pur-
poses of nutrition, and which  finally faUs altogether.
  Remote causes are : all protracted febrile diseases, espe-
cially nervous  fevers; all  nervous diseases that last long
and are intense;  excesses in venery  and masturbation,
long continued violent corporeal exertions, waking during
the night, mental exertions carried too  far, sorrow, prema-
ture and too frequent parturitions, too long continued lac-
tation,  chronic  diarrhoeas, salivation,  particularly  leucor-
rhoea, etc.
  Among the psychical causes, despair, longing for a cher-
ished object, also for  one's native country (nostalgia) are
particularly noticeable.  They may bring on a fatal nervous
consumption.  I have seen even children die by longing for
the departed mother.
  Therapeutics.  The  principal   thing to be attended to is
invigoration, especially of the nervous system and restora-
tion.  To attain this  end,  great caution in the choice of
means is to be  observed for two  reasons :  1, on account of
the weak digestion, incapable of  bearing the fixed roborants
which  might produce impurities in the first ways;  2, on
account of the morbid irritability, which will not bear ex-
citing  roborants,  the use of which  is liable  to  create
spasms.   We must, therefore,  comply  with  three  rules :
1, to begin with  mild tonics easy of  digestion, and gra-
dually  increase to stronger  ones;  2, to keep the bowels
open, and to cleanse the digestive organs ; 3,  apply the ro-
Lorants endermically.   For the  first purpose  1 particularly 
304                  TABES DORSALIS.
   recommend  radix caryophyllata? with valerian,  in decoc-
   tion or infusion ; next quassia, or still better columbo, gra-
   dually up to Peruvian bark,  at  first in cold,  then in warm
   infusion, tinct. Whyttii, and lastly  in decoction ; finally,
   the  easily digestible volatile ferruginous remedies, as the
   a?ther martialis,  and chalybeate waters.   In a febrile state
   and a hectic  disposition elixir  acidum Halleri will be ser-
   viceable.  Intermediately bitter  dissolvent  extracts,  rhu-
* barb and aloes may  be given to open and cleanse the in-
   testinal canal; saline purgatives ought to be avoided, on
   account of their debilitating properties.   Baths are highly
   serviceable ; by them alone  1 have frequently succeeded to
   make a whole cure ; even the lingering fever is readily re-
   moved  by them.  Simple baths of tepid water are  excel-
   lent; but  malt-baths are more efficacious; to which,  in
   cases of great debility,  aromatic herbs may be added, and
   embrocations of aromatic water applied to the skin,  spirit.
   serpyll., roris marini, etc.
     The diet and mode of living of the patient also deserves
   especial regard.  The  food must be  easy  of  digestion,
   concentrated into a  small volume, and  proportioned  to the
   digestive powers of the patient;  as milk, especially asses'
   milk, salep, arrow-root, Island, moss, animal jelly, snail-
   broth, nutritious beer ; in great debility, generous old wine ;
   particularly  the daily enjoyment of fresh air, that of the
   country and  mountains,  daily  moderate exercise in the
   open air ;  but when there is great debility, rest and a hori-
   zontal position.
     Finally,  the greatest  attention must be  paid  towards
   avoiding all things  of a debilitating tendency, mentally as
   well as corporeally ; particularly  to abstain from sexual in-
   tercourse, and to guard  against pollutions, and the remote
   debilitating causes,  as fluor albus, too profuse menstruation
   and diarrhoea.
                  DORSAL CONSUMPTION.

              Tabes  Dorsalis s. Medullaris.

  Diagnosis.  Emaciation, weakness, and finally paralysis
of the lower, and  sometimes  of the upper extremities*  a
feeling  of heat or cold, crawling, and sometimes violent
pains in the lower part of the spine.  The first appearance
of the disease  is commonly announced by an unsure tot-
tering, wavering gait. The disease  sometimes stops at this 
MARASMUS  SENILIS.
305
 stage, without penetrating deeper into the system, leaving
 the individual in this state for 10, 20, and more years.  Ge-
 nerally, however, the paralysis continues to spread, seizes
 upon the bladder (creating difficulties to make water);
 upon the great gut, causing costiveness or involuntary
 stools alternately; upon the organs of the senses, particu-
 larly  the  eyes; the  organs of the mind, producing defi-
 ciency of memory and judgment, fatuity ; finally upon the
 vital organs, disturbing respiration and the functions of the
 heart, causing death either by paralysis of the lungs, heart,
 or brain; or by a total emaciation and exhaustion of power.
   Pathogenesis.  The proximate cause is paralysis, finally
 exsiccation,  atrophy, and  a disorganization  of  the lower
 part of the spinal  marrow. The most frequent remote
 cause  is  debility brought on by  excesses in venery and
 masturbation, a too profuse loss of semen; it may also be
 caused by sanguineous congestions to the spinal marrow,
 myelitis  chronica;  metastases, particularly  the arthritic
 and  rheumatic, but only  when  combined with  seminal
 losses.  It therefore happens that this disease  almost al-
 ways attacks males, rarely females.
   Therapeutics.  The treatment consists  in removing the
 enumerated causes. Congestions  require leeches  and mer-
 curial  embrocations on  the suspected  part  of  the spine
 (vide myelitis) ; metastases and debilitations must be at-
 tacked in their source, e.g. the loss of semen (videpollutio).
 The nervous  system,  but particularly  the spinal portion
 must be invigorated and animated. But alas! experience
 teaches that this is almost always impossible,  or if ever
 practicable is only rarely and imperfectly so.  Besides the
 general dietetic and pharmaceutical  restauratives and ro-
 borants,  the  use of Teplitz and Pyrmont baths ;  the appli-
cation  of moxa to the lumbal region, continued a long time
in  suppuration, and repeated from  time to time, have proved
to  some extent efficacious.

                  Marasmus Senilis.

   Life itself, by its continuance, finally  produces a morbid
 state, which we call old age, and in which are combined
 all the peculiarities of tabes and atrophy.  A gradual ex-
 haustion  of the vital power, imperfect digestion  and nutri-
 tion, deficient secretion and excretion, weakness of all the
 voluntary as  well  as involuntary corporeal and  mental
 functions, exsiccation of the body, and  decrease of vital
 warmth  are  its effects and characteristics—it is this that
                           26* 
306                     ATROPHY.
we  term marasmus senilis.   This marasmus is a gradual
mortification,  a  natural transition into death, in which it
terminates.   No mortal who lives long can escape it, and
to pretend to cure it would  be ridiculous.  All that we can
do is to retard its progress, and render its effects tolerable.
  But this state of body, this  marasmus senilis,  may be
brought on prematurely, by what is termed living quickly;
that is to say, by those excesses which concentrate and
hasten  self-consumption, as excessive exertions of all the
powers, and the waste of noble humors, especially excesses
in venery, so that the  vital capital is used  up within half
the time, that it was destined for by nature.  Now-a-days
it is  not rare to  meet with cases  of premature old age
(marasmus senilis fuctitius).  We see men  only 30  years
old, bearing  all the characteristics  of age: as gray hair,
bald head, shrivelled, stiff and useless limbs, enfeebled sen-
ses, and defects in all the functions.
  For such a state of things the treatment of tabes nervosa
and dorsalis is to be pursued ; but we rarely,  perhaps never
attain the end  wished for.   Lost life can not be revived,
and all that  can be done is to  preserve  and prolong the
semi-life which remains.
                        ATROPHIA.

   Emaciation by  deficient absorption  or animalization of
 nutriment.
   The causes may vary. It is owing
   To exclusion of aliments: as long fasting (in melancho-
 lic,  superstitious persons), a starving treatment,  worms
 which share the nutriment (atrophia verminosa) ; diseases
 which prevent  swallowing, as dysphagia, cancer  of  the
 tongue ; maladies of the throat and  stomach, in which  the
 food is returned, by rumination (as  in  sacculated oesopha-
 gus) ;  or vomiting  (as  in  induration  and cancer  of  the
 stomach), or its too quick discharge by stool (as in lientery);
   Or to defective admission  of nutriment into  the orga-
 nism by disturbed assimilation, animalization, sanguifica-
 tion, obstruction in the mesenteric glands (atrophia mesen-
terica), obstruction, induration, and  other disorganizations
 of important viscera, which are necessary to animalization
 and sanguification, as the liver, spleen, lungs (atrophia he-
patica, lienalis,  abdominalis, pulmonalis,  phthisis tubercu-
 losa).
  Its  signs  are : disorders in the functions of the respec- 
PHTHISIS TUBERCULOSA.
337
tive organs, without symptoms of suppuration ; in abdomi-
nal disorders there is tension and perceptible hardness in
that region. Hectic fever shows itself very late, generally,
not till the induration passes into chronic inflammation or
suppuration, indicated  by increased pains,  heat in the re-
gion and fever, to which particular attention must be paid.
   Death is  caused by  total  exhaustion,  or  the entire de-
struction of some indispensable organ.
   Atrophy may also occur in some external  part (atrophia
localis externa), tabes of a single part, as  of the arm, hand,
and  foot; and which in children opposes their growth; it
may even pass into a total mummification.
   Causes, vide disorganizations.
   The cure consists in  the removal of the obstructions,
and  that of the  accidental formations, without neglecting
inflammation, which is  apt to set in, and for  which repeat-
ed applications of leeches are highly recommendable; and
in promoting restauration by nutritives and roborants.   Par-
ticular care must  be taken  to prevent the  local disorder
from passing into suppuration, or in scirrhosities into car-
cinoma,  accidents which are always produced by inflam-
mation, and are therefore prevented by proper antiphlo-
gistics.  The same is true of dropsy, which  is common in
abdominal diseases.  When suppuration sets in,  the treat-
ment of phthisis is to be followed.
   For the treatment of  single species, see the "respective
articles atrophia stomachica et  pancreatica in vomitus chro-
nicus, atrophia mesenterica and  verminosa under the diseases
of children.
   The local atrophy of single parts requires frequent em-
brocations of spirits and balsams, also frequent frictions
and manipulations, which have  often effected cures, as I
have witnessed in children.
               TUBERCULOUS CONSUMPTION.

                 Atrophia Pulmonalis.

      Phthisis Tuberculosa s. Sicca s.  Scrophulosa.

  Diagnosis.  Short dry cough, especially on taking a long
breath,  speaking loud, laughing, and exercise of the body,
occasionally  mucous  expectoration,  particularly in the
morning,  which is often mixed  with little  cheesy lumps
that smell bad.  Respiration is slightly  embarrassed  in 
308              PHTHISIS TUBERCULOSA.
  some, in others it is perfectly free (according to the size
  and number of the tubercles), but exercise, certain positions
  of the body make  it difficult;  frequently there  are flying
  stitches through the chest, a burning sensation which al-
  ways returns in the  same spot ; hoarseness and catarrhs
  frequently occur,  emaciation without  evident cause ; fre-
  quent  slight accessions of fever that  finally become con-
  stant, and pass into hectic.
    Diagnosis is  difficult in the beginning, and until the tu-
  bercles  increase in  size and number.   If they  are small
  and few, the patient  may live long,  even without knowing
  that they exist.  But, by repeated little  inflammations they
  may insensibly increase in size and number, and  thus pass
  into phthisis.  Such a case may continue without expecto-
  ration from the  commencement to the end [phthisis sicca),
  and the patient dies  of exsiccation, induration,  vital and
  functional disability of the lungs.  Or  the tubercles may
  pass more or less quickly into suppuration, converting the
  dry consumption into the purulent.  This may happen gra-
  dually, or suddenly by the bursting of a vomica.   Some-
  times,  however, the  emptied tubercle may cicatrize, and
  the patient remains free from purulent expectoration, until
  a new vomica breaks, and  in this way  years may pass on
  with interruptions and pauses of purulent expectoration.
   Pathogenesis.  Scrofula,  measles,  pneumonia,   hemorr-
 hages, weakness, and  blennorrhoea of the lungs  and me-
  tastasis.
   Therapeutics.   For  the treatment  of  the predisposition
 and incipient tuberculous phthisis, I refer to the respective
 heads already described.
   The treatment which is most essential,  consists in dis-
 solving the  tubercles,  and  preventing their increase and
 transition into suppuration.   The two last are the  effect of
 inflammation, for which a most strict antiphlogistic diet is
 necessary, and on the least accession of inflammation in a
 tubercle,  which is  made manifest by a  fixed local pain in
 the chest, a  small venesection is immediately to be made
 leeches applied, cooling laxatives, and nitre administered;
 should these  fail,  we must resort to vesicatories, and main-
 tain a continued artificial ulcer over the part affected
  The radical  cure requires  dissolution of the tubercles.
 In attempting this, great caution is requisite, lest  the dis-
 solving remedies  create a new inflammation. For this rea-
 son all resolvents which have a tendency 10 irritate are to
be avoided, and  only  cooling ones administered, 'and in
 using them we must carefully watch their effect; and if 
HECTICA.
309
 they excite pain in the chest,  they must be discontinued.
 Even calomel, which  is apt to cause  pain  and irritation,
 is dangerous.   The  only safe, and the  most efficacious
 remedies, according to my experience, are the following,
 persevered in for a long time : the fresh expressed juices
 of tussilage,  chervil, rad. graminis, juice  of  cucumbers,
 serum  lactis, acetate of potash, mellago graminis et tar-
 axaci,  baryta? murias, murias calcis, aqua laurocerasi, Set-
 ters water, Egers  salt-spring, digitalis, cicuta, dulcamara,
 hyoscyamus, small doses of tartar emetic  dissolved  in a
 decoction of rad. althaea?, fresh honey.   At  the same time
 moderate passive exercise, especially on horseback ; wool-
 len clothing on the chest, and fontanels on the arm.
  Long and patient  continuance of these remedies is es-
 sential.


          CONSUMPTION FROM CHRONIC IRRITATION.

                         Hectica.            *■

  A considerable and  constant  irritation of the principal
 systems of the  economy necessarily produces—by  dis-
 turbing that rest,  which is requisite to  organic  crystalli-
 zation—a diminution of nutrition  and loss of substance.
 This is produced particularly by the material irritations of
 morbid matters, generally spread through the humors; such
 as the psoric, syphilitic (in inveterate ill-treated syphilis),
 arthritic, scrofolous dyscrasias, chronic mercurial, arseni-
 cal, saturnine poisonings ; also acute fevers which have not
 terminated by a crisis ; too speedily suppressed intermittent
 fevers,  which we must suppose to have left a febrile matter
 lurking in the system.   In all these cases a hectic state, a
 lingering fever,  an  emaciation is frequently developed,
 the sole cause of which is the presence of a heterogeneous,
 continually irritating matter.   In  this  way chronic in-
 flammations, chronic cutaneous diseases, scabies, herpes,
 lepra, even constant  pains and mental affections may, by
 their  continual  irritation, produce  hectic fever and ema-
 ciation.
  The cure depends on the removal of the  causes, of the
injurious or specific morbid irritants, and in a proper resto-
 ration and inyigoration.
  In all cases, where a material dyscrasia is the cause, as
in the syphilitic,  mercurial, arsenical, psoric, and arthritic
hectic,  milk diet is the principal remedy.  It fulfils both
 indications ; mitigates the irritation produced by the acri- 
310
HYDROPES.
mony, neutralizes and destroys it, gives a new and milder
blood, and thereby destroys the fever, restores the humors
and  strength of the  system.  Tepid baths, and in great
weakness, cinchona  and similar tonics may be simulta-
neously employed.  Even in cases where specifics are still
necessary to  combat a specific poison (as in  syphilitic
hectic, mercury; in psoric, sulphur), persisting at the same
time in  milk diet, will best assist the  treatment, and render
it efficacious and the specific remedy less injurious.
           EIGHTH CLASS.

ACCUMULATIONS OF WATER AND AIR.

           HYDROPES, PNEUMATOSES.
                   I,  Ilydropes.

                      Generalities.

  Diagnosis.  Distention and swelling of a part, with fluc-
tuations when it is soft ; when the part is hard and sur-
rounded by bones,  there is a sensation of pressure on the
organ, and its functions are disturbed.  At the same time,
the serous secretions  (especially that of urine),  appear
diminished.
  Pathogenesis.   The proximate cause of dropsy is always
a disturbance between  the  balance  of exhalation  and ab-
sorption ;  therefore, this disease  may be caused  as well
by an increased secretion of serous fluid, as by deficient
imbibition.
  The remote causes may be classed as follows:
  1. Debility, by which the activity of the absorbent sys-
tem is weakened.   All chronic diseases which exhaust the
powers of the system, end  in  hydrops or  consumption ;
dropsy is only their last  stage, the commencement of
death.  It is also  produced by acute diseases ;  especially
by profuse waste of semen, or of blood, provoked by disease
or by art.  It may  also follow a local weakness, caused by
concussion or commotion. 
HYDROPES.
311
  2. Irritation, which  augments the serous  secretion of
cavities, or converts the internal gaseous perspiration into
fluid. Thus inflammation, by its accompanying exsudation,
may produce consecutive  dropsy ; as hydrops cerebri acu-
tus.   Under this head must  be placed such specific morbid
irritations as  the syphilitic, scarlatinous, psoric, but chiefly
the irritation produced by spirituous liquors.  Those who
indulge greatly in  wine and brandy, end always by dying
of dropsy.
  3. Antagonism,  metastasis.   The suppression of a natu-
ral  as well as of a pathological secretion  and  excretion ;
likewise that of an external morbific deposition  may create
a morbid internal  accumulation of water.  The most  fre-
quent is the suppression of cutaneous perspiration.  Every
rheumatism is accompanied by a local serous exsudation,
a rheumatic dropsy, which  may invade the whole cellular
system (anasarca), or fill the  internal cavities ; hence, drop-
sy is endemic in moist regions, as in Holland.   The same
thing is observed  after suppression  of urine,  which  fre-
quently occurs in  aged persons and  children ; after sup-
pressed hemorrhages,  particularly that of menstruation ;
also, after suppressed morbific depositions, as gout, cutane-
ous diseases,  diarrhoea, fluor albus, and suddenly arrested
intermittent fevers.
  4. Mechanical  pressure.  Every pressure  impedes  the
circulation of the venous and lymphatic vessels, and there-
by  creates accumulation, serous effusion and swelling.
This is made apparent  by  tying a ligature round any part
of the body.   External tumors and indurations operate in
this way ; thus indurated  axillary glands cause swelling of
the arm, and  the gravid uterus an oedema pedum.  This
is true also of internal ones, as indurated  pancreas, tuber-
cles of the lungs;  but especially enlargement and obstruc-
tion of the liver,  because it is the  central organ  of the
abdominal circulation and absorption.
  5. Rupture of lymphatic  vessels.   This, however, cre-
ates only a local dropsy.
  6. Thin, watery blood predisposes to  dropsy ; particu-
larly blood which is  deficient of cruor, as after bleeding, in
chlorosis,  and the abuse of spirituous liquors.
  Therapeutics.  Removal of the remote  cause is the first
thing to be done.  To accomplish this object, we must first
inquire into the dynamic character of the  disease, whether
it be inflammatory or adynamic (the latter is the most
common).  The next thing is to remove the material cause,
which may be an obstruction, a mechanic pressure, or the 
312
ABDOMINAL DROPSY.
like.  After this, we must pay due regard to the cause of
the specific dyscrasia and its treatment.
  The second indication is to effect the absorption of the
effused  water; for it cannot  be evacuated  by the natural
ways.   With this object in view, we must  prescribe such
remedies as have a specific  influence over the  lymphatic
system anJ augment its action ; as mercury, digitalis, and
all  the  evacuants, particularly emetics, purgatives, and
diuretics.
  The first indication is often sufficient by itself to accom-
plish the cure ; but it is better to unite both.
  The third indication is  to evacuate the water in the nat-
ural way if it be  possible,  by  promoting the  watery secre-
tions and excretions, particularly that of urine, and if this
cannot be done, recourse  must be had to the artificial way ;
that is, an operation.
                    ABDOMINAL DROPSY.

                     Hydrops Ascites.

   Diagnosis.   Tumefaction  and  tension of the abdomen,
 following the position of the sick ;  fluctuation, the wave of
 which is felt against the palm of the hand placed on one
 side of the belly, while the opposite side is percussed with
 the fingers of the other hand.  In the beginning of the dis-
 ease, the fluctuation is best felt in  the lower  part of the
 abdomen, and while the patient stands  up.   The urine  is
 scanty and  of a dark brown color  like beer (peculiar to
 ascites).  The stools also are  scanty and  dry ; and  there
 i.s dryness of  the skin,  tongue and mouth,  therefore thirst.
 Respiration is  rendered difficult by  the  ascent of the dia-
 phragm,  sometimes also by dropsy in the chest coexisting.
 The greater the tumefaction  of the abdomen, the more are
 the limbs emaciated.   In hydrops saccatus the tumefaction
 is unequal in the beginning, is,  however, more equally dis-
 tributed as the disease  advances.  Also the urine is of a
 less dark color, and less scanty.
   Subsequently, as the disease increases, the feet, scrotum
 or labia vulva?  swell ; a dry  cough,  and towards the end
 there is lingering or acute  fever, which is a sign of ap-
proaching death.
   Death ensues either by suffocation, or by the fever assu-
ming a putrid  character, or by  local  inflammation and
gangrene supervening in some abdominal viscus. 
ABDOMINAL DROPSY.                313
   The  diagnosis may be rendered  difficult by coexisting
 pregnancy.
   Hydrops  abdominalis  saccatus is  distinguished  by  the
 swelling commencing in a particular part, and even  when
 far advanced, the distention of the abdomen is not uniform;
 and in general the urine is less dark.
   The  duration  of  the  malady varies  very much, lasting
 sometimes  for many  years, according to  the cause, and
 constitution of the patient; hydrops saccatus lasts longest.
 Next to phthisis, this is one of the most common diseases.
   Pathogenesis. The most frequent causes are obstructions
 and other diseases of  the abdominal viscera, especially of
 the liver, badly treated  or too  long standing intermittent
 fevers,  atonic  gout, and other  dyscrasias, abuse of wine
 and spirituous liquors, previous acute  fevers, particularly
 scarlet  fever, mechanical lesions, by blows on the abdomen,
 falls, etc.
   Therapeutics.  The disease belongs to that class, which,
 properly speaking, scarcely admits  of a cure.  The  cura-
 bility depends on the cause, being incurable  in indurations
 or other disorganizations of the abdomen, which  are them-
 selves incurable ; or on the more or less vigorous consti-
 tution of the patient.
   In the treatment,then, we must first take  the various cause
 and character of the disease into consideration.  A dropsy,
 which comes  on  quickly,  with febrile symptoms, a full
 pulse, suppressed  hemorrhages  or signs of a  local  inflam-
 mation, calls for|a treatment differing from that of one which
 is the consequence of great and chronic  loss of blood or
 other great debilitating causes.  In the first case, moderate
 abstractions of blood, nitre, calomel, in  short, the antiphlo-
 gistic method ; in the  latter case, cinchona, quassia, even
 chalybeates, the  strengthening  method,  form the funda-
 mental character of treatment.  Specific dyscrasias require
 specific remedies, as mercury in the syphilitic, sulphur in
 the psoric (suppressed itch).  In obstructions of the abdo-
 minal viscera, taraxacum is to be given with diuretics ; in
 suppressed perspiration of  the feet, old  ulcers and hemor-
 rhages, the original complaint must be reproduced.
   Besides this remote  treatment, we must also, and at the
same time have recourse to the direct treatment, which is
the.evacuation of the water.  The  principal thing to  be
done for this purpose,  is to excite the action of the  lym-
phatic system, which  may be best attained by emetics,
 mercurials, barytes, digitalis, guaiac. Then diuresis  is to-
 be promoted, as  most serviceable and least debilitating.
                          27                        * 
314                ABDOMINAL DROPSY.
Here radix scilla? ranks first in all its forms, but as it is apt
to create nausea and  vomiting, it is best administered in
pills (vide No. 152), or combined with aromatics, or given
in vinous and spirituous tincture, tinct. scill. kalin (Pharm-
ac Pauper.).  Squill is also of great value, applied ender-
mically.  A  small spot on the abdomen about the size of a
sixpence is to be denuded of the epidermis by a vesicatory,
and three grains of rad. or extract, scilla? is to be applied
on it three times a day.   Besides the foregoino-, digitalis
nitre, cream of tartar, soda, juniper (No. 153,  154), bryo-
ny, tobacco, cantharides,  drinking largely of the  diuretic
tea (vide No. 151), as well as of  cold water mixed with a
little Rhenish wine, are the remedies most  confirmed by
experience.  At the same time, diuretics (No. 155) may be
applied  externally,  likewise mercurial inunctions on the
abdomen.  The evacuation of water by acting on the intes-
tinal canal is rarely practicable, and must never be resorted
to in great weakness ; but in the commencement, and when
strength remains, and  that there is a natural tendency to-
wards the bowels, purging is of excellent service. For this
purpose,  gamboge, bryony, colocynth,  pilul.  hydragoga?
Janini, elaterium (with great precaution  !), rad. gratlola?,
jalap., aloes are most recommended.   Of great effect and
confirmed in my experience, is a combination of diuretics
with  purgatives (vide No.  156, 157,  158, 159,  160,  161).
An addition of a mercurial, particularly mercurius nitrosus
No. 162,  163) is of great practical use, since it  increases
the efficacy of all the medicines before mentioned.
   We must always attend to the secretion which nature is
most disposed to,  and promote it.  I have seen, in great
tendencies to intestinal  secretion, dropsy cured  solely by
the  continued use of Glauber's salt.  Nature has  some-
times evacuated the water even  by vomiting.  If all kinds
of diuretics  are unavailing, discontinue  them for a few
days, replacing  them by resolvents, extract, tarax., chel-
idon., soluble tartar; after this, return again to diuretics
and they will not fail.   If this also fail, a  high degree of
torpor or a spasmodic state of the minute vessels  must be
the cause of the want of action ;  and in  such a case an
emetic,  after which, roborants, excitants,  and  antispasmo-
dics used, may likely prove efficacious. I can recommend
from my own experience, quassia,  wine (especially Cham'
pagne),  rad. bel'adonna? and opium.  If this also should fail
bandages applied moderately tight to the  extremities, and
even to the abdomen, have promoted absorption and diuresis.
Acu-puncture of the abdomen, especially in connection with 
DROPSY OF THE  CHEST.              315
galvanism, is also a good auxiliary.  If no success should
be obtained by any of these means, paracentesis abdominis
(tapping) may be resorted to.  For it  has been often  ob-
served that, as soon as the pressure of the water had been
removed, the absorbing vessels and the kidneys commenced
to operate and  to accomplish the cure.  In the second
place, a momentary and very great alleviation is thereby
procured to the  sufferer, and it is the best palliative.  Fi-
nally, there have been cases (especially of hydrops sacca-
tus) in which the life of the patient has been preserved for
many years, by  this operation repeated from time  to time.
I have seen instances where the  patient had his life pro-
longed from  twenty to thirty years by forty or  fifty tap-
pings,  repeated every  two  or  three  months.  But that
tapping may be  useful,  we must be careful not to  perform
that operation too late,  when the  water has become putrid,
or local inflammation or fever has set in.  After the paren-
tesis, roborants, especially quassia, combined with diuret-
ics, are to be used.
                 DROPSY OF THE CHEST.

                      Hydrothorax.

  Diagnosis.   The recognition of this disease is very diffi-
cult, and in most cases not with perfect certainty until it has
reached  the  last stages.  The  symptoms are : great  op-
pression of breath, particularly on motion, and  when lying
on the back, great anxiety, short cough, commonly  dry,
very often spasmodic,  spasmodic pains between the shoul-
ders, which are frequently very tormenting, swelling of the
hands, sometimes of the face and around the eyes.  When
the patient turns quickly round, the fluctuation of the  wa-
ter may sometimes be felt or heard if the quantity be great.
Percussion, and auscultation by means of the stethoscope
will throw some light on the case.  Principal signs :  sud-
den awaking in  the night, with  a feeling of great anxiety
and suffocation, and an irresistible impulse to rise and rush
to the window for fresh air.   Impossibility to lie down
towards the end of the disease, none  but a sitting posture
is practicable, and finally a standing position  is the  only
one  which affords  some alleviation  to  respiration.   The
urine is  diminished, but  is  not  as dark  as in  ascites, and
sometimes it is natural (as in hydrops saccatus). 
316            DROPSY IN  THE PERICARDIUM.
  The patient dies by suffocation, or in a soporous state by-
apoplexy.  Cure is rarely possible.
  Pathogenesis.  All causes of dropsy in general  can pro-
duce this disease, particularly pneumonia,  tubercles of the
lungs, arthritic metastases, obstruction of the liver, chronic
asthma, ascites.
  Therapeutics.  The treatment must conform with  the
general principles laid down for dropsical maladies, in the
same manner and  by the  same remedies as  in ascites.
Diuretics,  digitalis, squills,  and  bryony  are  particularly
efficacious.  Nitre one  scruple, along with sulph. aurat.
antimonii,  one grain, three times a day ; also tinct. nicot.,
cantharid., belladonna?,  likewise  artificial ulcers on  the
arms and  on the  chest, also foot-baths of  mustard, sina-
pisms on the calves of the legs, in order to shift the oedem
to the feet, have proved serviceable.  Towards the end, and
when fluctuation between the ribs is clearly discriminated,
paracentesis  thoracis may be resorted to.   It is always a
great palliative, sometimes leads even to a radical cure.
To assuage  the anxiety, aqua  laurocerasi,  with  extract.
hyoscyami and opium may be given.
  As the rarity of cure is principally owing to the tardy
discovery  of the disease, we will do well to suppose the
existence of incipient hydrothorax in every chronic and
considerable  asthmatic difficulty ; and to endeavor  to  ex-
cite diuresis, by which the further progress of  the disease
may best be  prevented.
               DROPSY OF THE  PERICARDIUM.

                   Hydrops Pericardii.

  Diagnosis.  Presents much similarity with  the signs of
hydrothorax, with which it is  frequently associated.   Its
principal characteristics are :  palpitation of the  heart, ex-
tending through the whole extent of the chest, intermitting
pulse, fainting  fits, extreme anxiety.   Examination^ the
stethoscope may assist in  distinguishing it from organic
disorders of the heart.
  Causes are :  besides the general ones, inflammation of
the heart, organic diseases in this organ, and metastases.
  The treatment is the same as advised in hydrothorax. 
HYDROCEPHALUS.  ANASARCA.
317
                  DROPSY OF THE HEAD.

                     Hydrocephalus.

                  DROPSY OF THE BRAIN.

                    Hydrencephalon.

   We distinguish hydrocephalus externus and internus. The
 first is an accumulation of water  without the cranium (pro-
 perly edema capitis) ;  the latter is either  accumulation of
 water between the brain and its membranes or in the cavi-
 ties of the cranium themselves (hydrencephalon).
   Hydrocephalus internus occurs only in children, and as
 a  primary and independent disease (either congenital or
 acquired), (vide diseases of  children, hydrops cerebri) ; but,
 by becoming chronic, it.may last from infancy to a more
 advanced age.  I have seen  individuals live in this state to
 the age of sixteen years.  In such cases the head acquires
 an enormous size, and the individual is imbecile. In grown
 persons it is always a  secondary or symptomatic disease,
 succeeding to«inflammation of the brain, or violent commo-
 tions ;  it is a consequence of chronic  insanity, and of or-
 ganic disorders within the cavity of the cranium.
   The treatment  is the same as for dropsy in  general.   It
 is, however, worthy of remark, that  the  affusion  of cold
 water on the head, repeated several times a  day, and con-
 tinued for some time, may sometimes effect a  cure of con-
genital as well as of chronically forming hydrocephalus,
Water is here of  more use than any other means.
                  DROPSY  IN THE SKIN.

            •      Anasarca, GZdema.

  Accumulation of water in the  cellular tissue, generally
in that which lines the skin, but also in the internal viscera,
as the lungs.  The  most  common is cutaneous dropsy,
either general (anasarca), or in single parts, as iu the hands
and feet (adema).  The signs are  : a swelling which yields
to the pressure of the finger, and  retains the impression.
  Predisposition to it is owing to a lax constitution of the
fibre.  All individuals possessed of such a constitution are
more liable to it than others ;  therefore it is common in
                          27* 
318
ACCUMULATIONS OF AIR.
females, a sex in which laxe fibre predominates.  In such
persons oedema pedum often occurs after great exertions in
walking or long standing, and during the summer season is
very common and unimportant.
  Oedema.  It is either symptomatic, a consequence of an
internal accumulation  of water (as oedema  of  the  feet, of
the scrotum in ascites, and of the hands in  hydrothorax);
or it is idiopathic, contracted by  colds, inflammations, es-
pecially by  rheumatism or psora, also by  local debility.
The first kind is remedied by removing the internal dropsy  ;
the latter  by cushions of dry, aromatic herbs, especially of
hops and absinth ; by  balsamic fumigations,  local vapor
baths, finally by the application of rollers.  We must dis-
tinguish between hot and  cold oedema.  When the skin
is painfully distended, and  has  an  inflammatory character,
leeches and  cups are  of  use.  Scarifications,  cautiously
made, are likewise  serviceable in  cold oedema,  when there
is great tension.
  Anasarca.  General dropsy of the skin  may be of an acute
character, caused by violent colds, suppressed perspiration
or cutaneous eruptions, especially after scarlatina, and calls
for an antiphlogistic treatment, combined  with  diuretics
and diaphoretics ; particularly nitre with digitalis,  squilla,
and calomel.  The chronic  is owing to obstructions of the
circulation of blood in the  heart and the larger vessels, or
is a concomitant of a general hydropic disposition and ac-
cumulations of water.
  The treatment is the same as is usual  for  dropsy in gen-
eral; at the same time, frictions, flannel clothing, aromatic
fumigations, sweating  baths, especially by  spirit of wine,
are proper.
          II. Accumulations of ,lir.

                      Generalities.

  They may arise by the entry of atmospheric air into the
tissues from without.
  Or by an internal formation of gas.   This species may
originate in chemical dissolution, as by putrefaction, fer-
mentation of aliments; or by a conversion of the secretion
of \he internal surfaces into a gaseous  form, owing  to an
abnormal influence of the nerves. 
FLATULENCY.
319
  The cure is effected  either by the artificial evacuation
of the air; by its absorption ; or by dissolution, and recon-
version into liquid.
                      FLATULENCY.  •

                      Flatulentia.

  Diagnosis.  Excessive and incessant generation of air in
the stomach and intestinal canal, manifested by tension and
swelling of the epigastrium, the whole abdomen, and by
frequent discharge of flatus*per os et anum,  which gives
relief.  This accumulation of air creates great and manifold
complaints, partly local by distention and pressure, partly
consensual by nervous irritation. These are:  most intense
anxiety, difficult respiration (asthmaflatulentum), even men-
tal anguish and phantasies (incubus), hypochondriacal in-
disposition, violent pain  in the  abdomen  and praecordia,
particularly on the left side, which  might be mistaken for
pleuritis (colica flatulenta), palpitation of the  heart, even
spasmodic  affections  of remote  parts,  pains,  illusions of
the senses (susurrus aurium, visus duplex, diplopia).  When
it attains great  height, it may excite two diseases: ructu-
ositas, when the patient is troubled incessantly with  loud
irretainable, often crying ructus, and the murmuratio, into-
natio intestinalis, when the air is agitated in the intestines
with loud and  often most singular sounds, frequently re-
sembling  the quacking and crying of animals, which, in
former times, was considered as a kind of bewitchment or
demoniacal possession ; and now the effects of a livino- an-
imal.   Sometimes the air is agitated by spasms (a wan-
dering globus hystericus).
  Pathogenesis. The primary cause is atonic weakness; that
is, debility combined with deficient elasticity of the stomach
and intestinal canal; with hypochondriacal and hysterical
nervous disposition of these organs, in  which case a mere
nervous or mental affection may  produce a violent genera-
tion of gas. The occasional transitory causes are : flatu-
lent food,  cabbage, turnips, fermenting beverages (in a very
high state of this  disease, the least piece of vegetable cre-
ates flatulency) ; nervous or mental affections, taking cold,
when the  usual cutaneous exhalation seems suddenly to be
transmitted antagonistically to the internal surface of the
intestines.
  The generation of  flatus  originates always in atony of 
320                   FLATULENCY.
 the stomach, slow, weak digestion, and particularly in dif-
 ficult assimilation.   The more promptly and vigorously the
 food experiences the influence of vitality, and performs its
 metamorphoses into the vital substance (assimilation), the
 more will all purely chemical dissolution, and consequently
 also development of gas be prevented.  There are individ-
 uals who do not labor under flatulency, even after taking
 the most flatulent kind of food ; and, on the other hand,
 persons of this disposition are plagued with it by the most
 innocuous aliments.
   Therapeutics.  The treatment is double, palliative and
 radical.  The  palliative  treatment has for its  end  the
 prompt removal of the present flatus.  This is to be ef-
 fected by carminatives and antispasmodics ;  as semen foen-
 iculi, anisi, carvi., herb, menth. piperit., olea aetherga and
 etherized acids, liquor anodyn. Hofmanni, liquor ammon.
 anisati, with valerian (vide  164), castoreum,  with  opium
 (No. 165); frictions of the epigastric and abdominal regions,
 the application of warm cloths or stones, inunction of vol-
 atile antispasmodic ointment, ol. destil. chamomille, four
 drops, dissolved  in half a drachm  of  aether sulphuricum ;
 injections of peppermint, caraway, and chamomile flowers.
 Very efficacious  for such  patients, is to take every morn-.
 ing fasting, a  cup of  cumin-tea (one drachm of cumin,
 steeped in a cup of water) in the bed, and  sixty drops of
 elixir aurant. composit. (Pharmacop. Boruss.) in the  fore-
 noon  and afternoon.  It  is better than the  use  of cumin
 liquor, which  is  likely to lead  to  habits of intoxication.
 Vegetables, drinking during meals, and warm beverages
 and soups are to be avoided.
   The radical  treatment required is that of strengthening
 the stomach and intestinal canal, and  restoring their tone
 (vide  weakness of the stomach).   Cold  dry regimen,  cold
 roast meat, ice-cream, ice pills, a generous wine, like old
 Madeira or Malaga, cold lotions and douches to the epigas-
 trium  and  abdomen,  also  injections of cold  water, much
 and  strong exercise,  and internally No.  166, 167.   Hypo-
 chondriasis and hysteria  must be cured.  In a hysterical
 person, who  had suffered a long time  from ructations,
which were accompanied with loud screaming sounds, the
 treatment of  stomachical  spasm by magisterium bismuthi
 finally proved efficient. 
TYMPANITES.
321
                       TYMPANITES.

   Diagnosis.   A great and frequently an enormous elastic
 swelling  of the abdomen, sometimes so large as to excite
 a fear that the parietes may burst.  On percussion this
 tumor sounds hollow, like a drum,  and does not vary in
 different  positions of the body;  these symptoms  and  the
 absence of fluctuation distinguish it from dropsy. The dis-
 tention is generally unequal ; some parts being more, and
 some less elastic to the touch (tympanites intestinalis, when
 the air is accumulated within the intestines).  Sometimes,
 however, the abdomen js equally  elastic  and  distended
 (tympanites abdominalis, when the air is accumulated in the
 abdominal cavity).  The  patient has borborygmi and roll-
 ing  in the intestines,  but  has  no discharges of ructus or
 flatus; respiration is difficult, the abdomen  is painful, and
 at last great  anxiety,  cold extremities, costiveness, and
 sometimes diarrhoea supervene.
   Tympanites intestinalis is always liable to inflammation ;
 therefore, when fever associates with it, the case becomes
 more important.   Finally, a rupture may take place.
   Pathogenesis.  The causes of tympanites intestinalis are :
 overloading of the stomach with flatulent, heavy, and con-
 stipative  food ; such  as peas, lentils,  beans,  or with very
 fermentable substances, as cabbage and milk, mixed with
 new beer; also an accumulation of gastric, glairy, and bi-
 lious matters, and such as are  apt to pass into putrid fer-
 mentation ; taking cold,  especially after eating the above-
 mentioned food ;  obstinate costiveness, spasm ;  extreme
 atony,  a kind of paralysis of the intestinal canal; inflam-
 mation and gangrene, wounds in the abdomen, typhus, par-
 ticularly organic,  gastric, and intestinal disorders, such as
 indurations and ulcers.
   This disease may,  therefore, break out suddenly and
 idiopathically, but, in general  it  is only a symptom of other
 disorders.
   A  predisposition to it is owing to habitual flatulency.
   The causes  of tympanites abdominalis are : escape of air
 from the  intestines into the abdominal cavity (which may
 happen in  great tympanitic distention of the  intestines, and
 when they are pierced by ulcers and wounds) ; putrid dis-
 solution (it may be a symptom of putrid fever), taking cold
 after great overheating (which  may bring on  also emphy-
 sema).
  Therapeutics.  In the first place we have to search  for
the cause, and to  consider whether a spasmodic or an in- 
322
EMPHYSEMA.
flammatory state exists.   When the latter is the  case, we
must  commence by the abstraction of blood.  Y\ hen thig
is absent, carminatives and antispasmodics are most called
for : pills of  asa foetida and rhubarb, columbo and oleum
cajeputi, and oily emulsions, embrocations of oil of mint,
of cajeput., and camphor  oil with  laudanum, dry  cups, in-
jections  of chamomile, or  cumin  with  asa fatida.  The
chemical fermentation must likewise be corrected  : when
the patient has eaten of fermentable vegetables, we may
suppose  the  presence of  acids,  for which magnesia pura,
lapides cancrorum,  and aqua calcis with rhubarb are to be
administered;  in putrid fermentation, acids, as elixir aci-
dum Halleri,  cold (which is known to prevent all kinds of
fermentation  and the development  of gases), ice, internally
and externally, dropping  of naphtha on the abdomen; and
when the stomach is overloaded, emetics.
  If all these remedies fail,  there still remain three means
of relief, and  by which life may be saved in extreme cases.
The first is clysma inversum, that is, drawing the air off by
means of a syringe.  A flexible tube from 12 to 18  inches
long, attached to a syringe, must  be  introduced  into the
rectum,  and  by drawing  the  piston  up, the air may be
pumped  out.   Should  the tube become obstructed,  it may
be cleared by forcing a little warm water through it. The
second  is compression.  A  girdle  is  to be applied  around
the abdomen, as tight as the patient can  bear it,  and gra-
dually tightened as the swelling diminishes.  The third is
puncture. A needle  or a trocar is to be thrust into the part
which is most distended, and the  tube left in until  all the
air is expelled.
  Subsequently, roborants are always  to be used.
  Infants are subject  to  a  distention of the praecordium,
which may be readily removed by merely rubbing the part,
and still more effectually by  unguent, althaea?, with chamo-
mile and peppermint oil;  also by the  use of pulvis  puero-
rum and  injections.
                      EMPHYSEMA.

  Diagnosis.  Air in the cellular tissue.  A tense, elastic
swelling, which yields a crepitous sound under pressure.
  It  may arise from lesions, which permit the external air
to enter the  cellular tissue ;  or from an internal decompo-
sition and a development of gas, which is particularly the
case in the general emphysema that accompanies nervous 
PHYSOMETRA.  PROFLUVIA.
323
and putrid fevers ; even from taking cold after violent over-
heating, as sometimes suddenly occurs, even in one night.
  The cure is effected by absorption  and reception of the
air into the humors of the body,  whence  it is  discharged
in the form of perspiration  (gas developed by the skin).
This end is attained by frictions, and the application of dry
aromatic herbs ; in general emphysema, by the use of in-
ternal diaphoretic  remedies,  and bathing with aromatic
spirits repeated every two or three hours.
  Emphysema pulmonum (vide asthma aereum) deserves par-
ticular attention.
              TYMPANITES OF THE  UTERUS.

                      Physometra.

  It  is known by distention of the uterus,  and an occa-
sional expulsion of air from the vagina (vagma crepitans).
  The causes are hysteria or infarctus uteri; to  which the
treatment must conform.
                 NINTH  CLASS.


                     PROFLUVIA.

                      Generalities.

  Diagnosis. Increased evacuations of the serous, mucous
and other fluids, and which are altered in quality.
  Pathogenesis.  The general causes are : an increased de-
termination  (congestion) of the humors to  a secretive or-
gan; or an  increased action and irritability of the organ,
or a local irritation excited by organic stimuli (as tuber-
cles in the lungs), by chemical and mechanical stimuli (as
stones  and gravel in the kidneys), by metastases, which
likewise act  as stimuli, by sympathetic influences,  as the
gastric; or a local weakness and laxity of the parr, which,
by reason of diminished resistance permits of an accumu-
lation of humors, or by reason of the relaxation of the lin-
ing membranes of the vessels affords a ready passage of the
fluids. 
324                  HEMORRHAGES.
  Therapeutics. The cure requires first the removal of the
causes: to diminish congestion, subdue  increased action
if it be the cause, discriminating, however, phlogistic from
erethic  irritability ; to remove  idiopathic as well as con-
sensual stimuli (which frequently requires great variation
in  the treatment); to strengthen where  weakness is the
cause ; finally, and in imminent  danger, to directly and lo-
cally  impede  and ameliorate the evacuation (styptic, sup-
pressing remedies).
                 Mm  Hemorrhages.

                     HEMORRHAGIC.

                      Generalities.

   Diagnosis. Escape of blood from its channels outwardly,
 or inwardly into cavities, or into the cellular tissue (extra-
 vasata,  sugillationes).  This happens from  distentions or
 ruptures of the vessels.
   The immediate effect of haemorrhage is debility, since a
 portion of the vital  humor, even of life itself is lost; there-
 fore the significance and danger  is measured by the quan-
 tity  of blood lost.   If  the loss  has been great and rapid
 (hemorrhage), it may prove  instantly  fatal.  If it is less
 abundant, but continues to escape, it produces chronic de-
 bility, and may thus become the cause of all the asthenic
 diseases.  But on the other hand it may serve as a natural
 venesection,  prove  salutary, and act as a wholesome crisis
 in plethoric and inflammatory diseases.  Besides these ge-
 neral effects it  may also produce an important local one,
 especially when it affects noble organs, as the Jungs, sto-
 mach, and is the result of rupture.   In such cases it  must
 always  be considered in the light  of a wound,  and may
 produce all the like consequences; as those of inflamma-
 tion, extravasation,  induration, suppuration.
  Pathogenesis.  Proximate cause:  disturbed balance  of
the impulse of the blood and the resistance of the vessels:
 sometimes the impulse  overpowers  the resistance of the
 vessels, even their cohesion ; or the latter is so  impaired
 as not to be able  to resist  the  usual afflux  of blood, and
 confine it  in  its channels.   Therefore, two  principal
 classes  of hemorrhages,  the active and the passive, are  to
be distinguished.
  The remote causes of the first class are: 
HEMORRHAGES.
325
   1. The general, and this again  has a double character.
 It is either a general increased action of the vascular system
 (phlogistic sanguineous excitement), a plethora,  particu-
 larly when there  is excitement produced by external and
 internal over-heating, by spirituous liquors, corporeal exer-
 cise, mental affections,  suppression of habitual  hemor-
 rhages, fevers,  an  inflammatory state ; or is an irritation of
 the  nervous system (nervous, erethic, spasmodic excite-
 ment).
   2. Or local:  local inflammation and a disposition to in-
 flammation, local  increased sensibility (spasm),  local irri-
 tation by metastasis or organic  disorders (tubercles,  poly-
 pus, etc.),  consensual  and  antagonistic irritation (gastric
 acrimony, worms, dentition).
   The  remote causes of passive hemorrhage are:
   General: general weakness, asthenic fevers, putrid fevers,
 scorbutis, hectic colliquation.
   Or local: local  weakness and relaxation caused by dis-
 ease, over-irritation,.pressure, moist  warmth.
   In hemorrhages owing to  local weakness,  it is not un-
 comrrron to meet  with the curious case of a mixed state,
 that is,  a  general  increased activity of the whole system,
 combined with  local weakness of a single organ,  as in he-
 morrhage of the lungs and uterus.
   Finally, the too limpid, dissolved, uncoagulable quality of
 the  blood* itself may give rise to hemorrhages, as in scurvy,
 in morbus hemorrhagicus ; and the congenital disposition
 to bleeding (bleeding families).
   Therapeutics. The principal general indications of every
 hemorrhage are:
   First, to examine to what species it belongs ; whether to
 the  active or to the passive, and here again whether to the
 phlogistic, which calls  for purely antiphlogistic treatment ;
 or to the nervous,  spasmodic  (erethic) species, which re-
quires antispasmodic assuaging  remedies.
  Secondly, to  remove the occasional cause, as a gastric
matter,  or a local irritation.
  Finally,  if all this do not suffice,  or real danger of life
sets  in from the beginning, we must endeavor to suppress
the hemorrhage by styptics, astringents, applied internally
and  externally, also by mechanical pressure, where this is
practicable.  The signs  of  inanition and  danger  of  life,
  * Modern anatomy  will  not admit vasa exhalantia in the internal
surfaces ;  but it must allow the existence of pores and the possibility
of fluid* perspiring through them ; which conies to the same thing in
the pathogeny of hemorrhages and  other profluvia.
                           28 
326
EPISTAXIS.
which immediately require the use of active suppressive
means, are: small, filiform or unequal and remittent pulse,
cold extremities, buzzing at the'ears, sparkling before the
eyes, fits of fainting.                        #
  A combination of a generally increased action with local
weakness of the bleeding organ claims our greatest atten-
tion,  since  such a case  requires at the same time general
debilitating means, and  the local application of roborants.
Such a mixed state occurs in all hemorrhages due to a vio-
lent mechanical concussion, which impairs the  local struc-
ture, and at the same time produces a general revolt of the
vascular system, and from the union of both these causes
an increased local plenitude (overfilling of blood). In such
a case a venesection  must be made, and immediately after-
wards cold,  arnica and  other strengthening remedies re-
sorted to.
                       EPISTAXIS.    •

                 Hamorrhagia Narium.

  Bleeding at the nose is one of the most common hemor-
rhages.  It occurs during good health as  well as in bad,
and is  most generally salutary and critical,  acting as a de-
rivative of plethora and congestion in the head ; but if the
loss be very great, it may become  dangerous, even fatal.
  In most cases it is owing to a plenitude of blood ; there-
fore, it is most  frequently met with in youth ; it may, how-
ever, arise also from a sanguineous dissolution (scorbutis,
morbusha?morrhagicus maculosus), hemorrhoidal and men-
strual anomalies, even from abdominal  irritations (worms).
  As a  rule, we ought  never to  suppress  bleeding  at
the nose by local means, until its injurious effects become
evident.  There are not wanting instances of the bad conse-
quences of a  sudden  suppression of epistaxis, as blindness,
deafness, and cerebral  inflammation.  Suppression,  then,
is to be resorted to only when the loss of blood has become
enormous; when there is palor of the  face, vertigo,  small
intermittent pulse, and fits of fainting set in ; or when the
bleeding is evidently a consequence of weakness, and of a
putrid  dissolution of the blood.   The remedies are :  cold
water applied to the forehead, drawn into the nose, vinegar,
solution  of alum, injections of sulphate of iron, foot and
hand-baths, pledgets of  lint  moistened with alum,  plug-
ging the nose.   Chewing of a piece  of  blotting paper 
HEMOPTYSIS.
327
sometimes affords the promptest relief; also  cold lotions
on the genitals.  Cooling purgatives, especially cream  of
tartar dissolved in a large quantity of cold  water, elixir
acid. Halleri;  in a spasmodic  state, ipecacuanha  in small
doses, even opium with acids,  are the internal remedies  to
be used.
  The radical cure  of the ever-and-anon returning epis-
taxis requires a due  consideration and treatment of the
causes,  especially of plethora,  of  abdominal stimuli,  of
scorbutis, weakness,  and of a putrid diathesis  in the vascu-
lar system.  In the last  case, cinchona and  acidum  sul-
phuricum are most serviceable.
                       HAEMOPTYSIS.

       Sputum Cruentum, Hamorrhagia Pulmonum.

   Diagnosis.  Expectoration of blood which is brought up
 by coughing or hawking, the only sign by which we  can
 know whether the blood comes from the lungs and the up-
 per part of the trachea.  A mere spitting of blood (sputum
 cruentum), w'hich exsudes into the mouth, or only comes
 from the nose, is to be discriminated, and we must be care-
 ful not  to be deluded in this respect.  Ha?moptysis varies
 very much in intensity and importance.
   The mildest kind is that which has not been preceded or
 accompanied  by  difficulties  in  the chest (dyspnoea or
 pains), does not return, and leaves no cough or other pec-
 toral complaints behind.
   A severer kind  is : that one which is preceded by the
 patient's previous difficulties in the  chest, dry cough, and
 shortly before its occurrence, shivering and excited pulse ;
 and which is accompanied by anxiety and irritative cough,
 very excited pulse, palor and altered  countenance;  and
 which returns after a few hours cessation, followed by dys-
 pnoea and dry cough.
  The highest degree occurs in patients who previously
had suspected lungs, are of  a phthisical disposition ; and
who, during the attack, suffer great anxiety and oppression,
are in a febrile state, expectorate pure blood, which repeat-
edly returns, and is followed by considerable pectoral com-
plai nts.
   The quantity of blood expectorated is of no  importance';
 all depends upon its causes and the constitution of the pa-
tient.  It may be thrown up by cupfuls without detriment, 
328                   HEMOPTYSIS.
 if it is owing to a hemorrhoidal flux through the lungs, and
 the patient enjoys a sound chest, and does not labor under
 a phthisical disposition ;  whereas in the latter case, even a
 small expectoration of blood is very dangerous, and may
 be the transition into  phthisis.
  We must not  suffer  a continuance of the bleeding to
 alarm  us ;  but look to  the color of the  blood,  which,  if
 dark, does not indicate a continual  bleeding, but that the
 blood  now expectorated  has been already  some  time
 effused.
  The danger is not at the moment of bleeding, but in the
 consequences, pneumonia  and  phthisis.   We rarely meet
 with hemoptysis which  is a real  hemorrhage, and capable
 of causing  death by suffocation.
  Pathogenesis.  A knowledge  of the predisposing cause is
 here of the greatest moment;  for it is by this knowledge
 that danger is known.  It is the dispositiophthisica (vide
pulmonary  consumption); or a  real  phthisis  does already
 exist, with  which hemoptysis associates as a  symptom.
  The exciting causes are: violent  over-heating  of the
 body by  dancing or running, ardent drinks, violent  mental
 affections, great external heat, immoderate exertion of the
 lungs by screaming, blowing musical instruments, strong
 concussions affecting  the chest, as blows to the back, falls,
 wounds  of the lungs, inhalation  of corrupt air, acrid va-
 pors^ suppressed piles, menstrua,  and other  habitual dis-
 charges of blood ;  suppressed cutaneous eruptions ;  pneu-
 mony, catarrh, tubercles  of the  lungs, scorbutic dissolution
 of the blood.
  Therapeutics.  Absolute  rest of mind  and  body, lying
 still, abstaining from speaking (the  least motion and irrita-
 tion of the lungs is injurious),  removal of the pressure of
 dress, sitting upright,  cool air and cool beverage, a clyster
 when there is constipation of the bowels, and a venesec-
 tion in the arm, scanty or copious,  according to circum-
 stances (if extreme weakness or putrid  diathesis do not
 forbid it).  These  are the first and general remedies.  The
 promptest styptic  in hemoptysis, is a teaspoonful of pul-
 verized culinary salt, taken  dry into the mouth,  and swal-
 lowing it gradually by  drinking  a little  water  over it,
 repeated every quarter of an hour, as circumstances may
 require.
  The different characters of hemoptysis are to be investi-
 gated.
  1. The inflammatory,  plethoric, sanguineous.  Signs:
 constitution, youth, fulness of  the  pulse,  warmth,  thirst, 
HEMOPTYSIS.                  329
 suppressed hemorrhages, vascular exciting causes, mechan-
 ical lesions.  Here  a copious venesection  is to be made,
 and repeated according to circumstances, as when bleeding
 returns ; the most strict  antiphlogistic  diet  is  to be  ob-
 served, and  nitre, with cream of tartar, hyoscyamus, and
 digitalis (vide  No. 145) to  be given as  internal medicine.
 Nitre with cream of tartar  in powder, mixed in a mucila-
 ginous vehicle, is most efficacious.  Foot-baths, hanging
 the feet down, cool lotions  to the chest, injections, and in
 suppressed hemorrhages, leeches to the spot of suppression
 may all be applied.
   2. The spasmodic. Signs:  absence of the signs mentioned
 in  the preceding section, a  perceptibly weak  constitution,
 cold extremities, small pulse.   In such a case, ipecacuanha
 in small doses (vide No. 146), and tartaric acid  with hyos-
 cyamus (No. 147), must be given.  If this is of no use, and
 the state of the patient is purely nervous, acids with opium
 (No. 148) are advised.  Sometimes, however, a sanguine-
 ous congestion is combined  with  the spasmodic state; then
 give nitre with hyoscyamus, and intermediately elix. acid.
 Halleri, with  mucilaginous  emulsions,  also digitalis with
 acid, muriaticum oxygenatum (No.  149).  In  a  spasmodic
 state of the  chest, spasmodic cough,  pains and  the like, oily
 and mucilaginous remedies  (No. 150), are of excellent ser-
 vice, combined with narcotic fomentations on  the  chest,
 and sinapisms on the arms.
   3. The gastric.  Gastric,  and particularly bilious tumes-
 cences are  evidently  associated with hemoptysis.  Here
 cooling purgatives, Glauber's salt with tamarinds, and in-
jections must be prescribed ;  even small doses of ipecacu-
 anha,  and  when  the  patient  already throws up bile, its
 discharge is to be promoted by small doses of  ipecacuanha.
   But  if hemoptysis in these three stated cases does not
abate,  but persists in spite of  a treatment directed against
the causes,  or is excessively copious, it  must then be im-
mediately stopped by styptic remedies, such as  have  been
mentioned under No. 148.
   4. The passive, occurs  in  great laxity of  the  lungs
(phthisis pituitosa),  scorbutic  dissolution  of the blood,
erosion of the vessels by matter,  commotion.  None  of the
signs of vascular excitement, and of a spasmodic state are
seen here.   It therefore requires only immediate stoppage
by styptics.   However, if the  pulse  admits of it, it will be
well to commence by  a moderate venesection in the arm.
The remedies  are:  cold  above  all  others, cold air, cold
 water, cold  applications, ice on  the  chest, alum, particu-
                           28* 
330                   HEMOPTYSIS.
larly alum-whey (No. 135), which, according to my expe-
rience, is  the  most effectual of all ;  cinchona, ferrum sul-
phuricum, terra  catechu, also  culinary salt, one teaspoon-
ful at a time.
  Subsequent treatment.  After every hemoptysis, besides
the possibility of a recurrence of hemorrhage, we have
two things to  dread : inflammation of the injured spot, and
extravasation  into the substance of the lungs ;  the conse-
quence  of either  may be  suppuration  or a formation of
tubercles ; therefore it ends either in phthisis purulenta or
tuberculosa.   The  most strict antiphlogistic diet is to be
the mode  of living, the lungs  must be left in repose, and if
oppression or pain remains in the chest, a moderate venesec-
tion on the arm, or leeches are to be applied ; after this, a
vesicatory on  the spot, kept open for some time ; nitre and
cooling purgatives.  The  best means  for  cleansing the
lungs is sweet whey, or whey acidulated with tartaric acid,
solutions of mellago graminis, with  tartras potasse, after-
wards Selters water.  If, after a lapse of three weeks, the
patient has ceased to cough, and feels nothing more  in the
chest, he  is surely safe from  phthisis.   We must also at-
tend to  the remote causes and their cure ; as hemorrhoids,
abdominal diseases, dyscrasias.  Be particularly careful to
prevent relapses.  For that purpose the patient must avoid
all corporeal exercise, spirits,  singing, and any exertion of
the lungs; constipation of the bowels guarded against, and
a venesection applied, if the slightest difficulty is felt in the
chest.
  The spitting of blood, sputum cruentum, hemorrhagia oris
et faucium, when the blood is evacuated without hawking
or coughing,  and is also  generally mixed with saliva or
mucus, is  a very common occurrence and free from danger.
In this  case, the blood comes either from the mouth, the
teeth, the gums, or the  nose.  Its  causes are sometimes
local; but it may also have remote and general ones ; two
of which  deserve particular  attention ;  anomalous  piles
(for the two  terminations of the intestinal canal are in
antagonistic relation, hemorrhoides  faucium may  stand in
lieu  of hemorrhoides ani), and scorbutic dyscrasia.
  The spitting of blood generally takes  place only early in
the morning.  The treatment  consists in  local application
of astringent  collutories, of sage, vinegar,  mineral  acids,
alum ; and in the treatment of piles or scurvy. 
HEMATEMESIS.
331
                  VOMITING OF BLOOD.

           Hamatemesis.   Vomitus Cruentus.

  Diagnosis.  Evacuation of  blood  by vomiting, which
comes up pure, or is mixed with food, bile, etc.  Its color
may be light red, but is most frequently dark, blackish, and
of a venous nature.   The  quantity is sometimes small ; at
others it is great, several pounds at a time.  The vomiting
may be repeated twice or three times a day, and continue
so for several days ;  sometimes it is repeated only after
the lapse of several days, sometimes ithappens periodically.
It is followed by discharges of black, coagulated blood by
stool.  The diagnosis is sometimes doubtful.
   Concomitant  symptoms are: violent  anxiety, nausea,
tumefaction of the precordia, sometimes, but not always
pains in that region ; sometimes fever, great  prostration,
chilly sweats, fits of fainting, pale  collapsed  face,  head
generally  free  until the weakness seizes the  sensorium.
Then appear deliria blanda,  spasms; the pulse becomes
smaller and smaller, and intermittent, frequent fits of faint-
ing, death.
   It is always a dangerous accident; when it  sets in with
violent fever, it is most frequently  fatal; likewise when the
vomiting of blood returns every three or four hours.   The
same is true when it is owing to incurable  causes, scirrhus,
etc.  It is  less dangerous when it appears periodically, least
so when it is the consequence of hemorrhoidal or menstrual
anomalies.  I have seen  a man advanced in years,  who
threw up  blood from that cause,  by cupfuls, and  was so
little  affected by  it, that he was able  to take food immedi-
ately after its discharge.
   The danger to be apprehended is  subsequent inflamma-
tion of the stomach or inanition.
   Pathogenesis. The proximate cause,as in  all hemorrhages,
is a dilatation or  a bursting of the vessels of the stomach.
The blood  may come from the stomach or from the spleen
by the vasa brevia.  The remote causes : the most frequent
is an  anomalous hemorrhoidal or menstrual congestion to
the stomach ; hence it often  occurs in females after the
cessation of the menses;  after this comes obstructions of
the abdominal  viscera, effusions of  acrid bile, swallowed
glass, insects, worms, particularly leeches, contusions, and
other lesions of the stomach,  acrid poisons, among which
are violent emetics and purgatives, putriti'dissolution  of
the blood. 
332                      piles.
   Therapeutics.   The principal rule is not to suppress the
bleeding suddenly  by strong astringents, since to do so
may produce inflammation  of  the stomach, subsequent
induration of it, or, by the  accumulated blood, a gastric
putrid  fever.  Therefore  the first  and general means to
be  tried are mucilaginous  beverages of gummi  Arabic,
acidulated  with tartaric  acid, or tamarinds,  the  Riverian
saturation and oily emulsions ; intermediately fomentations
of vinegar on the epigastric region, emollient clysters, foot
baths, mustard plasters on  the calves of the legs,  warm,
emollient narcotic  cataplasms  on the abdomen.  When
plethora, or fever, or signs of an inflammatory state exist,
a venesection in the foot; leeches to the anus or vagina in
suppressed hemorrhoidal or menstrual flux.  In the absence
of these signs, or in a spasmodic state, extract of hyoscya-
mus, ipecacuanha, one eighth of a  grain every quarter of
an hour; in violent spasms, opium and musk must be ad-
ministered.
  If the vomiting of blood does not abate-after these means,
or if it set in with violence  from  the beginning, and signs
of inanition (small, intermittent pulse, fits of fainting, etc.),
alum whey  is  the  best  remedy;  intermediately, River's
potion  with laudanum and  ice-cold water may be taken,
and cold fomentations of vinegar applied to the stomach.
  After every fit of vomiting of blood, two  indispensable
rules must be complied with.  The first is to continue for
several days the use of mild acid laxatives;  the best tama-
rind whey, or a decoction of tamarinds, made with cream
of tartar ; also injections, in order  to evacuate  the  blood
which may have passed into the intestines ; the second is,
to avoid  taking  solid food for several days, since even a
crumb of bread may irritate  and  renew the  lesion of the
stomach.
                         PILES,

                     Hamorrhoides.

  We are to discriminate between hemorrhoidal disease
and piles, as between arthritic disease and local external
gout, or scrofula and scrofulosis :  they relate to each other
as cause  and effect.  The hemorrhoidal  disease is the in-
ternal morbid state, which lies at  the bottom of the piles ;
the piles  are otijy its local external phenomena.
  The hemorrhoidal disease exhibits four principal forms: 
hemorrhoids.                 333
1, predisposition  (molimina hamorrhoidalia);  2, formed
hemorrhoids,  a disease of the rectum (hamorrhoides ani
ceca et fluentes) ;  3, retrocession of the hemorrhoids (ha-
morrhoides retrogressa) ;  4, their degeneration (hamorrhoides
anomala), which may again vary in reference  to the  loca-
tion (hamorrhoides incongrua), or the quality (hamorrhoides
mucosa).
  It  is rarely a merely  local disease, but in most cases is
an internal morbid state,  of which the piles are the crisis.
This ensues either at regular periods (similar to the  men-
strual flux), or at indefinite times.   It is, however, always
an imperfect  crisis, which does not entirely  remove the
original  disease,  but may give great relief as an effect.
This is one of the most  chronic maladies, and often accom-
panies man through all  his life.  It is curable only when it
is not congenital, when it is  recent, and when  the remote
causes, embracing generally the whole mode of living, may
be corrected.   It is not  fatal in  itself, but may  turn so  by
retrocession of the  congestion to noble organs, and  by
hemorrhage.   Frequently, as a sanguineous evacuation, it
is most beneficial  and critical, in acute as well  as in  chro-
nic diseases.
  This malady is very common, and is of great importance,
not on its own account, but because the hemorrhoidal dis-
position originates many diseases, and must be  understood
before they can be cured.


               Hamorrhoidal  Disposition.

  Molimina Hamorrhoidalia, Dispositio Hemorrhoidal.

  Diagnosis.   Frequent pains in the back and the gacrurn,
sometimes flying stitches through the abdomen, feeling of
fulness there  and at the end of the rectum, costiveness,
hard, knotty stools, sensation of pressing or burning and
boring in the rectum, tickling in the rectum, perineum and
genitals,  local sweats in these  parts,  urgency to  urinate,
strangury, dysury, ischury, occasional swelling, varices on
the end of the rectum.   These signs  are frequently con-
nected with congestions of blood to other parts, as to the
head, lungs, stomach, and flushes of heat. Hereditary pre-
dispositio^a  sedentary life,  immoderate  enjoyment of
heating food and  drinks, may lead to a suspicion of hem-
orrhoidal disposition.
  The recognizance of  this period is important, since this 
334
hemorrhoids.
is the stage in which a radical cure of the disease can be
effected, and its consequences prevented.
   Pathogenesis.  The proximate cause is plethora abdomi-
nalis, plenitude of blood in the portal  system, venous con-
gestion.
   The remote causes are the same as  in every congestion.
   1. Local debilitation of the abdominal viscera, especially
of the hemorrhoidal  vessels, caused by frequent purging,
abuse of warm  drinks, especially of tea and coffee ; im-
moderate venery ; the cause may even be local, as the too
frequent use of injections, too much warmth locally applied
on these parts.
  2. Local irritation of the hemorrhoidal vessels:  caused
by the too  frequent enjoyment of heating meals and  bever-
ages, of spices, wine,  particularly  Burgundy and Cham-
pagne ;  by  aloetic and other drastic  purgatives, but also by
morbid irritations, as  metastases of arthritic, syphilitic and
other morbific matters to  these  organs, hence it is that
attacks of gout and piles frequently alternate.
  3. Mechanical pressure, by which the free circulation of
blood in the abdomen  is impeded, such  as tight lacing of the
abdomen, a continued  sitting posture, which compresses the
abdomen (hence hemorrhoids are a disease of the studious,
of sedentary workmen, especially shoemakers), constipa-
tion of the  bowels and accumulation of feces and infarcts,
physconias  and obstructions  of  the  abdominal  viscera,
especially of the liver,  which is  the centre of the  portal
circulation, the gravid uterus ; hence piles are common in
the last months of pregnancy.
  Finally, a hereditary predisposition may be the cause, and
congenital  local weakness of the hemorrhoidal system.
  The most healthy can contract hemorrhoids, when they
lead a sedentary life for a year, take much coffee  or high
seasoned food, and  stimulant beverages.
  The effects of this abdominal  plethora  (by  which all
hemorrhoidal complaints, and the importance of its patho-
genetic influence may be explained)  are the  followino- :
   1. Local  : swellings, various tumefactions of the hemor-
rhoidal vessels, inflammation, and hemorrhage from them ;
costiveness, disturbed digestion, anorexia, apepsia, acidity
of the  stomach, spasms of the stomach, colic,  diarrhoea
blennorrhoea of the rectum, vesical  diseases of all kinds
disordered  secretion of bile.                 4)
  2. General :  partly by nervous  consensus,  partly  by
transmission of the congestion  to  other parts, hypochon-
driasis, spasms, fits of  fainting, vertigo, paralysis, apoplexy 
HEMORRHOIDS.
335
diseases of the heart, asthma, hemoptysis, phthisis, partic-
ularly laryngea, hemorrhagia uteri, narium, fluor albus, vo-
mitus cruentus, mictus cruentus, cutaneous diseases of dif-
ferent forms, particularly herpes, first on the genital organs
and the small of the back, and also  on remote parts ; some-
times  transitory,  but also  sometimes permanent,  even
chronic ulcers.  A  peculiar acrimony  (acrimonia  hemor-
rhoidalis)  seems sometimes  to be developed from the stag-
nant hemorrhoidal blood.
   In all these  chronic disorders the physician must  care-
fully  regard a hemorrhoidal state  as  the source  of the
disease ; for their radical cure often depends altogether on
freeing the abdominal circulation.
   Therapeutics.  The cure of this disease can be attempted
in a double manner.
   1. By radical  treatment  (curatio  causalis, treatment of
the predispositioti), when the cause  of the  hemorrhoidal
disease is operated upon, and the hemorrhoidal symptoms
and the necessity of flowing piles are dispensed with  by its
removal.
   2. By producing the hemorrhoidal flux, which removes
local plethora and also its effects for some time, but this is
only a palliative cure; for it places the patient under the
necessity  of  the  hemorrhoidal  flux, which  at  the  best is
troublesome and  tedious, and may be followed by bad, even
by dangerous consequences.
   It must therefore  be adhered to  as  a rule, to use the
first mode of treatment, and to reserve the second for such
cases only as do not admit of a radical cure (in insur-
mountable obstructions of the  circulation of blood in the
abdomen, or other irremovable causes, also  in hereditary
disposition), or for those in which hemorrhoidal fluxes
have become a habit, or finally, when sudden  and danger-
ous accidents arise by hemorrhoidal accumulation, which
call for speedy relief.  It is only  in  these cases that the
palliative  treatment is admissible.


          Cure of the Hemorrhoidal  Disposition.

                     Radical Cure.

   Continued corporeal exercise, avoiding to remain sitting,
abstaining from  heating food and  beverages, and keeping
the bowels free, are in general the most sure means to re-
move the  hemorrhoidal predisposition.  As  certainly as it 
336                  HEMORRHOIDS.
 can be produced by a course opposite to the  one just re-
 commended, so certainly will this mode of treatment over-
 come it.   I have often had occasion to observe that travel-
 ling, or an  active country  life  continued for six months,
 combined with the diet enjoined above,  has perfectly at-
 tained the end.
   The principal indication  is to remove the  abdominal
 plethora, which is the proximate and original cause of the
 hemorrhoidal  disease.  This is done, 1. By the removal of
 all the circumstances which can  favor it,  namely: heating
 meals and beverages, sedentary life, compression of the ab-
 domen, excesses in venery ; and by taking daily a great deal
 of exercise,  frictions  on the abdomen.  No hemorrhoidal
 patient ought to work in a sitting position, but on the con-
 trary, only  in a standing one, or resting  on a high chair.
 2. By promoting the abdominal circulation, and removing
 the obstructions and accumulations that  have formed in
 the intestines.  3. By keeping the  bowels moderately open.
 The  two  last  indications are best complied with by mild
 resolvents,  extract,  graminis,  taraxaci,  tartras  potasse
 (vide No.  168), and sulphur.  The latter is the true speci-
 ficum  antihemorrhoidale.  It is undoubtedly possessed of
 a  particular  power over the hemorrhoidal vessels,  to in-
 crease their action and to dissolve the stagnations in them ;
 therefore it is also the most efficacious remedy against all
 the complaints  which arise from that source, as phthisis,
 hydrops hemorrhoidalis.  It is best administered  in pow-
 der along with cremor tart, (vide  No. 169), or in nervous
 individuals with pulv. aerophorus  (vide No. 170).  The so-
 lution of the  above-mentioned extracts, continued for seve-
 ral weeks, is often sufficient; or sulphur, continued  for
 some days and repeated  as occasion may require. The use
 of aloetic remedies, so much recommended by some prac-
 titioners,  is to be avoided in such cases, because they in-
 crease the abdominal  plethora,  the original evil, and are
 apt to cause inflammatory affections  in the abdomen, or
 local hemorrhoids, which are the very thing to be prevent-
 ed.  Castor oil  is  an  excellent laxative  in this disease.
 4.  Finally, when the remote causes are deeper seated, as
 in  great and frxed visceral  obstructions, vigorous  resol-
vents are to be used; above all the natural Carlsbad  spring
and when this cannot be  had, the  artificial  one,  which Is
likewise an antihemorrhoidal specific confirmed  by expe-
rience.  Against the metastatic causes of this disease we
must have recourse to their respective remedies* as mer-
curials for the syphilitic.   5. In merely local hemorrhoids 
HEMORRHOIDS.
337
due to local debility  of the rectum and the hemorrhoidal
vessels, injections of cold water, which may be combined
with sulphur, are the principal remedy when the accumu-
lations are considerable.
  I must not omit to strongly recommend the use of a tea,
made with the  summitates millefolii, one cup morning
and evening continued for years, in hemorrhoidal disposi-
tion and chronic hemorrhoidal complaints.
  Merely local treatment consists in the application of cold
water  to  the hemorrhoidal knots and disorders  of the
rectum, even in cutting them off.  It is not to be  denied,
that this  local  treatment will promptly remove the affec-
tion, but  this method is at once irrational and  dangerous.
It is irrational,   because  it is only  a symptomatic  mode of
curing, a removal of symptoms without  vanquishing the
cause ; and is about the same thing as attempting  to cure
scrofula by cutting and suppressing the scrofulous tumors.
But  it is also  extremely dangerous; for nothing is more
certain than that, should the abdominal plethora continue,
the suppressed  sanguineous congestion,  being deprived of
an excretory organ, will take other directions, retroceding
to the bladder,  the stomach,  or  other noble viscera, and
will produce dangerous diseases of them.  This mode of
treatment is admissible  only when it is evident  that the
disease is purely local  (owing to local weakness  of the
rectum), and when no molimina hemorrhoidalia,  no indi-
cations of visceral obstructions, no hereditary  predisposi-
tion are present.  Farther, it is  dangerous, and must be
avoided, where  flowing  piles  or retrocession  of  hemor-
rhoids to noble viscera has previously existed.

          Promotion  of the Hemorrhoidal Flux.

  This is not a radical but only a palliative method of cure,
and ought not to be resorted to except in the above-describ-
ed cases.
  Its promotion is effected in a double manner; either by
attracting the sanguineous  congestion  to the  rectum by
external means  (altrahentia), or by  exciting such a conges-
tion from within, by means which have a specific tendency
to the  rectum (pellentia).
  Altrahentia are: footbaths, steambaths, warm fomenta-
tions  ad  anum, emollient mildly  stimulant  injections,
leeches ad anum, cups in the region.
  Pellentia are  of a double kind : the mild, as pulvis aero-
phorus, borax ; the ardent, as aloes, myrrh, crocus, hellebore,
                           29 
338
HEMORRHOIDS.
iron, the balsamic pills (vide No. 171), Burgundy and Cham-
pagne wine.  (For  the use  of these remedies look under
menstruation.)
  In all plethoric individuals predisposed to sanguineous
congestion, we must employ the  drawing and the milder
exciting remedies; and when the warm excitants are  ad-
missible, they must be assisted by the external ones,  that
they may not excite sanguineous congestions in remote
noble viscera instead of in the rectum.


                      Blind Piles.

                  Hamorrhoides Ceca.

  Tumefactions of the vessels or effusions  of blood into
the  cellular tissue of the  rectum,  sometimes  without,
sometimes within the orifice of the anus (hamorrhoides ex-
terna et interne),  sometimes small, sometimes large, some-
times prominent, sack-like (h. saccate), sometimes  without
pain, sometimes  painful  (h.  dolentes),  even insupportably
painful  (h. furentes); finally they  may also become indu-
rated (h. scirrhose).
  The treatment  of the blind hemorrhoids is in  general
that of the hemorrhoidal disease (which see) : cooling diet,
exercise,  cooling purgatives, especially  the sulphur pow-
der.  External cold must only be applied when local debi-
lity is the cause, without any signs of visceral obstructions
or abdominal plethora.
  The painful piles call for the same treatment; but at the
same time rest, horizontal position, especially on a bolster,
by which  the pressure of the sanguineous accumulation is
redressed.  In very violent pain,  when  an inflammatory
state is  present,  venesection, leeches on the varices, anti-
phlogistics, externally fomentations of cold water; in great
sensibility  the unguentuxn  de Linaria,  so well renowned
from ancient times, and the same combined with oleum
hyoscyami; a methodic pressure by a compress continued
for  half an hour; in an extreme  case fomentations with
saturnine  water, or unguentum de Linaria, oleum hyosc.
of each £ ounce,  sugar of lead $ dram,  but not long con-
tinued, are the remedies.   Some individuals derive great
benefit from apple pulp steeped in red wine.  The knots,
particularly if they were internal and have been protruded,
are  sometimes really incarcerated by  the sphincter;  in
such a case replacement is necessary. We must, however, 
HEMORRHOIDS.
339
attend, and act according to  the accessory causes whieh
excite the painful state.  They are hard feces, gastric im-
purities,  taking cold, moist air,  even sometimes they are
specific,  as syphilids.  Finally, the whole attack is some-
times of a spasmodic nature.

                 Hamorrhoides Saccate.

   Here,  besides the general treatment, the local applica-
tion of cold water is required.
   The sacks grow often to  a considerable size, and thus
become  very  troublesome,  may  produce  even chronic
bleeding (daily emptying a little from the relaxed vessels),
which weakens extremely  and may cause cachexy.   In
such a case the only and sure remedy is cutting them off.
The scirrhous hemorrhoids are  often  nothing  but sacks,
containing coagulated blood ; also here a surgical operation
(opening or excision) must be resorted  to.  They may,
however, pass into  real  indurations or suppurations, and
originate fistule of the  rectum.  Here surgical treatment
is needed.

   Sudor, Serpigo, Rhagades Ani, Perinai, Genitalium.

   In these  troublesome  symptoms, besides  the  general
treatment, sulphur with cream of tartar, external cleanliness
and frequent washing with tepid (not with cold) water are
serviceable.  External astringents, saturnine and such re-
 medies are carefully to be avoided.

                 Hamorrhoides Fluentes.

   The hemorrhoidal flux is always to be considered as a
 crisis, which must not be disturbed.   All that will be said
 of the menstrual flux, applies also to this.  It  is only when
 the  discharge  becomes profuse and injurious, that  it is to
 be regarded as a hemorrhage, and requires to be stopped.
 It may burst out all at once in so great a quantity, as to
 prostrate  the  patient and endanger life; or (what is more
 common), it may put on a chronic character,  discharging a
 small quantity daily, imperceptibly leading to chronic  dis-
 eases, to nervous  affections, cachexy, dropsy.  In either
 case  astringent  suppressing remedies, applied internally
 and externally, are  requisite (vide menstrua  nimia, hamor-
 rhagia uteri). 
340
HEMORRHOIDS.
                  Suppression of Piles.

   The hemorrhoids may suddenly stop flowing, and give
 rise to violent inflammatory attacks,  colica inflammatoria,
 etc.,  which  require a prompt  antiphlogistic  treatment,
 leeches ad anum, venesection, etc.; or they may gradually
 cease to discharge.  In either of these cases the treatment
 is the same as in suppressio menstruorum. €)


        Vesical Hamorrhoids, Mucous Hemorrhoids.

                Hamorrhoides Anomala.

   There are anomalous hemorrhoids of two kinds ; first, as
 regards location ;  second, as regards quality.
   1.  Location.,  Hemorrhoidal congestion may tend  to
 every part of the organism, and produce in it the same ef-
 fects  as in the intestinum rectum, tumefactions of the ves-
 sels,  disturbed function, pains, inflammations, extravasa-
 tions, hemorrhages.  Thus arise hamorrhoides ventriculi
 (vomitus  cruentus), hamorrhoides pulmonum (hamoptysis)
 etc.  These anomalies are the effects of a hemorrhoidal
 disposition, which has not yet settled  upon the  rectum;  or
 are the effects of a suppression of piles.  The  diagnosis is
 easy  in the latter, difficult in the first case. The cure con-
 sists  in a derivation of the piles to their legitimate place,
 the rectum,  which is effected by repeated application of
 leeches and other attrahents.
   The most troublesome and painful  anomalous piles are
 hamorrhoides vesica.   They  can be  also either ceca  or
fluentes.  In  the  first  case they create great difficulty  to
 make water, strangury,  ischury, even most violent pains,
 vesical  spasms,  inflammations and their consequences,
 blennorrhea,  induration, suppuration  of the bladder.  In
 the latter case hamaturia occurs; the  blood coagulates  in
 the bladder, obstructs the  meatus, and  prevents the dis-
 charge  of the urine, and finally may lead to the generation
 of stone.   The bladder is  here in  the same  state  as the
 rectum  is in piles.  The treatment consists in drawing the
 congestion  towards the rectum, by  the  application of
 leeches to the anus and other attrahentia ; and in repelling
 the congestion from  the bladder by cold lotions to these
 parts, in combination with the  general hemorrhoidal treat-
 ment.   Four leeches  are applied to the rectum every  4
 weeks,  or as  often as local molimina (burning, swellings)
 appear at  the rectum.   The use of Selters, still better Wil- 
MELENA.                    341
dunger waters, and the spring of Carlsbad are very recom-
mendable.—In blind vesical hemorrhoids the diagnosis  is
often very difficult, they are  apt to be mistaken for stone,
vesical gout,  syphilitic affections (especially when vesical
catarrh  is present).   The chief signs are the  previous or
coexisting  hemorrhoidal complaints and their periodical
return.
  The  most dangerous  symptom that  can set in here  is
ischury, owing to occult varicose swellings in the  bladder;
or,  in fluent  vesical piles, to coagula which remain in the
bladder.  In  either case the  catheter must be  resorted to,
but only after the inflammation has  subsided.  If the intro-
duction of the catheter is difficult, bougies must  be previous-
ly passed, in order to compress the swoln vessels,  or to
force through the coagulum.
  In all cases of retroceded  and anomalous hemorrhoids
the  application of leeches to the rectum  has been observed
to be more useful than general venesection.  Nature re-
quires the  evacuation to take  place on  the critical part,
and the loss of a few  ounces of blood from the  rectum pro-
cures more relief, than pounds of blood discharged from
the  large  vessels, because the former discharge acts di-
rectly on the portal system, the latter does not.
  2. Anomaly of quality.  Hamorrhoides mucosa.  The he-
morrhoidal flux may be mucous as well as sanguineous, and
this anomaly  can happen by the rectum as well as by the
bladder and  vagina.  Tenesmus and other hemorrhoidal
difficulties coexist, follow, or have  preceded the piles.  It
is a fluor albus intestini recti,  and  like this produces ca-
chexy. The cause may be hemorrhoids, which are prevent-
ed from flowing, or a local weakness, or metastasis, or ge-
neral cachexy.  The  cure consists either in restoring the
hemorrhoidal flux, or in the general hemorrhoidal treat-
ment, or in the use of bitter resolvents and roborants, espe-
cially an infusion of millefoil, and Pyrmont and other cha-
lybeate waters.  At  the same  time regard must be had  to
such specific  causes, as may perhaps exist, especially sy-
philis (vide blennorrhaa).
                       MELENA.

                    Morbus Niger.

  Diagnosis.   Evacuation of a black tarlike, sometimes of
a brown  or  grayish  colored matter,  by vomiting and by
                          29* 
342
M ELENA.
sms.                      .     c  •
eceded by  diverse  complaints of  the
stion ; as want of appetite, pressure in
letimes violent pains in the pit  ol  the
stool; accompanied with  fits of fainting, trembling, great
prostration, and spasms.
  It is  generally prece
stomach and  of digestu
the scrobiculus, sometimes violent pai
stomach, the  abdomen, and back, increasing so as to cause
syncope.   Hypochondriacal  and  melancholic  disorders,
cachectic complexion, particularly pale yellow (habitus luri-
dus).  Precordia  tense, distended.  Most frequently the
pulse is unequal, intermittent, very variable; an important
symptom, since it justifies a suspicion of considerable dis-
orders in the abdomen  and  of imminent  danger.   Great
trouble from flatulency.—Unquiet sleep, constipation of the
bowels.
  Suddenly,  either without cause, or by a commotion, phy-
sical as well  as moral, as a fall, fright, and disease, a vio-
lent vomiting of black tarlike  matter sets in, and the same
kind is evacuated from the intestinal canal by stool.  The
pulse is soft, small,  unequal, scarcely perceptible ; there
are painful sensations in the abdomen, often with the most
violent spasms, anxiety, meteorisms, trembling, a constant
urgency to stool, cold extremities, cold sweats, ffts of faint-
ing.  This state may continue in some persons for a num-
ber of days with frequent relapses; in others for  weeks,
discontinuing a few days and returning.  I have met with
patients, where it lasted  for a  long time, (3 or 4 weeks,)
ceased, then  returned again,  and continued  so for  more
than six months.  The weakness is extreme.   The quan-
tity of the evacuated  black masses  is often incredible;  in
some cases several pounds are evacuated daily.
   It is distinguished from vomitus cruentus, by the blood
being old, corrupt, tarlike, while in the latter it is fresh ;
by cachexy  having preceded and increased to a high de-
gree, and generally by being accompanied from the begin-
ning by discharges of the same kind from the anus.
   It is always a dangerous tedious disease; death may hap-
pen by exhaustion in the paroxysm itself, or by putrefac-
tion and  putrid fever or  cachexy, hence tabes or hydrops
is a most common sequel.
   Signs pointing to a fatal issue are: weakness always in-
creasing, fits of fainting becoming more frequent, cold ex-
tremities and cold sweats setting in,  rep< ated and larger
quantities of the  matter  being discharged, and the pulse
becoming so small as scarcely to be felt.
   Pathogenesis. This disease  originates in an exceedingly
 engorged state of all the vessels of the stomach, intestinal 
                       HEMATURIA.                   343

canal, and mesentery; chronic overfilling of all these ves-
sels with old stagnant blood, which by length of time be-
comes excessively tenacious, tarlike,  and finally putrid*,
corrupt,  and acrid.  The veins, indeed, seem to be in a very
varicose condition, for the quantity of corrupt blood evacua-
ted is often so large, that great sacks and dilatations must
be supposed to exist, in which it had stagnated.  The ves-
sels have been found on dissection, sometimes enormously
dilated, resembling thick cords.
  This stagnant blood renders  the vessels more and more
fragile, so that they burst from a slight cause, and effuse
their contents into the intestinal canal.
  The remote causes are : particularly a sedentary life,
which compresses  the abdomen (hence  it is most frequent
in sedentary  workmen,  as shoemakers, etc.), continuous
sorrow,  heavy, constipative, or too rich, nutritive,  heating
food, ardent beverages, suppression of piles or menses.
  Therapeutics.  The indications are :  to assuage the ir-
ritation,  and  correct the corruption ; then to  administer
mild roborants,  paying continual  regard  to stagnations
in the abdominal viscera.   But a sudden suppression is to
be avoided here as well as in  vomiting of blood. The best
remedies are : tamarind-whey, tartaric acid,  potio Riveri,
with frequent mucilaginous drinks,  emollient injections;
aromatic, narcotic fomentations with vinegar, and plasters
on  the epigastric  region ;  but above  all tepid aromatic
baths, from which I have  seen  material relief in several
cases, when  vomiting refused all internal medicine.  In a
long duration of the  malady and great prostration,  malt-
baths,  and nutritive  injections of  broth and the yolk of
eggs. As roborants, an infusion of millefoil, centaur, minor,
finally columbo and cinchona are to be given.
  Millefolium and  visceral injections are particularly  re-
commendable for subsequent treatment and for preventing
relapses.
                 MICTDRATION OF BLOOD.

              Hamaturia,  Mictus Cruentus.

  Diagnosis.  Discharge  of blood  with the urine, either
mixed with it like dark beer (from the kidneys,  hematuria
renalis), or separated from the urine,  coagulated, lying on
the bottom of the glass (from the bladder,  hamaturia vesi-
calis).  In renal hematuria difficulties and  pains are felt in 
344
HEMATURIA.
 the region of the kidneys;  in vesical hematuria the same
 are felt in  the region of the bladder.  The discharge of
 blood  from the urethra (stymatosis)  is recognised by  the
 blood  issuing independently of making water.
   Vesical hamaturia is  most frequently hemorrhoidal (ano-
 maly of piles, hemorrhoidal flux through the bladder;  see
 hemorrhoidal disease).  Besides, it may  be produced by the
 irritation  of  a  stone in the bladder  (vide lithiasis), or by
 ulcers  and other organic diseases situated there.
  Renal hamaturia  is  owing to  gravel or to debility and
 atony of the renal vessels (principally by excessive drink-
ing, particularly diuretic beverages,  as  beer, tea, or diure-
tic medicines;  strong commotion from  continued riding in
a carriage or on horseback, blows, also excess in coition);
likewise to suppression  of  habitual  evacuations of blood,
as piles ; to spasm and consensual irritation,  especially of
gastric accumulations, worms, violent  exertions in lifting
a heavy load, by which the blood  is forcibly pressed into
the kidneys; to inflammation of the kidneys, and finally to
a dissolution of the blood, as in scurvy, morbus h&morrha-
gicus,  putrid  fever; and to  old age.
  Sty?natosis is merely  hemorrhoidal, a consequence of he-
morrhoides urethre, varicose vessels in the urethra.
  Therapeutics.   The treatment must conform to  the gene-
ral principles, especially to  the various  causes and charac-
ters (vide hamoptysis).  Adynamic  hematuria is the most
common.  It is recognised by the debilitating causes, ab-
sence of pain, signs of congestion,  old age, and frequent
relapses. The best remedies are: cold washing and fomen-
tations on the lumbar region, spirituous embrocations, infu-
sions  of agrimony, millefolium, salvia;  in  worse cases
alum-whey, also chalybeates, cinchona, ratanhia, sulphate
of iron, avoiding all   fermenting drinks, mineral waters,
and concussive  motions.   When there is sanguineous con-
 gestion, suppressed hemorrhages,  and  an  inflammatory
 state,  blood is  to be abstracted ; the  suppressed hemor-
 rhages are to be restored or compensated, cooling remedies
 (vide hamorrhoides  vesica)  are wanted.  In a spasmodic
 state  ipecacuanha in small  doses, oily  emulsions, opium;
 in commotion cold fomentations,  venesection, then arnica;
 after abuse of cantharides, oily emulsions and camphor are
 advised. If it is owing to calculus, bleeding, antiphlogosis,
 and the treatment of stone (vide  lithiasis) must  be  resort-
 ed to. When  it is consensual,  arising from bilious and
 gastric accumulations,  purgatives,  and, if indicated,  an
 emetic, are best. 
HEMATOSIS.
345
  In all  kinds of hematuria a  tablespoonful of poppy or
almond-oil,  taken morning and  evening,  has proved very
beneficial. If stoppages of the urinary discharge are caused
by coagula of blood in the urethra, injections, bougies and
catheterism are required.
  Afterwards, a cleansing of the kidneys and bladder from
coagulated blood  must be effected, which  may be done by
Selters water with milk, or still better by Wildunger water.
            METRORHAGIA.

Vide Diseases of Women, Menstruation.
                HiEMATOSlS, PETECHIANOSIS.

       Morbus Hamorrhagicus Maculosus Werlhofii.

   Diagnosis.  Small and large dark blue, petechia-like spots
 on different, sometimes on all parts of the body, sometimes
 also vibices, frequent epistaxis, bleeding  gums  and palate,
 also other hemorrhages, great prostration ;  no fever.
   The disease is very similar to pectoral  fever and scurvy.
 It differs from the  first by the absence of fever, from the
 latter by the absence of the bad smell from the mouth, and
 is a more  infantile malady.  It is, however, to  be classed
 among scorbutic diseases.
   The disease may last very long, and  finally terminate
 fatally by  entire  debilitation, or by violent, ever-and-anon
 returning unsuppressible hemorrhages.
   It is always owing to a decomposition  of the blood and
 weakness of the vascular system.
   The treatment  requires vigorous administration of robo-
 rant and astringent remedies.  Cinchona,  mineral  acids,
 combined with baths of oak bark are here most serviceable,
and I have always conquered the disease by them.
  The hamatosis  hereditaria, the innate disposition  to all
kinds of  hemorrhages, which is peculiar to  some families,
which are »alled on that account bleeders, can be only pal-
liatively assuaged, but not  radically cured.   It commonly
leads to death by hemorrhages. 
346                  BLENNORRHCEE.
                 II. Hlennorrhcea?.

                       Generalities.

   Diagnosis.   Unusual or excessive evacuations of mucous
 or serous humors.
   They can take place in all secretory organs, and constitute
 one of the most common and numerousclasses of diseases.
   The effects are multifarious, partly local, partly general,
 and then  often very  important to the well-being of the
 whole  system.  The  local ones  are :  local  debilitation,
 increased irritability, constant disposition to inflammatory
 affections, various  degenerations of reproduction and dis-.
 organizations; the general ones are: general debilitation
 of the whole organism, increased sensibility (especially in
 fluor albus), nervous diseases,  emaciations, finally, when
 the  loss of humors becomes considerable or concerns  a
 noble organ (as the lungs), lingering fever and fatal tabes.
   Pathogenesis.  Their cause is, as in all  profluvia, either
 increased action (irritation) or debilitation.
   1. The first is of an inflammatory or of a nervous nature,
 and the exciting causes may operate either idiopathically
 or sympathetically.  Of the first (idiopathic) class  are :
 sanguineous congestions, metastases, specific, miasmatic
 morbific matters, foreign bodies (to which also pseudo-or-
 ganizations belong), often also  increased irritability  of  a
 single part, by which it happens, that even common  irri-
 tants create too strong a reaction.  The sympathetic are
 either consensual or antagonistic.  The consensual  irrita-
 tion originates most frequently in the  intestinal  canal and
 the abdominal viscera ; the antagonistic in the skin.  Sup-
 pression of the  cutaneous  action, and transmission of
 the function of the  skin to another muco-secreting organ is
 frequently  the sole cause of obstinate  blennorrhceas (as
phthisis pituitosa, fluor albus).
  2. The  second  fundamental cause,  debility,  is  either
the product of  general debility or only a local debility of
the affected organ, sometimes primitive, but more  fre-
quently only consecutive of a former irritation^sometimes
also  both united ; weakness combined with increased irri-
tability or stimulation.
  Therapeutics.  The general treatment  consists partly in
doing away with the remote causes, which alone often suf-
fices for a cure (indirect  cure) ; as removal of  the inflam-
mation, sanguineous congestion, general debility, the idio- 
SALIVATION.  SWEAT.               347
pathic (often specific), or  consensual, or  antagonistic
morbific stimuli, etc. ;  thus, the restoration of the cutane-
ous function  is in itself sufficient for curing fluor albus and
phthisis pituitosa.  The treatment may be partly direct,
operating  immediately on the morbid state of the affected
organ ;  or local  weakness,  morbid  irritability, perverse
secretion, disorganizations ; for which purpose  general as
well as local means are applicable.
  The blennorrhea  of single organs, see  under their  re-
spective  names, as blennorrhea  vagina et uteri,  s. fluor
albus, blennorrhaa pulmonum s. phthisis pituitosa.
                       SALIVATION.

                       Ptyalismus.

  Immoderate secretion or discharge of saliva.  When of
a long duration, it is also injurious to health, even to life ;
as it not only is a waste of the elements of the body,  but
especially  of  a juice  which is indispensable to digestion
and nutrition.   The consequence is emaciation, tabes.
  It is most  frequently owing to an abuse of mercury,
taken for too long a time or in too large  a quantity.  Be-
sides, it may be generated by  scurvy or obstruction in  the
abdominal  viscera, especially  in the pancreas, and even by
the habit of constant spitting, particularly  by immoderate
smoking or chewing tobacco.
  The cure of mercurial salivation is effected by repeated
purging, sulplrnr, tepid  baths,  opium (treatment of mercu-
rial disease);  in extreme  cases  by iodine.  If it be  the
effect of scurvy or of abdominal obstructions, it  calls in
the first case  for the  antiscorbutic, in the  second for  the
resolvent method of treatment.
                         SWEAT.

                       Epidrosis.

  Diagnosis.   Immoderate and  constant sweating.
  This is very rare  as  an independent  disease ;  when it
occurs, it is generally a symptom of other  diseases, espe-
cially of  the colliquative stage of consumptive maladies, of
scurvy, of  several kinds of nervous  debility, cessation  of
the menses (in this case may last for years), and of the mi- 
 348             INCONTINENCE OF URINE.

 liary fever, in which it exists as a pathognomic  symptom
 from the onset, and is  particularly abundant.  In extremely
 rare cases, it may appear without the miliary eruption as a
 febrile disease (the sweating fever), even epidemically and
 contagious, which is proved  by the sudor Anghcus of the
 seventeenth century, when men wasted  away by sweating
 within a few days (an external cholera).
  This profluvium prostrates the vital power exceedingly,
 and may rapidly exhaust it.
  The cause is weakness, a paralysis of the skin, too strong
 congestion of the humors towards the surface, and decom-
 position of them.
  Accordingly, the cure requires invigoration of the skin
 and  arrestation of the internal dissolution and decomposi-
 tion of the humors.   The principal  remedy, complying
 with both indications,  is mineral acid ;  the most vigorous
 is acid, muriat. oxygenat. (of which I have  seen excellent
 effect, when  taken in  the quantity of one half up to two
 ounces a day), acid, sulphur, and alum.  Next to these, a
 tea or a vinous infusion of sage, has proved specific in such
 cases, rnd boletus laricis, five to thirty grains daily.  The
 conditional cause of the disorder, such as a  scorbutic dia-
 thesis, phthisis or hectica, must be attended to at the same
 time.  Bathing with vinegar, cold water, diluted mineral
 acids, ice, are advised  as local applications.
  Epidrosis localis (sweating of the feet, the genitals, hands
 and axille), occurs more frequently, and is generally con-
 nected  with a qualitative  corruption of the secretion  by
 which a bad smell is emitted, thereby rendering  the com-
 plaint very disagreeable.  It  can  be  easily suppressed  by
 alum and saturnine ablutions ;  but he who ventures to  do
 so is threatened with blindness, deafness, asthma, phthisis,
 indeed, all  kinds  of metastatic disorders.  The only safe
proceeding is  gradually to wean and invigorate these parts
of the skin, by washing and bathing them with a decoction
 of chamomile  and sage; in order to smother  the bad odor,
 the parts may  be  washed with chlorine water.
                INCONTINENCE OF URINE.

             Enuresis, Incontinentia Urine.

  Diagnosis.  The patient has a constant involuntary drib-
bling of urine (enuresis complete), or the urgency to pass it
is so sudden  and great, that he is immedrately forced to 
                 INCONTINENCE OF URINE.             349

yield (enuresis  incompleta,  spastica) ;  or it  escapes from
him  only during sleep (enuresis nocturna).
  Pathogenesis.  The causes of enuresis spastica may be : a
continual irritation in the bladder or in some contiguous
part : calculus, acrid, sabulous urine (as in  old persons),
worms, particularly ascarides, menstrual or  hemorrhoidal
congestion of blood to the bladder, gastric accumulations,
scirrhosities in the bladder, rectum, or  prostate gland, or
ulcers,  fistulas.   Or  mechanical pressure, as that  of the
gravid uterus in the last months, or of other tumors in the
abdomen. Finally, the bad habit of too frequently urinating,
by which the size of  the bladder is diminished.
  The causes of the enuresis completa paralytica are : atony
and  paralysis of the bladder, difficult parturition, apoplexy,
strong commotion of the spine (after a fall on the back or
nates), tabes and paralysis dorsalis, too great distention of
the bladder  by long retention of  urine, operation of litho-
tomy, old age.
  Therapeutics. The enuresis spastica is cured by removing
the respective irritation.  I cannot sufficiently direct the
attention to worms and their  removal, also  to  gastric ac-
cumulations; the continued use of dissolvents and  purga-
tives give most  relief.  In sabulous  accumulations  in the
bladder, pulvis aerophorus natronatus (No. 172) is advised.
The remedies may be combined with hyoscyamus  and
spasmodic embrocations.
  The enuresis atonica admits with difficulty of a cure.
The remedies are : roborants, excitants, astringents, ap-
plied internally and externally ; cold douches, electricity,
cantharides (vide ischuria, paralysis).   When the  case is
incurable, there  is no expedient left, but that of wearing a
urinal or a compressor.
  The nightly enuresis of children is most frequently only
a bad habit, and is corrected by care, by diminishing the
quantity of  the  evening potation, lying  on' the side, awa-
kening them several  times during the  night in order to
make water, also by chastisement in  the morning, the ef-
fects of which will be remembered, even in sleep.  If all
this  do not avail, we tnust examine whether or not an irri-
tation, as worms, be the cause of it, or a local  weakness,
especially in adults ;  if so, roborants are to  be given.  In
extreme cases, a flexible bottle  properly secured, may be
used.
30 
350
DIABETES.
DIABETES.
   Diagnosis.   Excessively increased  secretion  of urine,
 which may or m'ay not be qualitatively altered, accompa-
 nied by a morbific  influence on  the whole system.  It is
 merely  an increase of urine, which  generally becomes
 more and more watery (diabetes insipidus spurius), the
 quantity of which reaches to fifty or one hundred pounds a
 day ;  or is alteration of it, milky or vinous, partaking of the
 properties of the  beverages drunk (diabetes verus).  The
 most frequent and  remarkable species  is that in which the
 urine is inodorous, of a sweetish taste, and contains sac-
 charine  matter, up to an ounce in a pound, (diabetes melli-
 tus), while the urine itself decreases.
   The  concomitant accidents of diabetes are : dry skin,
 thirst, drawing  pains in the back  and  loins, disagreeable
 sensations often increasing to a violent burning in the pre-
 cordia.  At last, a  lingering fever, emaciation, paralysis,
 accumulations of water, finally death, under symptoms of
 colliquation or apoplexy.                         •
   An important practical rule is, never to omit examining
 the  urine of all patients who emaciate  independently of
 pectoral complaints or other considerable local disorders
 for many a person has died of this disease without its being
 suspected by the physicians, since it often happens that the
 quantity of urine is not much increased in this species (the
 diab. mellitus).                                      v
   Pathogenesis.  The proximate cause is a faulty condition
 of the secretive function of the kidneys, either in quantity
 or in quality, or in both.
   The most important  of the remote causes is : chronic
 suppression of the cutaneous  secretion transmitted  to the
 kidneys.  I know an instance of a woman, who, having
 gone in a state of perspiration into a cold cellar where she
 remained long, contracted so violent a diabetes that it  lasted
 for years, and could  be remedied only with great difficulty
 Another  cause is debilitation of the kidneys and  of the sni
 nal marrow by excesses in  venery and in drinking ; also
 sanguineous congestions to this organ, suppression o piles
 and catamenia ;  hysteria, hypochondria, gastric stimufants
 and worms ; metastases and local irritants of the kTdnevs
 as stone and gravel.                              lu"e)i')
  In diabetes mellitus a singular derangement of  the ani-
mal-chemical process of the kidneys takes place, by which
sugar is  prepared from  the humors carried th ther in  a 
DIABETES.                    351
manner analogous  to that by which stone and gravel is
created in lithiasis, and by which starch and linen  may
be transmuted  into sugar by (sulphuric) acid.  This is
formed chiefly  from the chyle in the blood, which, when
first admitted,  may be  easily separated by that peculiar
chemical affinity and attraction, which  seems to exist for
if in the kidneys.  This loss of chyle accounts for the ema-
ciation and debility met with in this disorder.
   Therapeutics.  The cure  is very difficult.   It is most
essential to inquire.into the various remote causes  and to
act accordingly.  This  will lead to very different modes of
treatment.  If  it be owing to long checked perspiration,
this function  of the skin must be restored by diaphoretics,
especially by camphor and ammon. sulphurat. (two grains
daily Beguin's  sulphur balsam), from both of which I have
seen excellent effects in diabetes  mellitus;  hot baths, Rus-
sian baths, frictions ;—a treatment which, On  account of
its vigorous derivation from the kidneys, is also beneficial
in all other kinds of diabetes.  If atony or preceding debil-
itating causes have given rise to it, roborant remedies will
be needed ; suppressed  hemorrhages, or a plethoric  inflam-
matory constitution require abstractions of blood ;  I have
seen diabetes mellitus arise from amenorrhea, and disap-
pear on a return of menstruation.  If the disease is due to
gastric accumulations and worms, emetics and  helminthics
are to be administered ; if owing to visceral obstructions,
resolvents.   I  have seen it  happen as a consequence of
obstruction in the liver, and cured by Carlsbad spring and
the  use of soda and bitter extract.  If nervous debility,
increased sensibility, hysteria and hypochondria are con-
stitutional causes of diabetes, nervines, antispasmodics (asa
fetida, belladonna, cuprum ammoniacum) are advised ;  if
nephritic  calculus, gravel, lime-water, magnesia, andalka-
lines must be prescribed.
   Should these means not suffice, it  is best to operate
directly on the  renal complaint and the lumbal nervous sys-
tem by active  nervines and  narcotics,  by  roborants (cin-
chona,  iron,  particularly Spa water), by derivation to the
skin, and artificial ulcers. Opium  in increasing doses, along
with lime-water and warm baths, have also, according to
my experience, performed the  cure of diabetes mellitus;
likewise kreosote in large doses, from ten to twenty drops
a day.  A consideration of the chemismus is very  import-
ant in this species.   It is certain that, as long as the patient
does not take vegetable food, and lives solely upon eggs
and meat, he does not produce  saccharine matter  in the 
352        LEUCORRHOEA.  CATARRHUS VESICE.
urine, and though no radical cure is effected, animal diet is
promotory and essential to cure it.  The use of fresh ox-
gall has also proved efficacious.
                      LEUCORRHCEA.

               (Vide Diseases  of Women.)


                   CATARRHUS  VESICE.

                      Cystorrhea.

  Diagnosis.  Discharge of mucus with the urine, accompa-
nied sometimes with little, sometimes with great difficulties
in making water.
  This disease in itself is generally without danger, except
such as  may  attach to the cause, of  which  it is a sign.
  However, besides the difficulties of  making water,  it
may itself become injurious to  health and to life, even pro-
duce tabes, when the discharge of gelatinous matter useful
to the economy becomes very copious.  We must be care-
ful  to discriminate between the discharge of mucus and
that of pus.   The corrupt  secretion of mucus may  (as in
phthisis pituitosa), gradually degenerate  into phthisis vesi-
calis.
  Pathogenesis.  The causes are most  frequently local; as
a local irritation of the bladder  by gravel, stone, chronic
inflammation, induration (also of the prostate gland), the im-
moderate use  of diuretic drinks, also  diuretic  medicines,
wearing  a catheter or bougies for a long time, metastases,
especially psoric, arthritic, rheumatic,  syphilitic, most fre-
quently  hemorrhoidal  congestion (hamorrhoides mucosa
vesica) ;  or  local debilitation, in consequence of a prece-
ding irritation,  inflammation (subsequent malady of the
diseases  before mentioned), or venereal excesses,  or  as
a consequence of too great a distention of the bladder
after long continence  of urine.  Also sympathetic  irrita-
tions of the abdomen, worms, and infarcts may contribute
towards engendering the disorder.
  Therapeutics.  For the treatment we have  to carefully
examine  whether  stone  or gravel is" not the  cause;  in
which case the correspondent course is to be taken.   The
various remote causes are also to be considered.  In hemor-
rhoidal congestion, sulphur, a solution of extractum  tarax- 
GONORRHOEA.
353
aci with soluble tartar, the occasional application of leeches
ad anum (vide hemorrhoidal disease, vesical  hemorrhoids) ;
in catarrhal, rheumatic,  arthritic, psoric metastases,  the
cure of chronic rheumatism, of gout, of psora must be pur-
sued ;  for which woollen clothing, warm baths, and exuto-
ries  are  recommendable.  Roborants, cinchona, and iron
may be prescribed to remedy  atony,  in all kinds of cys-
torrhea, Wildunger water is an excellent remedy.  Besides
uva ursi, lime-water, also phosphoric acid have proved very
salutary  ; likewise all remedies recommended in fluor albus.
   Particular attention is due to the  discharge, whether it
be pus or mucus ; if the latter, the treatment of  phthisis
vesicalis is  to be adopted.
  •                      CLAP.

                      Gonorrhea.

  Diagnosis.  Constant or periodical flux of mucus from
the urethra, with or without pain.
  The most frequent cause is coition with a person already
affected with a syphilitic or other kind of fluor albus, or a
local disease of the uterus and vagina.   But a gonorrhea
may arise also without improper connection, by metastases
(especially the rheumatic, arthritic, psoric), to the mucous
membrane of the urethra ; or by hemorrhoidal congestion,
and by anomaly.
   The discriminative signs can be derived only from the
origin.   Gonorrhea which follows coition must always be
regarded as a specific syphilis; the non-specific species is
recognized by not  having been preceded by sexual connec-
tion,0 but by rheumatic, arthritic or hemorrhoidal affection
having previously  existed or alternated  with them.  It also
sometimes happens that a gonorrhea primarily specific, is
subsequently  entertained  by some external  or  internal
cause, and  passes into  a  non-specific  (gonorrhea secun-
daria).
   Therapeutics.  For the treatment  of the specific,  look
under syphilis, gonorrhea syphilitica,   'ihe treatment of
the non-specific is adapted to  the respective causes,   ihe
arthritic and rheumatic is treated as gout and rheumatism ;
the hemorrhoidal  as hemorrhoidal disease.   Use the rem-
edies appropriate  to the various morbid states, and it  this
do not suffice, combine with them such  medicines as have
a  specific tendency to the mucous  membrane  of the  ure-
    V                       30* 
354                SEMINAL WEAKNESS.
thra ; of which balsamum Capaivae, twenty to thirty drops
on a piece of sugar, taken several times a day, is the prin-
cipal remedy.   Avoid in  such cases astringent injections,
by which very bad metastases may be engendered.
                   SEMINAL WEAKNESS.    •

                   Pollutio.   Onania.

   Diagnosis.  Involuntary and too frequent  emission of
 semen ; nocturna, when it occurs only in the night in vo-
 luptuous, dreams ; diurna, when it happens in day time by
 the least mechanical or physical irritation, as by riding on
 horseback,  by defecation,  especially  when costive; by
 every amorous thought, sight, touch.
   Pollutio nocturna is a natural excretion,  if it occurs but
 seldom, as in young, plethoric, abstinent  persons, and is
 not injurious except when it is too frequent, every two or
 three days; then it produces all the consequences of onan-
 ism (by which it is also generally caused), as : debilitation
 of the nerves, hypochondriacal and hysterical  complaints,
 spasms, weakness of sight, of memory, of all  the mental
 faculties, .especially that of manliness of character and of
 love of life. The abundant loss of semen, of that substance
 which  imparts life, has this peculiarity, it destroys the love,
 courage of life, and brings on a disgust of life (tadium vita),
 becoming one of the most frequent  causes of suicide.
  The pollutio diurna is the most debilitating and destruc-
 tive of all the profluvia, and causes, besides what hal already
 been mentioned, falling out of the hair, local lameness, im-
 becility, t.ibes  nervosa,  particularly  dorsalis,  and finally
 terminates in death.
  Masturbation (onania), although, properly speaking, this
 is a vice, is also  to be mentioned here, since through habit,
 it at last becomes a disease, an irresistible instinct for sem-
 inal discharge.
  Pathogenesis.   The proximate cause is weakness, with
 increased  sensibility and  irritability (irritable debility) of
 the genital organs, especially  of those  which procreate,
 preserve, and discharge the sperm.  In the highest deoreej
 that  of pollutio diurna, there is extreme  atony of the
 seminal vesicles and excretory canals, so  that mere pres-
 sure suffices to empty them.
  The  occasional causes  of too frequent pollutions may
be all  kinds of  abdominal irritants,  as  worms,  gastric 
SEMINAL WEAKNESS.
355
accumulations, habitual  obstructions,  plethora of the ab-
domen, constant sitting, but most frequently they are owing
to masturbation, which in children and young people often
proceeds from the same causes, the physical as well as the
moral, that is, a corrupt  imagination,* constant indulgence
in voluptuous images and thoughts.
  Pollutio diurna is the final product of long continued and
immoderate onanism.
   Therapeutics.  The  cure of too frequent pollutions is si-
multaneously the cure of self-pollution ;  and is impossible
without conquering the last.   The first thing to be done  is
to annihilate the remote causes, abdominal  irritations, as
worm.s, gastric accumulations, costiveness, plethora abdo-
minalis ; to alienate the imagination from voluptuous ideas,
and to occupy it  with serious abstract topics ; to use  and
fatigue the physical powers by  strong exercise and exer-
tion of the body,  so that the patient shall be fatigued at the
time of going to bed; to avoid a too nutritive and stimu-
lant  diet, as meat, eggs, spices, wine  and spirits, and to
live more on vegetables  and fruit;  to eat little or nothing
in the evening, not to lie on the back, and to rise early in
the morning.  Masturbation, if already practised, must be
abandoned.
  To this must be joined the cure of the proximate cause.
The genitals must be invigorated, and their  morbid irrita-
bility diminished.  Here, however, great caution is neces-
sary.   For if the roborative treatment  is carried on too
violently, too rashly,  or by too stimulative  means, the local
irritation will be increased, and thereby will the pollutions
and debility be augmented; effecting just  the contrary to
what  was intended.   Therefore, we are to  begin with such
roborants as  cool and diminish the  irritability ; as mineral
acids, especially  acid,  sulphuricum.  The  best method,
according to my experience, is  the elix. acid. Halleri, ten
to twenty drops three times  a day, combined with  Island.
moss, in jelly  or decoction,  mixed with  tinct. cinchone
Whytii (vide No.  173), then pass to columbo (vide No. 174),
which is here the most proper of all tonic roborants, and
will  often cure  by itself.  The pills No.  175, are also of
excellent service.  At the same time, local means of a  sim-
ilar tendency to diminish the irritability  and to invigorate,
may be used ; as, frequently washing the genitals, perine-
um,  and  sacrum  with cold  water ;  afterwards with the
liquor anterethi<?us (No. 176), mixed with one sixth part  of
spirit of camphor ; immersion of the genitals, perineum,
and sacral regions in a tub of cold water,  repeated several 
356                   OTORRHCEA.

times a day;  likewise river and sea baths  are  necessary.
The undeniable power of camphor  to diminish  the sexual
desire and pollutions, may also be profited of with benefit:
it may be given internally, one or  two grains along with
nitre, morning and 'evening ;  externally, combined with
liquor  anterethicus, or  in  little bags worn next the scro-
tum (vide No. 177).  See satyriasis, nymphomania.   If this
is not sufficient, or the evil has attained the highest stage,
that is pollutio diurna, then strengthening and  astringent
remedies, as cinchona, quassia, ratanhia, terra catechu,
gummi kino, iron, especially sulphate of iron, and the cha-
lybeate wine (No.  106),  the Pyrmont spring, internally and
by baths, by which I have seen perfect cures  performed,
may be  resorted  to; when the latter cannot be had, the
artificial chalybeate baths (half an ounce of sulphate of iron
for  each bath) may be substituted.
                       OTORRHCEA.

   Diagnosis.   Discharge of a serous, mucous, sometimes
 purulent matter, which is either inodorous, or of an offen-
 sive, putrid odor,  from one or both ears.
   It is usually met with in  children, and is almost always
 the effect of a scrofulous metastasis to the mucous mem-
 brane of the meatus  auditorius, being analogous to scro-
 fulous blennorrhea of the eyes, with which it very often
 alternates.  It is often  owing to a  rheumatic or catarrhal
 metastasis,  a  catarrh of the ears.  It may,  however, be
 concomitant or consecutive of otitis, which is recognized
 by the presence of pain.  A psoric or syphilitic metastasis
 may also  be the cause.  Finally, an internal  suppuration,
 even caries may produce it ; a cause that is recognized by
 the fetid and  purulent quality of the matter.   It is, how-
 ever, well to  remark, that not every putrid smell of the
 discharge does indicate  suppuration  or  caries; for  this
 may also exist in a purely catarrhal otorrhea, as is like-
 wise observed in  a  violent coryza.-  This complaint is
 insignificant in  itself, especially in  children.   If of long
 duration, it  may be followed by weakness of hearino-  and
 organic disorders.
  The cure must be effected by general  means, and such
remedies as have a particular tendency to the respective
dyscrasia ;  or  by derivatives.  Thus, the use of pulvis an-
tidyscrasicus,  intermediately purgatives, and vesicatories
behind the ears are generally sufficient to cure  the scrofu- 
LIENTERY.                    357
lous and rheumatic  otorrhea.  Lukewarm milk or weak
soap water may at the same time be used for cleansing the
ears.  Be careful  not to use strong,  lpcally suppressing
remedies, as zinc, vitriol, mercury, lead, and other metallic
salts. They are apt, by sudden suppression of the discharge,
to cause the  most  serious consequences, deafness, and
even metastasis to the brain.  It is only when the discharge
is obstinate and  continues  after the  use of the general
means, or becomes malignant and purulent, that they may
be resorted to.
                        LIENTERY.

                        Lienteria.

   Diagnosis.  Evacuation of the aliments (solids as well as
 liquids), in an indigested state.  (We must not mistake for
 it the discharge of such substances as the  best  stomachs
 do not digest; the hulls of  peas, lentils, berries,  the fibres
 of some vegetables,  the green color  of spinage).  It is
 sometimes combined with vomiting, generally with  insa-
 tiable hunger.  Pale countenance, prostration, emaciation,
 finally lingering fever, associate with it.
   Pathogenesis.   The proximate cause is a  too quick  pas-
 sage of the nutriments through the stomach, and without
 being digested.   It can originate in a  total  loss* of assimi-
 lative  power, faulty condition  of the  chyle, a morbid irri-
 tability of the stomach, or in a morbid stimulus, particularly
 gastric impurities, acrimonies thrown there per metastasin,
 worms, also in organic disorders of the stomach.  Gluttony,
 especially  of raw, fermentive  vegetable substances, sour
 wines, too  rapid swallowing of the aliments, also abuse of
 purgatives, frequently give occasion to it.
  Therapeutics.    When indications  of impurities  exist,
 cleansing the stomach  by  emetics  and purgatives, and
 strengthening it,  simultaneously diminishing its  increased
 irritability.   This  purpose  is  attainecFTiy the  following
 remedies:  bitter  roborants with aromatics and small doses
of opium, particularly radix columbo, quassia, extract, cort.
aurantiorum,  myrrh, aquosa ; also aloetics, the  balsamic
pills of  Hofmann, extract of hops, tinct. cinchone Whytii,
rad. calam.,  zingiber, chalybeate  milk, with  the yolks of
 eggs (prepared by quenching a hot iron in it) ; salep, rice-
pap, substantial broth, strong,  sweet, or astringent  wines
 without acidity (Madeira, old Malaga, Burgundy, Pontiac, 
358       FLUXUS COELIACUS.   FLUXUS HEPATICUS.
wine with  nutmeg), ferruginous mineral waters  in  small
doses,  with  milk, lime-water,  acorn coffee, quinces,  bitter
beer.  Externally balsamic spirits, herb cushions moistened
with rum applied to the epigastric region, in extreme cases
a moxa (vide weakness of the stomach, diarrhaa chronica).
We must at the same time attend to the removal of worms,
metastases, and other  morbific causes, especially  those  of
a rheumatic and arthritic character, also lurking  syphilis,
when they  exist.
                    FLUXUS COELIACUS.

  Diagnosis.  Evacuations from the intestinal canal of a
white color, resembling milk or chyle, sometimes  mixed
with excrements, also with blood ; sometimes suddenly fol-
lowed with tenesmus.  Bad digestion, pale countenance,
finally emaciation, lingering fever, death.
  Pathogenesis.  The cause is a blennorrhea intestini recti
(similar to the blennorrhea uteri), a fluor albus intestini
recti.  The remote  cause  may be the same as in fluor al-
bus, especially a hemorrhoidal congestion  (hemorrhoides
mucosic), metastases, atony of the intestinal canal.
  Therapeutics.  The cure of the hemorrhoidal disease, of
the  specific morbific matters accidentally existing, of the
metastases, obstructions of the liver, and other abdominal
viscera; the use of bitter tonics, as columbo,  millefol.,
quassia,  lignum campechiense, martials, Pyrmont  water,
visceral and roborant injections are particularly advised.


                    FLUXUS HEPATICUS.

  Diagnosis.  Watery and mucous  stools, resembling in
color the lymph of blood, with and  without excrements,
without  tenesmus and  colicky pains,  in  greater  or less
quantity, up to te^or twelve times a day ; it is also some-
times intermittent;  very chronic, lasting for years ;  final-
ly prostration, emaciation, lingering fever.   (It is  a rare
disease.)
  Pathogenesis.  The cause is an exhalation of serum into
the small intestines.   Most frequently it is caused by hem-
orrhoidal disease, by obstructions of the abdominal viscera
especially of the liver, also by great atony of the intestines'
and  colliquation.  Nor can it be denied, that the discharge
is sometimes really hepatic ; that is, the product of soften- 
DIARRHCEA.                    359
ing and dissolution, perhaps also of suppuration of the sub-
stance of  the  liver; in which  cases it is associated with
chronic liver complaints, and ends in death.
  Therapeutics. The treatment  must conform to the causes.
Mild  resolventia  subamara, millefolium,  centaur,  minor.,
with soluble tartar, roborants, cinchona, Campeachy wood,
diluted mineral acids, tonic injections, Eger, Spa, Pyrmont
water in small doses, are the most beneficial remedies.
                       DIARRHCEA.

  Diagnosis. Increased fluid discharge from the intestines.
It may be free from, or accompanied with pains (diarrhea
torminosa);  continue for a few days, or by becoming chro-
nic, last for months and even years.  The matter evacu-
ated varies  very much ;  may be excrements, watery fluid,
mucus, bile, pus, blood.  It differs  in  regard  to  danger;
sometimes it is insignificant, without  danger,  curing by
itself, in many cases it  is even a salutary crisis;  at other
times it is very important, running into danger or indica-
tive of already existing  vital danger.
  A  principal  rule  is,  to  consider  every diarrhea as
salutary, and therefore  not to  stop it, as long  as clear
proofs of the contrary do not appear.   These  are : quite
watery evacuations (though these also  may sometimes be
critical and wholesome ; as the  rheumatic), great prostra-
tion after each  stool, increasing sometimes to fainting.
  Protracted diarrhea is exceedingly debilitating, and may
finally produce all the consequences of weakness, as ner-
vous  diseases, hysteria, cachexy, tabes, hydrops, and lien-
teria.
  Pathogenesis.  The  proximate  cause is always an  in-
creased activity of the intestinal  canal, of the peristaltic
motion as well as of that of the  secretory vessels.   But the
causes may be various, even opposite, either an augmenta-
tion of the irritability or an unusual  stimulus.   The irrita-
bility may  be  increased in a double  manner, either by
increase of power (sanguine, phlogistic, inflammatory diar-
rhea);  or  by  weakness,   namely,  irritable  debility  (to
which belong adynamic, nervous,  hysterical,  finally col-
liquative diarrhea) ; for the torpid weakness of the intes-
tinal canal brings on  costiveness.   The exciting  stimulus
may likewise vary ; be  local, idiopathic, in  the intestinal
canal itself: indigestion, sordes, worms, metastases, organic
diseases of the  intestinal canal (saburral, bilious, mucous, 
 360                    D1ARRH02A.

 verminous, metastatic, organic diarrhea);  or sympathetic,
 consensual, as dental irritation, mental  irritation, anguish,
 pain ; or antagonistic, as suppressed action of the skin (the
 rheumatic and catarrhal diarrhea).  It is \yorse when both
 irritations unite, increased irritability and increased stimu-
 lus; as sordes  in an erethic state of the intestinal canal.
 Even a fluid stool several times a day may continue through
 life, as I have  observed in a man who labored under it up
 to his eightieth year without any prejudice.
   There exists also a predisposition to diarrhea, which is
 of a double description. 1. That which is individual: there
 are men  whose intestinal  canal constantly inclines that
 way,  so that they are affected with diarrhea on the slight-
 est occasion ;  becoming the common way by which nature
 excretes diseases and morbid dispositions and restores the
 normal state.   2. General: there are universal constitutions
 of the atmosphere which  render all men liable to diarrhea.
 Of that character is especially that one which returns annu-
 ally in the summer time,  and is due to an increased secre-
 tion of acrid bile. Similar to this  is the climatic, in tropical
 regions, where bile again is the cause.
  Therapeutics.  The principal indication is : to remove the
 irritant cause, or to assuage the increased irritability of the
 intestinal canal;  or  to do  both.   This fundamental idea
 may be carried out in very various ways, according to the
 various irritant causes, or the increased  irritability being
 dependent on weakness or augmented vitality.
  Hence the treatment of the single species.
  The most common and first to be mentioned is Diarrhea
 estiva, which  springs up epidemically  in  the prolonged
 heat of the months  of July  and  August, and  is accompa-
 nied with more or less griping pains.  It is always of a bi-
 lious nature; the bile being increased  in quantity and acri-
 mony by the heat of the season.  In general  nothing more
 is wanted than rhubarb, which is here a specific, and a strict
 observance  of diet, avoiding  all acids, fruit,  beer,  vegeta-
 bles, and  living  on  water gruel,  pearl-barley soup, rice-
 water, chicken, or veal.  The rhubarb may be taken in the
form of tincture, as an ounce of tinct. rhei. aquos., or the
 mixture No. 178 daily.  This will generally be sufficient.
I have found pulv. rad. rhei. still more efficacious, prescrib-
 ed in doses  of 3 or 4 grains every  3 or 4 hours, formed in-
 to pills with liquorice, in order to correct the taste. Some-
 times the evacuations are watery, and signa sordium sur-
sum turgescentium exist;  here sal ammoniac, dissolved in
mucilage, will  best stop the watery effusion, followed by 
DIARRHCEA.
361
an emetic of rad. ipccacuanhe (which is also a specific in
diarrhea), afterwards rhubarb.  It may be necessary to re-
peat the emetic several times.
  Sometimes the diarrhea  is watery,  and accompanied
with violent griping pains ; here oleosa combined with sal
ammoniac and anodynes (vide No. 179) will give the most
prompt relief; at the same  time  inunctions,  cataplasms,
oily injections may be made  use of.
  In diarrhea owing to indigestion,  the same treatment is
required ; if an  emetic is indicated, let it  be ipecacuanha;
and followed by rhubarb.
  Generally, these remedies suffice  to perform  a cure.
Sometimes,  however, the diarrhea will  notwithstanding
persist  and  continue watery, prostrating the patient, with-
out  any signs of the presence of gastric impurities.  The
indication here,  is to sjppress the aqueous flux.  The  first
ways must  be  previously cleansed, lest  the  suppressive
means produce injurious and even dangerous consequences;
and a proper succession must be observed, gradually pass-
ing from the mild to the stronger kinds. The remedies are
the followinor: Above all  is  antagonismus of the skin.   As
suppression  of cutaneous action is able  to create imme-
diately diarrhea, so also  may its restoration instantly de-
rivate and remove the diarrhea ; therefore let the abdomen
and back be wrapped in double flannel,  which, in many cases
will be alone sufficient.  After this rhubarb in powder 1 or 2
grains,  ipecacuanha in  small doses  (vide No.  180), and
testaceous substances, as prepared shells, lapid. cancrortim,
especially clay and bolus  armenie (vide No. 181) ; farther,
mucilaginous, gelatinous substances,  gum arabic, salep,
rice-pap,  starch injections.  1 recommend extract, casca-
rille (vide No. 182) as a  very valuable remedy, confirmed
to me in many cases by my own experience, since it stops
diarrhea without the least detriment; farther, nutmeg; at
last opium, which is the most sure of all other mean*, but
for  that very reason it is also the most dangerous ; there-
fore it  must always  be given in combination with  eva-
cuants (vide No. 183).
  Simple rheumatic diarrhaa, owing merely to taking cold,
generally requires nothing but flannel  around the abdomen,
to lie in bed, to  perspire,  and to  take  mucilaginous drinks.
If at the same time there is a gastric complication, this
must have its appropriate treatment.
  Habitual or chronic diarrhaa, is a  continual looseness
of  the bowels, or a disposition to looseness from slight
causes;  in  the  latter case it is subject  to alternate with
                           31 
362                    DIARRHCEA.
costiveness. It is frequently the sequel of a previous acute
diarrhea.  A  local weakness combined with increased ir-
ritability (irritable weakness)  must always be supposed to
be the original cause and object of trea'.ment; but it  is
equally important 10 pay  attention to the morbid stimuli
connected with it, which frequently excite an erethismus,
and, without  the removal of which  the  use  of the  most
powerful roborants will be fruitless, yea the removal of
which  alone  is often sufficient to a  cure.  We therefore
distinguish the following cases.
  The merely adynamic, erethic chronic diarrhoea, requires
the continued use of tonics, especially the bitter, astrin-
gent, narcotic, and antispasmodic kinds, and counter-irri-
tants.  Those  most  approved  of by  experience  are: co-
lumbo  (vide No. 184),  of the powder 1 scruple 4 times a
day, cortex cascarille, lign. campech. (vide No. 185), cort.
aurantiorum, simaruba, salicaria, acorn-coffee,  red French
(claret), Pontac,  Cahors wine, the  same aromatized  with
orange peel, chalybeates ; particularly Pyrmont  water, flan-
nel vest,  strengthening  embrocation  on  the abdomen and
spine,  strengthening  baths, douches on the abdomen.   I
have found a little spice-bag worn on  the  abdomen (filled
with cloves, cinnamon, pepper, cardamomum, and  ginger,
moistened morning and evening with cold  rum), very effi-
cacious.  I should not omit to remark that, while  irritabi-
lity  continues, small  doses of laudanum  must be added to
the tonics.   In several  cases,  where other means failed,
tinct. macis along with  laudanum (vide No. 186), has prov-
ed serviceable. When there is great atony,  a cold diet must
be observed.   Nux vomica (vide No.  187) will often  have
an excellent effect.  Terra catechu, as in the mixture No.
188, is very  recommendable.   In very ob&tinate  cases  I
have performed perfect cures,  merely by milk-diet and cold
food ;  the patient being suffered to take nothing but milk,
cold meat and white bread.
  If one of these methods does not suffice, investigate close-
ly whether  or not a foreign irritant keeps up the diarrhea ;
especially worms, or metastatic and  specific morbid  mat-
ters  ; most frequently gout, rheumatism, and psoric (parti-
cularly herpetic) acrimony, even lurking syphilis; if so,
each of these will require its respective remedy.  In the
hemorrhoidal, sulphur as combined in No.  189  is  most
valuable.  Even the dietetic mode of living  and clothing of
the  patient is to be regarded;  too thin  clothing, moist
dwelling, frequent use of red  wine are often the unknown
causes. 
DYSENTERY.
363
  Diarrhaa colliquativa, which associates as a symptom
with phthisis, tabes,  hydrops, and  hectica,  requires the
treatment of the original disease, and besides the use of the
stringent remedies previously mentioned, along with opium,
especially starch injections with opium.
  Putrid diarrhaa (which occurs in scurvy),  is remedied
by alum-whey, Peruvian bark, terra japonica, along with
small doses of opium.
  Diarrhea  owing to obstructions in the mesentery, tu-
bercles of the intestinal canal (frequently met within scro-
fulous children), requires acorn-coffee, extract of cascaril-
la, nutritious jellies,  and  malt-baths. The same applies to
that kind of diarrhea which is caused by other abnormal
states and organic disorders of the abdomen.   The use of
snail-broth with cascarilla has proved  beneficial in hectic
persons, laboring under diarrhea for years.
  Diarrhan purulenta with discharge of real pus is indica-
tive of suppuration in the intestinal canal, and requires the
use of milk, whey, butter-milk, salep, snail-broth, milk with
an addition  of lime  water, myrrh,  copaiva  balsam, cin-
chona,  injections  of milk with myrrh or copaiva,  1 to 2
drachms and a little  laudanum  several times a day;  even
an addition of a few  drops of acetum plumbi may  be per-
mitted.
  Diarrhaa infantilis, vide diseases of children.


                      DYSENTERY.

                      Dysenteria.

  Diagnosis.  Constant urgency to go to stool,  tenesmus,
violent abdominal  pains, fever;  only mucus and blood, but
no feces in the stools.  Therefore  the disease is not pro-
perly  a flux but a constipation, an essential difference, and
the reverse of diarrhea.   In diarrhea nuisible intestinal
impurities are evacuated; in  dysentery they are impeded
and retained.  Diarrhea can get well by itself, not so dy-
sentery.   As soon as feculent impurities are discharged in
dysentery, the disease may be said to be cured.
  The course of the disease varies.  Sometimes it is an-
nounced by  previous symptoms, sometimes not.   It may
be of short  duration, sometimes long, even  passing into
chronic dysentery.   The precursory  symptoms are fre-
quently diarrhea  or dull pains in  the abdomen.   It com-
mences by a cessation of bilious stools, which is followed
by tenesmus with  small  mucous evacuations  (white dy- 
364                   DYSENTERY.
 sentery), which on account  of increasing irritation subse-
 quently  gets  mixed with blood (red dysentery).   In the be-
 ginning  there arejebrile motions, which soon  cease in  a
 slight attack of the disease.  When the malady is severe,
 the pains continue to increase and the stools may augment
 to 100 in 24 hours, and their fetor increases, with the lever.
 This  aggravation is owing to the addition of inflammation,
 or to an excess of bilious putrid matter, or to exhaustion.
 Death ensues by  inflammation and gangrene, or by exhaus-
 tion.   The  signs of gangrenous mortification are : sudden
 cessation of pain after having violently raged, a sunken-in
 countenance, cold  extremities,  small  intermittent pulse,
 the evacuations are highly offensive, and are passed with-
 out consciousness.   Amelioration  is indicated by diminu-
 tion of the pains and fever, and the evacuations becoming
 feculent.
  Violent dysentery is frequently succeeded by paralysis,
 chronic  diarrhea, nervous fever, and lingering fever.
  Pathogenesis.   The proximate cause is a  violent convul-
 sive irritation of the large intestines, the secretion of mu-
 cus  pathologically  increased and  rendered  acrid.  It  is
 therefore not  primarily an inflammation, but inflammation
 may  grow out of it by an increase of irritation.  It is very
 similar to that of catarrhal irritation of the mucous mem-
 brane of the bronchia;  (when in more  severe  coryza and
 cough, streaks of blood are mixed with the mucus, and it is
 apt to pass into inflammation merely by an increase of irri-
 tation),—a catarrhus or rheumatismus intestini crassi.
  This local  irritation  may have various  remote  causes:
 an unusual excitement or irritation of the organ.  The most
 common  cause is suppressed action of the skin (antago-
 nistic irritation), with  increase of quantity and acrimony
 of bile. On  this account it is frequently epidemical, in Au-
 gust  and September, after great heat of  the day (which
 renders  the bile  more acrid arid increases it), followed by
 cool evenings and nights, which arrest the perspiration. It
 therefore has always a bilious rheumatic cl aracter.
  In  severe epidemical  dysentery, especially when it as-
 sumes a  putrid character, a contaojuni dysentericum  may
 be developed,  which, however, seems to be  only local, ad-
hering to the  intestinal  evacuations,  and rendering their
 emanations dangerous.
  'J here  is  also an  endemic  disposition to this disease.
Low,  moist, marshy regions,  such as predispose to inter-
mittent fevers, incline also to dysentery; hence they  gen-
erally prevail in such places. 
DYSENTERY.                   365
   Besides these  causes of primary essential dysentery,
 there are also others which may create it symptomatically
 and  secondarily,  either  by  a violent local  irritation,  as
 caustic poisons,  worms ; or by  an exceedingly increased
 irritability of the intestinal canal, as a hemorrhoidal con-
 gestion, metastases ; or consensually, as from difficult den-
 tition.
   Therapeutics.   The fundamental indication is to assuage
 the excited  state  of the colon  by removing  the  irritant
 cause and the increased irritability.  The next thing to be
 done is to consider the respective characters  of the diffe-
 rent  irritations.
   The  rheumatic-bilious character is of the most frequent
 occurrence, and is common to the autumnal dysentery. In
 this kind of dysentery we have in geneial only need of the
 following remedies : an emetic of ipecacuanha in the com-
 mencement;  then a laxative  mixture of manna and tama-
 rinds, with a small addition of sulphate of soda and tartar
 emetic, continued for 24  hours; should no amelioration
 ensue, a mucilaginous emulsion  containing small doses of
 opium (vide   No.  190).   Pearl-barley, water-gruel, gum-
 waier, given  at the same  time as beverage, the abdomen
 and back clothed in  flannel,  and an embrocation  of anti-
 spasmodic ointments with opium to the abdomen.   Ipeca-
 cuanha given in the beginning  as an emetic is generally
 necessary  and of great  benefit  for  the after  treatment
 There is but  one exception to this rule : it is when  the pa-
 tient has no signs of saburra, and the stools contain no fe-
 culent matter.
   Should no  improvement follow this treatment, it is be-
 cause of the  following cases,  which must be carefully dis-
 tinguished.
   1. The fever increases, the pulse becomes full and hard ;
 or the patient is young and plethoric, the pains are seveie,
 or confined to one spot; the abdomen is tense and painful
 to the touch.  Here is incipient  inflammation, and  imme-
 diate  need of venesection ; or of leeches when the  case is
 light.  At the same time an oily emulsion (vide No. 47) is
 to be given,  to which opium may be added as soon as ve-
 nesection has abated the pulse.
  2. Or  the  pulse is not full,  but  the tongue  is unclean,
with  many other indications of gastric  impurities,  which
are generally of a bilious nature.  In thi* case the  prime
vie are to be cleared, carefully distinguishing whether the
stools contain feculent matter or not.  II they do, the above-
mentioned tamarind mixture is to be  given along with mu-
                          31* 
366
DYSENTERY.
cilaginous drinks, until the stools become watery.  But in
the second case, when the evacuations are not feculent, an-
other eme»ic must be prescribed which will usually render
them feculent.  Should  this be unavailing, rhubarb (vide
No. 191) or calomel with opium must be tried.
   3. Or  there  exist neither  signs of inflammation nor of
gastric  impurities;  but  the patient suffers violent pains
with tenesmus, the  stools are scanty, watery, mucous or
bloody.  Such a case is caused  principally  by cold ;  its
character is rheumatic,  a real rheumatismus intestinorum.
Here opium with gum  arabic administered  internally,  ex-
ternally, and in clysters are the chief remedies ; at the same
time a  vesicatory  to  the abdomen  and  warm  baths  are
proper.
   4. Or finally, the case  is marked by extreme prostration
from the beginning (dysent. nervosa adynamica).  Here, the
foregoing remedies (opium  and mucilages, also  emetics
and purgatives  when  necessary)  must be combined with
nervines,  valerian, angelica, arnica, wine, and  warm baths.
If it assumes a putrid  character, which  is  recognised  by
extreme  weakness and a cadaverous odor of the stools,
arnica  (1  scruple of the  powder every 2 hours,  or a de-
coction of ■*; ounce to 8 ounces of fluid) and wines are par-
ticularly recommendable.
   Sometimes, however, the dysentery continues obstinate
and will not cease, though it diminishes in force. Here, ex-
perience has shown  that  the  following remedies are very
efficacious:  10 grains  of powdered nux vomica daily, or 2
to 4 grains of the extract; sulphur, calomel, even sublimate
in  minute  doses (^ grain  to 4 ounces of  water with 3
ounces  of mucilage of gum arab. and 12  drops of lauda-
num, one table'spoonful  every 2 hours),  which may also
be given  in  injections, though ifi smaller  doses, as the
r1^ of a grain with opium and  mucilage.   In  such a case
too, when all other means fail, the vitrum ceratum  antimo-
nii, in f  or 1 grain  doses,  which according to the expe-
rience of the most approved  practitioners, has been used
with the  greatest benefit ; also wax,  made  into emulsion
with the  yelk of eggs;  warm  baths, especially in rheu-
matic dysentery.
   If dysentery becomes chronic, arnica, the root (1  scruple
of the powder every 2 or  3 hours) is the principal remedy.
But denudation  of the intestines by loss of mucous mem-
brane, and the rawness  thereby created, deserves great at-
tention ; for which the  frequent use of  salep-mucilage  is
the most efficient, and will often alone suffice. In obstinate 
CHOLERA.                    367
cases it is best to hold to two ideas : that of weakness, and
that of a chronic passive inflammatory state of the mucous
membrane of the rectum.   In the first, especially when ac-
companied by lingering fever, rad. columbo, lignum  cam-
pechiense, and simaruba are most beneficial; in the second,
injections of  ^ of a grain of sublimate  with opium and
mucilage or starch.
  Suppressed dysentery This name designates a oase, when
the dysenteric evacuations have been suddenly stopped by
violent  means,  as by red wine,  brandy,  large doses of
opium, producing bad attacks. They are of a double kind:
acute or chronic.  First  are inflammatory  or spasmodic ;
known by violent pains, distention of the abdomen, totally
suppressed discharges from the intestines,  great anxiety,
spasms.  Here the discharge is to be restored  as promptly
as possible by oily remedies, manna, calomel, especially by
frequent  emollient clysters and cataplasms ; where the cha-
racter is  more inflammatory, leeches; when very spasmo-
dic, hyoscyamus, tepid baths.  The chronic consequences
are obstinate  rheumatisms, paralysis,  hydrops.  Here re-
solvents  and  purgatives must be administered,  and  the
newly generated diseases treated at the same time.
  After every dysentery the use of bitter roborants, flannel
around the abdomen, and careful diet are necessary.
  The cure of the symptomatic and chronic dysentery is ef-
fected in conformity to the causes.   Dysentery caused  by
worms,  vide helminthiasis ;  by  dentition, vide diseases of
children ; by  metastases and ulceration or organic disor-
ders of the intestinal canal, vide diarrhea chronica.
  The first  indication is  always to assuage the irritation,
and  then to  remove the irritant cause.  In every chronic
dysentery we  have carefully to examine, whether a fistula
of" the rectum may not be the. concealed cause.

  The best preservative against  dysentery is a flannel vest
worn around the abdomen.  Ripe fruit, when not eaten in
excess, is not  injurious.
                        CHOLERA.

  Diagnosis.  Incessant vomiting and purging, accompa-
nied with pains in the stomach and abdomen, anxiety  and
tenesmus.   Sometimes  the disease  is very violent.  The
vomiting and urgency to go to stool beiriLr incessant;  but
sometimes it is moderate.   The severer kind is soon fol- 
368                     CHOLERA.
 lowed by exhaustion, small, scarcely perceptible pulse, fits
 of fainting, coldness of the extremities, spasms,  convul-
 sions. The discharged matter  in the beginning consists of
 the contents  of the stomach and bile (the latter is always
 present  in cholera biliosa), afterwards of the watery 1\ m-
 phatic fluids, the intestinal  secretions, finally  nothing at
 all,  there being  mere  vomiturition and  urgency to go to
 stool.  There may also be cholera without any  material
 evacuation  (cholera sicca), sometimes only with a disen-
 gagement of  air.   Then it is  a kind of windy  colic (vide
flatulency).
   The course is  variable.  Sometimes the  disease is an-
 nounced by anxiety,  pressure in the stomach, disturbed
 appetite.  Sometimes  it suddenly breaks out, sometimes it
 is slight, less  severe, less fatal (as when owing  to indiges-
 tion).  Sometimes,  however, it is very virulent,  forcible,
 rapid (fatal even  within 24 hours, as the epidemic, espe-
 cially the oriental cholera).   It cannot last longer than 3
 or 4 days,  without ceasing or ending in  death.   Death
 is brought on by inflammation, or  by total exhaustion of
 vital power.
   Pathogenesis.   The  proximate  cause  is  a convulsive
 state, a true epilepsy of the stomach and intestinal  canal,
 generally including the  liver,  as is evident in the cholera
 biliosa by the  enormously increased secretion of bile. The
 proximate cause therefore is not inflammation, but this may
 easily become associated  with it as an effect  of violent
 nervous  excitement.  The exciting causes  are :  caustic
 poisons, indigestion (purely specific is  the roe  of the bar-
 bel), gall-stones,  irritation by  worms, dentition,  parturi-
 tion. The endemic and epidemic causes are the most fre-
 quent ;  moist  marshy  regions  (the same where  dysentery
 is engendered), above all the season, when great heat  of
 the  day  alternates with cold nights (month of August).
 The  endemico-epidemic may  sometimes  be transformed
 into a true  epidemy, and  then become contagious, as in
 the oriental  cholera.
   Therapeutics.  Assistance must be prompt and efficient;
for the time  is short, only one or two days.  The principal
indication is:  to assuage the convulsive excitement of the
intestinal canal, cautiously however,  not  to  suppress too
quickly the  evacuations.  The  best remedies for this pur-
pose  are: mucilaginous  beverages taken frequently, such
as pearl-barley,  water  gruel, gum  water,  weak chicken
broth (Sydenham's specific), River's potion, small doses of
hyoscyamus or ipecacuanha; oily injections, antispasmodic 
SUPPRESSIONS.
369
ointments, narcotic cataplasms, dry cups on the epigastric
region (a very valuable means to stop vomiting),  warm
baths.  This treatment is sufficient in ordinary cases. Two
points  must be well attended to:  1. The danger of inflam-
mation.  As soon as the pains become  violent and burning;
and  in a youthful plethoric constitution or in an inflam-
matory character of the epidemy, a venesection is imme-
diately to be made.   2  The  danger  of exhaustion  (of
power).   When the attacks do not abate under the above
treatment, the pulse  becomes small, the extremities cold,
or fits  of faintings set in, then there remains no other sal-
vative  for life but opium.  It  is best given in a mucila-
ginous emulsion,  in  divided doses, 2 or 3 drops of lauda-
num Sydenhami every half an hour ; it  must at the  same
time be employed externally by embrocations and clysters ;
always remembering  that it is to diminish but not to stop
the evacuations from the intestines, by which inflammation
dangerous to life might be produced.  In extreme prostra-
tion, besides opium a strong warming wine must be admi-
nistered, best old Malaga.
  For  the treatment of the oriental cholera, vide  cholera
orientalis.
                 TENTH  CLASS

                   SUPPRESSIONS.

                      Generalities.

  Diagnosis.  Retention of normal secretions, the evacua-
tion of which is necessary to health.
  Every interruption to  the  usual and necessary evacua-
tions from the economy  is important in its consequences,
and claims the greatest  attention of the  physician.  The
more  necessary a discharge is to the system, the more
sudden and complete the suppression of it is^the more im-
portant and  dangerous will it be.  The effects are always
double :  1, retention of a corrupt matter injurious to health
(materia  excrementitia retenta),  hence the  purification and
integrity of the system are impeded and  disturbed by the
presence  of acrid,  irritant  humors,  the  consequences of 
370                  SUPPRESSIONS.
which are  deficient nutrition, dyscrasia  and cachexy ;
2, disturbance of the organic balance, and an excitement
of an antagonistic  reaction, which will  produce  acute as
well as chronic morbid affections of the  internal parts, and
vicarious secretions of different kinds.  In this manner sup-
pressions become one of the most  prolific and formidable
sources  of  a great  number of diseases, acute as well as
chronic,  and merit the greatest attention and regard of the
practitioner.
  Pathogenesis.   The cause of a retention  or  impediment
to the flow of fluids, may be seated  in the canal (continens)\
or be due to the contained matter itself (contentum).
  The first may be a spasm, a cramplike  contraction, or
inverted peristaltic  motion (as in some  species of ileus) ;
or inflammation, or the reverse of both states, an inactivity,
atony, want of stimulus, or finally a mechanical impediment,
organic induration, swelling, or excrescence in the vascu-
lar membranes, which obstructs the  passage of the fluid.  It
is not uncommon for all the three causes to follow in suc-
cession,  one engendering  the  other.  First inflammation
sets in, after its removal spasm continues, and finally,  the
long continued over-irritation and extension of the vessels
create extreme atony and  paralysis; they may even pass
into disorganization.
  The second cause may reside in  a qualitative alteration
of the matter to  be discharged ; an  alteration which dis-
qualifies it for motion (thickness or tenacity), an  extreme
over-filling; or finally a foreign  body may be the cause.
These material disorders  may be consequences of the  dy-
namic impediment, so that both  classes of causes united
produce  the retention.
  Therapeutics.  The principal indication is :  to remove the
causes which give rise to the suppression ; that is, the in-
flammatory state,  when it is  the  cause ;  the spasm, or
weakness,  or mechanical hinderance, when they  are the
causes.  This alone will  often suffice to re-establish the
normal discharge.  Should  it not succeed, we must  have
recourse to means  which operate locally and directly ; as
laxatives, irritatives, even  surgical  assistance  in  extreme
necessity.
  When  we are unable to restore a suppressed secretion
■we have  but one  expedient left, which is to  create a sup-
plementary evacuation of a natural or artificial  kind. 
       CONSTIPATION OF THE  BOWELS.   COSTIVENESS.   371


       CONSTIPATION OF  THE EOWELS.   COSTIVENESS.

              Obstructio alvi.   Dyscopria.

  Diagnosis.   Individuality is to be discriminated.  There
are men, to whom it is natural to have a stool only every
two or three days, and without annoyance.  It is, however,
a rule of the normal state and proper to health, to have one
stool every day. If constipation continues for too long a time,
the consequences are :  the feces thicken, harden, accumu-
late, and distend  the colon; create abdominal obstructions,
hemorrhoidal complaints,  and congestions to the head and
chest, sympathetic disturbances and hypochondria.
   Pathogenesis.   The causes are : insufficient drink (hence
constipation is more  frequent  in  females than in  males),
hard, heavy,  dry aliments (farinaceous meals, potatoes,
pulse, nuts, almonds, chestnuts),  continual sitting, tight
lacing of the  abdomen, deficient and  defective bile, espe-
cially the habit of resisting and neglecting to  go to stool.
   Therapeutics.   To prevent this troublesome  complaint,
the patient must  acquire and adhere to the habit of going
to stool regularly every morning.  This is more important
than medicines, since nature thereby resumes her  healthy
order. To cure constipation, a larger quantity than usual of
water must be drunk, or of light beer ; the patient must live
on vegetables, juicy  greens, fruits, especially  apples and
prunes; avoid dry, heavy food ; take exercise, make frictions
on the abdomen; take remedies  which promote, amelio-
rate or replace  the secretion  of bile, even gall itself (fel
tauri insip.) ; rhubarb  (vide No. 192), aloes,  senna leaves,
herb, gratiole, will prove serviceable.  Purgative salts  must
 not be used, for they leave a disposition to costiveness.   A
 combination of aloes or scammony, with a smill  addition
 of iron (No. 193 a), is worthy of notice, for iron greatly in-
 creases the efficacy of the first articles.   The most innoc-
 uous and surest  remedy, but which loses its power by habit,
 is senna, in pills (as  No. 194), or the tea of St. Germain
 (No. 195), which is still better, since  in this the  resinous
 principle is abstracted from the senna leaves by the previ-
 ous  digestion.   Two  ounces  of  this  specific are to be in-
 fused in five cups of boiling water, and then digested  for
 ten minutes in  a warm place, without  boiling ; after this
 the clear fluid is to be decanted from the sediment.  Halt
 a cup of this, for a weak  stomach with a small  addition of
 Malaga, will be  a cfose. I have seen persons who made use 
372
ILEUS.
of it all their lives, without experiencing the least incon-
venience, and with a never failing effect.
  In the most obstinate cases of constipation, in  the utmost
inactivity of the intestinal canal, and when all other means
are  inefficacious, there  still  remains one remedy which,
according to my  experience, is almost infallible, extractum
colocynthidis composit.  (No.  193 b), one grain  for a dose.
The use of Carlsbad water, which often removes this dispo-
sition for ever, at least for a* long time, is very recommend-
able : besides injections of cold  water ; or,  where  there
exist accumulations and obstructions, Kampf's  visceral
clysters,  finally,  nux vomica, given on the homeopathic
principle, and in  minute  doses, is very useful.

                          ILEUS.

                        Miserere.

  Diagnosis.  Obstinate constipation, vomiting  of the food
and  drink taken, then of the gastric juices, finally of excre-
ments, violent pain in the abdomen.
  The disease is always liable to inflammation, which brings
on danger of life.  If there is fever, a continual burning
pain, impossibility to bear the pressure of touch, a distend-
ed,  hot  abdomen, and quick, small  pulse; inflammation  13
present.
  If the pain suddenly  abate, followed  by copious,  fetid
stools, the abdomen become tender and shrink, the pulse
extremely small, weak,  and  intermittent, the extremities
cold ; the inflammation has passed into gangrene, and death
approaches and cannot be prevented, though the patient  in
general feels happy,  and considers himself past  danger ;
when the physician must be very cautious, not  to be de-
ceived.
  Pathogenesis.   The proximate  cause is a  stoppage,  an
interruption to the passage of the contents of the intestinal
canal, owing either to stoppage,  or to an  antiperistaltic
mot'on having been  created.  This may arise 1. From a me-
chanical impediment within the intestinal canal, as an accu-
mulation of indurated excrements in the colon and rectum ;
to foreign bodies, stories, kernels of fruit, worms  ; to volvu-
lus, imperforatio ani, callous or scirrhous straitening of the
intestiral canal,  especially where the colon terminates in
the rectum ; or external to the intestinal  canal, as from in-
carcerated hernia,  compressing indurations  and  tumors
newly formed ligaments.   2. From inflammation.   Hence, 
ILEUS.
373
ileus is always a symptom of enteritis.   3. From irritation
ani spasm.  An accumulation of acrid bile, fermentive ali-
ments, especially the antagonistic irritation by colds taken
in the feet and in the abdomen, produce ileus, and  render
it sometimes  epidemical; spasm  is also apt to associate
secondarily with the other causes, and to entertain the evil.
4. From torpor and atony of the intestinal canal, which may
take place as a consequence of  long constipation and dis-
tention of the intestinal canal, and keep  up the disorder.
   Therapeutics.   In the  treatment  of  ileus we must first
proceed  to ex imine whether the patient has a rupture ; the
neglect to do so  has often rendered  the treatment futile.
For  when this  cause exists, salvation lies only in the cure
of the  incarcerated hernia.  We must not be satisfied with
the affirmation of the patient that there is no rupture, since
they often do not know it themselves (in small incarcera-
tions), or are  ashamed,  especially  females, to tell it ; but
we must  examine, ourselves, all  those places in which rup-
ture  can  happen.
  The  second is to  investigate whether there exists inflam-
mation of the intestines.   He who neglects to do that, and
prescribes strong purgatives in such cases, kills his patient.
The  signs are : a constant burning  pain, great tenderness
on the  least pressure ; tense, hot abdomen, violent fever,
red  urine, thirst.  Such a case is to be  treated  as en-
teritis (vide enteritis), the cure  of which also cures ileus.
  If neither is the case, or ileus continues after the inflam-
mation has been subdued, the next indication is to conquer
the stoppage, partly by irritatives which increase the peri-
staltic  motion,  and  partly by  relaxative  antispasmodic
remedies, to remove  the obstructing contents and to  re-
store a normal direction to the intestinal action.   The rem-
edies most approved for  this  purpose are  oily emulsions ;
they are  more effectual than the  strongest drastics, and
particularly valuable is the fresh expressed linseed oil, one
tablespoonful every two hours or oftener.   If this  do not
avail, a stron? infusion of senna with sulphate of magnesia,
and extract of  hyoscyamus (No. 196) ;  of this two table-
spoonfuls may  be given  every hour, and after  it a table-
spoonful  of linseed  oil ; and in  order to  prevent  vomiting,
the Riverian saturation  may be given intermediately.   If
this  also  have  no effect, we may give a tablespoonful of
castor  oil  every hour, and half a drop of croton oil on
sugar or  in the form of  pills;  also aloes and jalap. The
mixture  No. 197 has, according to my experience, some-
times operated extremely well.  In a spasmodic state thes< 
374                 CHRONIC ILEUS.

medicines may be mixed with extract, opii aquos.; an infu-
sion of tobacco (No. 198) is still more efficacious.   But
more serviceable than all  internal remedies, which  very
frequently are immediately rejected by vomiting, are injec-
tions, administered  every three or four hours.   In the be-
ginning they may be composed of sulphate of magnesia,
infusion of senna, or castor  oil ; then of two or three ounces
of vinegar, four grains of tartar emetic ; the most effectual
is half an ounce of  an infusion of tobacco.   It is true that
the narcotic power of this remedy affects  the nerves, and
may even induce syncope, but a  stool ensues during that
fit.  Also the " douche  ascendante" into the rectum  may
be used ; it is effected by hanging a leather pipe of  three
or four feet in length, and filling it with warm water.
  To this treatment external applications  may  be added,
as emollient  narcotic cataplasms, sinapisms, cups,  espe-
cially warm half baths ;  also  embrocations of croton oil on
the abdomen.   Cold water used  in  any form (frequently
repeated draughts of it,  cold  injections, and  continual cold
applications or ice on the abdomen), is here of extraordinary
efficacy.
  Should ileus resist all these means, a venesection may
bje made, although no signs of inflammation exist.  It will
often instantly dissolve  the incarceration ;  it prevents in-
flammation from setting in  as an accessory, and allows the
free  use of opium and other heating remedies. Venesection
is urgently required when, in the course of the disease,
symptoms of abdominal inflammation  appear ; such as a
tense, painful  abdomen, very painful  to the touch, small,
quick pulse, cold extremities, thirst and red urine.
  Nor must we neglect  to take the various remote causes
into  consideration ;  as the  arthritic metastasis, which  re-
quires venesection  and a vesicatory on the abdomen ; or
hysteria, spasm, when opium internally and externally may
boldly be administered ; or  worms, when anthelmintics and
calomel are to be used.
  In extreme necessity,  provided  that no inflammation ex-
ists,  quicksilver may be  tried. Half a pound of  it may be
swallowed at  once, with a spoonful  of oil or emulsion.
It sometimes quickly produces an evacuation  from the
bowels.

                     Chronic Ileus.

  Ileus may have also a chronic  character.  The patient
has suffered a long time ; has constipation, stools are forced 
         ISCHURIA. DYSURIA. STRANGURIA. ANURIA.       375

from him with difficulty, by internal and external  means;
finally, they entirely cease to pass, and the  usual remedies
are unavailing.  Here  two causes  are  to be  considered.
The protracted costiveness has produced an engorged state
of the colon by the long accumulation of hardened excre-
ments  which obstruct the passage; in  this case one can
often  feel the whole region  of  the colon  distended and
hard ;  also  isolated, prominent knots and strictures, which
are frequently mistaken  for organic obstructions  of the
viscera, but which may be distinguished by their mobility
from  place  to place,  spontaneously or by pressure.  In
such a case, after death, the colon is found distended into
an enormous sack, and full  of excrements.   The  part of
the rectum   immediately below the distention, and  in con-
sequence of it, is often so contracted as to have been mis-
taken for stricture.  In such a case  relief can only be had
by a  continual  administration of  emollient,  dissolvent,
soapy, oily  injections;  by the "  douche ascendante," and
even by mechanical dilatation and gradual removal of the
indurated feces.
  A second case is that of an  induration or scirrhosity
formed in the rectum  or colon.  This  is to be treated by
bougies and other mechanical dilatations, combined with
vigorous resolvents.   It is in this very case, that we  may
resort with safety to quicksilver,  and derive benefit from it.
         ISCHURIA. DYSURIA. STRANGURIA. ANURIA.

  Diagnosis.  In strangury the discharge of urine is painful
and difficult; in dysury difficult and incomplete ; in ischury
it  is totally suppressed.   When the latter species is ow-
ing to an impediment in the passage, and is  accompanied
by  swelling of  the bladder, it  is  termed ischuria  vera;
when no urine is secreted, and there  is no  distention of
the vesical region, the case is ischuria notha, anuria.
  They are, therefore, only different degrees of  the  same
affection ; of which the slighter are only troublesome, but
not  dangerous.   But  true  ischury,  total   retention of
urine,  ranks among  the most dangerous diseases, and
kills either by inflammation or by gangrene of the bladder,
or by rupture of the  bladder, the  urine effusing  into the
abdomen (ascites urinosus).  The urine is also sometimes
resorbed into the mass of the circulation ; in this case the
disease lasts for a long time, and the blood exhibits a urin-
ous acrimony;  there  is violent itching in the skin,  even 
376      ISCHURIA. DYSURIA. STRANGURIA. ANURIA.
cutaneous  eruptions and  urinous  perspiration,  saliva and
the like.
   Pathogenesis.   The causes of ischury are:
   Spasmodic contraction  of the  vesical sphincter ; hysteria
and  hypochondria;  nervous fever;  every irritant,  within
as well as without the  bladder, such as worms, metastases,
piles, suppressed  perspiration, gastric  accumulations.  It
is also  frequently the consequence of a previous inflam-
mation.
   Or sanguineous congestion in the vesical vessels ; inflam-
mation  of the bladder (by all the above mentioned stimuli,
when the irritation  is increased to inflammation ;  contu-
sions, too long  sojourn  of the  urine  in the bladder ; fre-
quently hemorrhoidal congestion and syphilis; also ardent
diuretics, as cantharides and savin).
   Or inactivity, paralysis  of the  bladder,  which  may be
brought on by  the  causes previously mentioned, and by
too long retention, and thereby immoderate distention of
the bladder, apoplexy, old age, violent commotion.
   Or  finally,  mechanical impediments,  such   as calculi
sticking in  the  urethra, or sanguineous or  mucous clots,
varicose vessels, callosities and strictures, ascarides, hin-
derances or external impediments, as scirrhus  prostrate,
polypus, prolapsus, and retroversio uteri and other tumors
near  the bladder, pessaries,  most  frequently the pressure
of the gravid uterus in the last months of pregnancy.
   Anuria is sometimes  caused merely  by spasm of the
renal .vessels (hence it is often met with in hysterical per-
sons) ;  by inflammation of the kidneys; also by accumula-
tions of calculi and organic diseases of the kidneys ; such,
however, which affect  both kidneys simultaneously, else
one  kidney would replace the function of the other.
   A slight degree of the  disease is more frequent, and is
due  to  a diminished secretion, which is particularly the
case  in old  persons  and  in little children.  It is often an
unsuspected cause of many diseases and  dyscrasias.
   Therapeutics.   The treatment of strangury and dysury,
as a symptom of gonorrhea and vesical hemorrhoids,  will
be found under the heads syphilis and hemorrhoids.
  In  every  strangury, one drachm of semen  lycopodii,
made into an emulsion with mucilpge of gum. arabic and
syrup, or in  an oily emulsion, is a very salutary remedy.
  The treatment of  ischury must  strictly conform to the
causes and  the various  characters of the disease ; what is
useful in one case, may be injurious  in another; hence its
recognition  and discrimination is very important. 
          ISCHURIA.  DYSURIA. STRANGURIA. ANURIA.       377

   1. The sanguine, the inflammatory, is recognized by vio-
 lent and painful urgency to urinate ; violent and permanent
 pain  in  the  vesical region,  augmented by external pres-
 sure ; distention of that region, heat  and fever.   Ihe in-
 sertion of a catheter and a  bougie causes great pain, and is
 impracticable.   It is also recognized by a knowledge of the
 exciting cause, as abundant potation of wine, ardent diuret-
 ics, hemorrhoidal  congestion, external lesion.  Here the
 promptest  and  most vigorous antiphlogosis  is  required,
 as venesection, leeches to the perineum and vesical re-
 gion ; emollient clysters and  cataplasms, embrocations  of
 mercurial ointment, with oil of hyoscyamus and camphor;
 internally nitre and calomel.  Due regard  must be paid to
 the exciting cause : as  to cantharides, for which oil and
 camphor are wanted ;  hemorrhoids, metastases  require
 anti-stimuli by sinapisms  (plasters  of cantharides  are  to
 be avoided), catheterism  must be  abstained from, for its
 use will increase  the  pain  and  inflammation, and  bring
 no relief.  But, if  after a sufficient abstraction  of blood,
 the urine does not come  away, no time  must be lost  in
 administering opium  with calomel, internally and exter-
 nally, especially in injections ;  for the inflammatory one
 has a tendency to pass into the spasmodic  state.  Urine
 will flow after the administration of opium ; or we  may
 now venture a use  of the catheter.  Warm baths are also
 serviceable.
   2.  The spasmodic or erethic, is marked by the absence
 of fever, by the absence of violent pains, heat and external
 sensitiveness in the  vesical region,  sometimes also by
 a  periodical  return.   In this case,  antispasmodics,  espe-
 cially hyoscyamus  and opium  (emulsio oleosa cum opio),
 must be given ; and externally it is to be treated  by injec-
 tions, oily embrocations, cataplasms of hyoscyamus, linseed
 cataplasms, tepid semicupia ; after these remedies, we may
 endeavor to introduce the  catheter, but with  caution, and
 if found difficult to  pass, it will be better to desist.
  The remote cause must be duly considered.
  3. The adynamic or paralytic  is  recognized by the ab-
 sence of pains and the facility of introducing the catheter ;
 also by the circumstance that some little urine may be dis-
 charged  by external pressure applied to the bladder.   The
 first thing to  be attended to is to evacuate the urine by the
 catheter, once in every twelve hours, in order to prevent
distention of the bladder,  which might cause additional
atony and hinder recovery  ; or the constant application of
                          32* 
378              ANIDROSIS,  ISCHIDROSIS.

a flexible catheter, which must be changed every eight  or
ten days.
  The next thing  is to invigorate the  bladder and its ner-
vous  system, by  administering  roborants and excitants
(vide paralysis), especially arnica, cinchona, and stimulant
diuretics, as juniper (No. J99), turpentine, savin, canthand.
(No. 200), cold lotions to the vesical region and the sa-
crum, cold affusions to these regions,  to the feet, also cold
injections, even injections of cold  water into the bladder,
electricity (sparks in the vesical  region, shocks in the di-
rection of the  os  sacrum towards  the bladder), stimulant
embrocations on the  lower part of the spine, vesicatories,
moxa on the same part.  Wildungen  water may be drank
at the same time.
  It must be remembered, that these opposite states, ischu-
ria and incontinentia  urine, may be produced  by the same
cause,  paralysis, and are then to be treated alike.
  4. The  mechanical obstruction  requires suitable  me-
chanical and surgical aid.  When the obstruction is caused
by clots of mucus  or blood, it is to  be  treated by bougies,
injections; also by bougies when caused by strictures.
  Anuria is cured  by removing the spasm or inflammation,
or the mechanical  or organic causes.
                 ANIDROSIS, ISCHIDROSIS.

  Diagnosis.  Diminished and suppressed  perspiration;
the sign of which is a dry skin (chronic anidrosis) ;  or sud-
den suppression of perspiration by cold (acute anidrosis).
The latter state is easily recognized ;  but not so  the for-
mer ; it  requires the  balance  of  Santorini, in order to
determine the invisible increase or diminution of imper-
ceptible perspiration.  The diagnosis,  therefore, depends
upon a knowledge of the causes which have  operated  on
the patient, as suppressive of  the cutaneous  perspiration ;
and of the effects, especially of rheumatic catarrhal affec-
tions.
  Suppressed cutaneous secretion is rarely looked upon as
a disease, but it is the most prolific source of innumerable
maladies; a fact easily explained, since there is no secre-
tion which has so general and  important, material as well
as dynamic influence on the whole system, as perspiration
has.
  1. Material.  It is by perspiration that the greatest part 
MENOSTASIA.   SUPPRESSIO HJEMORRHOIDUM.
of the materials of the fabric which are no longer fit for the
purposes of life, which have  become  deteriorated  and are
heterogeneous to the  body, and which amount  to two
thirds of all the excretions, is evacuated.  Obstruction to
this  discharge, therefore,  always  engenders  a  morbific
matter of a serous and acrid nature, which  operates first
as an irritant ; but subsequently and  in chronic  suppres-
sion, alters the quality of the  humors,  and generates a pecu-
liar dyscrasy  (the rheumatic).
   2. Dynamic.   No secretory organ has so large an extent
and so universal a nervous connection as the skin ; hence its
vast antagonistic influence ; firstly, on the organs and mem-
branes which have an affinity to the skin, as on the serous
and mucous membranes, and particularly the lungs and the
intestinal canal ; secondly, as a reflex on the nervous sys-
tem of other secretory organs and on all the  other systems
of the body.   The diseases  which arise from  this double
influence are: cutaneous diseases, inflammations  of inter-
nal  and  external parts,  rheumatisms, catarrhs,  blennor-
rheas, nervous affections  of all kinds, dropsy, pulmonary
consumption, chlorosis,and other dyscrasias and cachexies.
   Pathogenesis.  The suppression maybe acute or  chronic;
the first is brought on by  the sudden influence of cold on
a heated  or perspiring body.  The chronic, the impercep-
tible diminution or obstruction of cutaneous secretion by
too  light  clothing,  a mojst atmosphere  (moist  climate,
moist dwelling), frequent  change of  temperature  (change-
able  climate,  or  an  occupation  which produces sudden
changes), uncleanliness, neglected cultivation  of  the skin,
unctions,  suppressing external applications,  particularly
such as  contain  lead;  also  sadness, inactivity,  idleness,
apathy.
   Therapeutics.  The  treatment of the  acute consists in
warming the  skin by clothing and baths, and by the use of
diaphoretic  remedies;—of  the chronic,  in  exciting  the
cutaneous action, in directing the humors towards the sur-
face, cleansing the  skin,  which is done by frictions and
baths; corporeal  exercise, pure, dry air, cleanly habits,
exhilaration, activity of mind, medicines which have a ten-
dency to  the skin  (diaphoretica,  especially  antimonials,
 vide rheuma).

          MENOSTASIA.  SUPPRESSIO HiEMORRHOIDUM.
Vide Menstrua and Hamorrhoides. 
380
EXANTHEMATA.
              ELEVENTH  CLASS.

              CUTANEOUS  DISEASES.-

                     EXANTHEMATA.

                      Generalities.

  Diagnosis.   Alterations  of the  skin  in regard  to  color
or form (hair and nails included), not owing to  external
lesions.
  They appear in the following forms :
  1.  Maculosa, without elevation of the epidermis (scar-
latina, petechie, lentigines).
  2.  Papulosa, with  elevation of the  skin, but  without
pustules (morbilli, essera, verruce).
  3.  Pustulosa, with elevation  of  the epidermis, empty or
filled with a fluid lymph or pus (variola, miliaria,  rubeola,
pemphigus, scabies).
  4. Crustacea, with dry crusts, scurfs (herpes siccus, tinea,
serpigo).
  5.  Ulcerosa, with purulent destruction of the skin (herpes
ulcerosus, lepra, ulcera).
  These forms, however, especially those that are  chronic,
are very changeable, and liable to  numerous modifications,
which of late years have been carefully  specified and gath-
ered into a cutaneous flora of exanthemata.  But these dis-
criminations are  only a kind of nosological natural history,
and are of no practical value.   The most of them depend
merely on the individual peculiarity of the patient, are un-
essential, and afford no indication.   Therefore it is best to
comprise them under the principal forms, as is done in the
preceding statement.
   A more important distinction is that which  belongs to
 their nature ; that is, whether they are necessarily accom-
panied with  fever or  not.  Some are only a symptom or
 exanthema of an acute fever (exanthemata acuta)  ; others
 set in without fever, though it may accidentally associate
 with them in their course (exanthemata chronica).
   Their duration and course accordingly varies.   The du-
 ration of the acute exanthemata is confined to that of the 
EXANTHEMATA.
381
fever which  accompanies them, varying  from seven  to
twenty-one and twenty-eight days.   That of the chronic is
indefinite ; they may last for days,  weeks, months, years,
even through life.
  Their importance and danger are not less variable.   In
the acute form, danger depends on the degree and charac-
ter of the fever, which may.render  them very  dangerous.
The chronic, generally speaking, are not  dangerous,  but
may become so  by retrocession and metastasis, or by long
continuance, an important  disturbance in  vital functions,
nutrition and reproduction, and by  bringing on a general
dyscrasy and emaciation.
   Pathogenesis.   The proximate cause is  an alteration in
the  nutritive process appertaining to the skin, and which is
generally connected with a little local inflammation. These
diseases vary essentially, according as they may originate
in a febrile or non-febrile state.

             1. Febrile or Acute Exanthemata.

   They are essentially and originally connected with fever
(exanthemata essentialia, primaria) ;  or are accidentally gen-
erated   during a febrile attack (exanthemata  accidentalia,
secundaria).
   The  first form is always due to a contagion, which by its
 nature  tends to  the  skin and creates a peculiar fever, the
 crisis of which, though imperfect, is a cutaneous eruption.
 This formation  may properly be compared to vegetation:
 contagion is the seed, the fever is  the process of develop-
 ment and reproduction,  the  exanthema appearing at  the
 height  and  perfection of  fever (the plant), the  florifica-
 tion and fructification.
   Exanthematic contagion maybe of a double origin, atmos-
pheric  or organic (individual) ; or  mixed  (originally  indi-
 vidual,  but  then  communicative   from one  to  another
 person).  The same is true of a fever not originally exan-
 thematic.   A cutaneous eruption may be developed, which
 exhibits a contagium exanthematicum. Every fever, ac-
 companied by an exanthema, may become contagious.
   In the second form, that of secondary  or accidental
 exanthema, the eruption is not a necessary and essential
 effect of the fever,  but arises from accidental, internal or
 external causes.   The principal causes, by which an erup-
 tion may be created in every fever, are :
   Heat, which promotes all  kinds  of vegetation, and this
 s0 called  animal vegetation  also.   Hence, every high de- 
382                  EXANTHEMATA.
gree of fever predisposes to  eruptions by the increase of
animal caloric which accompanies it ; but a hot regimen,
feather beds, stove heat,  heating  medicines, more surely
do so.  By immoderate warmth every febrile  patient is
transmuted into an organic hot-house.
  Dyscrasia, acrimony of humors, above all the ga"stro-bil-
ious (as when evacuants have been  omitted  in gastric
fevers), the putrid disposition to decomposition, the rheu-
matic, catarrhal, arthritic.
  Impure, confined air.                            *
  Cutaneous irritation.   It may be local  or sympathetic.
The first is caused  by  rough, woollen, unclean clothing,
diaphoretics, and applications which irritate the skin.  Of
the second class are verminous and other gastric irritations.
It may depend on the season and  local  conditions, on the
situation of the residence, the mode of living, atmospheric
and  epidemic constitution,  and  therefore be temporary,
endemic, epidemic.  Even medical treatment, the method
of cure contributes to produce it;  and it cannot be denied
that, whilst the diaphoretic and heating method prevailed
in  fevers, purples, petechie  and other eruptions appeared
more frequently  than at the present time.
                  Chronic Exanthemata

originate always in weakness or in irritation of the skin.
  Three points must ever be  kept in view: 1.  The skin is
the intermediate organ between general or dead and indi-
vidual animated nature,  the  boundary line between death
and life. It is constantly exposed to the noxious influence
of the first—the  dead chemismus; between which and the
living  there is a  perpetual  struggle.   The former  may
easily preponderate  in  the reproductive chemistr}' of the
skin,  and engender  an  abnormal vegetation, a bastard or-
ganization, which shows itself in the form of exanthema.
2.  The sk;n is the  most general, and the most powerful se-
cretory and excretory organ  of the system, the function of
which is inseparably connected with life and circulation,
and cannot be interrupted for a  moment without detri-
ment.   It may therefore readily become the receptacle of
injurious internal  morbific matters, and is used  by nature
for their expulsion.  3.  By  means of the nerves it has a
very general and close connexion with the whole organism ;
hence it may  be morbidly affected  by the irritation of any
internal part.  This  accounts for the frequency of cutane-
ous diseases and their vast influence on the whole system.
   The remote causes of exanthema are the following : 
EXANTHEMATA.                  383
   First  of all  is  uncleanliness  and neglected care of the
 skin; hence  cutaneous diseases are more common among
 the  lower classes  and among uncleanly nations (the Rus-
 sian  protects  himself against them  by his steam  bath);
 chronic  suppression  of the cutaneous secretion  by moist
 air,  moist dwelling, moist  climate, bad  diet, acrid, salt,
 smoked,  corrupt fat  aliments,  and cheese eaten  too fre-
 quently, stimulating drinks, too  rich food, exuberance of
 humors;  whence are  generated crudites not only in the
 first  but  also in the second passages (that is, matters not
 properly  elaborated and assimilated into the blood ;  whence
 they are  deposited as  acrimonies in the  skin—a frequent
 occurrence in children); contagia, the scabious, the syphi-
 litic ; dyscrasias of all kinds,  especially  the scrofulous,
 arthritic,  scorbutic,  atrabilious;  sympathetic irritations,
 gastric accumulations, infarcts,  worms;  antagonistic irri-
 tation of the  skin, metastases  to the skin,  by suppression
 of other  secretions,  as that of the intestinal  canal, liver,
 kidneys,  of menstruation,  hemorrhoids,  or morbid secre-
 tions and crises, of blennorrheas, arthritic crises, dysen-
 tery, intermittent fever ;  quantitative  disorders,  plethora,
 over-irritation of the skin as well as weakness, deficiency
 of vitality in it (the first is met with in children and young
 persons, the latter in old people, and is often the only cause
 of cutaneous  diseases);  metallic  poisonings,  especially
 chronic ones,  by mercury, lead,  arsenic; local influence of
 corrupt and noxious irritant substances, expired air, new-
 built rooms, great heat, too  warm regimen and clothino-,
 rough woollen  clothing  on the bare skin.  In protracted
 cutaneous diseases one more cause is to be mentioned, one
 which renders the evil  obstinate, it is habit.  Nature  has
 finally become accustomed  to the eruption, the  skin  has
 become the excretory organ of morbific matters which
tend  thither, and which now  rank among the necessary
 secretions.  Finally,  also the complete destruction of the
skin  may  become a cause of their continuance and incu-
rability.
   Disposition  to  eruptions is  owing to  a  psoric constitu-
tion,  a proneness to  cutaneous  diseases,  which  is either
congenital (prevailing through whole families); or acquir-
ed, most commonly by too warm  regimen, in the first years
of life, at  both extremities of life—childhood and old age.
In either  case the  secretion of the skin is altered, and
thereby a  disposition to cutaneous diseases is imparted;
old acre alone often generates obstinate cutaneous diseases, 
384                  EXANTHEMATA.
which are nothing else than incipient dying away (mortifl.
cation) of the skin.
  Therapeutics.   The principal thing is to discover whe-
ther the  exanthema is the product and concomitant of an
acute fever, or not.
  In the first case fever alone is the object of treatment,
which must be adapted to its variety ; this cured, the erup-
tion disappears.   However, the-difference in the  nature of
the eruption, whether it be contagious,  symptomatic, or
critical, must be taken into consideration,  and requires a
corresponding modification in the treatment.
  In the second  case, in  chronic exanthemata, the  chief
indication  is: to  restore the normal  function  and organi-
zation of the  skin.  This  can be effected by general as well
as  by local means; but in pursuing a  merely local treat-
ment, we ought to remember, that,  when the cause is ge-
neral and deeply seated,  the cure is never radical and last-
ing, but the evil will ever and anon return, or, what is still
worse, is followed by shifting to  internal  noble parts.  A
radical cure  of cutaneous  diseases, therefore, has the fol-
lowing rules.
   1. Search for the general and remote  causes and remove
them ; therefore, remove dirt, bad diet, the dyscrasias that
cause the  disease  (vide dyscrasia) ; abdominal accumula-
tions, hemorrhoidal and menstrual disorders;  in plethora
and hypertrophy of the skin, an abstractive  treatment, de-
rivation ; in  vital  weakness and atrophy of the skin  (as in
exanthemata of atrophic  children, and persons poor in vital
powers by  want of aliments and old age),  restorative treat-
ment, nutritive food.  This often suffices  for a complete
cure ; the eruption disappears without any use of local re-
medies.
  2. If this do not succeed, we must presume that the evil
has already become idiopathic and independent in the skin
itself; and  then the treatment must be directed against the
proximate cause, the abnormal state of the skin itself,—the
direct treatment of cutaneous diseases.  It comprises two
things:  a,  the use of such universal and  internal remedies,
as improve the condition of the humors  in general, and are
possessed of a power tending to  the skin and ameliorative
of  its action;  b,  the application  of local  means,  which
have the same  effect.  They are: pure dry air, exercise,
great cleanliness,  frequent change of linen, washing,  tepid
baths, promotion of all secretions, especially of that of the
skin, purgatives frequently repeated,  the antipsoric speci- 
EXANTHEMATA.                  385
fics, as sulphur, antimony, ethiops, Plummer's powder, gua-
iac, root of sarsaparilla, bardan, carex. arenar., lapath. acut.,
taraxac, graminis, stipites dulcamare, cort. ulmi.  To these
means, when the general treatment fails, we must add such
local ones as are able,  by their dynamico-chemical power,
to remove the vicious  organization of the skin, and stop
the morbid secretion. They attain this end by suppressing
the vital action (lead, vitriol, alum, astringents),  or by
qualifying it.  They first are risks, since they are apt to
produce metastases, and must on that account be avoided;
the latter are preferable.   We  may use  for that purpose
the most simple and innocuous,  as soap and lime-water, or
lime-ointment; also all medicines mentioned above,  mer-
cury, sulphur, antimony ;  likewise graphites, baryte mu-
rias, calx chlorin., coal  in the form of lotion and ointment,
the previously named depurative vegetables in decoctions,
ointments, and baths. Simply washing and bathing are often
alone sufficient and are the best external means, they may
be rendered more efficacious by the addition of soap, culi-
nary salt,  sulphur, cort. ulmi, sublimate.
  3. When  the disease  is of a mere local origin,  it may be
treated in the beginning only locally, but when protracted
it may have generated  a general dyscrasia, or be sustained
by complication and habit, and requires  a general  treat-
ment.
  4. On  the other hand, a cutaneous  disease, sprung  up
from general causes, may become merely local, and cannot
be cured but by  a concentrated application of local re-
medies.                                               '
  5. In very  obstinate cutaneous diseases two indicjjjjons
are  recommendable for a  cure:  a, to investigate whether
it is  not dependent on some complication that keeps it up;
b, whether the cutaneous disease has not become a natural
and  necessary habit  of secretion.   In the first case the
complication must be remedied; in the second derivatives
and supplementary actions must be created ; and especially
purgatives and artificial ulcers resorted to.
  6.  It is  advisable in the treatment of every protracted or
habitual  cutaneous disease,  to  keep open  a  fontanel for
some time,  and even after it has disappeared, in order to
prevent the injurious consequences which  are apt to arise
from the  suppression of a  habitual secretion.   This is the
more necessary,  when the cure has  been performed  by
local remedies.
33 
386                   SMALL POX.
                          SMALL POX.

                            Variola.

      Diagnosis.  Fever, at the end of the third day of which
    red spots appear; they grow  larger during the next three
    days, and form pustules,  then stand suppurating for three
    days more, begin to dry on the seventh day of their break-
    ing  out,  (the eleventh  of the  disease,) and  form scabs.
    Such is the course of each variolic pustule.   Sut as new
    pustules continue to break out during the three first erup-
    tive days, and as each pock runs through its own periods,
    the whole eruptive  stage  lasts three days longer, so that
    the  general desiccation  happens only on the  fourteenth
    day.
      This is the image of the normal, simple (benign) small
    pox.   It cannot be mistaken.   It  can be  confounded  only
    with  one of its  varieties (varicella); a mistake which is
    injurious, and to be  avoided only because it leads the  indi-
    vidual to believe that he is  safe from  future infection,
    while he is not.

                            Course.

      The disease passes through the following stages :
      Stadium infectionis (communication of the virus).  It is
    imperceptible, for the  virus is"still latent, without reaction.
•   It may last seven days (as we see in inoculation), but may
    be fourteen days and longer in the natural infection.
      Stactium  irritationis  s. febrile.   The small pox fever is
    mild in the commencement, but increases from day to day
    until the  fourth, when the eruption appears. It is a f. conti-
    nua remittens.  It is distinguished from other fevers by the
    following peculiar symptoms, which will enable us, even in
    this period, especially if variola is then  prevalent, to say
    that the disease is small pox, which is of importance on ac-
    count of the treatment. Nausea, vomiting, putrid odor of the
    breath  and urine (peculiar to this exanthema), epistaxis,
    headache, which in adults increases to  delirium, even  to
    furor, in little children to epileptic convulsions, colic, pains
    in the back.
      Stadium eruptionis et florescentie. At the end of the third
    febrile exacerbation, the small  pox commences to break out
    first on the face, the day  after on the hands, the third day
    on the feet and the rest of the body.  They appear first as 
SMALL POX.
387
 small, red points (stigmata variolarum), but increase every
 hour in extent and elevation.  As early as the first day we
 may perceive, on close examination, a  little knot, like a
 grain of millet, in every stigma (the pock  to be), and there-
 by distinguish the small pox from spots  of measles, pete-
 chie, and other cutaneous diseases.  This stage lasts three
 or four days, when  new pocks continue breaking out, so
 that the patient always has pustules of three dates, each of
 which  observe this measure of time in  all the  following
 changes.  Thus, the pustules on the face are in a  state of
 suppuration, while they are only forming on  other parts,
 and dry while the latter are suppurating.  As soon as the
 eruption  appears, in mild variola, the fever ceases, and the
 patient often  feels quite well, except his suffering from the
 local irritation of the  pustules.
   Stadium suppurationis.  The epidermis rises up and forms
 a pustule, small at first, depressed in the centre, and filled
 with a watery fluid.  It gradually increases, grows elevated
 and filled with a yellowish  pus, so that a perfectly formed
 pock appears  as  a  convex, yellowish pustule, filled  unto
 bursting, and resembles a split pea.  This period, too, lasts
 three or four days.   During  it the following symptoms
 usually take place : fever, called secondary or suppurative ;
 swelling, which generally accompanies the local  suppura-
 tion, appearing first on the face, and when  there are  many
 pustules, the head is swollen like a deformed ball ; the eyes
 are completely closed by  the swelling of the lids; it then
 attacks the hands, at last the feet; salivation.
    But all these  accidents  depend on the number of pus-
 tules, for where there are but few, and they are benign,
 the suppuration goes  on without any of them.
    Stadium exsiccationis. The pustules dry and form scabs in
 the same order as they broke out.  This period lasts three,
 four, in  many case,s  eight days  altogether; single  pocks
 may subsequently suppurate even longer. The scabs loosen
 slowly, and leave red spots for a long time, generally also
 cicatrices.   The  incipient exsiccation of the face is the
 most dangerous period of the whole disease.  The  most
 fatal issues then ensue, either by a putrid dissolution, mor-
 tification of the pustules, hemorrhages, or local inflamma-
 tion of noble viscera  (as of the lungs, the brain, the abdo-
, men), or by nervous fits and convulsions.
    Bad  consequences and subsequent diseases are very apt
 to remain.  They are : disfiguration of the face by cicatri-
 ces, which often totally change the physiognomy,  blind- 
388                   SMALL  POX.
ness by destruction of the eyes, chronic ophthalmias, entire
exhaustion of stttngth and humo:s, emaciation, pulmonary
consumption, caries, chronic ulcers.
  We  distinguish variole  discrete and  confluentes.  The
first, when the pustules appear single, separate  from each
other ; the latter, when they break out in groups, and arri-
ving at maturity, flow together into great suppurating sur-
faces.
  Form and course may become subject to important anom-
alies by complication with other fevers (as the inflammatory,
nervous, putrid, gastric).  They are : in the stad. eruptionis,
the pustulesappearall atonce in great numbersor in groups,
or come out irregularly, tardily, interruptedly.  The fever
continues after  the  eruption,  the pustules form  imper-
fectly, or  are  stopped forming ;  they  appear  depressed
(without areolas), watery (crystalline, lymphatice), empty
(siliquose), of a false color, filled with blood (sanguinea) ;
during the suppuration, renewal of the fever;  the pustules
become  suddenly depressed, and so does the swelling in
the face ; the exsiccation comes on too quick,  too early,
and too general.
  This complication and anomaly of small pox is  called
malignant in antithesis to the simple,  mild (be?iigne).
  Small  pox is  one  of the most  dangerous, painful and
loathsome, even hideous diseases  which we know of.  It
can transform the healthiest person within eight days into
a putrescent, deformed, stinking corpse, which alone shows
its foreign and tropic character.
  The danger depends especially on the number of the pus-
tules, particularly on the face (the more, the greater the vir-
ulence) ; on the complication (the more simple, the better),
on the age (more perilous in adults  than in children, except
in the  period of dentition), on the  general constitution.  It
is always a milder disease in the beginning and at the end
of an epidemy, than in the middle  of it.   Convulsions pre-
vious to their  breaking out are not dangerous, but are most
dangerous afterwards, during exsiccation.  An eruption  of
a great many pocks  setting in suddenly  all at  once, and
gathered in groups is dangerous and ominous.   The same
is true of depressed, pale, or badly colored pustules; still
worse  are sanguineous pocks; worst of all, is evacuation
of blood  by urine and stool during  the exsiccation.
  Pathogenesis.  Proximate cause  is infection  by the  con-
tagium variolosum. The whole disease is nothing else than
a poisoning process, created on one hand by the  virus and 
SMALL POX.                   389
 its reproduction and multiplication, on the other hand by
 the reaction of the organism endeavoring to assimilate and
 expel it.
   1. The  variolous virus  has the following properties:  it
 has been known in Europe only since the seventh century, in
 America since  the fifteenth, and  in Iceland not earlier than
 the eighteenth  century.   Its origin is purely organic, not
atmospheric ; that is to say, it can only be generated by
 the living body, and after previous  reception of the germ
 (infection).   It is not communicated  by the atmosphere,
 but only by contact, either of the patient himself  or some
 solid body infected  with  it ; in  these ways  it  may be pro-
 pagated  for hundreds of miles; though  the immediate
 atmosphere of the sick also is  infective.  It can  produce
 its  effect only once ;  that  is, create one reaction in the
 same individual, twice in very rare cases.  There are at-
 mospherical  constitutions,  which favor  its reception and
 reproduction, and vice versa; hence the disease may pre-
 vail sometimes epidemically, sometimes  only sporadically,
 sometimes it does not at all appear for years.
   2. The reaction of the system  against the variolous virus,
 the poisoning process, the internal disease, comprises two
 things: the poisoning of the  whole system, accompanied
 by a multiplication and reproduction of the virus ; and the
 irritation of  the nervous  and sanguineous systems thereby
 created (the variolous fever), also the effort of the organism
 to assimilate and expel it.   This internal process continues
  during the whole course of the disease, suffering various
 modifications, which constitute the different stages.
    a. Communication of the virus.   It is yet dormant, not
 yet vivified by the reaction of the living organism.
    b. Perception and reaction of the system, manifested  by
  fever (stad. irritationis).   This  is the  very period in which
 the virus is reproduced  and multiplied in the body ; and
  that one in which the reaction of the organism prepares the
  crisis which follows.                   ,               .
    c. Elimination and  deposition of the  virus into the skin.
  This  is  a  crisis,  though  an  imperfect one—metastatic.
  Simultaneously critical  urine and perspiration.   By this,
  in benign variola, the internal disease is terminated,  tever
  ceases, appetite and digestion return.
    But when the number of pustules  is very great, a new
  disease follows; the  secondary or suppurative fever.   Its
  causes are : the violent  inflammatory cutaneous  irritation
  accompanying the numerous little abscesses  in  the  *>kin,
  the new  poisoning and infection brought on by the absorp-
                            33* 
390
SMALL POX.
tion of the pus and the suppression of perspiration, causing
an accumulation of acrid serous humors; hence the swel-
ling and  the salivary flux.  The character of this  new
disease is therefore a mixed one and very malignant; partly
inflammatory by the  inflammatory irritation, partly  ady-
namic by  the exhaustion, partly putrid by the admixture of
purulent and contagious matters.
  d.  Termination of the  crisis, dying away of the conta-f
gious exanthematic  efflorescences, exsiccation.
  It is  at  this period, in cases when the  pustules have been
very numerous, that life is most endangered by a retroces-
sion inwardly of the virus which was hitherto confined to
the skin, and its attacking noble viscera.
  Therapeutics.  The fundamental idea  here is: respicefe-
brem, regarding at  the same  time the  peculiarity  of  the
variolous contagion.  The treatment, therefore, varies as
much as the fever which  accompanies it does.   However,
there is one thing which  never varies, because the  nature
of the variolous contagion essentially requires it, and it is
indispensable in the  treatment ; it is—cold, and fresh air.
It is incredible  what may be accomplished by these natural
agents  in  this disease, partly to  diminish the reproduction
of the  poison and the  multitude of pustules, partly to as-
suage the dangerous attacks inherent to this plague;  We
must consider that the patient is immersed in a poisonous
fermentation which  cold can  decrease, and warmth aug-
ment;  and. at  the  same time  that he  is  surrounded by
a cloud  of poisonous vapors, the reaction of  -which on
the organism  is most hostile and destructive, and which
therefore ought continually to be dispelled and supplied
by a constant renewal of fresh air.  The experience of all,
and also mine, have fully confirmed this  great power, and it
is certain, that a warm  regimen  and confined air alone
suffices to render the mildest small pox  malignant.
  The  modern  treatment of this disease is advantageously
distinguished by this, that it tends to decrease the  repro-
duction and.quantity of the virus ; whereas the old faulty
method was only calculated to  throw it  out, by which  the
internal poisoning was increased.

                   Special Treatment.

  1. Stadium irritationis.  This  stage is the most impor-
tant, and must be turned  to profit  in order to restrain  the
generation of too much virus in the system.  Very much
may be done in the first and second stages towards arrest- 
SMALL POX.
391
 ing an excessive formation of matter, and thereby dimin-
 ishing the violence of the disease.  The principal means for
 attaining that end are :  cold and a moderate use of calomel;
 for children one half to one grain, for adults two to three
 grains, several times a  day.   The next thing is to prevent
 complications, which is to be done by cool regimen, free
 air, keeping out of bed  as much as possible, discarding fea-
 ther beds, by cold washing of the face and eyes, cleansing
 the first ways by an emetic and cooling laxatives (vide No.
 245 a.), (for children in the beginning, as much as will pro-
 duce several stools ; at a later  period of the disease,  in
 such doses as will  give two fluid evacuations a day), and
 venesection, if the fever be violent or the patient young
 and  plethoric.
   Convulsions occur very frequently in children.  In gen-
 eral they require no other treatment than exposing the
 patient to the influence of cool, fresh air near an open win-
 dow. This will act like a charm in removing them. Injec-
 tions are also useful.
   Violent delirium, furor  in  adults, requires  venesection,
 mustard plasters on the calves of  the legs, foot baths, in-
 jections, cooling purgatives.
   If, in children, the convulsions and other nervous attacks
 continue, and that in the beginning the eruption comes and
 goes (eruptio difficilis), other causes are in operation, and
 the treatment must accordingly vary.   We distinguish the
 following cases:
   The  child's face is pale, its extremities are rather cool
.than  warm, and the  urine is pale.  This is merely a nervous
 condition ; for  which  tepid baths, injections, zinc along
 with  musk, and sinapisms to the soles of the feet are the
 best remedies.
   Or gastric signs may be  present, and the  cleansing  of
 the first ways has been neglected.  It is  this that  causes
 the spasm and restrains the eruption ;  emetics, purgatives,
 and injections best promote  the eruption.
   The  same is true in regard to a verminous complication,
 for which  calomel  and  milk injections  are  particularly
 recommendable.
   Or finally, the convulsions having  ceased,  the  child  is
 soporous, its face is red and forehead hot.   In such a case
 inflammatory irritation of the brain exists, and  inflamma-
 tory irritation restrains the  eruption.   The application  of
 a  few leeches behind  the ears  and  cold  washing of the
 forehead, along with internal  cooling remedies, will best
 remove the spasm and  facilitate the eruption. 
392                   SMALL POX.
   The same considerations must be observed in the deli-
 rium  and furor  of adults, which arises  from  the  same
 causes.
   Particular attention is due  to the eyes, in order to pre-
 vent pustules forming there ;  for this  purpose cold lotions
 and the  frequent application  of  camphorated  rags is ser-
 viceable.  Even stigmata already formed may be dispersed
 by dropping weak lead water  on them.
   2. Stadium eruptionis.
   If the treatment previously advised  has  been complied
 with in the first stage, nothing else is to be done during
 the eruptive days.   In benign pox, the  cool regimen and
 No. 215 a. must be continued.   But if the first stage has
 been neglected, and the same indications are still present,
 the necessary remedies,  emetics, even venesections in
 adults are called for.  In  complicated small pox the treat-
 ment of the complicated fever is  to be continued.
   3. Stadium suppurationis,  suppurative fever.  In  mild,
 discreet small pox nothing is  needed but a continuance of
 the regimen and remedies already advised.
   But  when the pustules are very numerous and confluent,
 when the disease is very complicated, when a new disease,
 that is, the suppurative or secondary variolous fever springs
 up, when it is of a mixed and malignant character ; the case
 claims the whole attention of  the physician on account of
 its fatality.  The indications  are :  to mitigate the inflam-
 matory cutaneous  irritation,  to  purify  the blood of the
 absorbed purulent and retained perspirable matters, to cor-
 rect the  putrid disposition of  the  humors.   The first will.
 be better and more promptly attained by opening the pus-
 tules by means of a broad vaccinating needle, by which
 the resorption of the pus will be diminished.   When there
 is violent pains and inquietude, a  moderate dose of opium
 is to be given in the evening.  If the pustules refill,  they
 must be  opened again.  The  second indication is fulfilled
 by drinking largely of cooling acid beverages, and by pro-
 moting the intestinal  and  urinary secretions, since  that of
 the skin is closed.   The third end is accomplished by  mix-
 ing sulphuric acid in the drinks.  But above all, the utmost
cleanliness, constant renewal of air, daily change of linen
 and bedclothes are necessary.
   Salivation is to be  entertained by drinking abundantly
 of cold beverages.   When it is suddenly suppressed, it  may
 be re-established by warm vapors, emollient  gargles, and
 fomentations around the throat;  in  attacks of suffocation,
 a vesicatory on the chest will be found serviceable.   The 
SMALL POX.
393
 eyes are  closed by the swelling  which accompanies this
 stage ; the same  cause and  internal pustules close the
 throat.  Against the first nothing can be done but foment-
 ing and warhing these  organs with tepid milk ;  against the
 latter, injections of emollient decoctions may be used.  It
 often happens during this period that a complication which
 was  hitherto  imperceptible, becomes clearly apparent; in-
 deed, it is often only now that fever assumes a complicated
 character.  This, in most cases, is an inflammatory move-
 ment recognizable by intense redness of the variolous are-
 olas  (halones), a  hard pulse,  heat, thirst, and the local
 inflammations of the lungs, brain, or abdominal viscera.  It
 calls for vigorous antiphlogistics, calomel, leeches, vesica-
 tories,  even for venesection in adults, especially if this has
 been previously omitted.   If  the complication be nervous,
 which is known by t!ie pustules being flat, limpid, empty,
 the areolas absent, the  skin pale and cool, and the swelling
 of the face imperfectly formed, and by a spasmodic trem-
 bling, opium  is the principal remedy, since it diminishes
 sensibility and spasm, strengthens the vascular  system, in-
 creases the impulse to  the  skin, and  specifically promotes
 the suppurative process, it therefore unites all the requisite
 qualities  needed in this case.   It  may be  combined with
 calomel, which, by its specific power as an  antidote, weak-
 ens the poisonous  property of  the  variolous virus which
 now  attains its highest degree of malignancy ; recourse
 may  also be had to musk, camphor, arnica, a warm bath of
 28° Reaumur (63° Fahrenheit), sinapisms, vesicatories, even
 to embrocation of mercurial ointment.  In the putrid (com-
 plication), which is marked with discolored, bluish, brown-
 ish pustules, intermixed with petechie, cadaverous fetor,
 tendency to gangrene, confluent variolous ulcers, which
 often cover the whole body and transform the patient into
 a putrid mass of flesh, with hemorrhages  from  the nose,
 mouth,  intestinal canal, kidneys, and the pulse extremely
 small ;  the most  vigorous application of cold  and the
 excitant, antiseptic  method is to be resorted to.  Ice-
 cold  air  incessantly renewed, cold  affusions,  wrapping
 the body in cloths saturated with camphorated vinegar, or
camphor dissolved in the  yelk  of eggs ;  wine,  sulphuric
acid, alum, cinchona, serpentaria, camphor internally, have
sometimes procured salvation, when all seemed despaired
of.  Finally,  a gastric  complication manifests itself, for
which evacuants, especially the  laxative, are of the great-
est service ; matters evidently purulent, are frequently thus
discharged. 
  ^*                  SMALL POX.

   Sudden exsiccation, abatement of the facial swelling.  This
 is the most dangerous occurrence in  the  whole disease,
 and is generally a  signal of death.   The  pustules in  the
 face suddenly and prematurely lose their redness, sink in,
 become dry, and the swelling of  the face also disappears.
 Art must now apply and unite all that has a tendency to
 raise the sinking vital  power, to  increase the impulse of
 the humors to the  periphery, and to prevent a metastasis
 to noble viscera, which would certainly prove fatal.   For
 this purpose, sinapisms,  wrapping the hands and feet in
 emollient warm  cataplasms,  sharpened by mustard, wine,
 opium, with calomel and  camphor, must be used.
  4. Stadium exsiccationis.
  The principal indication is to purify the humors of  the
remaining variolous virus, and which have been increased
by resorption  of pus.  As  the  skin  is  inaccessible  and
closed, there  remains no other way than by the secretion
of the intestinal canal and the kidneys. Purging, therefore,
is the principal thing  to  be  done  ; indeed nature sets  the
example by a voluntary diarrhea,  which sometimes carries
off matter evidently purulent.  At the same time, purifying
beverages, as whey, Selters  water, decoction of radix gra-
minis, althee  and  diuretics   (spirit, nitr: ether.) must be
abundantly  used.  Gentle cathartics must be continued for
three or four days, and even  repeated for two or three days
more, according to  the quantity of pustules.  The purga-
tives are best combined with small doses of calomel. This
is all that need be done in mild small pox.  But in compli-
 cated, malignant variola, the previous strengthening,  ani-
 mative method of cure must be  continued, especially the
 use of cinchona.  It may also happen,  in a  sudden, prema-
 ture exsiccation, that  a  congestion  of blood to the brain
 and lungs endangering life,  may  take place ;  if is recog-
 nized by a soporous, apoplectic or suffocatory state.  This
 requires a prompt  abstraction of  blood as  the only salva-
 tive of life.

                 Subsequent Treatment,

   Requires free air, baths, blood-purifying beverages, mild
 nutriment; animal food, which is apt to produce metastases,
 must be delayed.
   When a patient survives the highest degree of malignant
  smallpox,  his condition is deplorable.   There is no malady
  which is capable of exhausting the humors and strength of
  the body within so short a  time  (a fortnight), and of im- 
   f»                  VARICELLA.                   395

pregnating the system with as poisonous a matter as small
pox.  The constitution wants an entire revival and resto-
ration.

                       VARICELLA.

                     Variola Spuria.

  Diagnosis.  Pustules sometimes small, and perfectly sim-
ilar to genuine small pox ;  sometimes they are found only
on  single parts, sometimes  everywhere.  They break out
after a febrile commotion  of twenty-four hours, which is
in some cases very slight and scarcely perceptible, and in
others violent, and increases to  delirium.  Some pustules
form  within the first twenty-four hours, and dry  up in
twenty-four hours  more ; but a  few  single pustules will
continue to suppurate'for a longer time.        •
  The distinction  between  this and genuine small  pox,
therefore, consists neither in the form, nor in the fever,
which sometimes is very slight in the genuine, and violent
in the spurious, according to  variety  of  constitution ; but
merely in the quickness of its course.  In the genuine va-
riolous disease, there are three days of  fever before the
eruption ; in the spurious  only one day ; in  the genuine
there are  three days for suppuration, in  the spurious  one
day ; the  same proportion for exsiccation, so that the gen-
uine small pox completes its course within nine or twelve
days ; the spurious within three or four days.
  Life is never endangered by this disease.
  Pathogenesis.   The cause is a contagion similar to vari-
ola,  but much weaker and essentially different; it may be
communicated  by inoculation, as the former, but it  does
not  protect against variola; one may have had  varicella
and  be still  subject to variola, and  vice versa.  Thus, du-
ring the period when the small  pox inoculation prevailed,
it has happened through want of discrimination, that the
spurious disease was inoculated instead of the  genuine,
and  proved, of course,  no protection.  Varicella  appears
often before, during, and after a variolous epidemy, but
often also independently of it.
  Therapeutics.  Nature makes the cure.  There is rarely
need for art to interfere ; except at the end, and when the
suppuration of single pustules lasts too long, a purgative is
recommendable. 
396                   VACCINELLA.                  d
                 COW  POX.  VACCINATION.

                       Vaccinella.

   Vaccination is one of the greatest and most salutary dis-
 coveries of modern times.
   Protection  from small pox may be attained in two differ-
 ent ways; either by avoiding the virus, separation ;  or by
 annihilating the  susceptibility to it.  Trie first is totally
 impracticable on account of the  intercourse of mankind,
 and the impossibility there is to avoid infected substances,
 which are so  without our being able to perceive it. There-
 fore  there  remains  only the  second protective method,
 annihilation of the  susceptibility.  An  endeavor to attain
 this end was made by the artificial inoculation of the  small
 pox itself;  for this disease generally has the peculiarity of
 annihilating for ever a future susceptibility, and experience
 had taught that artificial infection, the patient being  prop.
 erly prepared, was less dangerous than the natural one.
 But there remained  still  some danger  (one fatal case in
 five hundred), besides a perpetuation of the variolous virus.
 In the year  1769  it was discovered in Germany,  that the
 pox communicated to men from the udder of cows was  a
 protection against a future infection of  small pox; and in
 1798, Edward Jenner  of England, made the first trial of
 vaccinating  the human, species, carrying in this way the
 discovery into practical use.  It  will easily be  conceived
 how superior  this vaccination is to the inoculation of hu-
 man small pox, since there  is  never  any danger from it,
 and man  escapes a formidable malady by undergoing an
 insignificant, often a scarcely perceptible cutaneous affec-
tion, and by which he escapes a most hideous disfiguration.
Vaccination has since  been  spread, not  alone throughout
Europe, but throughout the  world, and in many countries
it is enforced by legal enactments, which at the same  time
strictly prohibit the inoculation of human small pox.
  Th*e operation of vaccination is very simple and easy.
The principal  care is  to obtain genuine  and perfect  cow
pox, and to watch that it turns out so, for  it is subject to
degenerate and become spurious, in which case it loses its
protective power.
  The following points are to be  complied with for  that
purpose.
  1. Selection of the vaccine matter.  The lymph must be
taken as soon  as it is generated, and while it is yet pellu- 
VACCINELLA.
397
cid ; as early as the sixth or seventh day after vaccination.
The earlier it  is taken, the more infectious it is, and the
more sure and protective will be  its effect.  When it has
become yellowish and puslike, it has lost its power.   We
must also be careful that it is genuine, and that the person
to be vaccinated be healthy.
  2. Vaccination.  The principal condition for  obtaining
perfect and protective virus  consists  in transferring the
lymph directly from one living person to another.   A broad
and slightly concave, very sharp needle is to be insinuated
into the pustule,  and becomes charged with  the virus.
Being  so prepared, we  make with it three or four punc-
tures  in each upper arm of  the person to  be affected.
These  punctures arS made by passing the  instrument be-
tween  the epidermis and the cutis, so that only a little red
spot appear, but no  bleeding  follow, for this would wash
away the vaccine matter, and  thereby render the operation
fruitless.  We are next to cover the  spot with a small
piece of linen, in order to prevent it from being rubbed off,
and this completes the operation.   It may be done at any
season  and  at any age,  except in the two  first  months of
life, for as yet the skin is too imperfectly organized, and an
imperfect pock is apt to form.
  3. The phenomena which follow the  operation are to be
observed, in order that we  may be convinced of the genu-
ineness of the protective pox, and the protective quality of
the generated pox.
   The  diagnostic  phenomena and the  course of genuine
protective pox are as follows:
   For  the first  two or three days after the operation no
alteration is perceived in the vaccinated spot;  on  the
fourth  day it appears red  and somewhat elevated, on the
fifth day it grows  still more elevated, and  on the sixth a
small  pustule filled  with watery lymph is evident.  This
pustule continues  to increase in  size on the seventh  and
eighth days, but more in breadth than in height. It attains
a diameter of two, sometimes of four lines; is surrounded
by a red inflammatory  halo  of several lines in  diameter,
and fills with a watery lymph of a bluish cast.  On the
eighth day it commences to assume a yellowish color, to
grow thicker  and  purulent.   The axillary glands swell a
little, but not always; slight febrile motions are manifest
in the pulse,  by an increased warmth and a sensation of
fatigue.  In adults the  irritation is sometimes  more vio-
lent.   Appetite  and  digestion remain generally undisturb-
ed. Only in some  cases a transient diarrhea and vomiting 
398                  VARI0L0IDES.
 sets in. On the eighth, ninth, or tenth day a new peripheric
 inflammatory  redness around the pustule is exhibited,  ex-
 tending several inches,  even sometimes  occupying  the
 whole upper-arm, and which causes more itching than pain.
 This lasts  for two or three days.  The pustule  then dries
 up,  and  changes into  a dark brown scab, which loosens
 after eight or more days.  Now the disease is  at an end.
 Generally,  as many pustules as vaccinated spots are gene-
 rated. But sometimes after the eighth day little red pus-
 tules are observed also on the rest  of the body, which how-
 ever  disappear after a few days.  No subsequent malady
 takes place; only a pale color, and sometimes an insignifi-
 cant  miliary-like eruption is generally observed for some
 weeks longer.
  The imperfect, the spurious, non-protective cow pox is
 distinguished by the following signs: premature eruption
 (already on the third or fourth day after vaccination a pus-
 tule raises), the form of the pock is not flat and depressed
 in the middle, but convex and quite filled;  want of the  se-
 condary peripheric redness around the  genuine vaccinated
 spot on the eighth or ninth day, which  is the chief sign of
 a general infection and of the protection against the human
 small pox.
  The causes of this- anomaly  are: matter is taken too
 late, or which is too old, and which has lost its contagious
 property; or a deficient susceptibility of the individual.
  This artificial disease requires  no  medical treatment.
 The vaccinated may be allowed to  continue their custo-
 mary mode of living.   It  is advisable on the seventh or
 eighth day, when fever  and general infection  is expected
 to take place, to keep them at home.   After the  disease is
 terminated, that is, after the peripheric redness has disap-
 peared and the pustules dried up,  it  is recommendable to
 give several purges  of calomel and jalap, in order to pre-
vent subsequent cutaneous diseases  and glandular swell-
ings.
                     VARIOLOIDES.

  A variety of genuine small pox, generated by the vario-
lous virus, sometimes attacks an individual previousjy vac-
cinated.
  It is a bastard-plant,  originated by variolous seed,  but
which, by the vaccinated soil in which it springs up, is so
modified in its development and  vegetation, that it does 
VARIOLOIDES.
399
not exhibit the genuine variola, but a milder variety of it.
In its nature it is variola,  and may again produce variola
by infection, though  sometimes only in the second gene-
ration.
  It is distinguished  from genuine variola  in its external
form by the following signs: It observes on the whole, the
same stages as  variola, differing in this respect from vari-
cella ; but the fever is generally much lighter, and the sup-
purative fever is  in most cases entirely absent.  The pus-
tules appear in the same order, sometimes also very nume-
rous, even  confluent; but they are commonly small and
filled with  lymph;  sometimes they are entirely  empty
(siliquose); the  scabs are less thick and hard, and there-
fore leave neither impression nor cicatrices, but only a red
elevation on the  variolous spot for some time.  They ge-
nerally  do not endanger life; but there are rare cases,
when they  assume the virulence  of  the genuine variola,
and may prove even fatal.
   The cause of their  appearance resides in the susceptibi-
lity  of the organism  for the variolous contagion, not hav-
ing been entirely annihilated by the vaccination.  It is not
owing to time.  Some have believed that it depended on
the  vaccine matter having lost its infective power by the
length  of time it has been in use, and its frequent repro-
duction, or on the receptibility of the organism having been
re-established by the length of time elapsed since the vac-
cination. Both assertions are refuted by the circumstance,
that varioloids may  originate equally well in those vacci-
nated for 20 and more years, when the vaccine matter was
yet fresh, and in those but recently vaccinated.   Nor can
the small number of vaccine grafts be regarded as a cause,
 since it is not the quantity of virus communicated, but its
 intensity and the susceptibility of the person which are to
 be considered. Even  Jenner never made more than 6 grafts,
 and these were  perfectly protective.  The true reason of
 receptibility not having been entirely annihilated, must be
 sought for either in a spurious,  or too old and corrupted
 lymph  used for vaccination, or in the imperfect reception,
 infection, on account of the organism wanting the disposi-
 tion to it at the time of vaccination, whereby also the re-
 ceptibility was but imperfectly annihilated.  The  best pre-
 servative  therefore is revaccination, by which one  may
 hope to extinguish entirely the rest of receptibility which
 might perchance have been left.
   The treatment is the same as that of variola. 
400                    MEASLES.
                        MEASLES.

                        Morbilli.

   Diagnosis.  Red spots, one or two lines in size, in most
 cases somewhat elevated, which are preceded by a catarrhal
 fever, the symptoms of which are : a dry cough, red lachry-
 mating eyes, frequent sneezing.   It precedes the eruption
 for three or four days, and follows it as many.  The cough
 and affections of the eyes continue with the fever, and dis-
 appear with a branny desquamation of the epidermis. This
 peculiarity of desquamation is important for the diagnosis,
 since it is often the only sign by which we are able to dis-
 criminate this exanthema from others.
   Course.
   Stadium infectionis et irritationis.—This  stage which lasts
 generally three days, sometimes still longer, is distinguish-
 ed by remittent fever, which is similar to a catarrhal one,
 but which is marked by a peculiar, short,  dry  cough, red,
 lachrymating eyes, intolerance of light, frequent sneezing
 and running of the nose.  These symptoms and the fever
 increase every day until the eruption breaks out; headache,
 especially in the forehead, associates with it; when the ma-
 lady is severe, there is also delirium ; and in infants spasms
 may set in the same as in small pox,  and frequently also
 diarrhea.
   Stadium eruptionis et florescentie. — At the  end  of the
 third or fourth day the measles appear, generally first in
 the face and on the arms;  in the shape of small red spots,
 which  form sometimes little elevations,  but no pustules.
 When  they are very numerous,  the  skin of the face and
 hands swells, similarly but never so much as in small pox.
 The affection of the eyes and the cough  increase at the
 same time, for it is nothing but the morbillous irritation in
 the mucous membrane of the lungs,  which may  sometimes
 increase to a  real bronchitis and pneumony.  After three
 days of florescence, the spots grow pale, and disappear in
 the same order  as  that in which they sprung up.  Cough
and ophthalmia decrease in the  same proportion.  The fe-
ver, in mild measles, ceases after they have  broken out; if it
continues, it is indicative of a complication,  or effect  of
profuseness of measles and  of a too great irritation.
  Stadium desquamations, the scaling off.—After the red-
ness disappears,  the epidermis scales  off in little bran-like
pieces, often like meal; it is the fading and the decay of 
MEASLES.
401
the blossom.   This takes place  on the sixth or seventh,
sometimes also on the ninth or  tenth day of the disease,
and lasts for several days.  Sornetimes however, especially
in a slight eruption, the desquamation is so trifling, that it
is not at all perceived. There also occurs at the same time
a critical perspiration and critical  urine; in  most cases a
diarrhea also sets in, which is here a very salutary crisis;
after  which all morbid symptoms disappear. But some-
times new and dangerous attacks occur in this period, a
new fever,  local  inflammations,  most  frequently  of the
lungs, but also  of the abdomen and head.
   The  measles are very apt to leave subsequent diseases,
especially of the  lungs (cough,  generation  of tubercles,
phthisis); or of the eyes, and of the glandular system, also
of the nerves.
  The disease itself is much less dangerous than small pox;
only pneumonia or retrocession of the eruption or compli-
cation may make it fatal.   But the  consequences are dan-
gerous,  and two thirds of those  who die by the measles,
die subsequently and often without  showing any signs that
death is owing to them.  It is especially dangerous to those,
who  labor  under  morbid  lungs  and a  phthisical  dispo-
sition.
  Measles, like small pox, may be simple (benign), or com-
plicated with other species of fever, from which arise many
anomalies in form as  well as in course.  When the com-
plication is inflammatory,  a very  violent fever, early  and
copious eruption sets in ; but this  last may also be impeded
and accompanied with a pulmonic affection ; in the nervous
complication, the eruption is interrupted and  apt to retro-
cession  ; there are nervous attacks of all kinds, and a pale
color;  in the  putrid complication,  intermixed petechie,
hemorrhages,  colliquation ; in all the  complications, the
fever  continues after the  eruption; in the inflammatory, a
new pneumony; in the nervous, a retrocession and metas-
tases; in the putrid, increase of colliquation.
  Pathogenesis.  The proximate  cause is, as in"variola, a
specific  contagion, and the disease is nothing but  a reac-
tion of  the organism brought on  by the contagion.  Like
the variolous virus, it is of modern origin, and has been ob-
served only since the sixth or seventh century;  like the
former,  it infects only by immediate contact or  in the
neighborhood of the sick, but not by the  atmosphere;  like
variola,  it affects the system only once (to this, however,
there are a few exceptions), and requires, like it, a specific
disposition for its reception ; the atmosphere also may favor 
402
MEASLES.
 or hinder its  development, hence it  may appear sporadi-
 cally and epidemically.
   The morbillous virus is distinguished from the variolous
 and  other contagia by the following peculiarities:  It has a
 particular affinity for the mucous membrane, especially for
 that of the lungs, and thereby produces a state very like
 catarrh; its virulence is less intense than the former, and
 is more of a lingering than of an  acute character.
   Therapeutics. The indication is the same as in small pox :
 to pay attention to the fever  and the peculiarity of the
 morbillous virus.  As regards  the latter, the treatment is
 opposite to that of the variola, for the principal rule is to
 keep the patient moderately warm, as in a catarrhal fever.
 Whereas cold is the best mitigator and regulator of small
 pox ; in measles it js apt to disturb the crisis and cause a
 dangerous retrocession.  The principal object of the treat-
 ment must be to promote the proper development and eva-
 poration  of the virus through the skin; to prevent retro-
 cession and metastases; and to prevent the acute contami-
 nation from passing into a chronic one, and into subsequent
 diseases.  The principal  means in this respect is to main-
 tain a uniform  moderately warm regimen  (not over-heat-
 ing) and to avoid cold.  As for this, especially in children,
 no other means exist but  staying in bed, it must be an in-
 violable rule in measles, to confine the  patient to bed for
 14 days from  the  commencement  of the disease;  and in
 winter  time for 3 weeks; not in  feather beds but on ma-
 tresses, and covered with blankets.  The temperature of
 the room must be 15° Reaumur.  In winter the open air
 must  be avoided for 6 weeks,  an important precaution to
 prevent metastases.—In benign  measles nothing more is
 needed than  this regimen,  an antiphlogistic diet, much
 drinking, and at the last a laxative.
 '  In  the first  stage  of benign measles this general treat-
 ment  along with a cooling diaphoretic (vide No. 245, b.) is
 sufficient j at the same time due regard must be had  to the
 ophthalmia and cough,  which are  the most  troublesome
 symptoms. They are, however, a component part of the
 disease, and cannot be  removed, but only mitigated;  the
 ophthalmia by  keeping from the light, by fomentations of
lukewarm milk,  decoct, of mallows, mucilage of quinces
(beware of saturnine and astringent remedies) ; the cough
by frequent drinking of water gruel and barley water, and
similar linctus, to which, when there is great irritability
oils and narcotics  may be added (vide No. 246) •  bv Dro
moting perspiration; for this is in direct proportion to the 
MEASLES.
403
increase and decrease of the cough ;  by removing any ac-
cessory stimuli and complication, which may often render
the cough extremely violent, especially the gastric irritants
which may be  removed by emetics; and the inflammatory
irritation, which leeches  will remedy.
  In general, this is the period in which complications and
accessory irritants are most easily combated and removed;
particularly gastric accumulations and  an inflammatory
diathesis, even pneumonia, which is not uncommon at the
approach or at the time  of the eruption.   In such a case
venesection is not to be omitted in plethoric subjects;  in
children  leeches are to be used.
   The stage of eruption and florescence requires a conti-
nuance of the foregoing treatment; carefully avoiding cold,
and paying particular attention to pneumony, which  may
occur, especially if this care has been neglected in the first
stage, in which case the  abstractions of blood must be sub-
sequently made.
  The most  dangerous case that can arise is retrocession
of the eruption,, caused either by taking cold, or by a men-
tal  affection, or faults in  diet. This emergency must never
be disregarded, though it may  seem in the beginning  to
have no injurious consequences ; for it is always the result
of  a disturbance of crisis,*which,  if it does not, as often
happens,  endanger life,  may  give occasion to the worst
metastases and subsequent maladies.  The principal indi-
cation is to re-establish the cutaneous crisis.  All depends
here  on  a due consideration of the various causes and ef-
fects,  and we distinguish three  cases:—either, no bad
symptoms appear, but critical sweats, urine, and  even mo-
derate diarrhea  follow.  Here  nature  has herself taken
charge of the crisis; a  warm regimen, warm diaphoretic
beverages, elder tea  with small doses of vinum antimonii
will be all that is necessary for a cure.  Or dangerous at-
tacks, inflammation of the lungs, of the throat, of the ab-
domen, of the head set in,  with  violent fever and delirium,
bordering often on fury.  Then, above all, the metastatic
inflammation must be subdued by abstraction of blood, and
antistimuli applied to the  skin (sinapisms, vesicatories),
and nitre; and when this has subsided, the eruption must
be  re-established by diaphoretics,  of which camphor  with
nitre is the most appropriate.  Or the patient lies in a state
of greatest weakness  and spasm, with convulsions and cool
extremities.  Such a condition calls for antispasmodic dia-
phoretics, first  camphor along  with  spiritus  Mindereri,
liquor c. c. succin., musk, opium, sinapisms and particularly 
404                    MEASLES.
 warm baths.  Profuse  diarrhea,  if such exists,  must be
 stopped. If overloading of the stomach has brought on the
 retrocession, an emetic is the best means of relief.
   In complicated measles that method of treatment is  con-
 tinued, which is suited to the respective febrile state.
   The stage of desquamation, in benign measles, does not
 require any thing but the continuance of a warm regimen,
 in order to make the crisis perfect;  an antiphlogistic  d et
 and the use of mild and cooling  purgatives, manna wth
 soluble tartar.  We must always bear in mind the idea,  that
 the virus yet lurking in the system is to be expelled, either
 through the skin, or, as the skin has been made partly im-
 practicable, by  desquamation, through  the intestinal ca-
 nal and the kidneys. When new local inflammations, espe-
 cially of the lungs, take place, the  treatment appropriate to
 them is  required, and even the abstraction of blood, calo-
 mel and vesicatories may be needed. These two remedies
 are in general those, which answer  best in the metastases
 which might form; also camphor may be used. The great-
 est attention, however, is due to the remaining cough ; for
 it indicates a lurking remnant of morbillous poison in  the
 mucous membranes  of the lungs, and leads to fear an inci-
 pient formation of tubercles,  and finally a transition  into
 tuberculous consumption.  We must  first attempt to re-
 medy this  state by  a continued use of laxatives and dia-
 phoretics, calomel,  vesicatories, covering the  chest with
 flannel, and warm  baths, which will often be followed by
 good success.  If this treatment do not suffice, the repeat-
 ed  use of  emetics  is recommendable.   If this also prove
 vain, prescribe serum lactis, Selters water with milk, calo-
 mel with sulphur aurat.  antimonii and opium, senega root.
 A combination of sulphur with aqua laurocerasi and cicuta
 has likewise proved very efficacious; also artificial ulcers,
 especially by cort. mezerei, entertained for a long time. If
 cough continues with expectoration, Iceland moss jelly is
 serviceable.
  The measles have been inoculated ; the tears flowing dur-
ing the efflorescent  stage,  or the blood from a morbillous
spot have been used  for  that purpose.  But as the disease
is far less dangerous to life than the small pox, this miti-
gating method is to be recommended only in very malig-
nant epidemies. 
SCARLET FEVER.                 405
                    SCARLET FEVER.

                      Scarlatina.

  Diagnosis.   Fever with a greatly accelerated pulse, pain
in the throat, after  one or  more days a breaking out of
large scarlet-red spots, without definite limits, and like ery-
sipelas  gradually diminishing in color, as they approach
the surrounding skin ;  they  often extend over whole limbs
with a uniform redness.  They disappear after four or five
days, when the epidermis  scales off in  large pieces or
patches, and are followed by a great disposition to watery
accumulations. The spots are generally smooth, but some-
times little miliary-like pimples  form on them.  This has
given rise to a distinction of scarlatina into two kinds (the
smooth and the pustulous scarlet fever) ; but they are only
varieties of one disease.
   Such are the essential pathognomic symptoms.  But no
malady affords so many anomalies in its appearance as this
one.  Sometimes there is merely an angina (internal scar-
latina of the  mucous membrane of the throat), and exter-
nally  little or no redness appears.  Sometimes this is en-
tirely wanting, and the existence of the disease is recog-
nised only by the  subsequent desquamation or hydropic
accumulations.
   Course.
   In the first stage  there is pain in the throat and the pulse
is greatly accelerated.   An  equally quick pulse is not met
with  in any  other  disease,  and is  to  be regarded in this
stage as a prognostic sign of imminent scarlet fever.  It is
distinguished  from measles by the absence of cough, sneez-
ing and lachrymation. Fever and angina increase with the
approaching  eruption ; and  in some subjects delirium and
spasms are also  observed.
   In  the stage of the eruption and  efflorescence the spots
appear first on the  fore-arms and hands, gradually spread-
ing over the whole  body, but rarely in the face.  They in-
crease in size and  redness, and are  augmented  by new
ones.  The angina  also increases in equal proportion ;  for
it is nothing but internal scarlatinous inflammation.   The
fever continues and becomes often very violent.   Only in
slight cases it ceases with the appearance of the eruption.
In'more severe attacks the brain and abdominal viscera are
inflammatorily affected.  The exanthema, like erysipelas,
is very volatile, and apt to disappear and shift inwardly.
This  stage lasts five or six days. 
406                 SCARLET FEVER.
  Sta^e of desquamation.  On the sixth, sometimes not
earlier than on the ninth day, the epidermis begins to scale
off in large pieces or patches.  After violent scarlatinous
inflammation,  the whole  skin  of a part, as of the hands,
feet, or scrotum scales off, retaining the shape of the part.
A  similar desquamation takes place also from the internal
membrane of  the throat,  after a violent angina.  The de-
squamation lasts many days, and in some cases is repeated
several times.   The fever ceases during critical secretions
by urine  and other ways, except when metastases happen.
  It  is not unusual for this stage to be followed by  a sta-
dium secundarium s. metastaticum, generally hydropicum,
most frequently the consequence  of taking cold or  a dis-
turbed crisis.   The most common  occurrence is dropsy, a
hydrops  acutus, which may become  fatal within 8 or  14
days. Its onset is first recognised by an edematous  swell-
ing of the eyelids, then of the extremities, succeeded by
general anasarca, ascites, hydrothorax, and hydrocephalus.
Metastases to the eyes,  ears, glands, indurations, and ab-
scesses are still more frequent. The scarlatinous metastases
are very destructive.   I have seen within 8 days eyes lost
by suppuration,  and  the  auditorial and nasal bones  de-
stroyed.
  Scarlet fever is one of the most  malignant and deceitful
of all eruptive diseases.  It may, in. single cases,  and even
prevailing as an epidemic,  be  so  slight and benign that
fatal  cases seldom occur.  But sometimes single cases,
and even a whole epidemic is  so  virulent and dangerous,
that its  fatality equals a  pestilence, one patient  in  every
sixth, even fourth, or  third becoming its victim.   The ma-
lignity may be  so great that the patient dies on the first or
second day, from metastasis to the brain and nervous apo-
plexy.  Thus, in single cases it may appear slight and be-
nign at first, and nevertheless suddenly kill afterwards, by
a metastasis to the brain, or by  a rapidly generated dropsy.
Death is most frequently caused  by inflammation of the
brain, by angina or dropsy.
  Scarlatina may associate with every species of fever and
thereby becomes anomalous.  The inflammatory complica-
tion  is remarkable for the intensity.of the fever and heat, the
high scarlet redness and the universality of the eruption, the
intensity of the angina, and by the readiness with which in-
flammation  of internal viscera happens ;  the nervous  is
distinguished  by a pale,  cool skin, the imperfect appear-
ance and disappearance  of the eruption, the spasms and
nervous  apoplexy, which are likely to arise, foreboded by 
SCARLET FEVER.
407
a constant urgency to  urinate; the putrid is marked by
extreme  debility, violent fever, hemorrhages, colliquative
evacuations, livid color of the eruption* intermixed with
petechie, and by angina rapidly passing into a gangrenous
corruption.  Most cases of angina gangranosa belong to
this species of scarlatina.
  Pathogenesis.  The proximate cause  is an atmospheric
contagion,  but which is  afterwards  communicable from
one person to  another.  The infection may, therefore, be
double, atmospheric as well as individual.  The  effect of
this contagion has the peculiarity of  affecting specifically
the throa>t and the skin, and generating in both an inflamma-
tion similar in appearance and fugaciousness to erysipelas,
apt to be propagated to the brain ; of prostrating particu-
larly the action of the absorbent system, finally producing
watery infiltration, due in part to the disorganization of the
skin,  and consequent arrestation of transpiration,  partly to
a debility of the lymphatic system.  Susceptibility to a fu-
ture attack is not so completely annihilated as in small pox
and measles.  It may, therefore, affect the same individual
oftener than once.   It also differs from those diseases in
this, that it is not  propagated by contact from one to an-
other person like  small pox and measles, but is much more
frequently communicated  by  atmospheric influence.
  The disease is  of modern  origin, and has not  been ob-
served before the seventeenth century.
  Therapeutics.  The treatment must be fundamentally an-
tiphlogistic, excepting as  regards  external warmth.  Stay-
ing in bed for three weeks in order to prevent metastases,
is to be  observed, and constant attention  must be directed
to local inflammation, especially of the brain, which may
happen.
  A difference in intensity and complications calls for cor-
responding special treatment.
  In benign scarlet  fever  nothing more is needed than  to
keep the patient  in bed, cooling,  gentle  diaphoretics and
laxatives that will give two  stools a day.  A solution of
soluble tartar, along with  small doses of vin. antimonii an-
swers this purpose best.
  But when the disease is violent, distinguished by great
heat, ardent fever, high redness and a general spreading of
the eruption, the  danger of approaching inflammation and
corruption is to be subdued as quickly  as possible.   Two re-
medies have proved particularly efficaciousfor attaining this
end :  internally the use of chlorine water (acid, muriat. oxy-
genat.) daily, two or three drachms for children, the same 
408
SCARLET FEVER.
number of ounces for adults, diluted in water, and agreeably
sweetened ; and externally (but only when  there is a dry
skin, burning hestf, and dizziness in the head), the skin  is
to be cooled by quick ablutions of cold water, which may be
repeated every two or three hours.  More active and debili-
tating antiphlogistics, especially abstractions of blood are of
dubious  utility, since  they  tend to produce an adynamic
state ;  therefore general bleeding is improper, but leeches
may be applied in youthful and in plethoric subjects, when
violent angina and affections of the brain  are  present.
   Cold fomentations to the head, and repeated affusions of
the head with cold water, are of excellent use when the
fever is  at its height,  and the brain so affected as to pro-
duce sopor and delirium.  When angina  is slight, it calls
for gargles of infusion of elder flowers, mallows, and oxy-
mel simplex (No. 247 a.), flannel round the throat ;  when  it
is more  intense, leeches and sinapisms must be applied.
   In a nervous complication the nervous power  is to be
supported from the beginning by appropriate nervines ; the
putrid complication requires antiseptics, and the treatment
already, mentioned  in putrid  angina  (vide  angina gan-
granosa), is of importance.   In gastric  complications, the
first stage requires emetics and cathartics.  But the most
important treatment is that which is to be observed during
desquamation ; and to  prevent subsequent dropsy.
   The principal thing during this period, is not to permit the
patient to leave the bed, and to confine him to the house for a
month in the summer,and six weeks in the winter season; to
prevent  iitn from taking cold, and to use gentle laxativesand
diaphoretics ; intermediately a few doses of calomel may
be given, in order to increase the action of the lymphatic
system.   This is generally sufficient, and prevents bad con-
sequences.  But as soon as the first vestiges of edema ap-
pear, prompt measures are needed, and the most concentra-
ted means must be used to procure absorption and secretion,
(especially by the kidneys and intestinal canal).  This end
is best attained by calomel  (one, two, or three grains, ac-
cording to age, to  be taken  every three hours), combined
with jalap and digitalis, a diuretic  tea (No. 247 b.), and
warm  baths.  Above all things, we must examine whether
a febrile  phlogistic state is present or not.   If there is, and
the pulse active, and the individual is plethoric, a venesec-
tion (of three or four ounces in children) produces  a most
excellent effect, and is  an indispensable remedy.  It will
generally be  followed  by diuresis ;  and diuretics  which
were previously inefficacious, will now operate. In aphlo- 
RUBE0L2E.  ESSERA.
409
gistic state, we ought to prescribe nitre, along with cremor
tartari, squilla, senega, wrapping the whole body in flannel
fumigated with amber.  Radix belladonne, combined with
calomel, has  proved very serviceable in some instances ;
and in obstinate cases so has tincture of cantharides.
  Belladonna in very small doses has been used, according
to Hahnemann's recommendation, as a preservative; and
many cases have confirmed its utility.   But as the disease
is sometimes very slight and without danger, this preserv-
ative is to be recommended only in malignant and danger-
ous  epidemies. The prescription  is :  one grain of well
prepared extract of belladonna, dissolved in  half an ounce of
cinnamon water, of which five drops may be given daily to
children of five years of age, increasing the dose  one drop
for every additional year.
                       RUBEOLA.

  Diagnosis.   Red spots, from a third to an inch in diam-
eter, in the middle  of which little vesicles  spring up in
groups.  They appear after a few days of febrile  motion,
and sore throat ; last for five or six days, after which they
desquamate in patches larger than in  measles, and smaller
than in scarlet fever.  Hydropic accumulations are apt to
follow.
  The shape, the angina connected with it, and the subse-
quent dropsy designate this disease as a variety  of scarla-
tina, not of measles.
  The treatment must therefore be the  same as  in scarlet
fever, and it is equally necessary to remain in bed.  Rube-
ola generally is benign, and requires only  three  weeks of
care, and the use of cooling, gentle cathartics and diapho-
retics.  In very severe cases, and  when complications ex-
ist, all the  rules which have been  given for  scarlet fever
are to be observed, and especially those  which are pre-
ventive and curative of dropsy.
                        ESSERA.

  Diagnosis. Red, elevated pimples, resembling bug bites,
accompanied with slight or scarcely perceptible febrile mo-
tions, and disappearing again  after a few days.  The disease
is never dangerous.
  The cause of it is gastric or catarrhal, and requires no-
                          35 
410          URTICARIA.  MILIARIA.  PURPURA.

thing further for a cure than a few days care and a cathar
tic afterwards.
                       URTICARIA.

  Diagnosis.   Large, red,  diffused patches,  white in the
centre, troublesome  by itching and burning.  It is similar
in shape and sensation to  lesions by burning, and  is pecu-
liar in this, that it disappears in warmth and  becomes visi-
ble  in the cold.
  They set in  without, sometimes with, febrile motions,
and disappear after a few  days.
  Cause and  treatment is  entirely the same  as in  essera.
Both, urticaria as well as essera, are apt to assume  a chro-
nic  character;  that is, they reappear on the least occasion,
and then  become a  troublesome  evil.   It is owing  to a
faulty condition of the skin and its secretion, or to a gen-
eral dyscrasy.   It is to be cured by a  general improve-
ment of the cutaneous action, and purging (vide above the
general treatment of cutaneous diseases); or, when it will
not yield  by  these means, by removing the deeper seated
causes ; which requires particular attention to  the  scrofu-
lous, arthritic, and syphilitic dyscrasies.
                  MILIARIA.  PURPURA.

                Miliaria Alba et Rubra.

  Diagnosis.   Miliaria alba: small, white vesicular eleva-
tions of the skin, resembling millet-seed, on all parts of the
body, especially on the chest; they sometimes unite, form-
ing large vesicles, even phlyctene, which  are  filled with
a limpid serum.
  Miliaria rubra: small, purple,  papular (not vesicular)
elevations  of the skin, so small  as  scarcely to  be  seen,
though easily felt.
  The white miliary disease is more  frequent than the  red
one.  Both kinds are  sometimes present  in the  same
patient.
  The concomitant symptoms are : fever, profuse perspi-
ration of a sour odor, dry cough, anxiety, oppression, and
moaning.
  The appearance, course, and duration are uncertain and
indefinite.  The eruption may appear as early as the third 
MILIARIA.   PURPURA.
4il
or fourth day of the fever, sometimes not until the seventh
or eighth, and even as late as the fourteenth day.  In some
cases it appears and disappears alternately.  The eruption
may be slight, or very abundant, covering the whole body,
but particularly the arms  and  chest.  The face  generally
remains free from  it.
   The indications  of an approaching miliary eruption are :
from the beginning of the fever very profuse perspiration,
which emits a putrid,  sour odor, anxiety,  difficult (not
short) respiration, accompanied with moaning and sighing;
short, dry cough, inquietude, frequent chills, stinging and
itching" in the skin, sometimes there are nervous attacks,
spasms, delirium.  The fever  sometimes abates after  the
eruption has come out ; so also does anxiety, cough, and
other  affections.  But  sometimes it continues, even in-
creases, and eruption augments, so do the nervous attacks.
It terminates by a light desquamation.   Miliaria is always
a redoubtable phenomenon, which rather increases than al-
leviates the disease.   It is generally symptomatic, an addi-
tional symptom to a fever that always affects the nervous
system in a particular way, and is apt to excite  dangerous
nervous attacks.  Symptomatic miliary eruption is recog-
nized  by its appearing  prematurely or  very late in a dis-
ease, and by the disease not diminishing on its appearance.
Death, which  follows a retrocession  of the eruption, is
caused by apoplexy or suffocation.  The eruption, how-
ever,  is sometimes  critical, if it appears on the critical
days,  the seventh, eleventh, or fourteenth, and the attacks
abate.  But even  then  there is danger, for the eruption  is
apt to retrocede and produce  fatal consequences.
   Pathogenesis.  The  proximate  cause  is a peculiar cor-
ruption of the perspirable matter.  This is  converted into
a volatile  matter particularly hostile  to the nerves,  and
which sometimes becomes contagious (miliary acrimony);
it is produced by great weakness and colliquation of the
cutaneous system.  The exciting causes are:  debility of
the cutaneous  system, a rheumatic and catarrhal diathesis,
too hot regimen in fevers, especially lying in feather beds
and in confined air, hot diaphoretics, omission to evacuate
gastric accumulations, and the puerperal state.
   The relation which this  disease bears to the history  of
mankind and the art of healing, deserves notice.  We find
no mention of it in antiquity, nor in the earlier periods  of
 modern times.  It first appeared in the seventeenth century,
 at the time when  the diaphoretic  method of curing fevers
 prevailed, especially in those countries where feather beds 
412
MILIARIA.   PURPURA.
 are used. It remained so up to the middle of the eighteenth
 century, when the antiphlogistic method and a cool regimen
 was introduced in  the treatment of hot fevers.   It must,
 therefore, be supposed that this pathological phenomenon
 was partly  the product of the  general constitution, and
 partly of art.   It is seldom met with now; generally only
 in particular epidemies, or in a subject  predisposed to  it,
 or in a too hot treatment,  and omission to cleanse the pri-
 me  vie.
   Therapeutics.  The  principal  indication is to anticipate
 miliaria, and always to consider it as a troublesome addi-
 tion to fever ; one rather to be avoided  than promoted.
 Therefore,  when light covering, moderate temperature,
 pure air, and cleansing of the prime vie are attended to,
 miliaria will rarely break out.   Even when its forerunners
 have already appeared, this treatment  will check it;  fre-
 quently it will  be sufficient to  remove a feather bed.  These
 remarks do not  apply to  critical miliaria; that is, when
 it appears at the  critical period of the fever and is followed
 by an abatement  of the fever and other symptoms.  In this
 case, it must only be moderately fostered, and its retroces-
 sion prevented.
  The special  treatment does not differ from that of the
 fever with which it is connected, and  must comply with
 the character  of  the former.  Miliaria and the cutaneous
 colliquation by which it is accompanied, indicate the use
 of mineral acids: as  of acid,  muriat. oxygenat;  or, when
 the colliquation is far  advanced, acid, sulphur.; when the
 prime vie have been  neglected, gentle, cooling purgatives,
 especially tamarinds,  must be given.  Cold must be care-
 fully avoided, lest it produce retrocession.
  When retrocession happens, its effect must be observed.
 If no injurious  consequence arises, and nature replaces the
 cutaneous crisis  by increasing another secretion, as that
 of the intestinal canal, nothing else is needed but a warm
 regimen.  But  if dangerous metastases, nervous  attacks,
 cerebral or pulmonary affections follow,  we must  en-
deavor  to promptly re-establish  the  cutaneous crisis by
sinapisms, vesicatories, camphor, musk, and warm baths.
A local  inflammation, which may perhaps happen in a pre-
disposed individual, calls  for abstraction  of blood (vide
morbilli.)

                   Chronic Miliaria.

  A miliary eruption may break out without fever, and then
it is of indefinite,  often of very long duration ; or the re re- 
PETECHLE.
413
mains a disposition in the skin  to reproduce it constantly.
This eruption is in  general only the form  or deposition of
a dyscrasy.  Thus  I have seen a miliary eruption break
out in the spring in gouty persons, and leave them free of
podagra and arthritic affections for the remainder of the
year.  The same is true of scorbutic miliaria.
  The treatment depends altogether on the dyscrasy that
lurks in the system.  Besides  the general skin-cleansing
remedies, baths  and repeated cupping may especially be
applied.
                       PETECHIiE.

  Diagnosis.   Spots of a  violet, brown, black, and some-
times of a red color;  of one  or  two lines in diameter.
They are generally round, circumscribed, and accurately
limited ;  but sometimes are irregularly shaped.  They ap-
pear on all parts of the body, without order or definite pe-
riods, accompanied by fever (petechia acuta, febrispetechia-
lis, spot-fever), or without fever (petechia chronica).  In
certain cases they break out in large spots of several inches
in circumference (ecchymoses, vibices).  We must avoid the
mistake  of taking the  smaller ones for flea-bites, which
they very much  resemble; but from  which  they  may be
distinguished by the mark of the bite.
   Febrile petechie (like  miliaria)  may break out on the
first days of the disease, or at any future period, even very
late,  they continue for  an indefinite  time, and disappear
without desquamation.  In general their appearance brings
with it no amelioration to the disease  (petechie symptoma-
tica), but in some  cases it does (petechia critica).
   Pathogenesis.  They  consist  of little extravasations  of
blood  under  the  epidermis,  and  ought  therefore  to be
classed with hemorrhages, which  they often accompany.
They are generally caused by debility or a decomposition
of the blood, and  are consequently often a symptom  of pu-
trid fever; but sometimes they are owing to local  debility
and irritation of the skin, the  effects  of hot regimen and
over-heating, in which cases the accompanying fever is of
an inflammatory character;  sometimes they are only sym-
pathetic, of a gastric  irritation, therefore, like miliaria,
they  frequently occur in gastric  and verminous fevers,
especially when purgative remedies have been neglected ;
finally they appear as concomitants of a crisis, of which,
however, they are only a  symptom.  Therefore, as regards 
414                   PEMPHIGUS.
their origin,  they are to be ranked with miliaria, which
they often accompany.   They may also happen in certain
epidemies.  They are not contagious, though the typhus
fever to which they belong may be infectious.
  Therapeutics.  The  principal indication is, as in miliaria,
to prevent as far as possible their formation, and, when
they have formed, to remove them as quickly as can be
done.
  The first end is attained by cool regimen and cleansing
the prime vie in the  onset of the fever.
  The second is  accomplished  by a proper treatment of
the  fever according  to  its  character (which is most fre-
quently  putrid, but sometimes  may be  inflammatory and
then abstractions of blood may be needed), and by the use
of gentle cathartics (especially tamarinds), mineral acids ;
by  washing the skin  with vinegar; by cool and pure air
(ventilation).  Purgatives remove them most promptly.

                   Chronic Petechie,

  Appear without fever and are commonly a symptomatic
phenomenon of various chronic diseases, especially of such
as are of a gastric and verminous origin.  They constitute
a peculiar disease in the morbus maculosus hemorrhagicus
Werlhofii, which is  a scorbutic dissolution  of the blood,
and must be treated accordingly (see hemorrhages).


                       PEMPHIGUS.

   Diagnosis. Blisters varying in size from a  pea to a wal-
nut ; filled with a watery fluid; of a round shape,  except-
ing when several  coalesce,  and  then it is irregular; sur-
rounded by a more or less  red margin, which feels itchy
and prickly.  Pemphigus may be accompanied with fever
(pemphigus acutus, febris bullosa), which lasts  several days,
at the end of which the vesicles either dry up or pass into
a protracted ulceration;  or it may be unaccompanied with
fever (pemphigus chronicus), in  which case  new blisters
continue to form for months or years.
  Acute pemphigus has a great resemblance  to erysipelas
bullosum, both in its origin and in its treatment.  The ge-
neral treatment must  conform to  the character of the fever.
Application of lead,  vitriol, and other repulsive remedies
are to be carefully avoided, lest they create dangerous me-
tastases.  When the blisters stay long, they ought to be cau- 
THRUSH.                    415
tiously opened by puncture, through which the fluid may
ooze, leaving the epidermis to protect the subjacent surface,
while nature  effects the exsiccation.  The painful prickling
is to be remedied by fomentations of rosewater and muci-
lage of quince-seeds.  If suppuration ensues, fat ointments
must be avoided; for they are apt  to render suppuration
chronic.  When  they manifest a gangrenous character, as
is likely to happen in old age  and typhus fevers,  fomen-
tations  of Peruvian bark, lime-water, and camphor  will be
useful.

                   Chronic Pemphigus,
   Is one of those maladies,  which is apt  to become very
protracted and very difficult to cure, since its remote causes
are deeply seated and are difficult of detection. They most
frequently reside in a  suppression  of distant secretions,
especially that of urine; or  in general dyscrasies.
   The  cure, therefore, consists, first in the general treat-
ment of cutaneous diseases (see generalities); and in an
investigation and treatment of the  particular causes.  If
the disease is owing to a disturbed secretion of urine, diu-
retics are advised ; if to a dyscrasy, this must be properly
attended to.   Regarding the latter I cannot forbear direct-
ing  the attention of the practitioner to a syphilitic taint of
long standing ; in which a mercurial treatment is the only
one capable of removing the evil.  Baths of chloride of
lime, one ounce to a bath, and sublimate baths are of excel
lent effect.
                        THRUSH.

                        Aphtha.

  Diagnosis.   Little,  white, sloughy  ulcers in the mouth,
on the  tongue,  palate, and fauces;  sometimes extending
the whole length of the intestinal canal; causing a pungent
pain; lasting for a few days, weeks, or months, one crop
being replaced by a new one.   The irritation from these
little  ulcers causes much local as well as sympathetic suf-
fering, corresponding with their seat and violence.  They
cause in the throat  anginous difficulties, painful degluti-
tion ; in the  trachea a cough ; in the  fauces and stomach
nausea, eructation, spasm in the stomach, vomiting; in the
intestinal canal colicky  pains, diarrhea, even dysentery,
charged with the sloughs, enteritis. 
416                     THRUSH.
   The precursors are : dryness  in  the  mouth  and throat,
 thirst, sensation of a foreign body in the throat, nausea, vom-
 iting, cough, rawness and pungency in the throat, hoarse-
 ness, anxiety, pressure at the precordia, soda, stupor.
   It  may  end fatally by angina, gangrene, and enteritis
 supervening.
   Aphthe are an exanthema of the internal mucous mem-
 brane, the organization of which is the cause of their pecu-
 liar form ; hence it is, that persons of a delicate and relaxed
 fibre (as children) are more subject to them. They are most
 frequently occasioned by gastric  impurities, the evacuation
 of which had been neglected; by suppressed secretion of
 the  skin;  by rheumatic and catarrhal metastases; .finally
 by a general corruption of the humors, therefore apt to be
 associated  with  gastric putrid  fevers, and to form in  the
 colliquative stage of phthisis. They resemble miliaria very
 much in their origin, and may be found under similar cir-
 cumstances; therefore they happen more as  a symptom
 than as a crisis of fever,  and like miliaria, they may also
 appear epidemically, as a peculiar symptom of the reigning
 fever.
   They may be chronically generated as a metastasis from
 a  sudden cure of ulcers on the legs or other cutaneous
 maladies.
   Therapeutics.   The indications are : to remove the local
 or general causes,  to attend properly to the fever or dys-
 crasy of which they are a symptom, and to cure them  by
 local  applications.
  In febrile aphthe the principal thing is to clean the prime
 vie by purgatives  and emetics, which are often sufficient
 to cure them.  Pure air, and proper treatment of the fever,
 according  to its  character  is needed.  When  the ulcers
 present a livid appearance, and there is a putrid tendency
 in the system, roborant antiseptics  are  called for.   The
 mouth must repeatedly be cleansed by gargles (vide No.
 251) ; borax is a specific in this disease. Alum, vitriol, and
 similar astringents must be avoided,  since  they are apt  to
make the aphthe disappear suddenly,  and to produce dan-
gerous metastases, especially to the brain. It is only when
they are  obstinate and  pass into a chronic state, that sul-
phate of zinc may be used as a wash.  When they are very
painful, mucilaginous decoctions of mallow flowers, or
marsh-mallow root  may be given as  gargles ;  in a putrid
disposition,  Peruvian bark and alum.  When the aphthe
extend into the fauces,  stomach, and intestinal canal, oily
emulsions, also oil and milk injections are of service.' 
ITCH.                      41?
  Chronic aphthe require, besides the local treatment, that
of the dyscrasy, which is their remote cause, as suppressed
cutaneous  eruptions or ulcers, which must be re-estab-
lished or replaced by artificial ones.
  Aphtha infantum, see diseases of children.
                         ITCH.

                        Scabies.

  Diagnosis. Small pustules with a reddish margin, contain-
ing a pellucid watery fluid.  They appear first between the
fingers and on the hands, and cause a violent  itching,  in-
creased by the warmth of the bed and by rubbing.   When
they last  long,  they  form scabs  which are  dry,  moist,
or even suppurate.   The eruption  may spread  over all
parts of the body except the face,  but  takes most hold in
the folds of  the skin and flexures  of the joints.  Its loca-
tion between the fingers is a sign characteristic and dis-
tinctive of herpetic and other cutaneous diseases.
  It is unaccompanied by fever, and, if left to itself, may
last for months, even  years.  In the beginning it does not
affect the organism perceptibly (except a great sensibility
to external cold and excessive hunger), but when it is pro-
tracted and universally spread, it finally causes emaciation,
even lingering fever.   Itch is contagious.
  Pathogenesis^ Genuine itch (scabies vera) is always  caused
by a peculiar contagion (contagium scabiosum), which is of
a fixed nature, and infectious only by immediate touch
either  of the person  or of things infected by him.  Infec-
tion, however, depends greatly on individual susceptibility,
which may sometimes be so deficient,  that any communi-
cation, even inoculation, is incapable  of producing it; on
the other hand it  may be exceedingly favored and promot-
ed by a number of circumstances,  especially by uncleanli-
ness,  corrupt air, bad food  or want of it, dampness and
exposure to cold; which accounts for its spreading in hos-
pitals, orphan asylums, armies, and in times of war.
  But itch may appear also as a product and  symptom of
internal diseases (scabies spuria).   Though it is only  the
form of another disease, it may finally develop a contagion
and thus become  infectious. Of this number are the syphi-
litic, scrofulous, arthritic, and scorbutic itch,  also the cri-
tical,  an  itchlike  eruption, with and by which  the crisis of
acute as well as of chronic diseases follows. 
418                      ITCH.
  Also in genuine itch we ought to be careful to distinguish
the causes of its formation,  and the causes of its duration
and obstinacy.  The latter are often debility brought on by
the disease, or a complication with other maladies and dys-
crasies.—The mites (animalcula) discovered in pustules
are not the cause, but the effect of the itch.
  Therapeutics.  The treatment has to comply with the fol-
lowing indications : to destroy the specific contagion by a
specific remedy,  which is sulphur (as specifically curative
of itch, as mercury of syphilis) ; to improve the action of
the skin and to remove the accessory causes, which nou-
rish and favor the disease.
  Many difficulties and many considerations are here met
with.   We may, for  instance, by a merely local applica-
tion of the specific on the skin, suppress the morbid cuta-
neous action;  but the contagion which has already pene-
trated deeper is not destroyed, and in consequence itch re-
appears, or,  what is still worse, is translated to internal
parts  and creates dangerous and obstinate metastases. Thus
it can generate pulmonary consumption, dropsy, spasm of
the stomach, epilepsy; and all kinds of nervous diseases.
This is still more hazardous, when itch is complicated with
another disease, or even the product of a crisis.
  The special treatment is to be regulated in the following
manner.
  1. Itch, engendered by  infection in an otherwise healthy
individual, and  still recent, that is only  since 8 to 14 days.
In such a case we may  rightly presume, that the  contagion
is superficial and still confined to the skin, and therefore
we may immediately  resort to the local application  of
sulphur.   Washing the affected  parts with sulphur water,
or anointing them with  sulphur ointment, or,  what is most
convenient, with sulphur soap (two parts of black soap and
one part of sulphur rubbed in every evening, and a soap-
bath in the morning),  will destroy the contagion and thus
remove the disease.   However,  it will  be better to take
sulphur (1 drachm of flor. sulphuris daily at the same time)
internally; this mode will guard  against all injurious con-
sequences, besides helping as an external remedy, for sul-
phur given internally  ultimately reaches the surface, as is
made  manifest by  the  sulphureous character of the perspi-
ration.  In slight  infections  mere local frictions of soap,
and a few soap-baths will suffice  for a cure ;  but the fric-
tions must be so made as to rupture the  pustules,  and per-
formed in the evening, that  the  remedy may remain ap-
plied until morning, when it is to  be washed off with  soap- 
ITCH.                      419
water or a soap-bath.  In children the  unguent. Helenii
applied daily,  is an excellent and innocuous remedy, sur-
passing all others.
  2. Itch by infection in a healthy person,  but already of
long standing.  Here the internal use of sulphur for several
days, before we proceed to an external application, is indis-
pensable.  A  blood purifying potion (vide No. 202) and
soap-baths may be used simultaneously.
  3. Itch generated by infection in an unhealthy individual.
In such a case the treatment of itch must be combined with
that for the disease with which it is complicated, which in
children is most frequently scrofula.
  4. Inveterate itch,  requires, besides sulphur,  such re-
medies, as excite and invigorate the action of the lymphatic
and  cutaneous systems, particularly the  use of mercury.
Aethiops  rnineralis, or Plummer's powder added to sul-
phur, answer this end. Also the use of Werlhof s ointment
(vide No. 252), rubbed on the wrists every evening, or sul-
phur ointment strengthened by the addition of white vitriol,
or of white hellebore ; washing the parts with a decoction
of tobacco, and sulphur baths are serviceable.  At the same
time a decoction of rad. bardane, sarsaparilla, lignum gua-
iaci, also resina guaiaci, £ drachm daily may be given in-
ternally. Most recommendable is external cleanliness; for
the obstinacy of itch is often caused by nothing  else than
by the patient continually infecting himself ;  linen, bed-
clothes and dress ought therefore frequently to be changed.
Another cause of obstinacy  often met with, especially in
poor people, or in persons debilitated by previous diseases,
even by the long duration of itch itself, is weakness of the
constitution; in such a case the best treatment is nourish-
ing food, the use  of strengthening medicines, among which
I have found arnica very efficacious.  Finally, the compli-
cation of another malady may be the only cause of the ob-
stinacy of itch ;  in such a case it must be investigated
whether concealed syphilis or scrofula, or a scorbutic  dia-
thesis exists, and we  must act up to the indication.
  5. Itch without infection, being the mere product and
symptom of another disease, as syphilis, scrofula. The ori-
ginal disease  is to be treated, and if its cure does not in-
clude  that of the itch, the specific treatment  of scabies
must be resorted to.

                   Suppression of Itch.
  As shown above, the translation of psoric matter to inter-
nal  organs.   The most  dangerous and obstinate maladies 
420                     HERPES.
may arise from a sudden suppression of the eruption, if the
system have not been properly  prepared  by the treatment.
In such a case sulphur is the true and sure  remedy. Phthisis,
nervous diseases, even dropsy,  may frequently be removed
by it alone.  Artificial ulcers may be used simultaneously.
                          HERPES.

    Diagnosis.   Small vesicles on a red ground, in clusters,
  sometimes in one, sometimes in several places ;  sometimes
  they are small and limited, sometimes continuing to spread,
  even covering whole limbs;  itching,  burning, and painful
  in a high degree.   They  may  be  dry (herpes siccus) ; or
  cause the epidermis to peel off in large patches, or like meal
  (herpes farinosus), which is renewed in successive series;
  or they discharge an acrid watery fluid (herpes humidus);
  or  form crusts and  exulcerations,  which with a violent
  painful itching, extend by corrosion  (herpes exedens, phage-
  danicus, esthiomenos, lupus), or may  form a herpetic ulcer,
  which is distinguished  by an ichory, imperfect suppura-
  tion, an exsudation  of an acrid watery serum  and a callous
  thickening of the cellular tissue.—The disease is  without
  fever and not infectious.
   Herpes may assume a variety of forms, even degenerate
 into a leprous state. They have  been classified into a mul-
 titude of species,  and designated by different  names.  But
 such an  attempt  is  a useless multiplication  of nosology;
 for they are only  varieties of the same disease, modified by
 individuality. They are  always herpes for the practitioner,
 and the treatment is the same.
   Their course  and duration vary very much ; they are of
 short, or  of long  duration, lasting for months and years,
 even through life ; permanent, or periodical, disappearing
 and returning;  in which the seasons have a particular in-
 fluence (being less in dry summer heat, more in damp cold
 air); confined to  one spot, or " vagus," wandering from
 place to place.
  Herpes is  a very troublesome and obstinate disorder
 though never dangerous unless greatly spread,degenerating
 and  destroying the  cutaneous function, whereby  hectic
 may arise, or by retrocession  and translation to internal
parts.
  Pathogenesis.  Proximate  cause: A peculiar corruption
and abnormal  condition of the skin,  altered in its  secre-
tion and reproduction,  by which at last a general dyscra- 
HERPES.
421
sias (herpetic acrimony), but  a  contagion is never deve-
loped.
  The remote causes may be referred to: hereditary dis-
position (which cannot be denied, is the most frequent, and
may render the evil prevalent in whole families) ;  diseases
of the liver and acrimony of bile  thereby created ; glandu-
lar diseases,  scrofulosis ;  long suppressed  perspiration
(damp dwelling); acrid, too much  salted or fat food;  he-
morrhoidal congestion to the  skin, anomaly of hemor-
rhoids, a frequent cause; disorders of menstruation, preg-
nancy ; local irritation of the skin by too great  heat or by
coarse clothing; old age, which makes the skin and even
the  kidneys dry and  inactive; finally a general dyscrasy,
especially  a lurking syphilis.   A tender delicate skin  pre-
disposes to the disease, especially to herpes farinosus.
   Therapeutics.   The first and  most important thing in the
treatment  of this as well as of all  other diseases, is to re-
move and  properly attend to the remote cause.  The pa-
tient must therefore adopt, above all other things, a mode-
rate and mild diet, avoid all kinds of heating food or beve-
rage, and  live in a dry pure air.  If the biliary secretion
and the liver are disordered, solvent remedies and such as
promote the secretion of bile must be used.   If the cause
is hemorrhoidal,  which is  recognisable .by  the phlogistic
character  of the herpes, by former and occasional hemor-
 rhoidal complaints, sulphur and the treatment of piles  must
 be resorted to.   The same principle applies  to disturbed
 menstruation.   If it is owing to scrofula, mercurials and
 barytes are to be given ; if to arthritis, guaiacum and other
 arthritic remedies ; if to syphilis, which is often the remote
 and concealed cause, mercury.
   If none of these causes can be detected,  or they have
 been removed, then the treatment is to  be directed against
 the proximate cause,  the  cutaneous corruption and her-
 petic acrimony  (the specific herpetic treatment).  Dulca-
 mara ranks first; to.be taken  in decoction, 2 to 4 drachms
 daily ; or as extract 1 or 2 scruples a day ; the next in rank
 of efficacy is crude antimony, (one  drachm or more  daily
 with magnesia).  A combination of both these remedies in
 the form  of pills (vide No. 248), is still more  powerful.
 Recourse may likewise be had to  Plummer's powder, pul-
 vis antidyscrasicus(vide No. 201), submuriate of mercury,
 a decoction of  cortex  ulmi,  sulphur, calx antimonii sul-
 phur (the artificial sulphur  water), resina guaiaci, corrosive
 sublimate in decoction of sarsaparilla, graphit  1 scruple to 1
 drachm daily, a strong decoction of pansy (herba jacese) 
422                     HERPES.
  continued for some time; in the most obstinate herpes the
  decoctum Zittmanni has effected a cure.  When herpes is
  of a phlogistic character, whey, the fresh expressed juices
  of herb and root of dandelion,  of dog-grass,  tussilage, nas-
  turtium aquat., fumaria, and repeated cupping are  service-
  able ; also muriatic acid (10 to 25 drops three times a day)
  is of excellent  use ; even the  most severe cases of this
  kind, even ichthyosis, have yielded  to it. Baths, especially
  of soap,  with one pound cortex ulmi,  or the cool sulphur
  springs,  particularly those of Nenndorf and Eilsen,  merit
  high recommendation as true specifics in inveterate herpes.
  I have seen the most malignant, suppurating,  crusty herpes
  which would not yield to any other remedy, removed by
  these means.  In obstinate cases baths  of corrosive subli-
  mate also may be taken.
    Local means may be added to this treatment; but no re-
 pellents, especially lead, which  are apt to cause a retroces-
 sion, and a dangerous translation to internal parts. In slight
 dry herpes, embrocation made of bruised walnuts, or what
 is better  of  fresh  expressed  nut-oil (oleum jugland^m),
 likewise  washing  with a solution of borax  (vide No. 249,
 particularly recommendable  for the face),  calx muriatica
 or chlonnica, lime  water, especially  when   mixed  with
 palm  soap, or  weak  sublimate water, ointment of white
 precipitate applied to the eruption, lime-ointment, which is
 particularly salutary in facial  herpes.   In  order to allay
 the violent burning, there  is nothing better  than sperma-
 ceti and almond  oil, and if that  do  not sufficiently mitigate
 it, repeated cataplasms of cream may be tried.  In inflam-
 matory and painful herpes,  especially in the face, the ap-
 plication  of rags,  moistened with  fresh water, renewed
 every hour, is often  the  best  mitigative, even curative ;
 when  the  pain  is  very  severe, recourse may be had to a
 frequent application of fresh  bruised leaves  of beta alba
 or plantain, by which I  have seen the worst suppurating
 and corroding herpes in the face (sycosis) cured.
  Also a covering of leather is often  a good curative.   In
 obstinate  cases,  which have resisted all other remedies
tar (pix liquida)  has proved the most vigorous and per-
fectly curative means, in the following form :  1 cup of tar
2 yelks of eggs,  and 1 cup of cream mixed  together, and
used twice  a day.
  One of the most  stubborn  species  of herpes is sycosis
menti, lupus.  When the remedies  before  mentioned  are
unavailing, Zittmann's decoction will be the best
  In every obstinate herpes, and especially  when local re- 
CRUSTA LACTEA.   CRUSTA SERPIGINOSA.  LEPROSY.  423
medies are used, derivations by artificial ulcers and purga-
tives are recommendable,  partly to promote the cure,  and
partly to prevent metastases to internal parts.
                     CRUSTA LACTEA.

              (Vide Diseases of Children.)


                  CRUSTA SERPIGINOSA,

  Is an assemblage of scabs, which cover the lower part
of the face, in adults.  It  is to be treated like herpes.


                        LEPROSY.

                         Lepra.

  Diagnosis. Uneven, tumid, knotty, entirely disorganized
skin, covered with thick crusts  and intermediate suppurat-
ing points;' violent pricking and itching, on different parts
of the body, even in the face.   Finally, a total destruction
of the cutaneous system.
  This disease presents itself in several degrees and forms.
  In the wor-t spec'u-s (lepra orientalis), which is no more
met with in Europe, whole parts, as eyes, nose, hands and
feet fall  into gangrene and destruction.  Corrosive ulcers
are  formed.  The pains are excessive, especially  during
the  ni'i-ht.   The whole body is covered with scabs, and is
deformed, especially the face. Swelling, anxiety, deafness,
hoarseness, hectic fever associate  with it, and death ensues
by consumption.  This kind is evidently infectious.
  In the milder  kind  (lepra occidentalis) all the accidents
are  milder,  the  destruction  of the skin is less extensive,
the  disease is  more  local, does  not  affect the  internal
parts; therefore it is neither fatal nor infectious.
   Elephantiasis exhibits  the skin of single parts, especially
of the feet, thickened,  indurated, and covered with a thick
rough crust, like the  skin  of an elephant,  discharging in
several places a fetid and corrosive ichor.
   Vitiligo is distinguished by large white spots on the skin,
with constant scaly desquamation of it, and induration of
 the subjacent cellular tissue. 
424
ERYTHEMA.   PHLYCTSNiE.
  Pellagra (which  seems to be a species of this disease)
forms on the back and the extremities large erysipelatous,
extremely pungent spots, which pass often into blisters, with
scaling off of the epidermis.  It appears in the spring, and
goes off  in  the  winter time.   The  nervous system, espe-
cially the brain, is  simultaneously much affected, and may
run into mental  maladies.   The disease is endemial and
occurs only in Upper Italy.
  Only the milder species  of lepra are now  seen in Eu-
rope.   The virulent  form of this disease has been extin-
guished in this country, by the careful measures of isola-
tion taken  in the previous centuries, and is now only found
in the East.*
  The cause of the violent oriental or genuine  lepra is a
peculiar  contagion.   The slighter occidental species seem
to be leprous forms of other cutaneous diseases, and rather
to be classed with the worst kinds of herpetic corruptions.
  Cure is very difficult.   It must be pursued according to
the same principles and by  the same remedies as  that of
herpes;  particularly  the following :—mercurials, antimo-
nials, sublimate with  opium, cicuta,  decoct, of rad. caricis
arenar.,  lapath. acut.; externally  mercurial applications,
salt, sulphur, and corrosive sublimate baths, the use of tinct.
cantharid.  30 to 40  drops,  acid, muriat., in  the  worst
cases the external use of arsenic.
                ERYTHEMA.  PH6YCT.EN.E.

  Diagnosis. Red spots, little blisters or suppurating pim-
ples,  which disappear after a few days; especially in the
face.
  A slight,  insignificant disorder of the skin, but which is
very common and displeasing to young  females.
  The common cause is plethora,  sanguineous congestion
to the head, caused frequently by  tight lacing and consti-
pation of the bowels, and tender skin.
  The treatment must  be : to  diminish the plenitude of
blood  by  a cooling,  less  nutritive and  vegetable  food;
avoiding all heating drinks, as wine, coffee, beer ; drinking
plenty of water,  to make a derivation by repeated cathar-
tics (bitterwater, fol. serine, rad. jalap.),  foot-baths, also re-
peated cupping;  externally  by washing the  parts  with
aqua cosmetica every  evening.

    *  It is also yet met with in the negroes of  the West  Indies. 
SCALD HEAD.                   425
  It is not  uncommon to meet with  these temporary in-
flammations of the skin, in catarrhal and rheumatic fevers,
especially in children; in which cases they are frequently
taken for scarlatinous or morbillous spots.  But they disap-
pear very soon, do not desquamate, and are merely sympto-
matica! cutaneous irritations, proceeding  from a catarrhal
or rheumatic acrimony,  and  which wear away  with the
fever and do not require a particular attention.
                      SCALD  HEAD.

                     Favus, Tinea.

  Diagnosis.   Little ulcers in the hairy parts of the head,
which  secrete a  viscous, fetid matter, itch violently and
form scabs. The disease exhibits two forms, favus, achores,
the slighter kind, the common scabi head; and tinea,  the
malignant scald head, when the  head  is  covered with
white,  fixed crusts, and the roots of the hair are enlarged.
  Scald  head is a disease very  common  in children ; it
has, however,  become strikingly  rarer, since the habit of
going bareheaded  and having the  hair cut shorter.  Less
frequent is the malignant scald head; but it is a very obsti-
nate disease.
  The causes may be referred to a neglect  of cleanliness,
keeping the head too warm,  most  frequently to a scrofu-
lous dyscrasy and mesenteric obstructions, also to sup-
pressed  perspiration.  Tinea is an  idiopathic disease,  and
has its proximate cause in a swelling and disease  of the
roots of the hair.
  The  cure   of  the common  scald  head  is effected  by
cleanliness of the head ;  frequent combing and cutting the
hair (with the precaution, not to  cut it too short, espe-
cially in cold  weather, since this would  have the same ef-
fect as the removal of a fur cap, and produce a retrocession
of the  eruption), washing of the head  with tepid  soap-
water ;  anointing the hard scabs with butter or oil ; inter-
nally ethiops  mmeralis with  rhubarb  and magnesia, a tea
of sassafras, and every 8 days a cathartic of jalap and ca-
lomel may be  used.   Thereby a cure is generally effected.
If the  evil be more  obstinate, baths, Plummer's powder
with o-uaiacum,  and also cicuta are needed.  External ro-
borants are seldom required ;  and great precaution must
be observed in using them, since they are apt to cause re-
                           36* 
426              QUTTA ROSACEA.   VARI.
:ession and dangerous metastases to the brain and tl
ans of the senses.   In obstinate cases, the apphcatu
trocession  and dangerous metastases to me "•«•■« «;id the
organs of the senses.   In obstinate cases, the application
of cabbage leaves is a very Rood remedy ;  they are to be
applied triple, repeated three times a day, which w|U gra-
dually loosen the scabs, and the cure may be finished by
oily applications.
  Tinea  calls likewise for the internal use of the remedies
mentioned above,  but the principal thing is to remove the
diseased roots of the hair.  This is done by small stripes of
pitch  plaster (resin mixed with  a little  flour), daily ap-
plied  to  a small spot, which when taken off draws with it
the roots of the hair. Or also gumm. ammoniac, cum acet.
squill, coct.  ad consistentiam  emplastri, put on  and left,
until  it can be easily taken off.. When the evil  is very ob-
stinate, take a mixture of one  teaspoonful of mercury dis-
solved in muriatic acid, mixed  with a like quantity of but-
ter, anoint the part with it everyday, and repeat this, until
the whole is entirely cleansed.
                 GUTTA ROSACEA.  VARI.

  Diagnosis.  Large purple, reddish brown or copper-color-
ed spots on the face, especially on  the nose, and sometimes
on other parts ; elevated, and imparting a sensation of heat.
  They are called vari when they are round  or  conical,
callous and elevated, with an orifice at the summit through
which exudes a purulent or watery, sometimes even a san-
guineous fluid.
  Each of these forms  may occur separately or together,
and both are  brought on by similar causes. "
  The principal cause is a peculiar disposition of the skin ;
hence  gutta  rosacea may be hereditary and run  through
whole  families.  The most common exciting cause is an
excess in  spirituous liquors ; but disordered bilfary secre-
tion and menstruation may also produce it.
  The cure  is difficult.  It consists in  a reirupval of the
causes, in a derivation  by purgatives, and  long continued
artificial ulcers on the arms, foot  baths of mustard, wear-
ing socks  of oiled silk, and the application of the cosmetic
water,  No. 249 ;  inunction  of white precipitate ointment
about the parts, or, when these remedies are  unavailing,
the mixture of sulphur  and camphor (No. 250), which is
specifically efficacious in this affection.  We must be care-
ful not to  use quickly repelling remedies, for they are apt
to produce dangerous metastases. 
BOILS.  CARBUNCLES.
427
                   BOIL.   CARBUNCLE.

              Furunculus.  Carbunculus.

                      Furunculus.

  Diagnosis.   Round or coniform hard elevations, from the
size of a few lines in  diameter,  to that of several inches,
which slowly inflame, assume a brown-red color, break and
discharge a purulent matter mixed with blood, but  retain
in their cavity a slough, that is to say, a portion  of dead
cellular tissue, the evacuation  of which is necessary to a
perfect  cure ; but should  the  ulcer heal over  the slough,
this may still be felt, and will cause the part to break again
sooner or later.   Furunculi may form on all parts  of the
body, especially in the bends of the joints and where there
is an adipose accumulation.
  The causes are the same as those of cutaneous diseases
in general ; but the furuncular form seems to depend on a
peculiar condition of the skin itself; hence it is that some
persons suffer from furunculi on the least occasion, and al-
most continually.  They are frequently the crisis of, and
follow acute fevers, acute eruptive diseases, the termina-
tion of itch and other chronic exanthemata; and  are also
a crisis of gout.  The topical  treatment consists in accele-
rating their maturation by emollient and irritant cataplasms
(of linseed), hyoscyamus, saffron  boiled in milk, and em-
plastr. diachyli composition or oxycroceum, and after they
are broken, in accelerating expulsion of the slough  by di-
gestive ointments.
  When a general disposition to furunculi exists,  or when
furunculi frequently return, we must  resort to the general
treatment of cutaneous diseases, or to the particular dis-
ease of which they are a form.

                      Carbunculus.
          (Malignant Furuncle, Pustula Nigra.)

  A livid, bluish or black spot of a large surface, violently
painful, and finally blistered.   It is most apt to form in the
neck, and between the shoulders; is a symptom of gastro-
nervous fevers, and endangers life, for a fatal  putrescency
may readily  spread  from the  local mortification  over the
whole organism.
  The cure consists in the cure of the fever (first an erne- 
428
INTERTRIGO.   RHAGADES.
tic, and then the most active antiseptic excitant remedies)
and in a proper  surgical treatment.   First, a  deep crucial
incision reaching  to the  lining flesh, must be made, and
then the most vfgorous antiseptic balsamic remedies,  cin-
chona, arnica, myrrh, and  camphor, the whole treatment of
gangrene  as taught by surgery, must be applied to.
  When the case is slight, merely cataplasms of aqua oxy-
muriatica, combined with scarifications, have been  suffi-
cient.
  The carbunculus contagiosus is brought  on by infection
from without,  and  is a symptom  of  the disease whence it
arises, as  well as are  bubo  and anthrax  symptoms of the
plague (vide contagious typhus).
                 INTERTRIGO.   RHAGADES.

  Diagnosis.  In intertrigo the skin becomes sore in the
bendings  of the joints, pubes, lips ; it  cracks  and causes
pain.
  It is most common in infants, and is owing to a neglect
of  cleanliness, or to the  acrimony  of perspiration  and
urine.
  Be careful not to apply saturnine or  other quickly dry-
ing remedies.   The best is cold water and the  powder of
lycopodium.
  The same remarks apply to adults, especially  to females,
who are very  subject to it.  We  must, however, inquire
whether some internal disturbance may not be its remote
cause.
  The cracked skin of the hands and feet, which happens
at  change of seasons, is generally due to cold,  but also to
general causes and dyscrasies, as the arthritic.
  The treatment consists in the  application  of mild unc-
tuous remedies, as almond soap,  cacao-butter, especially
deer's  tallow,  which  is preferable to any other kind of
grease, a  fact  which  proves that fatty bodies differ from
each other in  their action  as  a remedy, though  they  are
chemically alike as regards their  composition ; for there
are  persons whose skin is so excitable as to be irritated by
one kind of gre<-e, and be benefitted  by another ; of this
kind is that of the deer.
  Borax may also  be used in  combination with the aqua
cosmetica.
  When the chaps are caused  by cold,  we  must resort to
the  treatment  for  chilblains.  Often  a dyscrasy, esp> 
LENTIGO.   EPHELIS.  COMEDONES.         429
cially the arthritic, is the latent cause of the disorder, and
must be attended to accordingly.
  Intertrigo and rhagades may also be dependent on a too
great delicacy and tenderness of the epidermis ;  when this
is  the  case, astringent lotions and cold baths are recom-
mendable.

                       FRECKLES.

                   Lentigo.  Ephelis.

  Lentigines, small, brownish-yellow spots on the face and
on the hands, imparting no sensation, appear in spring and
summer  time, and disappear in winter.  They are most
frequently met with among females, in persons of light and
red hair, and generally in persons of a delicate and white
skin.
  Ephelides, yellow or brown spots, from the size of one to
several lines, or even inches in diameter ; in single patches,
or spread about everywhere, commonly divested, but some-
times accompanied  with itching and desquamation of the
epidermis.
  Both are superficial affections of the  skin ; in the ephe-
lides, however, a bilious ^%scrasy  is the remote ca*use, as
a polycholia or a disturbed function of the  liver.  Men-
strual disorders  are also capable  of producing them ; so
that there are women who discover that they are pregnant
by the appearance of ephelides, and which disappear after
parturition.
   The cure of lentigines requires shelter from the rays of
the sun, abstinence of washing immediately before exposure
to open air, and the use of aqua cosmetica in  the evening
before retiring.
   The ephelides are most certainly removed by borax (half
a drachm of borax  dissolved in an  ounce of rose  water;
moisten  the spots frequently); where there  is  an  indica-
tion of bilious acrimony,  by dissolvent remedies, which
purify the bile and blood.

                       COMEDONES.

   Diagnosis.  The skin of the whole  body is apparently
dead, languid, pale and  dry, beset with a quantity of small,
elevated, black points, from which a thickened matter in
the form of little worms,  may be  expressed.   In a high
degree the skin is covered  with these vermiform threads. 
430       COMEDONES.  CUTANEOUS EXCRESCENCES.
It is associated with all the signs of atrophy, general ema-
ciation, weakness, the physiognomy of old age.   It ends in
death by exhaustion.
  This  disease is met  with only in children  in the first
years of life, and  has its cause in a want of cutaneous vital-
ity, a suspension of secretion and absorption, which per-
mit an accumulation of sebaceous  matter in the little foli-
cular glands, in which  it becomes  moulded, and gives a
form  which has  been  mistaken for worms ; and,  as the
whole  nutritive process suffers, these worms  have been
considered as comedones (eating companions).
  The remote causes are always referable to a neglect of
cleanliness, or of cultivation of  the skin,  and to the use of
bad food.
  The cure consists in animating the skin  by baths of
soap, malt, aromatic  herbs, pure air, nutritious aliments,
and a cautious  use of wine, and internally exciting  reme-
dies; when the lymphatic  system, especially that  of the
abdomen, is greatly affected, aethiops mineralis, antimony,
and rhubarb may  be given (vide Diseases of Children).
   CALLOSITAS CUTIS.   EXCRESCENTIJE.  CLAVUS. VERRUOE.

   Diagnosis, common to all, is an induration or a thicken-
ing of the epidermis or the cuticle.
   Callositas, scirrhositas cutis, the induration of a great
part of  the skin.   This disease is not uncommon  in  new
born  infants, especially in  France, where it  is called  Ven-
durcistement du tissu celluluire, and has a fatal issue (vide
Diseases of Children).
   An induration  of the skin and cellular tissue of whole
limbs is sometimes met with as a symptom of scrofula, and
as a consequence of erysipelatous inflammations, and  it  is
occasionally  combined with considerable tumefaction  and
deformity.   It has  already  been  mentioned  above as a
symptom of several chronic, especially herpetic cutaneous
eruptions.
   The treatment requires a most vigorous use of internal
and external remedies ; such as have a particular tendency
to urticate and act on the skin, as mercurials, antimonials,
belladonna, cicuta, opium ; salt, sulphur, and alkaline baths,
emollient  cataplasms,  unguentum, oxygenatum  (which I
can highly recommend); and of artificial  ulcers.
   Verruca, warts,are single indurations and excrescencesof
the epidermis on all parts of the body ; called clavi (corns) 
PLICA  POLONICA.  .
431
on the toes ; cornua, when they attain a hornlike hardness ;
and also a hornlike form and size,which sometimes happens.
  Warts sometimes  spring up  single, sometimes in great
number, especially in children, and disappear again with-
out any perceptible cause. Frequently a mechanical pres-
sure  is  the evident cause ; but  frequently, too, particu-
larly  when numbers  come at once on various parts of the
body, they  are owing to a cutaneous disorganization,
brought  on by some internal  disorder ; their formation
seems also to depend upon the period of development (pu-
berty), upon scrofulous, arthritic, and venereal dyscrasies.
   The topical  treatment consists in the  application of
caustics, such as tinct. cantharid., nitric acid, muriate of
antimony, nitrate of silver, hot iron or the ligature.  When
they are symptomatic, the treatment of the original disease
must be pursued.
   Sometimes the whole skin becomes covered with wart-
like excrescences—morbus verrucosus universalis.         4
   The callous and porcupine  skin  is to be classed here.
The disease is  to be treated according to the above princi-
ples, but is rarely curable.

                      PLAITED  HAIR.

                    Plica.  Trichoma.

   Diagnosis.   Confusion  and entangling of the hair, which
 at last forms into cues.   The  hair curls and mats into in-
 extricable meshes like tails,  thickens and exudes a viscid
 matter,  which condenses  and  thickens  them  into  still
 greater  masses.  When  the  disorder is very intense, the
 disorganized  hair  may become  painful, and excrescences
 may also be formed on the nails.  It is preceded by lassi-
 tude, pain in the limbs, headache, dizziness, febrile irrita-
 tions, and fetid sweats.  After the eruption has appeared,
 these symptoms cease.   If the plaited hair is cut off pre-
 maturely,  it  soon reappears, accompanied even with lame-
 ness, deafness, blindness, etc.
   It is a chronic disease, and  cannot be entirely removed.
   The  proximate cause  is a peculiar disorganization, or
 rather hyper-organization of the skin.
   Its exciting  cause is purely endemical, for it occurs only
 in Poland (plica Polonica), and when it appears in other
 regions, the matter  of it has been originally brought thither
 from that country.   Probably a neglect of cleanliness, the
 use of fur caps, and  perhaps  a peculiar condition of the 
432              .   PLICA POLONICA.
water concur to originate it.  The peculiarity of the race
(the Sarmatic),* seems to be particularly liable to it, for we
meet with it only in Sarmatic villages,and not among Ger-
mans or  Russians living  under the  same circumstances.
But, according to the experience of the best observers, it
is contagious,  and  may be  communicated particularly by
coition.  Also  the preceding  complaints, their abatement
on the appearance and return, on the suppression  of the
eruption  show,  that the  disease is not merely  local, but
that this disorder of the hair  is the product or rather the
critical metastasis of an internal dyscrasy.
   The indications are: to  remedy the general dyscrasy
and to separate cautiously the plaited hair.
   The special treatment must  be  adapted to  the stage of
the malady.
   1. During  the precursory stage, the general dyscrasy
must be ameliorated and  the  metastasis promoted.  This
is to be attained by general diaphoretics, especially anti-
mony, which seems to operate specifically in this case, also
the decoction of guaiac.   In a sthenic constitution, the ex-
citement requires a venesection.
   2. After the hair has become plaited, these remedies are
to be continued and increased in strength, in order to ren-
der the crisis complete.
   3. When the  separation is completed, which  is recog-
nized by  the  hair losing its glossy appearance  and fetor,
and by its being replaced  by new, healthy hair, the matted
hair may be cut off.
   This period is to be particularly watched, and to be ac-
celerated by employing the means before mentioned.  If
the plaited hair is  cut off at an early stage of the disease,
the most dangerous accidents  happen.
   At the conclusion  of  the  treatment, tonics  must  be
given.
   1 cannot forbear remarking, that great attention is due to
the concealed trichoma, which may be a cause of the most
protracted and obstinate nervous diseases.

                         MOLE.

                       Navus.

   Diagnosis.  Congenital  spots, or spongy, wartlike eleva-
tions of the skin, of different colors, usually red, brownish
* It is found also among the Jews. 
BALD HEAD.
433
or violet; of various size and figures, often beset with hair,
(which liken them, by means of imagination, to strawber-
ries, raspberries, mice,  etc.).  They last for life and retain
their original form and condition, or, by accessory causes,
especially topical irritation, enlarge and are transmuted into
more injurious pseudo-organizations, and into cancrous dis-
organizations.
   They are owing to the first conformation in the womb,
and on thnt account they frequently appear hereditarily on
the same  spot, where the father or mother has the like.  It
is probable that  a continual pressure during the fetal state,
on the part affected, which hinders the free circulation and
formation of the skin,  may give rise to  them ; but other
causes also, even mental affections, which sometimes have
a fatal influence on the  fetus, may contribute to their ori-
gin, and excite  such disturbances in the  formation of the
skin, so that we need not presume a superstitious influence
of the imagination.
   The treatment must be entered into with great caution,
for any local irritation may excite an increase and a still
greater degeneration  of this pseudo-organization.  It will
be best to consider them a '■'■noli me tangere^ and to avoid
all touch and pressure.  Such trials are most dangerous, if
made in the face.-  When treatment is asked for,  weak so-
lutions of borax, alum, alkali,  submuriate  of mercury, and
limewater may be used  ; spongy excrescences with a small
base  may be  removed  by ligature.  In those called wine-
stains, tatooing  into  the part a color conformable  to that
of the natural skin has been done with success.
                       BALD HEAD.

                       Alopecia.

  Diagnosis.   The  hair is dry, white, cracks and falls out.
  As causes we may enumerate all  such as prevent the nu-
trition of the  hair,  especially old age, preceding  acute
fevers, particularly acute diseases  which affect the head,
as erysipelas, excesses in venery, violent grief and anxiety
(of which there are instances in which the hair grew gray
in a single night), chronic  cutaneous diseases, dyscrasies,
especially syphilitic.
  The treatment consists in frequent combing and brush-
ing the hair,  washing it with  soapwater, with a decoction
of burdock root; anointing it with a pomade of beef's mar-
                           37 
434               ULCER?.  DYSCRASIES.

row  and oil of cedar; powdering with a mixture of burnt
culinary salt and hair powder,  also washing with a solu-
tion  of blue vitriol.
                                                      V

                         ULCERS.

                         Ulcer a.

_ Ulcers of the skin and bones (caries, spina ventosa) are
treated  according to the  same principles as the cutaneous
diseases (vide generalities).
  Here also an  internal  medical  treatment, and an atten-
tion  to remote causes, especially to the various dyscrasies,
is of great importance ;  but of equal importance is the sur-
gical treatment,  therefore they are referred to the depart-
ment of surgery.
  Also  noma  is  here to be mentioned; for which we will
only observe,  that the application of pyroligneous acid has
proved  most efficacious.
              TWELFTH CLASS.

                    DYSCRASIES.

                      Generalities.

  Faulty condition of the humors, which operates  as an
exciting cause of disease, and is called cachexy,  when it
disturbs nutrition and reproduction.
  Diagnosis.   Alteration  of  the  complexion,  cutaneous
eruptions, secretions changed  in quality (especially the
urine, also the blood, as seen in venesection), irritations of
the nerves as well as of the vascular system, causing thirst,
pains,  spasms, irritated pulse, feb) ile motions, inflamma-
tions, faulty reproduction, and pseudo-organizations ; fre-
quently a production of contagion, parasitic formations and
disorganizations.
  Dyscrasies vary  in  their  nature  and in their  effects.
Sometimes they are slight and without danger ; sometimes 
DYSCRASIES.                   435
very important and destructive to health and to life; they
are chronic and sometimes last for life.  Their effects are:
all kinds of chronic and acute diseases, ending in hectic,
atrophy, phthisis,  dropsy, and terminating  in a general
consumption  of the powers, or in a local destruction of
noble viscera.
   Pathogenesis.  The purity or normality of our humors
and of organic matter in general depends on the quality of
what enters into the body from without, on its proper ela-
boration and animalization within the system, and on  the
due excretion of what has been used,  has  died away, and
has consequently become foreign and injurious.
   Dyscrasy,  impurity, anormality (acrimony) of the  hu-
mors may therefore be caused,
   1.  By a faulty accession from without.
   A. Here nutriments are first to be mentioned : food and
beverage must be  considered  in regard to quantity as-well
as quality.  Quantity :  a, too  much  may be taken,  over-
taxing  the digestive and assimilative powers, and there-
fore preventing its proper conversion, suffering it  to form
crudities; hence proceed degenerated, imperfectly assimi-
lated and consequently heterogeneous  humors ; b,  or  too
little.  Insufficient, bad, unusual food produces dyscrasy,
by absence of the necessary supply and  consequent debi-
lity.   In regard to quality,  heavy, indigestible, greasy, or
too irritative,  spicy, acrid, heating, salted or  putrid food
 and beverages are injurious.
   B. Air; subject to  a double consideration ; a,  by defi-
 ciency of oxygen ; as confined air, the oxygen of which has
 been consumed or annualized ; b,  by deleterious admix-
 tures.                            .       ,   V    •  •
    C. Warmth; its °xcess and deficiency; the climatic in-
 fluences fall under this  head.
   D. Poisons ; especially the metallic? as quicksilver, lead,
 arsenic, and silver.
   E. Contagia and miasmata, especially  the syphilitic and
 the psoric ;  and                             , • ,  .   r
   F. Neglect of cleanliness, dirt in general, which is often
 the  only^though  unperceived cause of dyscrasies in the
 lower  orders of people, even of certain nations.
   2. By faulty metamorphosis—the assimilation, animaliza-
 tion, and transition of the  ingesta into the animal, animat-
 ed,  and individual nature.   It consists of three main  ope-
 rations, each of which may become disordered and thereby
 cause a dyscrasy.
    A.  Digestion.   Weakness of-the stomach, imperfect d;- 
436
DYSCRASIES.
gestion produces saburra, acrimony, and  in  consequence
imperfect, vitiated, watery, and acrid blood.   This is also
true of the influence of warmth.
   B. Chylification.  Disordered condition of tha. chylopoi-
etic system, obstructions in the mesenteric glands, generate
a bad chyle and faulty humors.  The whole lymphatic sys-
tem is to be ranged  here, inasmach as it introduces into
the  blood all that is received from without; thus the dys-
crasia scrophulosa is engendered, the original seat of which
is in the lymphatic system.  Also  the dyscrasia arthritica
has  its original source and laboratory in disordered diges-
tion and chylification.
   C. Sanguification.   The proper transformation of chyle
and  lymph into healthy, well animated, and well organized
blood  may  be prevented  by general  debility, by want  of
muscular exercise, but especially by disorders  of the Jungs
and respiration, the principal  organ of animalization and
sanguification  (e. g. asthma, blennorrhea, pulmonary tu-
bercles, phthisis, even kyphosis);  and by disorders of the
heart (especially aneurisma, ossification, persistence of the
foramen ovale and ductus Botalli, interfering with the pas-
sage of the blood through the lungs).  Thereby are gene-
rated various dyscrasies of the blood ; too  watery or a mu-
cous condition of it, chlorotic dyscrasy, but especially the
deficient  transmutation of the venous into arterial blood,
the  venous character, hypercarbonization of blood, the
cyanotic and scorbutic dyscrasy.
   3. Faulty secretion and excretion.   Proper secretion and
excretion of what is corrupt, used,  decayed, is an essential
condition of pure blood ; hence disorders of these functions
are  the  richest  sources  of dyscrasies.   They  may  be
double :
   A. Obstruction,  suppression of secretion, by which the
matters destined to be discharged are retained.  The most
common of which is: a. Suppression of the secretion of the
skin, especially of the imperceptible  one (owing to cold,
dampness, uncleanliness,  want of exercise);  it generates
the perspirabile retentum, the rheumatic dyscrasy, the pso-
ric dyscrasy.  b. Suppression of the secretion  of the liver
(one of the most important blood purifying organs, espe-
cially for removing carbon);  hence the  dyscrasia biliosa,
icterica, atrabilaria.  c. Suppression of the secretion of
the kidneys, especially the chronic ; thence the dyscrasia
urinosa.
  B.  Degeneration, qualitative alteration of the secretion
(pathological secretion). -A novel  heterogeneous  matter 
DYSCRASIES.
437
(morbid matter)  is generated within the body, which may
become mixed with  the humors and corrupt them.  Here
the cause of the dyscrasy may  be  merely local.   Of that
number is the dyscrasia purulenta, owing to absorption of
pus, in external or internal ulcers, caries, gangrene, cuta-
neous diseases, the dyscrasia herpetica, leprosa, cancrosa.
   Therapeutics.   The principal  indications  are  the  fol-
lowing :
   1. To investigate into, and to remove the various causes.
In  this regard the treatment varies very much.  Faults in
the mode of living, of diet, of external influences, digestion,
chylification,  sanguification, secretion, specific miasmatic
and contagious matters, local diseases are to  be remedied.
   2. To purify the humors.  This  is effected by general
blood  purifying remedies (alterantia, purificantia).   The
principal one, and which is the basis of all others, is water.
Copious drii.king of pure water, and bathing in it alone is
capable of curing the most difficult  and obstinate dyscra-
sies, as experience has  sufficiently shown.  Besides, such
vegetables as are possessed of the above stated properties ;
the most efficacious are the fresh expressed juices  (of ta-
raxacum,  fumaria,  rad. graminis, nasturtium aquaticum),
the decoctions and infusions of rad. bardane, saponar., sar-
saparille,  caric. arenarie, guaiacum, lapathum.   Antimo-
nials, sulphur, mercury (only under  certain conditions),
cathartics (especially senna leaves,  indisputably the most
efficacious of all  vegetable antidyscrasic  medicines, even
in the form  of powder; I  have given  1 to lL drachm  of it
in an affusion daily with  the greatest benefit; and jalap).
In obstinate cases  several of these remedies  may be com-
bined, the  pulvis antidyscrasicus  (vide No.  201),  one  of
the most usual and efficient remedies in dyscrasies; the
species purificantes s. lignorum (vide No. 202), the decoc-
tum Pollini  (vide  No. 203), particularly the decoctum  Zitt-
manni  (vide No. 204),  which, in spite of its nonsensical
mixture, has most  excellent effects.  The doses must, of
course, be modified according to individuality.
  3. Abstinence,  fasting cure.  It operates by withholding
the matter,  as well as the power which engenders dyscra-
sy.  It  is most indicated and efficacious where excessive
nutrition and plethora are the causes of dyscrasy.
  4. Renovation  of the humors.  Direct correction of the
matter by pure sound additions  from without  ; the  genera-
tion of a new blood.  This  is  indeed  possible, and fre-
quently is highly efficacious.   The  principal means are:
milk and  pure air.  Dyscrasies, which were incurable by 
438
CHLOROSIS.
any other means, have been remedied by milk diet O'yjng
upon nothino- but milk, white bread, and country air).  1 he
method of the ancients—purificatio veteris, regenerate novi.
  There  are, however,  cases in  which a real want ol nu-
tritive substances in the blood is the sole cause of dyscra-
sy, as in poor, famished persons ; after severe maladies and
medical treatment. In such cases good, nourishing, healthy
food is the best curative of the dyscrasy.
                       CHLOROSIS.

  Diagnosis.  Pale,  white color of the  skin, cheeks  and
lips; deficient  warmth,  chilliness, lassitude, weak, slow
pulse,  want of air on the least exercise, palpitation of the
heart, edema of the  feet, want of appetite, and on the con-
trary a desire for substances, not usual as food, especially
for earthy matters, as chalk, and the like ; the blood is thin,
watery, poor in cruor, consisting almost entirely of serum.
When the disease is  protracted, general dropsy, ascites or
tabes, also nervous diseases are apt to form.
  Pathogenesis.  The essence'and proximate cause of this
cachexy is a peculiar disordered condition of the blood, in
which the watery constituent prevails, and the cruor and
fibrine, which contain the warmth, redness, plasticity and
vitality, are absent.
  The most usual exciting cause is an obstruction of  the
sexual development  and of the  first menstruation (in  the
female sex); it may  however be brought on by too great a
loss of blood.
   Therapeutics.  The principal  object is  to  increase  the
cruor and fibrine, the caloric and coloring ingredient of the
blood,  which  alone  is  possessed  of vitality.  The  chief
remedy is  iron.  Nothing in nature replaces so promptly
and directly the cruor,  redness, warmth, and vital power
of the blood, as this great and wonderful mineral, so nearly
kindred to animal organism, so necessary to its existence,
and so intimately related to magnetism, and the most secret
creatory powers of nature.   It is capable in younor chloro-
tic girls to  produce within a few  weeks a blooming com-
plexion, and to impart new life (hence the chalybeate pills
have received the name of red-cheek-pills). It may be used
in all forms and preparations, but it operates  most  vigo-
rously in substance (vide No. 205), in delicate individuals,
who labor under great weakness of the stomach and muco-
sity, dissolvent ferruginous salts,  ferrum  tartarisatum, 
•
                       CYANOSIS.                    439

flores sal. ammon. martial, (vide No. 206), and  chalybeate
waters (Pyrmont, Driburg, Schwalbach, Cudowa). The pa-
tient must enjoy open air, aad use moderate corporeal ex-
ercise  at the same time.
  If the disease is owing to  a retention of the menses, a
treatment appropriate to the  various  existing circum-
stances, must be combined with the above remedies  (vide
Diseases of Females).
  If it is caused by  onanism, iron and animal food are to
be prescribed.
                       CYANOSIS.

  Diagnosis.   Livid color, frequently (after exercise) even
a dark-blue one, of the extremities, especially of the fingers
and toes, and of the face, sometimes of the whole  body;
at the same time, difficulty of breathing  (especially when
exercising), palpitation of the heart, deficient warmth, gen-
eral debility.   Its duration is very indefinite, lasting some-
times for months, but also for years, even to  the  age of
25.   Issue: increasing decomposition of the blood, passive
hemorrhages, dropsy, also death by asphyxia.
  Pathogenesis.  The proximate cause is an impediment to
the conversion of the venous blood  into the arterial ; con-
sequently the blood persists in a carbonized, venous,  im-
perfectly animated state. The causes are either congenital
or acquired.
  The congenital (in the plurality of cases") are : the per-
sistence of the foramen ovale, the ductus Botalli; organic
disorders of the heart, the aorta originating from the right
ventricle, absence of valves, undeveloped lungs (which fre-
quently causes death immediately after birth).
  The acquired causes contracted in the course of life,
are : the bursting of the foramen ovale (by vehement  ex-
ertions, violent rushing of blood into the heart), aneurisms
of the heart, ossification of the valves;  tubercles  in,  and
impermeability of the lungs (hence sometimes produced by
asthma or  phthisis).   Also the scorbutic  state, which is
likewise a  venous condition  of  the  blood, may produce
similar phenomena.
  Therapeutics.  The direct cure must tend, as far as pos-
sible, to oxydation and carbonization  of the blood.  Acids,
muriatic as well as sulphuric, ought to be prescribed inter-
nally,  and  as lotions and  in  baths  (one  or two ounces of
muriatic acid to a bath), and pure air abounding in oxygen 
440
SCURVY.
may be inhaled. The causes must also be regarded. In dis-
eases of the heart, rest, avoiding all hard exercise, occa-
sionally small venesections, in short, the treatment of  the
diseases of the heart (vide asthma syncopticum), are  to be
put in practice.                             ,   .  r
  In the cyanosis of the new-born, to  make the infant cry
has been recommended, as a probable means to cause the
adhesion of the foramen ovale.
                         SCURVY.

                       Scorbutus.

   Diagnosis.  Lassitude, spongy, livid, dirty, itchy gums,
 bleeding on  the least  touch ; looseness and falling out  of
 the  teeth, putrid  breath, weak  respiration, rendered diffi-
 cult by the least  exertion ;  feeble, tardy pulse, pale coun-
 tenance, bloated  face, bluish spots on  the extremities,
 swelling of the feet, sadness, saturated urine, which readily
 putrifies.   When  the  disease is increasing, there are fre-
 quent hemorrhages from the mouth, nose, and other parts,
 which are difficult to suppress; increasing feebleness, fits
 of fainting easily  brought on by  exercise, unclean, livid,
 spongy ulcers on the feet, which are very apt to bleed, dull
 pains in the legs affecting the bones ; gangrene and spha-
 celus on the  feet set in spontaneously—unpreceded by in-
 flammation,  detaching sometimes entire parts from the
 body.
   We distinguish  land-scurvy and sea-scurvy. The former
 is slight, and may last for years without dangerous occur-
 rences, though it may sometimes  engender important dis-
 eases, as morbus hamorrhagicus  maculosus.  Sea-scurvy is
 more formidable ;  it grows rapidly worse, and is more de-
 structive.  It may end fatally by loss  of  blood, by  gan-
 grene, or by  extreme exhaustion.  Dropsy and emaciation
 are also apt to supervene.
  Pathogenesis.  The proximate  cause is a  decomposition
 or dissolution of the blood, diminished vitality, and plasti-
 city of it, and a disposition to  putrescency.
  The remote causes are: damp, cold air (hence is more
 prevalent in  the northern coastward countries), impure,
pent-up air, want  of fresh vegetable  food, salted, corrupt
 meat and putrid water, want  of muscular exercise, sadness.
All these causes are united  in a long sea voyage ;  there-
fore scurvy is most frequent,  formidable and fatal during 
JAUNDICE.
441
such a time.  On land similar occurrences  may happen ;
as during sieges and* other general calamities.   There ex-
ists, however, also a congenital dispositio scorbutica.
  Therapeutics.  The principal intention is, to enliven, re-
fresh, and oxydate the blood ; the second, to strengthen.
Therefore the cure of the sea-scurvy is very easily effected
by country air, fresh water, and fresh vegetables;  and it
is perfectly prevented even on board of vessels during the
longest voyages, by cleanliness (constant ventilation and
washing  of  the ship), exercise and exhilaration  of  the
crew, and by sour-crout, citrons and beer.  The most effi-
cacious remedy is lemon-juice, six to twelve  ounces taken
daily, and also externally applied to the ulcers.  In land-
scurvy, yeast has proved of excellent service ;_from four
to twelve ounces a day must be taken, and be also applied
externally to  the ulcers.  In great debility, besides the
foregoing remedies,  cinchona, calamus, acida mineralia ;
in a  disposition to hemorrhages, alum ; against  the ulcers
in the mouth and stomacace, mel rosar. with muriatic acid,
gargling the mouth with  chlorine water, decoction  of Pe-
ruvian bark,"calamus  with alum.   Carrot pulp, frequently
renewed, is  useful, to  heal the external scorbutic  ulcers.
In such cases, also, herba sabine, used in fomentation and
baths,  has extraordinary and specific  effects, even for
curing caries.


                  JAUNDICE (YELLOWS).

                        Icterus.

  Diagnosis.  Yellow  color, perceptible in the  white part
of the eyes first, next over all the rest of the body; vary-
ing in degree  from pale  to saffron yellow,-even to  brown
and blackish yellow (icterus niger) ;  urine orange-colored,
staining linen yellow ; feces hard, and without the  yellow
color, but white or gray ;  when the disease is very intense,
even the perspiration will color the  linen yellow.   At the
same time, difficult digestion, tension a,nd tumefaction of
the epigastrium,  flatulency, mucous  accumulations, acid-
ity, deficient appetite, nausea, tension, pressure, and some-
times pain of the hepatic region.            •
  Jaundice, by itself, is not a dangerous disease ;  it may,
however, become so  by the causes which produced it ; as
inflammation, incurable obstructions and disorganizations 
442                    JAUNDICE.

of the viscera, or by a long continuance creating cachexy,
and finally hectic or dropsy.
  The first sign  of improvement is the reappearance  of
color in the stools.
  Pathogenesis.   The proximate cause is :  the existence of
bile in the blood and lymph, and  absence of it in the intes-
tinal canal, caused by retrocession of already secreted bile
into  the vascular system.   It is therefore  not impeded se-
cretion, for without secretion there is no bile in the organ-
ism ; but  impeded excretion of bile, which is absoibed into
the blood.  The obstruction may take place in  the ductus
cysticus,  or choledochus, or in the  ductus hepatici, or  in
the puncta biliaria ; the latter is particularly apt to be the
case in the inflammatory and spasmodic jaundice.
   The remote causes of jaundice may  be dynamic or me-
chanical.   Such a suppression may be brought on dynami-
cally by over-irritation, or by deficiency of  irritation and
action (atony) of the liver.   The over-irritation may be
inflammatory or spasmodic.
   The exciting causes may be  ranged in three classes.
Irritation, which  retains the bile.  Of this  class are inflam-
mation of the  liver and contiguous parts, violent bilious
mental affections, indigestion, gastric accumulations, cer-
tain  poisons, taking cold, strong emetics and  cathartics,
gall-stones ; in great irritability of the  liver, spasms, as in
hysterical persons.
   A mechanical obstruction to the excretion ; due to bili-
ary  concretions, gall-stones, even worms,  which obstruct
the ductus choledochus—obstructio hepatis.
   Atony  of the liver, which arises very frequently second-
arily, and entertains the disease as a secondary cause.
   Therapeutics.   The principal intention is, to regulate the
function of the liver, and to restore the free discharge  of
bile into  the  duodenum.   This  may  be done  in various
ways, by  varying the treatment according to the character
of the disease.   Above all, examine whether an inflamma-
tory  state is present,  which  may be  recognized  by the
fever and  by pains in the hepatic region (signs of hepatitis).
When this is the case, abstractions of blood  and the com-
plete antiphlogistic  treatment  of hepatitis are  indicated;
which will also remove the yellow color, or at least render
the application of specific remedies practicable.
   In  ordinary cases, the normal  function of the liver  and
excretion of bile  are restored by  the continued use of dis-
solvents and purgatives ; among which  rhubarb (which has 
JAUNDICE.
443
a specific  tendency to  the liver)  is particularly to  be se-
lected (No. 207, 208).  Should these means not suffice, an
emetic is to be given intermediately.  Injections, antispas-
modic embrocations on the regions of the liver and stom-
ach aid the cure.   Should these also fail, then aloes, which
is an efficient  excitant of  the hepatic  secretion, may be
employed, and will in most  cases be sufficient to  accom-
plish the task.  Prescribe one grain, to be taken three or
four times a day.
   Should even this not effect a cure, then use more vigor-
ous resolvents, especially  soap,  gummi ammoniac daily,
up to two drachms, soda, mineral waters of Carlsbad, Ma-
rienbad, Saidchutz, Pullna; asa fetida,  calomel,  sulph.
antimon.  aurat., scilla, fumaria,  centaur, min., especially
fresh expressed juice  of taraxacum (herb and root), two
or three ounces morning and afternoon,  likewise extract
of chelidonium. maj., still better the fresh expressed juice
of it, one teaspoonful, gradually increasing to a tablespoon-
ful, two or three times a day.   At the  same time, three or
four yelks oLeggs in water  or broth, taken every morning;
also rad. belladonne, with rhubarb (No. 209).
   If even these remedies do not  succeed in attaining the
end. the cause of obstinacy must then be in a weakness and
deficient action of the biliary  organs,and  it becomes a rule
 of practice to combine resolvents with roborants, especially
 quassia ;  even ferruginous  remedies,  particularly the use
 of Pyrmont or similar  chalybeate waters.  Sometimes a
 spasmodic ^tate keeps up the di.-ease ;. in  which case, in-
 jections with  opium will  prove  efficient.
   .In all kinds of jaundice  we must attend  to an ameliora-
 tion and  purification of the blood, to removing the bile that
 has entered into the humors.   This end is best attained by
 frequently drinking of acid beverages, cream of tartar wa-
 ter, tamarind-whey.
    Nor ought the  remote causes  to be lost sight of, such as
 worms, metastases, especially psoric acrimony, gall-stones,
 obstruction  of the viscera,  especially of the liver; for
 which mercurial  embrocations on the hepatic region are
 of great use.  Sometimes icterus is purely spasmodic, and
 then opium  is most serviceable.   The periodical, typically
 intermittent  jaundice is to be  treated as an intermittent
 fever.
                      Icterus Niger.
    The severest kind of jaundice is when  the color becomes
  dark-brown or blackish.  It  manifests the highest degree 
444                    SCROFULA.
of biliary obstruction (usually incurable disorganizations of
the liver or concretions of irremovable gall-stones), and of
bilious corruption of the blood.  It rarely admits of a cure,
and passes in  most cases into dropsy ; in a few cases,  the
use of Carlsbad, the fresh expressed juice of taraxacum,
combined with the simultaneous use of the yelks of eggs,
also tartaric acid, and in one case oxalic acid salt has  ef-
fected cures.
                        SCROFUrA.

   Diagnosis.   This disease appears in two forms;—as a
 scrofulous disposition, and as a confirmed scrofulous affec-
 tion.
   1. Scrophulosis (scrofulous disposition) manifests itself
 in infantile age by the following si^ns: scrofulous parents
 (for hereditary transmission is so certain that we may con-
 clude that  it exists in the children),  an unusually large
 head, especially protuberant occiput,  short, thick  neck,
 compressed  temples, broad jaw-bones, tumefaction of  the
 face, especially of the  upper lip and nose (a principal sign),
 fair  hair, fine white complexion with red cheeks ; in most
 cases blue eyes and large pupils, the whole  body full and
 well fed, but the flesh, instead  of being full and firm, is lax
 and  spongy to  the touch, the abdomen  large  and more dis-
 tended than natural,  frequent bleeding at the nose, and
 constant disposition to accumulate mucositiesjn the intes-
 tinal canal and to  engender worms ; likewise  to blennor-
 rheas of the lungs, nose, etc., irregular stools,  costiveness
 and  diarrheaalternating ; acuteness of  understanding, pre-
 cocity of genius ; whilst the corporeal development, as den-
 tition, walking, is tardy and irregular.
  2.  The confirmed  scrofulous  disease.  Its  signs are:
 Glandular  tumors  and  indurations  (scrofulous glands),
 are the most universal  and surest symptom.  They  appear
 first  on the  throat,  under the jaws, in the  neck, as larger
 or smaller knots (from the size of a pea  up to that of a
 walnut),  sometimes as a  chain of small knots ;  on other
 glandular parts of the body, below the axille,  in  the groins,
 finally everywhere.  In the commencement they are  soft,
 without pain, movable, and  may continue in  this state for
 years; or they  gradually grow larger, and painful, the su-
 perimposed skin reddens ; they at last pass into suppura-
tion,  break  and form  scrofulous  ulcers.  Be  careful  to
distinguish genuine from spurious scrofulous knots (scro- 
SCROFULA.                    445
phulaveraet spuria) ; the genuine are owing to a scrofulous
diathesis, the  spurious are glandular tumors, which arise
from other causes ; as, dentition, development of growth,
irritation  of contagious  matter,  (as  that of small  pox,
measles, scarlatina,) and local inflammations.  The scrofu-
lous nodes may form in external as well as in internal parts
(scrophula externa et interna), especially in the mesentery,
and in the lungs, but  also in the liver,  spleen, and brain.
   2. Chronic inflammations of glandular parts, especially of
the eyes (ophthalmia  scrophulosa, psorophthalmia), marked
by great photophobia, epiphora and viscid secretion of the
Meibomian glands.  The frequent appearance of hordeola
betrays a scrofulous diathesis.
   3. Frequent and  chronic blennorrhea, in children often
otorrhea, also fluor albus.
   4. Cutaneous diseases; in  children the most  frequent
forms  are : achores, favus, tinea; besides universal erup-
tions of various kinds, especially the herpetic.
   5. Constantly a tumid, hard abdomen, lymphatic tumors,
extravasations,  indurations,  scirrhus,—scrofulous ulcers,
which are distinguished by the absence of pain, are of a
very passive character, have an impure surface, do not fur-
nish a good pus, but a watery, acrid ichor, which corrodes
the contiguous parts, dry in one place  and break in an-
other.
   6. Enlargement  of bones (spina ventosa, pedarthrocace)
and caries ° the first  is an internal, the latter an external
corrosion of the bones ;  the first is peculiar and character-
istic of the scrofulous disease.
   7.  Finally,  cretinismus  remains to be mentioned as  the
most complete, formed and universal scrofulous malady of
the whole organism,  in which  even the mind suffers, and
the whole body turns into scrofula.
   When scrofula is of long duration,  of a high degree, or
is inveterate, worse  and more  dangerous diseases form:
they  are atrophia  mesenterica,  tabes scrofulosa, phthisis
tuberculosa, hydrops (especially ascites  and hydrocepha-
lus), cancer scrofulosus, especially on the lips and in  the
face.
   Scrophulosis may become fatal by these diseases, though
it seldom goes so far ;  but disappears again, or accompa-
nies the patient through life ;  remains  his troublesome
companion, and mingles with all other diseases that  may
attack him, frequently produces  symptomatic fevers,  and
even nervous diseases.
   Its course varies much.  It is usually a disease of  chil-
                            38 
446                    SCROFULA.
   dren, and terminates at puberty.   It manifests itself some-
   times  in  the  first  year of life, generally not before  the
   second or third.  Its appearance is often brought forth by
   the influence  of accidental causes or pathological irrita-
   tions; as by serious lesions, dentition, acute  fevers, espe-
   cially exanthematic and contagious  ones, as variola, mea-
   sles, scarlet fever, even vaccine. But sometimes it remains
   dormant in the earlier  periods of life, and breaks out at the
  time of puberty. After this period, and during the years
  of complete growth and formation, that is, from the twen-
  tieth to the fiftieth  year of age, it is less perceptible, and
  lies dormant, but sets in again, in  females particularly  af-
  ter the cessation of the menses. A part of those glandular
  diseases and indurations which then form, must certainly
  be attributed to this diathesis.
    The season of the spring, the formative period of nature
  exercises an important  influence on this disease ; the symp-
  toms usually are then more manifest.  Even the moon, its
  increase, influences  the economy in this respect.
    Pathogenesis.   Scrofula is a disease of the lymphatic sys-
  tem, and of the lymph itself.  It depends on weakness, de-
  ficient and irregular  action  of this system and  its glands ;
  on faulty-secretion, by which the lymph is badly prepared
  assimilated  and animalized.  The effects  are /imperfect
  seemingly rich but unsound nutrition, stagnation, accumu-
 lation of lymph in the vessels, degeneration of it into scro-
 fulous  acrimony  (scrofulous virus), irritation,  even local
 inflammation (but of a passive nature), thereby thickening
 induration, formation of tubercles,  extravasations, suppu-
 rations  of the glands, of other organs also, of the bones
 and noble viscera ; abnormal secretions ; metastases, finally
 general cachexy, deformity,  rachitis, disorganization and
 destruction.
   The  lymphatic system  is  the system of development  •
 the scrofulous disease, which originates and is  located in
 this system, is therefore  a disease of development;  that is
 to say, it is intimately interwoven and  connected with the
 developing process of the  organism.  It therefore is most
 prevalent at these principal  periods, that of dentition  of
 growth, sometimes not earlier than that of puberty  but it
 is also terminated  by them  and their happy  completion.
 The double  schema, which this disease is able to assume
 the schema externum and  internum, is worthy of  particular
 notice.   In the first case, the disease  attacks chiefly the
 external  glands,  the  lymphatic  vessels,  the skin, and  in
general the external parts; in the latter, the internal ones 
SCROFULA.                    447
the mesentery, lungs, brain, bones, and few or no swellings
of the glands are observed, as happens in rachitis.
  All that has a tendency to  create faulty lymph,  or  to
weaken and depotenciate the lymphatic system, may act as
an exciting cause of scrofula.
   The remote causes are :  scrofulous progenitors (for this
disease is surely a hereditary one, and is peculiar to whole
families), also such ones as are very much debilitated by
dissipation or old age,  likewise syphilitic parents  (for ex-
perience  has but too frequently shown, that the children
of such parents are scrofulous  from birth, and that scro-
fula very often is nothing but  a degenerated, a modified
syphilis in the second generation).—Farther, bad nutrition
in the first year of life from sickly,  scrofulous, or even sy-
philitic mothers and nurses ; particularly rearing without
mother's milk, by artificial nursing ;—living in impure, con-
fined, animalized,Wdamp, moist-cold air (hence its climatic
diffusion, which is  most frequently met with in England
and the northern coastward regions; likewise in the deep
vallies of mountains, where the highest degree  of the dis-
ease,  cretinism, is  alone  bred) ; in a general  neglect of
cleanliness ; bad, heavy, indigestible food in the first years
of infancy,  especially  heavy, not  well fermented, farina-
ceous meals, potatoes, premature usage of brandy, much
sitting, and neglect of corporeal exercise during the age of
 childhood ;  premature  exertion of the mind ;—acidity, ver-
 minous accumulation in the prime vie;—former diseases,
 which particularly affect and weaken  the lymphatic sys-
 tem as small pox, measles, scarlet fever, also acute fevers,
 terminated  by incomplete or disturbed  crises.—Finally,
 strong astringent  medicines, which impede and stop the
 salutary  motions of nature,  especially the abuse of opium
 in children, may give rise to this disease.
    Therapeutics. The cure of scrofula, as of a constitutional
 disease,  takes a  long time and is difficult.  For a radical
 cure requires a deep penetration into the vegetation of the
 system ; altering and improving the functions of chylifica-
 tion, assimilation,  and  animalization.
    The principal intention is to ameliorate and regulate the
 function of the lymphatic system,  and correct the specific
 corruption  of the lymph and its  effects.  This is accom-
 plished in  part by general, especially by dietetic means,
 partly by  specific  remedies which have a particular  ten-
 dency to the lymphatic system and the dyscrasy in ques-
 tion (antiscrophulosa). 
448                    SCROFULA.
  Before  entering into the details, I will give a few gene-
ral  rules concerning the  cure of scrofula.
   1. In no  disease  does patience form  so indispensable a
part of the physician's  duty  as in this  malady.   Months,
even years,  are required. The end is not attained by rash
tempestuous means, but by a quiet and  persevering treat-
ment.
  2. Profit of the times,  the periods of development for the
cure.  Success has often failed a long time, but suddenly
makes rapid progress. The same remedy which  previously
proved unavailing, is now of excellent service. Also pauses
in the  administration of medicines are salutary,  by which
they often receive new efficacy.
  '3. Spring is the most favorable season for the cure of
scrofula, when the impulse, which the new  life  of nature
imparts, and which is also evident in the  more striking ma-
nifestations of scrofula,  increases also the efficaciousness
of the  remedies.
  4. Distinguish  palliative treatment (cure  of the symp-
toms)  from the  radical  one (cure of scrophulosis, scrofu-
lous diathesis).  The symptoms  may be removed and yet
the disease continue.
  The chief thing, the whole basis of treatment for scro-
fula is a suitable regimen.  Diet alone can ameliorate the
growth, the material organic state, the humors,  especially
the lymph—the chief object to  be attained.  Without diet,
the best antiscrofulous  remedies are  unavailing; on the
contrary,  the whole cure may be effected by it alone; and
it is by diet alone that the radical cure  of scrofulous dis-
eases is accomplished.
  It consists  in the following: healthy  food; that is, nu-
tritive, easily digestible aliment, such as resists acidity; it
is best to  combine vegetables with the animal food,  espe-
cially roots (carrots, scorzonera),  herb-soups, pure water,
light beer, also egg-water, the yelk of one egg shaken with
two pounds of water (a  little culinary salt and sugar  may
be added), to  be taken as beverages.   Pure salubrious air
is most essential.   The best is the country air in a dry re-
gion, living in the open air, ventilation of  the bed-chamber.
—Cleanliness, frequent,   daily change of linen and  bed-
clothes; feather-beds must be discarded,  and matresses of
hair, moss, or chopped  straw substituted for them.   It is
incredible how much this alone will contribute to a cure.
Succinous fumigation of  the linen, before using  it, is also
very wholesome.—Muscular exercise, even  strong, gym- 
SCROFULA.
449
nastic exercises.—Daily washing and friction of the body
with  cold  water.—A tepid bath every two days.  Bathing
alone is very efficacious, and its efficacy may be increased
by  additions of soap, culinary salt, malt.  Finally, I also
mention  acorn-coffee in the number  of dietetic remedies.
It greatly  supports  the  treatment, and  ought not to be
omitted in the diet  of any  scrofulous child, and is at the
same time an excellent nutriment.
   The pharmaceutic  treatment.  The principal remedies
are:  mercury, which is  here almost as specific to annihi-
late the symptoms as in syphilis. Usually and in ordinary
cases no other remedy is needed.  Its internal use is alone
sufficient to remove  all  symptoms and forms  of this dis-
ease,  such as swoln glands, indurations, tumors, cutaneous
maladies, scrofulous ulcers, scald-head, scrofulous ophthal-
mias, even pedarthrocace and caries. The use of it must be
persevered in until the symptoms disappear, sometimes for
a number of weeks, even months, but so that after two or
three weeks using it  a pause of eight days may be made,
in order to observe the secondary effect of the medicine;
then begin again.   It is necessary  to give it in combina-
tion with sulphur or antimony,  in order to prevent saliva-
tion, or, in  children to prevent excess of purging. The best
form  for children  is ethiops mineralis and  antimonialis
(vide  No. 210), mixed with magnesia and rhubarb, as many
grains as the child has attained years, up to 8 grains daily;
for stronger ones and adults Plummer's powder (vide No.
211) is best.   If this prescription does not purge by itself,
a cathartic of jalap and calomel is to be given every fort-
night.  In  obstinate cases, the  effect may be increased by.
an addition of resina guaiaci, or cicuta in substance or ex-
tract  (vide No. 212).  External means are generally not
needed, and it is better to dispense with  them.  Next to
mercury in efficacy  is murias baryte  (vide No. 213),  it
frequently surpasses even the former in this respect. Also
calx muriatica and chlorinica,  in the same form and dose
as baryta, sassafras as a tea (vide No. 214), or a few drops
of the ethereal oil triturated with sugar, may be adminis-
tered.—Emetics and  cathartics  may be given interme-
diately during this  treatment;  they assist by freeing the
first ways from the impurities  and worms, and partly by
exciting the action of the lymphatic system.  I have found
it best to prescribe every 8 or 10 days a cathartic of jalap,
10 to  20 grains, according to the age of the patient, com-
bined with  or without calomel.   Herba conii maculati and
digitalis have  also  proved serviceable  in scrofula.  The
                   P      38* 
450
SCROFULA.
   vegetable resolvents, the most efficacious of which are the
   fresh expressed juice of taraxacum (herb and root), of gra-
   ven, fumaria,  and  tussilage,  particularly the latter  in
   doses from 2 to 4 ounces, mixed with weak broth,  taken
  every morning,  I  have  seen produce  excellent  effects.
  Soda, soap, calx conche, lime water, are likewise advised.
  Seabaths,  the baths at Ems  and  Obersalzbrunn,  salt-
  baths are of great efficacy and recommendable in obstinate
  cases.   When great debility and atony exist, cinchona,
  and chalybeates are  to be prescribed ;  they often produce
  resolvent effects,  dissolving the glandular stagnations and
 knots.   Iodine has lately come into use in the treatment
 of scrofula; and  it  must be admitted  that it resolves the
 nodes and indurations very  efficiently; but it may  atte-
 nuate the whole system,  and produce irreparable injury in
 the general nutrition, and thereby create tabes and hectic.
 Therefore it must not be used in delicate children; but re-
 sorted to only in the most stubborn  cases,  and even then,
 only  in the alkaline mixture (vide No. 233), or as spongia
 tosta, and not for too long a time.  In very inveterate and
 obstinate scrofula, Zittmann's decoction also merits recom-
 mendation.  In general observe this rule : administer anti-
 scrofulosa until the symptoms disappear.  But do  not be-
 lieve, that the original disease, the diathesis scrophulosa,
 is always therewith removed; but have the general dietetic
 treatment continued, and watch, whether symptoms do not
 reappear, when the use  of the specific  remedies is to be
 resumed.  Also a change in  medicines  is recommendable
 in stubborn cases.
• As for single symptoms, the following remarks must be
 borne in mind.   The  glandular nodes and indurations,
 usually disappear  by the internal  use of mercury and by
 baths, in obstinate cases by combination of several anti-
 scrofulous remedies  (vide No. 215, 216).   But if this do
  not succeed,  the  efficacy must  be supported  by external
  means, -among which the following are  the principal:  em-
  brocations of mercurial ointment, ung. digitalis, a solution
  of chloride of lime in water (vide No. 217), as a lotion and
  applied by means of linen dossils, the continual wearing of
  a solvent plaster, emplastrum cicute, saponis mercurialis.
  In the application of plasters as well  as of all external
  means, we must be attentive, that  the swelling be neither
  red  nor painful.  As soon as this happens  they are to be
  laid aside, in order to prevent the part from becoming in-
  flamed and passing into suppuration ;  which is never salu-
  tary, but  generates a scrofulous  ulcer.   Also iodine  oint- 
SCROFULA.
451
ment (vide No. 218),  or a lotion made of iodine; likewise
aurum  muriatic. -f\ grain a day, rubbed under the tongue,
may be used.  In obstinate cases artificial ulcers next  to
the tumor ; salt,  sulphur, and  corrosive sublimate baths.
In a general glandular induration, I  have seen excellent ef-
fects follow the use of cicuta baths (2 to 4 ounces of cicuta
herb for one bath).
   Scrofulous ulcers do not require  an external application
of ointments and  plasters ;  these only serve to make them
more impure and phagedenic.  The best  treatment is a
course of internal medicines, moistening with a solution of
chlorine, weak corrosive sublimate  water,  or aqua phage-
denica, and an artificial ulcer contiguously.
   Scrofulous diseases of the bones (padarthrocace, caries,)
are treated in the same  manner.  The treatment consists
principally in internal medicines and baths, to  which,  in
such cases calamus and sabina may be added. Here also the
combination  of asa fetida with internal antiscrofulous re-
medies, as well as with external means, is of great efficacy.
Liver oil has an  excellent effect.   I have  seen  the worst
kind of scrofulous caries soon cured by its  internal use.
   Scrofulous ophthalmia must by no means be considered
and treated as inflammation, but only as blepharophthalmia
(an abnormal secretion, usually attended with a passive state
of the organ), which it really is.  Leeches, therefore, are
here unavailing,  even injurious; the internal antiscrofu-
lous treatment, especially mercury and baryta, baths, deri-
vation by  artificial ulcers, and externally nothing but fre-
quent  fomentations with a tepid  decoction  of mallow-
flowers and  herba  hyoscyami; also an addition of aqua
laurocerasi and precipitate eye salve (vide collyrium No.
219),  once or twice rubbed on the margin of the eye-lids
daily.  Borax in  the formula No. 220,  applied to the eyes
on linen dossils, is also very useful.  Sometimes, however,
a really inflammatory state may set in, and then the appli-
cation  of leeches will be salutary.
  The  scrofulous cutaneous eruptions do not require any
thing to heal them but the internal use of remedies,  espe-
cially ethiops mineralis,  or Plummer's powder,  good diet
and baths  mingled  with cathartics.  A tea of herba jacee
(pansy) taken at the  same time will assist the cure.  All
external  repulsive  means  must be avoided.   The  same
treatment applies to favus, crusta lactea et serpiginosa, and
tinea (vide Tinea). 
452                    RICKETS.
            Struma.  [Goitre, Bronchocele.]

   Tumescence of the glandula thyreoidea and the conti-
guous cellular tissue ; frequently to an enormous size.  In
the plurality of cases it is of a scrofulous-origin ;  the en-
demial  constitution,  however, exercises a particular in-
fluence ; hence it occurs most frequent in mountains, espe-
cially at their foot, and in the vallies, and the evil disap-
pears merely by a removal  from such places into a level
region.
   If it be a scrofulous symptom,  the antiscrofulous treat-
ment is  often sufficient to cure it.  The principal and truly
specific  remedy  is burnt  sponge (spongia  tosta)  in all
forms, most efficacious in powder (vide No. 221), but also
in a decoction  (lixivium spongie, vide No. 222).   Be cau.
tious however in persons that have irritable lungs, a phthi-
sical disposition, dry cough, or disposition to hemoptysis ;
for in such cases it  may accelerate the transition of the
morbid  disposition into consumption.  The use of soda is
also recommended as able to cure struma (vide No. 223).
Externally embrocation of hydriodic ointment.
                        RICKETS.

                        Rachitis.

   Diagnosis. The first indications are : slow and imperfect
acquisition of the power of standing and walking; enlarge-
ment of the epiphyses of the bones, especially those of the
wrist (a principal,  often the first and  only  sign).   In its
further course incurvation of the bones, especially  of the
tibia, sternum, and ribs (hence asthmatic complaints), and
of the spine; tumefactions and deformities of the  bones,
frequently of the whole body, particularly of the  pelvis,
hence a hobbling, waddling gait.   Usually precocity and
acuteness of the mental faculties.
  The disease  often  disappears of itself with the progres-
sive  development and growth of the body.  In the higher
degrees, however, incurvation of the spine, feet, sternum,
and ribs, even sometimes a universally crippled state, con-
tinue through life.
  The fundamental  cause is scrophulosis, and rachitis is
nothing but a particular modification of it, a metastasis of
it on the osseous system, a scrofula  of the  bones. An acid
character is prevalent. 
GOUT.
453
  The treatment is that of scrophulosis, especially the ge-
neral regimen, animal food and baths. Malt and salt-baths,
mixed  with radix calami aromatici,  also  dry sand baths
(sand  heated by  the sun), washing the back and the limbs
with whisky,  also with spirit of ants, are very serviceable.
Terrea  and iron (vide No. 224;  children  bear and digest
iron in substance very well;  in case of constipation a few
grains of rhubarb may be added), and rad. rub. tinct. and
calamus are very wholesome.   Liver-oil (oleum jecinoris
aselli) also# has  an excellent effect,  a  teaspoonful taken
morning and evening.
  Claudicatio spontanea is most frequently owing to scro-
fula or rachitis, and requires an antiscrofulous treatment;
besides  baths,  embrocations, leeches, exutories (vide dis-
eases of children).
                          GOUT.

                        Arthritis.

   Diagnosis.  Pains  in  the joints, with inflammatory  or
 chronic  cold swelling, readily passing into arthritic nodes
 and calcareous formations; connected with digestive diffi-
 culties, flatulency, generation of acidity, mucosity, apepsia,
 obstruction.
   This original and essential form may, however, be vari-
 ously modified, so that these signs only partially exist, or
 may be  entirely  absent;  in this case  the  disease  may
 appear in a form  foreign to gout, under the  mask  of any
 chronic  malady, and deludes the observer ; it is  therefore
 rightly termed  a  pathological Proteus.  We cannot suffi-
 ciently bear in mind that gout can be present as an occult
 cause in all complicated, chronic, and obstinate maladies.
   Its two principal forms are consequently arthritis mani-
festo and occulta.
   1. Arthritis manifesto is subdivided into :
   a. Arthritis regularis,  acuta,  which  makes regular  at-
 tacks at  the time of the equinoxes; is attended with fever
 and terminates  in crises;  followed  by longer or shorter
 intervals (six months to a year) of entire absence of gout.
 The attack presents  a  perfect image of an inflammatory
 febrile crisis.   The local affection consists in an accumu-
 lation of gouty matter in the part, a kind of critical metas-
 tasis added to the general crisis.   An  inflammatory affec-
 tion of a joint, with redness, heat, swelling, and pain, which 
454
GOUT.
are often considerable, accompanied with fever.  It  lasts
three or four weeks, even longer, and is subject to relapses;
it runs through the stages of increase, acme and decline ;
terminates in a critical perspiration, which has usually a
sour odor; and in a thick,  white,  chalky, sometimes red-
dish sediment in the urine.   It is named differently, ac-
cording to its  location, podagra,  gonagra, chiragra, etc.
Sometimes it is wandering (vaga) and  moves from one
place to another, in which retrocession to internal parts is
much to be dreaded.                         ,
  The attacks of regular gout most usually happen at the
end of winter,  in the months of February and March.
Sometimes,  instead  of them, other  critical  secretions,
sweats, cutaneous eruptions  (purpura arthritica),  lasting
for some weeks, take place.   I myself have seen critical
salivation in the place of an attack of gout.
  b. Arthritis chronica,  irregularis.  This  form of  gout
occurs at indefinite times, and without fever.  Its duration
is indefinite; it may last  for days and weeks, the  pain
changing place, and frequently shifting in a moment to  a
remote part; it may  also  last  for months, even for years
(arthritis fixa et vaga).  Crises are  rare or only imperfect.
The disease  may be  a primary or  secondary one;  or the
consequence of another attack not entirely  resolved by
crisis.

       Arthritis Nodosa, Destructoria, Disorganisans.

   It arises and grows out of the former  merely by length
of time.  It generates various disorganizations and degen-
erations of  organic  matter.    The  most  common  are:
arthritic nodes, calcareous concrements,  which form about
the joints, rendering  motion difficult, even impossible.   It
is not rare to see  real enlargement of the bones and exos-
tOS6Sf
   2. Arthritis occulta, larvata, anomala,  gout which  does
not appear with the usual, but with totally  heterogeneous
symptoms.   It seizes either upon the internal organs, in-
stead of the external  ones  (arthritis interna), when it pro-
duces painful affections, or painless, diverse, but very often
important and obstinate disturbances of function ; as  when
it affects the stomach, arthritis and spasm  of  this  viscus,
acidity, mucosity, chronic vomiting ; when the head, cepha-
lalgia, vertigo, deafness,  etc.; when the chest,  chronic
 cough, pains in the chest, asthma ; when the whole nervous
 system, hypochondriasis,  spasms, convulsive diseases, pa- 
GOUT.
455
ralysis; when the kidneys, lithiasis;  when  the abdominal
vascular system, hemorrhoids ; when the lymphatic system,
hydropic effusions.—Or it creates unusual external pheno-
mena,  as ulcers,  indurations, tumors, chronic cutaneous
eruptions.  In general it is noticeable, that  the internal as
well as the external affections of anomalous gout,  true to
their original character, are apt to generate  thickenings,
indurations, exsudations of coagulable lymph, stones in all
organs seized by it.
   Arthritis occulta and anomala may be  brought on in a
double manner, and is consequently of a double kind:
   1. By a retrocession which had already manifested itself
externally, to internal parts (arthritis retrograda).  This
may happen either suddenly in  a febrile attack of gout,
generally by taking cold (podagra retropulsa), of which the
consequences are likewise acute and inflammatory ; gastri-
tis, catarrhus suffocativus,  mania ; or, it may happen chro-
nically where also the cessation of  the habitual chronic
attack is to be mentioned.
   The diagnosis of these arthritic diseases depends on the
previous existence of arthritic attacks, after the disappear-
ance of which the actual evil arose.
   2. By impediment to the formation and deposit of  gout
externally, confining it within the internal system (arthritis
atonica).  It  remains most  frequently in the abdominal vis-
cera and nerves (its  receptacle); hence arise chronic dis-
orders of digestion, and abdominal  maladies,  especially
hypochondriasis and other nervous diseases (which, there-
fore, are removable by a single attack of podagra).  Also
all other chronic diseases may have an arthritic source; it
is frequently the cause of  cutaneous  diseases, chronic ul-
cers (arthritic ulcer).
   In such cases the recognition of the arthritic nature of
the  disease  is much more difficult.   The  principal  signs
are : descent from gouty parents, fugitive  arthritic pains
once in a while appearing, the beneficial effect of sweat, or
calcareous, arthritic  sediment in the urine, that  it greatly
depends on season and weather, especially on barometrical
changes of the atmosphere.  A peculiar sign  of concealed
gout which  I have observed very often is,  a  sensation  of
local numbness on a limited part of the skin, or a feeling
as if fur or wool was laid on the  place.
   Pathogenesis.   Proximate cause : a  peculiar dyscrasy of
the  humors  and  anormality of the general nutrition, the
character of which is a  disposition to thickening, to cal-
careous formations, development of acids, ossification, de- 
456                      gout.
 pendent and founded on weakness of digestion/ and faulty
 chylification.  The#whole phenomenon of the arthritic dis-
 ease is nothing else* than a continual attempt of nature to
 elaborate and eliminate this morbid matter.   When this is
 performed with energy and fever, a perfect local and  gen-
 eral crisis ensues, and the patient remains free of arthritic
 attacks for a longer or shorter time.  If this energy is
 wanting, the morbid matter is either left fixed in the exter-
 nal parts, and chronic gout forms which finally affects the
 organization of these parts, and destroys them in a pecu-
 liar  manner (for arthritic enlargement of  the bones, exos-
 tosis and caries differ altogether from similar syphilitic and
 rachitic affections) ; or it is deposited on internal parts and
 systems, giving rise to the occurrences of atonic and larved
 gout.
   It is this internal nature of the malady which constitutes
 the  essential difference between  gout and  rheumatism,
 which is double:   a. The gout forms from within to with-
 out, rheumatism  from without to within.  The  former,
 therefore, is  a disease developed in the internal organism,
 critically operated on by the same, and deposited by nature
 towards the exterior ; the phenomena of which are the so
 called  attacks of gout, and are  only  to  be considered as
 symptoms of a deeply seated internal morbid state.  Rheu-
 matism, on the contrary, is a  disease impressed  on  the
 organism from without by  checked action and secretion of
 the skin, the character of which, therefore, always remains
 more external and local, and, by its nature, does not in the
 least disturb the  functions of digestion and assimilation.
 b. Gout is combined with a specifically characterized mor-
 bid matter ; by a tendency to thickening in the tissues of the
 part affected ;  by  the generation  of earthy  matter  and
 acidity, an abnormal organic matter ; not so rheumatism,
 in which the "serum acre retentum" is the only morbid
material.
  Remote causes : luxury in eating and drinking, connected
with idleness (hence podagra is a disease of the  rich),  es-
pecially the immoderate use of  wine,  particularly  of acid
wines,  excesses in venery, particularly sudden continence
after long  prosecuted excesses ; damp,  cold atmosphere
(hence  it is  of frequent occurrence in  northern littoral
countries), moist  dwellings, moist occupation (washing,
laboring in water), colds, chronic as well as acute (rheuma-
tism assumes the  arthritic form);   suppressed  habitual
hemorrhages, as that of the piles,  and cessation  of  the
catamenia.  Women often become  arthritic after this  pe- 
gout.                      457
riod, the cause of which, however, is traceable to an arth-
ritic disposition, which hitherto had  been derivated by the
periodical evacuation of blood.  Above all other causes,
the most remarkable is a hereditary  disposition, which in
no disease is so great and striking as in gout, on which ac-
count it may attack even children.
  The generation  of the arthritic matter takes place  evi-
dently in the organs of digestion and chylification (abdomen
officina arthritidis), and  Bacchus, Venus et Otium  are, ac-
cording to the testimony  of the ancients, the contracting
conditions.  By the  first  (wine), rude,  sour, acrid  sub-
stances accumulate in the chyle; by dissipation and idle-
ness the organs are debilitated and the substances are defi-
ciently acted  on.   The proofs are:  the preceding cause,
the digestive difficulties previous to, or concomitant with,
every paroxysm of gout;  and the salutary effect of cathar-
tics for removing, and of the roborants for preventing arth-
ritic attacks.
  Arthritic  attacks  frequently  alternate with piles ;  this
points to a  causal connection  and  common origin in  the
abdomen.  There  used to be a hypothesis,  that gout  was
owing to retained spermatic matter; but this is sufficiently
refuted by the circumstance that eunuchs are also liable to
gout.
  There is also an arthritis spuria ; other maladies may
assume the form of gout.   Of this class are rheumatism,
syphilis, scurvy, metastases of suppressed  cutaneous  dis-
ease, healed old ulcers.
   Therapeutics.  The cure  is  double: the generation of
gout, and  the symptoms of gout are  to be  attended to.
Unless we admit the existence of a  material arthritic  sub-
stance, we  cannot form  a  satisfactory idea, nor decide
upon a proper treatment of gout.

Treatment of Gout already existing ; of Arthritic Affections.

  It varies according to the different forms.
  The acute feb Hie gout (podagra, etc).—In  such a  case
there is only one  indication: to  consider  the arthritic
attack as a  crisis, and to do  all to  make it as perfect as
possible ; but  especially to  avoid all that can disturb the
crisis.  In a moderate degree of fever this  is best effected
by  leaving nature  to operate  alone, and by prescribing  a
proper  regimen, which  is  antiphlogistic,  diaphoretic, at-
tending to  perspiration by flannel,  oiled  silk, ^r  what  is
better,  flannel.  All  other  external  remedies are  hazard-
                           39 
458                      gout.
ous, even injurious.  Cold water, saturnine remedies, cam-
phor,  and all dissolvent remedies are apt to cause a retro-
cession to noble parts, and to suppress at least in that part
the vital  action (the inflammation), which is necessary for
completing the crisis, thereby giving rise to- a transition
into chronic gout.  The same is true of the local abstrac-
tions  of  blood, which, surely, remove local  inflammation
and pain, but not gout, render it  on the  contrary chronic
and obstinate, or create such a local weakness, that topical
evils remain for a long time.  They not only take reaction
away, but they disturb the local  crisis and the operation
going on in the arthritic  matter, which is here so  neces-
sary ; consequently this matter either remains in that part,
causing tumefaction, stiffness, anchylosis; or the gout is
suddenly translated to another, often to a noble  part, or at
least, the disposition to a frequent return of arthritic at-
tacks is left behind.  Relaxants and warm cataplasms are
equally to be  avoided.  They, indeed, sooth the pain, but
produce  sluggishness, weakness, edema, exsudation, even
suppuration in the part.  Nor  is the  use of emetics and
strong cathartics, as recommended by many, advisable. It
is true, the attack of gout is thereby often immediately re-
moved, but  the consequences are hazardous.  In the  first
place a translation of gout from the surface to some inter-
nal part  may thereby be  effected (of which I  have seen
melancholy instances),  or only a temporary debilitation
and obstruction of the arthritic crisis ensues, the gout soon
returns in a worse form, or becomes even chronic.   Even
the specific remedies which quickly remove the evil, as
vinum seminis colchici, are unsafe, since  they are also apt
to interrupt the crisis and to create bad metastases.
   The only cases with which art may safely  interfere, are
the following :
   1. In violent inflammation, when the patient is very pletho-
ric, robust, the fever violent, the part affected very red and
hot,  nitre and sal. ammoniac along with tartar emetic, and
when the pulse requires it, a venesection besides the local
abstraction  of blood is needed.
   2.  In a gastric complication, gastric cleansing remedies
must not be neglected ; especially when used previously to
the paroxysm,  they can contribute to  shorten it very
much.
   3.  In  very  violent pains,  unaccompanied  by gTeat  in-
flammation, but with a nervous spasmodic character, nar-
cotics, of which the best  is extract of hyoscyamus diluted
with  water to the consistence of ointment, may  be applied 
gout.                     459
tepid to the surface, and also  taken  internally ; when this
does not sufficiently relieve, mix  it with pure opium, cam-
phor, or take a dose of Dover's powder in the evening.
  4.'When the fever ceases, but  the pain and local affec-
tion continue ;  the crisis, not  being  perfect, must be sup-
plied by art.  Here the  specific  antarthritica are proper,
above  all,  guaiacum,  which promotes all the secretions,
even  the discharge from the intestinal canal.  Give it in
the prescription No. 225 a., so  that it produces two stools
daily.   Also camphor, spiritus Mindereri;  in old persons
disposed to atonic gout, liq. c. c. succin. may be adminis-
tered •  if all this do not suffice, have recourse to the treat-
ment of chronic gout.

                     Chronic  Gout.

  Here all depends on the  proper operation  on, mobiliza-
tion, neutralization, and  secretion of arthritic matter; in
short on producing by art such crises as in the former case
nature effects.   This requires :
   1. Specific remedies, which have  a particular  power
to neutralize and  destroy arthritic matter, and to annihi-
late the arthritic character prevalent in the economy. For
that purpose, the alkalines rank first: Carlsbad, soda, soda
with bitters (No. 226), lime water, ammonium, sulphur and
 sulphur baths, as  Aix la Chapelle, Neundorf, Warmbrunn,
 the alkaline preparations of sulphur, ammonium sulphura-
 tum, which  is the strongest and most volatile, antimonium,
 sulphuretum antimonii auratum,  tinct. antimonii  acris,
 especially  aqua calcis, antimonium sulphurat. (No. 227),
 liquor  c. c. succin., liq. antarthriticus Eller. (liq. anodyn.
 Hofmanni and liq. c. c.  succinat. a a), ol. jecinoris aselli,
 mercury, especially corrosive sublimate, aconite, guaiacum,
 of which the solution of the resin in taffia, one tablespoon.
 ful morning and evening, and  continued for some time, de-
 serves recommendation as one of the most efficacious rem-
 edies,  savin (No. 228, 229), sarsaparilla, rhododendron
 chrysanthum, colchicum.   Baths of ants, of salt, of brandy
 lees, of Wiesbaden and Teplitz  the springs are  very effi-
 cient.
   2. To vigorously increase the secretions, to excite the cri-
 ses, artificial secretions, especially strong diaphoretics per-
 severed in, artificial ulcers. Vesicatories used consecutive-
 ly, are very efficacious.  First lay one vesicatory near to the
 affected part;  if it gives no relief, apply a second one next
 to it,  and thus several successively, by which the most ob- 
460
GOUT.
stinate gout may often be conquered ; antimonial ointment,
cortex mezerei,  steam baths, Russian baths.
  3. To purify and invigorate the digestive and abdominal
system, by warming resolvents and purgatives, emetics, the
continued use of bitter remedies, especially of quassia.
  4. To regenerate  and renovate the  humors, for which
milk diet, persevered in for several months, is the principal
means.
  5. To consider and treat  the various constitutions ;  the
debilitated torpid body by restaurants and roborants ;  the
plethoric and robust by abstractions, a  scanty antiphlogis-
tic diet,  evacuants, even bleeding,  particularly frequently
repeated cupping.
  6. Local  treatment, which has a double end : a, to as-
suage  the local affections by means that accord with its
degree  and  character ; in an  inflammatory  case by local
abstractions of blood (in which, however, the rule previ-
ously intimated, not to weaken too much, must not be lost
sight of) ; in a nervous case by sinapisms,  vesicatories,
narcotic, volatile, antispasmodic embrocations and appli-
cations ; b,  to excite the formation of the arthritic  matter,
when gout is fixed in a part.
  The most approved remedies are : continued warmth,
maintained by oiled  silk  cloth, wool, cat-skin, embrocation
of petroleum, ol. cajeputi, sabine, balsam of Peru, balsam
vite Hofmanni,  emplastrum resinos. resolv., galbani cum
opio., mercurial ointment, vesicatories long kept in suppu-
ration,  fontanels,  in obstinate  cases   moxa, local steam
baths,  made stronger by ammonia,  sulphur, and the like,
douche-baths, in extreme cases, and after proper internal
treatment, cold baths.
  Ischias, coxagra, when  they arise from an arthritic cause,
are to  be treated in the same manner.
  In conclusion, we must use the radical treatment; espe-
cially a proper invigoration.
  When contractions and disorganizations  have already
formed  (arthritis nodosa,) besides the internal use of alka-
lies, Zittmann's decoction,  baths of corrosive sublimate,
steam  baths,  local  douches,  but especially  the thermal
baths,  particularly  those of Wiesbaden,  Teplitz,  Aix la
Chapelle, are of excellent service.

                    Retroceded Gout.

  The leading idea in the treatment is  to  re-establish  the
gout externally.   Here we must well distinguish: 
GOUT.                     461
  1. Sudden febrile suppression.  In such a case, a vene-
section (for all gout is apt to  produce internal  inflamma-
tion), antiphlogistic treatment, application of sinapisms on
the  part previously arthritic, and  vesicatories on the actu-
ally affected part.  After the  fever has subsided, camphor
or sal succinatum along with nitre.   In cephalic arthritis,
one of the  most painful and dangerous metastases, I can
recommend the application of leeches and two  grains of
calomel, along with half a grain of aconite, to  be taken
every three hours, and a vesicatory on the neck, as capable
of giving prompt relief.   In arthritis of the stomach, after
a proper abstraction of blood, but which is often unavailing
for  removing the pains and the danger of inflammation,  a
vesicatory on the epigastric region is most beneficial.
  2. Chronic suppression.  Here likewise rubefacients and
vesicatories, and internally camphor, musk, ammonia, naph-
tha  phosphorata, tinct. guaiaci volatile (No. 225 b.), are to
be used.

                     Atonic Gout,

  Calls for the treatment usual in retroceded chronic gout,
especially during the violent attacks ; and the treatment of
gout in  general, invigoration and rousing of  the energies.
Particularly are to be mentioned : infusion of ginger, vinous
infusion  of mustard, tinct. guaiaci volat., pepper, quassia,
Pyrmont and Dryburg waters, strengthening baths.  A com-
bination of sulphur with a few grains of  alcoholized  iron,
and extract of quassia formed into  pills, is also of great
use.
  Radical cure of gout, cure of the arthritic disposition,
  Has three indications :
  1. To do away the remote cause before stated, to which
the  generation of  gout is due ; therefore  frugal meals,
avoiding excesses  in  venery and  wine, especially acid
wines; labor and  strong muscular  exercise, dry  air and
habitation, changing a cold for a warm climate  (most effi-
cacious).
  2. To strengthen digestion ;  which calls for bitter rem-
edies (quassia, gentian, Portland's  powder, etc.),  ferrugi-
nous remedies, especially Pyrmont and Dryburg water, and
the  like baths, also cold sea bath.
  3. To  promote all  the secretions, especially those by
which arthritic matter may have been engendered, and can
be secreted and discharged ; to promote the secretion of
the  skin by motion, friction, flannel  clothing, warm  baths
                         39* 
462
VENEREAL  DISEASE.
throughout the whole year, once a week ;  the secretion of
the kidneys by diuretics, particularly colchicum ;  and the
evacuations from the intestines by cathartics, but choose
those of a warming character.  For this purpose, the  use
of the herb-wine is  very  serviceable, continued for several
weeks in the spring and  autumn (infus. vinos, guaiaci, rad.
helenii,gentiane, jalape, fol.senne,rad. scille,cort. aurant,
cardamomi, cinnamomi).  Sulphur and  guaiac  combined
(No.  230), administered to a person predisposed  to  gout
every month for four or six days, in such doses as will cause
two or three stools a day, fulfil  this end  most  efficiently
and specifically, and are the best preservatives against arth-
ritic  attacks.   Warm sulphur or  thermal  batlfs, used for
four weeks during  the  summer  season ; in  lymphatic,
plethoric individuals, an  artificial secretion  by means of
fontanels, are likewise of great benefit.
                   VENEREAL DISEASE.

                     Syphilis,  Lues.

  Diagnosis.   It presents itself in two  forms, as syphilis
localis s. primaria, and  syphilis universalis s. secundaria ;
which latter again divided, appears as syphilis manifesto or
occulta s. larvata.

              Syphilis  Localis s.  Primaria.

  The diagnostic signs are :  local irritation and inflamma-
tion in the part affected, passing into increased and altered
secretion of mucus (blennorrhea), when the muco-secretive
organs are affected, or  into ulcers, or into both.
  1. Blennorrhea syphilitica.   It is either gonorrhea (ure-
thritis exsudatoria) or fluor albus.   It always runs through
two stages ; the inflammatory (when  in a high degree it is
attended with consensual  irritations, phimosis, paraphimo-
sis, buboes, tumor testiculi) ; and the abating or critical,
which is  frequently  succeeded by a  third stage, the sec-
ondary or gonorrhea chronica, fluor albus chronicus.  The
duration of the first stage is indefinite, varying from  three
to  six weeks; the last to  years.   Generally the infection
continues local, and when ulcers are not associated, it does
not become universal  through the system (constitutional).
There are, however, exceptions to this statement.
  2.  Ulcus syphiliticum (chancre).   It is discerned by a 
VENEREAL  DISEASE.
463
specky  surface and  prominent edges, and little  pain.  It
likewise excites, when the irritation is great, sympathetic
irritative occurrences, buboes and the like.   The purulent
infection may remain also  local, and die away  with the
local infection ;  but the danger of general infection is  by
far greater.  It may  last  three  weeks, but also  as many
months.
   The most important diagnostic sign is the  circumstance
that the local affection has followed  a suspected coitus, or
a  vulnerated part denuded of epidermis having touched
another suspicious object.  Therefore, every local pheno-
menon that follows such  contact, must be considered im-
portant, although it have  not  the  characteristic  marks.
The infection through lesions always produces  the  most
dangerous accidents.

            Syphilis  Universalis s. Secundaria.

   General infection follows the local affection in very inde-
finite spaces of time, sometimes within a few weeks, some-
t mes  after months.   It is readily communicated  through
wounds and chancres.  The difference  between blennor-
rheal and  ulcerous infections deserves to  be adverted to ;
the former is always more chronic and mild, the latter more
acute and  destructive.
   The  signs of  universal infection are all  those  syphilitic
 symptoms, which appear elsewhere  than in the place of in-
 fection. The principal ones are : condylomata, little ulcers
 on the palate and uvula, ophthalmia, eruptions of herpetic
 form, in the shape of small spots similar to essera, on which
 the epidermis scales off, especially on the  forehead ;  bu-
 boes and swellings of the testicles after the  local infective
 symptoms  have disappeared, swelling of the glands, and
 lymphatic tumors.
   The signs of a more severe and deeper seated infection
 are diseases  of  the  bones,  nodi, tophi, especially  on  the
 tibia,  caries,  particularly of the nasal and  frontal bones,
 pains  of the bones  during night,  scirrhous  indurations,
 spongy, fleshy excrescences, polypus.

   Syphilis Occulta et Larvata s. Degenerata s. Modificata.

    Syphilis may make pauses in its action for a while, that
 is to say, it lies dormant, exhibiting no sign of its exist-
. ence ; but reappears after a while with increased virulence ;
 or it may manifest itself under  entirely different and unu- 
464                VENEREAL DISEASE.
sual forms (larved).   There is no chronic disease whose
form syphilis cannot assume.  In either case the diagnosis
is difficult. There are only two means : a.  To trace the
evil to its often very  remote origin ; in the prosecution of
which task we  will ascertain that the patient has been ve-
nereally infected for  ten,  fifteen, and more years ago, and
has had  since that time a series of alternating diversified
complaints, frequently intermixed with pauses of apparent
health, until the accession of the present malady,  b. By
trying the  use of mercury, which will give a prompt ame-
lioration, if the disease is syphilitic, the surest confirmation
of the diagnosis.
   This  malady combines all that can render human suffer-
ing tedious, tormenting, and distressing in body as well as
in mind.  It is a most disgusting disease ;  and it is no less
remarkable that nature has  connected  it with a singular
degeneration of the human features, imparting its stamp to
the most noble prerogative of man, by a deformation of the
nose, the ornament of the face, and to the voice, the high-
est expression of human mental dignity.
   It is a protracted disease, difficult of cure, productive of
the most hideous disorganizations  and  painful sufferings
(especially  those of the bones, which torture the patient
nightly  often for years), tedious and dangerous not only to
the  affected, but also to  others,  frequently tormenting
through  life, even to  advanced age; yea,  a demon which
accompanies man through life, if not really, at least in im-
agination ; it may become even fatal by emaciation, colli-
quation,  and, dropsy.  It  owns farther  two properties,
which increase exceedingly its danger and obstinacy.  The
first is this, that at its commencement it appears light and
greatly insignificant, hence it is often not  at all or insuffi-
ciently attended to, creeps imperceptibly deeper and deep-
er, and poisons the whole system ; the second is: that the
virus, probably  in consequence  of  its human descent, is
possessed of a particular affinity and homogeneousness to
the human  organism, uniting with it more intimately than
any other infection, even becomes one and the same with
it, so that no power in the world can separate it from the
animal economy.
  Finally, it is  one of the unfortunate properties of this
disease,  that there exists  no certain sign, by which we
may judge  that the system has been entirely freed  from
it.
  Pathogenesis.   The  remote cause is the contagium syph-
iliticum  ; the proximate cause is the infection created by 
VENEREAL  DISEASE.
465
the communication and reception of this contagion in the
animal economy.
  The syphilitic contagion is of modern origin, at least in
Europe, and known only since the year 1493. It is perma-
nent (propagated from the first generation, and constantly
reproduced), and fixed (not soluble in the air).
  Infection, therefore, can happen only  by immediate con-
tact with the virus itself in an infected  person, or with an
infected object ; and can only take place through parts not
covered with epidermis, as the genitals, anus, lips, fauces,
nipples, eyes, nasal cavity, or where the epidermis is abra-
ded.  But even then there must exist a susceptibility, and
when this is wanting, no infection takes place.   The defi-
ciency of receptibility may depend on the whole system or
the location where the virus has been applied.  Thus infec-
tion is more difficult through mucous surfaces, but readily
and quickly effected through a wound or a surface denuded
of its epidermis.
  The interval between the application of the virus and the
eruption of the disease is variable ; being only a few days
when received  through wounds  and ulcers, but otherwise
an interval of fourteen days may occur.
  The affection thereby created is  always double: irrita-
tion and  reproduction of the virus.  But it is  variously
modified by the variety of the degree of infection, of local-
ity, and primary or secondary infection.  We distinguish
the local (primary), and the constitutional  (secondary) in-
fection.
  In respect to the primary infection there  are  evidently
different degrees of intensity and perfection.
  The most important to be mentioned here  is the distinc-
tion between blennorrheal and ulcerative infection (termed
by some writers clap and chancre, essentially distinguished
as such ; but they are evidently products of the same syph-
ilitic contagion, only  variously modified).
   1. Blennorrheal infection, the milder degree. The virus
is enveloped in mucus, mitigated, fixed.   It receives a mu-
cous character, creates but little local irritation and inflam-
matory reaction (clap, fluor albus), is only slightly repro-
ductive, and is therefore  less infective to the patient him-
self and to others, and may remain  local for a long time,
even  while it lasts.
  2. Ulcerous infection (chancre). This virus immediately
produces a topical destruction and erosion of the surface,
an ulcer.  The matter thereby becomes much more caus- 
466
VENEREAL  DISEASE.
tic, poisonous,  corrosive, infectious to the individual  as
well as to others.
  The length of time which the primary affection will take
to pass into the secondary (local into constitutional syphi-
lis), cannot be laid down.   In some cases it happens after
a few days, in others not before the expiration of weeks
and months.  The disease may remain local, especially in
females,  and in organs which secrete mucus for years,
without the infection spreading-™ the individual, though
she may  infect others.
  The transition depends :  a, on the liability of the indi-
vidual ; b, on the location and quality of the primary infec-
tion (most readily and rapidly when the infection is a puru-
lent one, and such as proceeds from a wound); c, on the
treatment (suppression of the topical affection, of gonor-
rhea, of chancre, may occasion the  virus to be translated
into the  constitution).
  The way by which the virus is conveyed into the organ-
ism, and  the  original and peculiar seat of the syphilitic in-
fection or  venereal disease, is  the lymphatic and gland-
ular system.  It creates through inflammation of the lym-
phatic vessels, swellings of the glands (buboes), first in the
adjacent, next in the remote parts.  Besides, the virus has
a particular affinity for the mucous membrane of the pal-
ate, the nose, the eyes, where  it produces inflammations
and ulcerations ; and to the external skin, where it engen-
ders  peculiar cutaneous  eruptions and chancres ;   and
finally, when it  penetrates  deeper, it affects the bones,
even at last internal noble organs.
  Of the essential nature of the venereal poison we know
as little as of any other contagion.  We know only that it
belongs to the  fixed (not soluble in the air) and chronic
(not febrile, but exciting  chronic  reaction) ones, that  it
loves most the  lymphatic and glandular system, the  mu-
cous membranes and bones, that it imparts to the organism
a particular disposition to abnormal productivity, to cari-
ous  and  osseous excrescences  and hyper-vegetation, and
finally penetrates the whole animal economy, most inti-
mately unites with it,  so that  it is  difficult to separate
them.  The essence of the disease must therefore be re-
garded not only as a dynamic, but as a  chemico-organic
poisoning process.
  Now in case of long duration, the virus may, as it were
assimilate with the human system, and assume  a milder
character, that of a lurking poison ;  yet may even rest for a 
VENEREAL DISEASE.
467
while, and make pauses in its operation (latent  syphilis).
The poisonous seed is dormant, but the germ has not died;
but may be revived by exciting reaction and re-exhibit the
disease.  The causes of such pauses are chiefly an imper-
fect mercurial treatment,  which has only  suppressed the
distemper, suspended the  operation  of the virus, but not
extinguished it (the germ of the virus is not killed).
  In the same manner, and by the same causes, the disease
may also assume another form, affect other organs, as the
nervous system, the lungs, the abdominal viscera, and cre-
ate unusual  occurrences, the phenomena of quite a differ-
ent disease (larved syphilis).
  Therapeutics.  The treatment has two indications: the
destruction of the poison and the cure of its effects.
  1. The cure of the venereal infection (the specific anti-
syphilitic treatment) comprises always two things : a. The
communicated or internally created poison is to be annihi-
lated,  b. Its regeneration is  to  be  prevented by annihi-
lating the capability  of reproducing the virus or the gener-
ation  of the virus in the system  itself.  Both must be
united to effect  a perfect cure.   The actual virus can be
destroyed and the present symptoms removed; but  if
the power of the organism to engender the virus anew  is
not annihilated at the same time, the virus will be regener-
ated within a longer or shorter time, and the disease will
reappear in the former or in a different shape.  This con-
stitutes the  difference between a symptomatic and a radi-
cal cure.   The  symptomatic cure may delude for a very
long time, for the venereal infection  and the specific  capa-
bility of its reproduction may remain inactive and dormant
in the  body for a long time.
  The only means for attaining both ends is mercury  ; and
the art of  curing  syphilis consists  in •administering this
remedy in such a manner that this double end be attained.
It must never be used to a greater extent than is necessary
for that purpose, paying  constant regard  to avoid those
detriments  which this metal itself may inflict on the animal
economy, and never forget that mercury is a poison, and
that a thorough mercurial treatment  is  an artificial mercu-
rial poisoning.
  Mercury  is capable of  curing a  venereal  infection  in
whatever form and way it  may be administered, provided
that two essential conditions are complied with, the first of
which is—that it penetrate into the  substance of the sys-
tem ; and secondly, that it excite such a degree of reaction
as is requisite for subduing the virus.  The proximate and 
468
VENEREAL  DISEASE.
 original  effect  of  mercury  is  on  the  lymphatic  and
 glandular system, and this very system is the primary and
 principal seat of  syphilitic infection.   It is in this that the
 process of taking away the poison must  next and princi-
 pally succeed.  As  for  this process, the best  idea, and
 which may safest guide in practice  is this :  as  syphilitic
 poisoning  is a specific  chemico-animal  abnormality and
 corruption of organic matter, so is the effect of mercury an
 opposite specific chemico-animal  alteration, by which the
 former is annihilated and  neutralized.  It is therefore ne-
 cessary that the  mercurial treatment be carried  to satura-
 tion. The signs of it, showing that mercury has sufficiently
 penetrated  the lymphatic  system, are  the forerunners of
 salvation.   *
   2. The cure of the effects and symptoms of the infection
 is only calculated to subdue the reaction  which the infec
 tion has aroused  in the animal economy.  This reaction is
 double: primary and secondary.  The primary is  inflam-
 mation or a nervous affection.  Either of them may, indeed
 must be attended to, and if possible removed ; we may
 thereby even succeed to apparently cure the symptoms;
 but let us be careful not to indulge in the belief that the
 infection  also  is removed.  The secondary effects and
 symptoms are:  various  disorganizations, indurations, tu-
 mors, exanthemata, ulcers or dynamic anomalies, secretory
 and nervous diseases.  They are attended with a continu-
 ance of the infection, or with diseases  that persist subse-
 quently and without the  infection.  In  both cases  they
 require particular attention as regards the treatment ; in
 the first case as an accessory and  assisting indication ;  in
 the latter, as the  principal  indication.
   But never forget that this treatment is only palliative, if
 the infection is not  overcome ; and  look  not upon disap-
 pearance of the symptoms  as a  cure of the disease.
   The special treatment is divided into the  treatment of
 primary and secondary infection.

             /. Primary or Local Infection.

  The first infection is always local,  and  may remain so
for a long time,  especially when  it  is  blennorrheal, and
may be removed and  annihilated by the healing power of
nature, and  disappear as a  merely  local evil.   Many have
left their case entirely  to  nature, and  have  been  cured
without any further bad consequences.  In modern times,
even art holds to  the maxim of leaving the primary infec- 
VENEREAL DISEASE.
469
tion  to nature, treating it only by antiphlogistics and a
scanty diet.  Experience has also shown that the affection
may  be entirely removed in many instances without subse-
quent  constitutional  infection.  But  experience teaches
likewise, that in some the symptoms do not disappear with-
out the use of mercury, and that in others, it is true, the pri-
mary local symptoms have disappeared under such treat-
ment, and the patients believed themselves cured,but sooner
or later the same symptoms have reappeared (proving that
the infection had  not been fully destroyed), or  syphilitic
symptoms appeared on other  parts (by which it is evident
that  the  virus had penetrated deeper and produced  a uni-
versal infection).
  As it cannot be known and determined on beforehand
that  the patient is one of the happy ones, in which  nature
alone or  the general treatment can and will effect the cure
and annihilate the infection, it must remain a rule to every
conscientious and true  physician to consider every local
infection as a source of poison, whence the virus sooner or
later  may pass into the organism and produce constitu-
tional infection; and to  do all that lies in his power to im-
mediately annihilate the virus, and thus  prevent it from
passing into  and affecting the whole system ;  which must
always be considered one of the greatest misfortunes that
can  happen to a man, since it is known how difficult the
extinction of the virus is, when it has once passed into the
animal economy.
  This can be effected by an early administration  of the
only  specific antidote,  mercury,  and thence results the
rule, to use mercury in  every local syphilitic infection that
does not heal by itself,  partly in order to  immediately de-
stroy the communicated virus, partly to excite by the spe-
cific operation of the  mercury  a specific antisyphilitic
reaction  in the  organism, by which  it is prevented from
being received, spread and reproduced.  For the possibility
of thiscannot only be demonstrated theoretically, but is also
sufficiently confirmed by a number of instances of experi-
ence, to which I can add my testimony. In the commence-
ment it requires a very  moderate and  minute use of mer-
cury ; on the contrary, when some time has already elapsed,
a tenfold larger quantity is perhaps wanted ; and which the
patient will therefore be spared, with all the certain and of-
ten horrible subsequent phenomena of mercurial poisoning.
I refer for illustration, how by the timely use of mercury a
contagion may be prevented  from passing into the  organ-
ism,  to hydrophobia, in which it is confirmed by a number
                          40 
470
VENEREAL DISEASE.
of experiments, that a vigorous use of mercury resorted to
immediately after the  infection of the  hydrophobic virus
has taken place, may prevent  constitutional infection, and
thus rabies itself.
   The primary infection is either a blennorrhea or an  ul-
cer.   This makes a material  difference in  the treatment.
I repeat here what I have previously said, of the dangers to
which mere topical and antiphlogistic and dietetic treat-
ment exposes.   We have seen instances when the  patient
felt perfectly well for months  ; and then, after good health
of several, even  ten months, the most formidable constitu-
tional  lues, even  enlargement of the  bones,  all at once
manifested  itself; an occurrence which the patient might
have escaped by a timely use  of twenty or thirty grains of
some light  mercurial.   What is the  detriment of  such a
trifling mercurial treatment, compared  with the danger of
a horrible constitutional malady!
   1. Blennorrhea (gonorrhaa,  clap ; fluor albus in  the
female sex).
  Yellow-greenish mucus at the commencement, whitish
pus subsequently escaping from the urethra.  The  inflam-
matory stage is attended in the beginning with pain at the
time of making water, and when the inflammation runs
high, with dysury, ischury, priapism, chordee, also sympa-
thetic swellings of the testicles and inguinal glands.  It sets
in after sexual intercourse.   This latter  circumstance is
the most essential for  diagnosis;  a gonorrhea  may arise
also  from other causes,  as the arthritic, scrofulous meta-
stases, hemorrhoidal anomalies (vide gonorrhaa), and then
calls for quite a different treatment.   Even that one which
manifests itself  after coition  may be non-syphilitic, and
generated by other topical diseases of the uterus ;  in  this
case it will nevertheless  be the best  plan to regard it as
syphilitic, and to treat  it as such.
  The treatment has two stages.   During the first,  the in-
flammatory one, it must be antiphlogistic, negative.  Com-
plete rest, avoiding every thing heating, and animal  food ;
drinking  frequently of mucilaginous  beverages, linseed,
hemp-emulsion with small doses of nitre, extract of hyos-
cyamus, cleanliness, frequent  ablution  with tepid  water,
wearing a suspensorium, and in violent  pains the applica-
tion  of leeches,  are the  principal means, and  often fully
sufficient to remove these evils without  any  bad  conse-
quences.   Injections are not necessary, they do more  in-
jury than good.   They are apt  to leave strictures  and
callosities in the urethra, the present frequent  occurrence 
VENEREAL DISEASE.                471
of which must be attributed to the abuse of  injections.  If
painful erections, priapism, increased to chordee associate
with blennorrhea, the first thing to be done is to abstract
blood (in plethoric  persons venesection), and  then  opium,
used  internally  and  externally,  is best given.   In phi-
mosis (contraction and swelling of the prepuce  before
the glands), the  inflammatory state is first to be  removed
by abstractions of blood, and then opium must be applied
internally and externally, connected with emollient  fomen-
tations of lead water and  decoction of hyoscyamus, and
injections between the prepuce  and  the glans, and local
baths, in order to  wash out the matter which may have
gathered there.   The greatest attention is needed, since
suppuration, gangrene,  and  loss  of the glans is  very  apt
to follow.   Chancres are usually present at  the same time,
and the simultaneous use of mercury is required.   Para-
phimosis (the retraction, constriction, and swelling of the
prepuce behind the glans), is treated  in a similar manner.
  When gonorrhea is not  removed by the foregoing anti-
phlogistic treatment, and the pains  do not abate  after a
fortnight, then it is always  advisable to make a moderate
internal use of mercury (in the same way as will be direct-
ed hereafter under  the  head of chancre), a  remedy which
we do not hesitate to resort to in every other kind  of ob-
stinate inflammation of the mucous membrane, as in moist
ophthalmia, and which  is here at the same time efficient,
and indicated as the antiphlogistic specific  for extirpating
infection.
  But should the  blennorrhea pass into   the secondary
stage  (gleet, discharge  of mucus without pain), balsamica
are proper,  of which  two rank highest: balsamum copaive
(twenty-five to thirty drops three times  a day, taken best
on sugar or in  pills),  and turpentine;  also  cubebe and
root of juniper (one ounce a day) are serviceable.  I have
found also one drachm of baryte  murias or chloride of lime
mixed in  an ounce and a  half of aqua laurocerasi, thirty
drops taken every day, very useful.   When  the disorder
is  obstinate, and there  is suspicion of a syphilitic charac-
ter, pulvis antidyscrasicus is most serviceable.   If these  in-
ternal remedies do not suffice, injections are  to be resorted
to, first of lime  water,  or aqua laurocerasi  mixed with  it;
then  a weak solution  of corrosive sublimate (one grain to
two or one ounce of water), vitriol, zinc, copper ; still more
vigorous is argentum  nitratum.  Finally, astringents, alum,
decoction of cortex  salicis with  aqua laurocerasi, myrrh
with sugar of lead, cold topical baths may be applied. But 
472                VENEREAL DISEASE.
if the gleet continue, we must pay attention to complica-
tions,  which may perhaps  exist, and  are  often  the only
cause of the persistence of the mucous flux.
   2. The ulcerous infection (primary  chancre, venereal
ulcer).
   Besides  originating after sexual connexion, it is suffi.
ciently marked by its specky surface, the elevated  edges,
and  the  trifling sensation  of pain ; it may be combined
with gonorrhea or not, hence examination is necessary in
every blennorrhea.
   Every chancre must be  regarded as  the beginning of
constitutional infection, and calls for the  internal use of
mercury, in order to remove it in  its onset and  to  check
its progress.  Therefore  instantly (it is understood after
abstractions of  blood have previously been  made  in in-
flammatory cases), the well prepared  velvet-black mercu-
rius  solubilis  Hahnemanni, which  approaches the  metal
most of  all mercurial preparations, consequently contains
more of the specific antisyphilitic nature, and is at the
same time  mild  and affects the organism less injuriously
than any other, is to be administered.  Give two grains of
it a  day, and increase the  dose one grain  daily, until the
specific manifests itself in the smell of the breath, pains in
the gums, light swelling of the cervical glands, precursors
and  commencement of salivation.  In such a  course the
chancre  usually heals on the seventh  or eighth day with-
out  any  external means.  Then continue the  remedy for
the same length of  time, but only one grain  a day.   It is
very momentous to observe the patient in this,  as in  every
mercurial treatment, for some time, in order to  discover
whether  any new syphilitic phenomena appear ; if so, the
course must be continued.
   External remedies are generally not at all needed.  Fre-
quent cleansing and washing with lime-water, and covering
the part  with a little digestive salve, is all that is requisite.
By such  treatment  we may be sure that the cure is pro-
gressing  from  within outwardly, by extinction of the  virus.
The  mere local treatment by water of corrosive sublimate,
red precipitate, zinc, sulphate of copper, alum, even lapis
infernalis, which is,  alas! too much in vogue, has  only the
effect of  a local suppression, and very often after the  chan-
cre has been cured, an ulcer in the  throat, or another ve-
nereal  disorder  presents itself, as  an evidence  that  the
cause of  the disease has not been eradicated, but only its
organ removed.
   Not  unfrequently  swellings  of the inguinal glands (bu- 
VENEREAL  DISEASE.                473
bones), and of the testicles (hernia humoralis, orchitis) accom-
pany gonorrhea and chancre.   They are generally nothing
but symptoms sympathetic of the  inflammatory irritation,
and disappear after the inflammation is gone ;  nor do they
require  any other  treatment  than the  antiphlogistic, and
externally fomentations of tepid lead-water.   They, how-
ever, may also be the symptoms of a deep spread infection,
which is recognized by their continuance after the inflam-
mation  has been removed.  In such a case,  the internal
use. of mercury must be  resorted to, conforming with the
directions I have already given. Buboes are also met with
as a symptom of primary infection, without clap or chan-
cre; an occurrence which calls for the  immediate internal
use of mercury, taken  as mentioned before.
   What here has been said of gonorrhea and  chancre, ap-
plies to that fluor albus which replaces gonorrhea in the
female.
   Condylomata require the general mercurial treatment,
which most commonly cures them simultaneously with the
ulcers.  If they persist for a long  time, the external appli-
cation of sabina and of  kreosote are the best means ; ex-
cision and cauterization may likewise be resorted to.
   I must add a word in  regard to  the suppression of  gon-
orrhea.  It takes  place  after the use of a too irritative  or
astringent  injection, or  after taking  cold,  and may leave
very  bad consequences ; as a violent increase of the local
and sympathetic inflammation, or  a  remote nervous affec-
tion ; even  trismus and tetanus have been observed to arise
from it.  The  treatment must be, first to  assuage the  in-
flammatory irritation (even venesection in plethoric  indi-
viduals), and the internal and external use  of  opium, emol-
lient  injections and warm  narcotic cataplasms.

II. Secondary,  Universal (Constitutional) Infection.  Syph-
                  ilis, Lues  Universalis.

   Eradicative  treatment of the venereal disease.—In the
first  degrees and signs of the  malady, which manifest
themselves by pains in  the  throat, chronic inflammation,
and ulcers in the  fauces ;  or  by ophthalmia, or cutaneous
eruptions,  especially in the forehead,  the use of  a  mild
mercurial oxyd, as mercurius cinereus, or  solubilis or cal-
omelas, is sufficient for a cure, and affects least theanimal
economy.  The most recommendable preparation is mercur.
solubilis Hahnemanni, taken in the same doses and in the
 same manner as in primary chancre, in doses,  however,
                          40* 
474               VENEREAL DISEASE.

to be augmented by less quantities (only for half a grain a
day).  I must here make a general remark, that it is possi-
ble for the symptoms  to disappear quicker  by very large
doses of mercury, but there is  never a certainty that the
remedy has properly penetrated  into the organism and fully
extinguished the  internal  infection.—Order at the  same
time ptisans of spec;es purificantes (No. 202), to be taken
as a  beverage,  since  the drinking of much watery fluid
greatly promotes the cure and the effect of mercury ; and
command the patient to stay in  his room during the treat-
ment, i. e. to  the  termination of the precursors of saliva-
tion and  disappearance of  the  symptoms.  At the same
time a scanty vegetable diet, avoiding acids, salted, acrid,
spiced nutriments, must be adhered to.
   If the disease has penetrated  deeply into the system, is
of an old date, or  has been treated unsuccessfully and im-
perfectly  by  other remedies, corrosive sublimate is the
best and  most penetrating  remedy,  and has at the same
time the advantage of not beinor  so  apt to create salivation.
This  is particularly  important  in  such  persons as  have
taken much mercury, and are so easily affected that a few
grains of simple oxide of mercury  will bring on salivation
and compel a  discontinuance of its use.   Corrosive subli-
mate may be used  without detriment and for a  long time,
by observing the  following rules :  let it be given in pills,
in order that  it may  dissolve slowly ; in  a  mucilaginous
vehicle, in order  to obtund its  caustic  operation  on the
membranes of the stomach and  intestines, and to  prevent
nausea, colic, and diarrhea.  Hence  results the  formule
No. 231,  which I consider  the   most appropriate for the
cure of syphilis, and  which I have always used, often for
months.   Prescribe half a grain, to be taken  every day ; if
the disorder is obstinate, increase  the dose to three quar-
ters of a grain daily.  It is understood that  a warm regi-
men and good diet be observed.   Also copious drinking of
ptisans of sarsaparilla  and the like  ; warm  baths assist the
cure.   It  is proper to  remark, that corrosive sublimate is
apt to  affect  the lungs ; therefore another preparation, as
the following,  must be  resorted to in persons of a phthisi-
cal disposition,.or when pain in the chest sets in  during
its use.  The use of a strong decoction of sarsaparilla (two
ounces in  two pounds of water reduced by boiling  to one
pound of fluid, taken every day), is often  alone sufficient
to perform a cure.
  Next to corrosive sublimate, red precipitate is the most
efficient mercurial  preparation to subdue syphilis, it even 
VENEREAL  DISEASE.
475
surpasses it sometimes, and cures when the former proved
abortive.  Give a dose of one eighth to one sixth of a grain
twice a day, in  the same way as corrosive sublimate, in
the form of pills (No. 232).
  It is worthy of notice, that the change of form is  also
promotive of a good effect.   If one  preparation does not
prove efficient, choose another, and the cure will immedi-
ately make better  progress. It has been also observed that
some mercurial preparations  are particularly appropriate
to, and efficient in certain  forms of syphilis, as calomel, or
soluble mercury in inflammatory affection, corrosive  sub-
limate  and  the  red  precipitate of mercury in cutaneous
affections and ulcers in the throat.
  Pauses and omission of the  use of mercury are also very
useful.
  It has frequently been proposed to cure syphilis without
mercury, and it cannot be  denied, that this may'be attained
in hot climates by sarsaparilla, guaiac, and  similar general
antidyscrasic  remedies ; but these same  are not sufficient
to eradicate the evil in  our climate. On the other hand, it
is certain, that when mercury has been sufficiently used
and the evil will not entirely  yield, the  best  treatment is
to discontinue mercury, and  to  administer strong decoc-
tions of guaiac or sarsaparilla for some time.*  In weakly
persons the use of roborants may exceedingly promote the
cure and  remove the remainders of the disorder.
  In speaking of venereal disease  in general,  it is greatly
to be regretted that  there is  no certain sign by which we
may know whether the disease  is perfectly and radically
cured ;  that is to say, whether the infection as well as the
capability of reproducing the  virus is entirely annihilated ;
for the disappearance of the  symptoms is  not sufficiently
satisfactory ; it may be demonstrative of the former, but not
of the latter condition.  There remains no other expedient
but to continue the use of  mercury in small doses for some
time after the symptoms have disappeared.  This must be
done longer, the  longer the use of mercury was required
for removing the symptoms  ; and shorter, when  this re-
quired  less time  to accomplish.   The  patient  must be
carefully  observed when he uses the above  mentioned (not
mercurial) antidyscrasic remedies, to discover whether any
new syphilitic phenomena appear.

  * An instance of it is the celebrated Hutten, who, after having used
mercury for a long  time, even undergone  inunction and salivating
treatment witliout success, was perfectly cured by decoction of guaiac
alone. 
476
VENEREAL  DISEASE.
   By the uncertainty of the diagnosis, and by neglect of
the above rules, now-a-days imperfect mercurial cures be-
come, alas! very frequent.   The patient  uses  mercury for
some time, until the  symptoms disappear, exposes himself
perhaps to taking cold and to dietetic faults, and considers
himself restored to full health, but he is  not so, and is at-
tacked again with the original distemper after a longer or
shorter interval.
   A second matter of much regret is, that the use of mer-
cury itself, when  long  continued, may  excite  affections
very similar to the  syphilitic, as  glandular swellings, ul-
cers, may partly affect the economy in its innermost  re-
cesses, and create  a dissolution, a scorbutic  diathesis, in
short, what we call  mercurial  disease (poisoning by mer-
cury)..

     III. Inveterate  Syphilis (Lues  Venerea Inveterata).

   When the disease is of old date and  is assimilated  to
the  vital  principle,  when it has  affected and disorgan-
ized the deeper seated organization, as the bones; when
the usual mercurial treatment has been undergone without
success, or imperfectly ; or when, what is of most frequent
occurrence, the disease has been suppressed for some time,
but has reappeared in an altered form : then a more effi-
cient treatment is required.
   The first means is the application of mercury to the skin,
the direct absorption of it into the lymphatic system. It is
undeniable, that mercury used in this way, operates more
vigorously and rudely to destroy the disease ;  and this fact
may be easily understood, by reflecting that  it thus ope-
rates in its primary strength, without having been submit-
ted  to the unavoidable  alterations which the digestive
powers of the stomach will exercise on  it.
   The first application of this kind are  baths<mf corrosive
sublimate.  One half or  one  ounce of corrosive sublimate
of mercury is  dissolved in the bathing water.   Such baths
are of excellent efficiency, and may be used without detri-
ment or exciting salivation.
  The second  is inunction.   Its effect is  double ; by sali-
vation or not.  The latter end is attained by frictions made
with Cirillo's ointment (No. 254, one drachm daily applied
to the soles of the feet), and it is preferable, and to be used
first, in order to save the patient  from  salivation, which
must always be considered a great evil.
  Inunction with salivation.  One or two drachms of the. 
VENEREAL DISEASE.
477
unguent, mercuriale cinereum alternately rubbed everyday
in various parts of the surface, and continued along with
tepid baths,  strict diet or even fasting, until salivation  en-
sues, generally announced by febrile irritation, after which
it must be moderately used for a  longer  or shorter time,
according to the intensity of the malady.   This method is
undoubtedly the most powerful, but also the most rigorous
kind of treatment for syphilis.
  It is a real  crisis, attended with good as well  as bad
qualities. It is remarkable for this : the mercury is imme-
diately introduced into the general system in its metallic
state, and in this way it has without doubt a more  power-
ful  action over the virus ;  and, therefore, it is more capa-
ble than any other method to combat the inveterate venereal
disease ; for the same reason it exercises on the organism a
more destructive effect, even may remain in it in the metal-
lic  form  : in the second place, for the loss of humors ;  and
that of one, the saliva, which is so indispensable to diges-
tion and nutrition, and may be followed by great debility,
emaciation, exhaustion, even hectic and tabes, when saliva-
tion is carried too far on in a predisposed individual.  It is,
therefore, to be resorted  to only in  extreme cases,  and
even  then with caution and moderation ;  and must be en-
tirely omitted in aged and very  debilitated persons.
   The fasting method of treatment by itself, or combined
with  small  doses of corrosive sublimate, is also very potent
 in  curing inveterate syphilis. Be careful however that ex-
 ternal appearances do not  deceive.  For abstinence from
 food has often no other effect than to  suspend for a while
 the power of the organism to react on the virus, but which
 it resumes when the patient returns to  a good diet, and with
 it has a return of the symptoms.
   The contrary may also take place  and assist the cure.
 By a long  duration of the  disease, and  by a debilitating
 treatmenr,  the system is brought into so great a degree of
 weakness and torpor,  that thouah the specific character of
 the disease has been annihilated,  it may continue as a sim-
 ple dyscrasy; this explains the use of roborants, as arnica,
 cinchona, iron, which is the best for removing these rel-

   This  is the very case in  which a decoction of sarsaparilla
 or guaiacum (in whose stead carex arenaria maybe substi-
 tuted), with an addition of senna leaves, or Pollmi s potion,
 (No  203)  removes the remnants of  the disease.   In the
 excruciating nightly pains  of the bones, mezereum  used
 internally  (cortex mezerei  two drachms daily, made to a 
478                VENEREAL  DISEASE.
decoction), but better if combined with sarsaparilla, proves
a true specific.
  Zittmann's decoction is of great service in obstinate ve-
nereal  disorders; such as have  been unsuccessfully corn-
batted  by other methods.  It  has frequently effected  a
perfect cure, as I can assure from my own experience.
  Aurum  muriaticum, in small  doses, rubbed  under the
tongue, has  been applied with benefit.
  Iodine has proved exceedingly efficacious for the final
extirpation of inveterate venereal disorders ; especially the
alkaline solution of it (No. 233).
  It may happen, after the specific character has been ex-
tinguished, that the  local disorders, especially the corrupt
secretions, eruptions and ulcers, which  were the conse-
quence  of a former syphilitic  disturbance, now continue
merely as the effects of a general dyscrasy. In such cases
mercury is no longer of any use ; but the general antidys-
crasic remedies must be resorted to.  Here mineral acids
are of excellent service, especially nitric acid, one to two
drachms daily, diluted in two pounds of mucilaginous water.
  It is not uncommon for a particular morbid state to set
in towards the end, which deserves the greatest attention,
and may seriously embarrass both patient and physician.
It is a mercurial disease, or a peculiar dyscrasy, created by
the non-expelled mercury and an imperfectly extinguished
syphilitic  matter (dyscrasia mixta).  It is  the consequence
of an immoderate or disorderly use  of mercury without
proper care, and a disregard of taking cold.  The distinc-
tive sign is, that the symptoms,  which  are often nothing
but mercurial symptoms, effects  of the mercurial poison-
ing, do not yield to the continued use of mercury, but be-
come aggravated.   For such a case, the principal remedy
is sulphur in its most volatile form, the artificial or natural
sulphur water, taken  internally, but especially  in  baths
(Neundorf, Weilbach) ; the most efficacious are the ther-
mal baths of Warmbrunn, Landeck, the  strongest of all
those, Aachen (Aix la Chapelle).

            IV.   Larved or Latent  Syphilis.

  The diagnosis is most difficult. The most dissimilar and
opposite cnronic diseases may be nothing  else than the ef-
fects and forms of a  lurking syphilis.  Paralysis, spasms,
hypochondriasis,  profluvia and  obstructions,  hectic and
dropsy, may be of a syphilitic nature and not curable but
by mercury.  We canuot be too much on our guard against 
VENEREAL DISEASE.                479
latent syphilis,  especially in certain ranks of society, and
in large cities, where syphilis  has become very prevalent.
This often throws light on obstinate chronic diseases.  On
inquiry whether  the  patient has  ever been infected,  we
shall  often find that to have been the case,  and  from that
period up to the time of inquiry there has existed a conti-
nuous chain  of phenomena, hitherto unsuspected of a vene-
real origin.  Now try mercury, and the promptly beneficial
result will surprise and immediately convince us of the true
syphilitic nature of the evil; and then  the antisyphilitic
treatment is regularly to be pursued.
  (Even lately I have  again had such a case.   A modest
woman, already advanced in age, labored for a year under
an extremely troublesome feeling of crawling and painful
borinar near the anus; without the slightest discoverable
trace  of swelling or altered color. She had  used many re-
medies without relief.   It was most natural to consider it
a hemorrhoidal anomaly ; but neither  leeches  nor other
antihemorrhoidal remedies had the least  beneficial effect.
Finally, on  accurate inquiry, it was ascertained, that  the
woman had  had a venereal infection 12 years before, and
as usual had been  treated in a very superficial manner.
Since that time she had been subject to various complaints
of one kind  or another, with occasional intervals of entire
freedom from the complaint.   I  first made  trial of an ex-
ternal  application of corrosive sublimate in water to  the
part, and I was astonished at the rapid amelioration, which
no other external means, either opium or other  narcotics,
had been able to effect.  I then prescribed pills  of submu-
riate  of  mercury in doses increasing up to f of a grain a
day, which perfectly cured her.   But some time after  she
had eruptions,  and once even glandular  tumors formed;
which were  likewise cured by corrosive  sublimate  or  the
red precipitate of mercury; but more than a year elapsed,
before the struggle  with the inveterate enemy was entirely
terminated and the patient  perfectly cured.)
  Finally,  one word may be said in regard to prophylaxis.
Various embrocations and lotions have been recommended
and applied previous to and after coition ; but none of them
has hitherto stood the  ordeal; and the old adage, Unicum
prophylacticum Mali venerei est abstinentia a Bono  venereo,
is still true. 
480
POLYSARCA.
                      POLYSARCA.

                       Adiposis.

  Diagnosis.  Excessive accumulation of fat either in the
 whole system  or in single parts; forming externally  adi-
 pose tumors (steatoma);  internally, accumulating  around
 the heart, in the omentum, and about the kidneys.—Its ef-
fects are: to  impede the  functions of the part concerned;
and when it is universal, to embarrass motion, to overload
the individual, to molest the whole economy, to oppress
the circulation, to obstruct secretion and excretion ; to dis-
pose to external erysipelatous inflammations and abscesses;
finally, transition into cachexy and  dropsy.
  Pathogenesis.  Immoderate  use of nutritive, especially
animal food, while exercise and elimination is wanting; a
phlegmatic temperament,  lax  fibre  and  constitution, ces-
sation  of habitual hemorrhages,  therefore occurring in
women  after the cessation of the  menses.  In general a
congenital disposition  has a great  influence ; hence some
men continue lean  though supplied with the richest food,
and others grow fat though subject  to restriction.
  Therapeutics.  The leading  idea  of cure  is  to diminish
the accession, and to increase  the elimination of the ali-
ments.  The principal remedies are, consequently,  scanty,
unnutritive,  vegetable, watery food ; strong corporeal ex-
ercise ;  little  sleep,  excitement of  mental affections, pro-
motion of all the secretions, especially that of perspiration
and the  discharge  from  the  bowels;  fasting, mercurial
treatment, in extreme cases iodine. 
disorganizations, etc.              481
            THIRTEENTH  CLASS.


DISORGANIZATIONS.   PSEUDO-ORGANIZATIONS.
                    PARASITES.

  We comprise under these terms all deviations from the
normal state of structure and internal organization of an
organ.  In external disorders of this kind  the  diagnosis
is easy, and falls more within the department of surgery.
Those disorders of the internal viscera which come under
this head more particularly concern the physician.  They
are, in regard to diagnosis as well as to treatment, the most
difficult tasks in practice.
  They were formerly comprised under the general name of
obstructions viscerum, or when in a higher degree, of excre-
scences, indurations, etc.  Modern, pathological anatomy
has distinguished them with more accuracy and care, and
has enriched nosology with a multitude of such abnormali-
ties and  metamorphoses.  But they  are  of value only as
regards the natural history  of the human body, nosology
and surgery, and much less  as regards internal treatment.
For, in the first place,  the diagnosis is deficient, it is im-
possible to recognise and accurately distinguish the various
species of disorganization in the internal viscera; in the
second place, special therapeutics are  also deficient, and, in
general,  we must be satisfied with  general principles of
treatment, which are most likely to effect a cure.
  Therefore, for practical purposes, it will be sufficient to
classify them according to the various cavities of the body
in which  they  are found, and to describe the symptoms
which authorize us to suppose, that organic disorders are
located in them.
  In the abdomen: Examine  the abdomen by feeling, whe-
ther in one  or several parts  a distention, tumor, hardness,
with or without pain is discoverable by pressure.  This ex- .
amination is best performed on  the  patient in a fasting
state, lying in bed, standing, bent forwards, and towards
the sides, since the deep seated and  smaller nodes appear
only in different positions.  Ascertain farther, whether the
                           41 
482               disorganizations, etc.
  patient finds trouble or impossibility to lie on either side or
  on the back ;  if so, the seat of the evil may  always be pre-
  sumed to be on that side,-on  which he  can  lie  best, with
  the exception of painful disorders.  Observe also the con-
  tinued disturbance or stoppage of the functions of that or-
  gan, in which the evil is situated ; likewise the faulty con-
  dition of its secretions, hemorrhoidal complaints. Finally,
  a peculiar cachectic complexion, pale, light-yellow ; in dis-
  orders of the liver, yellow, particularly in the eyes, deserves
  attention.
    In the pectoral cavity : Difficulty of respiration, inability
  to lie on either side, or on the back, disordered motion of
  the heart and the pulse (vide  asthma, phthisis), come here
  into consideration.
    In  the cephalic cavity: Constant, irremovable pains in
  one part of the head, most felt in certain positions,  dizzi-
  ness, stunning, disturbance or obtusion of mental action or
  of single senses; spasms and paralysis  are here observed.
    The proximate cause of all malformations, as well as of the
  parasitic products, is a faulty  plastic process.
    This can be caused in a quadruple manner.  By immode-
  rately increased plasticity,  as inflammation, congestion, in-
  fantile age, excess of nutrition ;  by diminished, obstructed
  plasticity (likewise as the monstrosities  of the first forma-
  tion),  as  old age,  debilitation; by qualitative  change of
  plasticity, as dyscrasy,  metastasis;  by mechanical pressure
  and chemical operation.
    The exciting causes may be the  following : inflammation,
  acute as well as chronic ; and  congestion.  Inflammation is
  the most frequent cause, but not the  constant one.   It par-
  ticularly engenders hypertrophy, physconies, thickenings,
  indurations, adhesions, pseudo-organizations ;—mechanical
  pressure obstructing the  afflux  and  reflux of humors, and
  the normal action of the  vessels,  as by  lacing,  ligatures,
  permanent  silting, contraction of the  abdomen;—nervous
  affections, the disturbed or faulty influence of the nerves of a
  part is capable of producing a disturbance and degeneration
  of its normal reproductive action; such  as the frequently
  observed influence of fright, grief, sorrow, tending to create
  such products,  especially in the glandular system (which
  is evidently proved in  the milk tumors  that  form in the
. breast of nursing  women immediately  after fright); meta-
  stases, when the normal nutrition is  deranged by the deposi-
  tion of a morbid matter, as after suddenly suppressed in-
  termittent fevers,  cutaneous eruptions, syphilis, scrofula
  arthritic matters (such organic disorders a*e nothing but 
disorganizations,  etc.              483
symptoms of these diseases) ;—finally, a  vitiated condition
of the humors ; thus  it is certain, that a too thick, viscid,
atrabilious blood  may contribute  a great deal to  produce
obstructions in the abdominal viscera ;  a too viscid bile to
obstructions  in the  liver and  the  formation of gall-con-
cretions.
  Of great  importance for  the  practice  is  the  circum-
stance,  that an organic disorder may become a depository
or derivative organ for other maladies and morbid matters.
This is especially true of internal congestive diseases and
dyscrasies ; even nervous and mental diseases arise from
that cause.   As soon as an  external  pseudo-organization
forms, these general or internal evils abate, they become,
so to say, concentrated in one  point, corporified and deri-
vated.
  In regard to their different nature we distinguish for prac-
tical use:
  1. Obstruction,  the  slighter degree.  Accumulation, stag-
nation,  thickening of the humors contained in the vessels
(particularly the  venous), thereby stoppage,  impermeabi-
lity, distention (hypertrophy, physcony, infarcts), disturb-
ed function  of a  viscus, most  frequently  in the abdomen
and in the plurality of cases occurring in the liver.
  2. The higher degree, real  disorganization.  Here scir-
rhus, tubercles, polypus, fungi,  tumors, steatomata and
osteosteatomata,  mollifications and ossifications, genera-
tion of calculus are to be classed.
  3. Parasits, newly  generated animated organisms,  ento-
zoa; to  which not only worms,  but  also several organic
diseases, as  hydatides, encysted tumors, even scirrhus and
cancer  are to be counted, inasmuch as they possess a pe-
culiar life and vegetation.
  Therapeutics.  Above all,  two rules must be adverted to
and  strictly  complied with.   In  the first place,  avoid as
long as possible to presume that an organic disorder is the
cause of disease;  for to do so, usually precludes all  kinds
of treatment, and discourages us  from searching for other,
curable causes, that perhaps  exist, and  seeking for new
ways and methods of cure.  In the second place, though
organic disorders  decidedly exist, they must not be judged
of precipitately, and  pronounced  to be incurable; but all
possible eurative means must be tried, since experience has
taught,  that  even in such cases complete cures have  unex-
pectedly been effected, or at least that the  evil may be ar-
rested and life preserved.
  The external (surgical) part  of the healing art has in this 
484
disorganizations, etc.
regard the advantage over the internal; for the surgeon
may easily recognise and discriminate the various species
of degeneration, but it is  not so with  internal  diseases,
which fall to the lot of the  physician.  In general, he only
perceives a  derangement in the functions  of  an internal
part, but is rarely capable of discerning of what special kind
it is.   He is, therefore, guided in his treatment by general
principles. These are: to  promote the internal, especially
the venous action of the organ by discutients (motion and
friction) ; to promote its absorbent action by absorbents
(among which mercury and soda rank first) ; to excite the
nervous  action  of the part by remedies  which have a spe-
cific influence ;  to derivate the nutrition of the part by di-
minishing or withholding the nutritive matter; to remove
the inflammatory state, if such a one exist; to dissolve and
discuss the  stagnant matter by  chemically decomposing
means (of which water,  soda, and iodine are the principal
ones) ; and  finally  to respect the specific character of the
obstruction  or degeneration, as the syphilitic, when re-
course is to be had to the specific antidote,  mercury.
  It is also useful to establish an artificial ulcer near the
disorganization,  in  order to derivate and to withhold its
support; which, if used at an early stage of the disorder,
will do away with it entirely, if at an advanced stage, will
stop and prevent it from increasing.
  The seat of the disorder makes a difference, and requires
a modification in the treatment.   We distinguish:
  1. Obstructions and  disorganizations  in  the  abdomen,
which are the most frequent.  They are most commonly
seated in the liver, the spleen, the pancreas, the mesentery,
and in the female, in the ovaries.  For the diagnosis  see
above.  The treatment consists in the employment of dis-
solvent vegetables, especially of dandelion,  solvent salts,
the gums of ferulaceous plants, soda, similar mineral wa-
ters, antimonials and mercurials,  clysters, baths; in obsti-
nate cases, great insensibility and atony,  aloes, scammony,
and similar  drastics (see visceral treatment of hypochon-
driasis).  When the liver is  obstructed, mercury, internally
as well as by inunction, is  chiefly to be relied upon.  But
in general, we cannot too strongly recommend in abdomi-
nal  obstructions, soda,  especially Carlsbad  spring;  when
that  cannot  be procured, it may be replaced by the arti-
ficial water.   I have seen cases of the worst kind, in which
the  whole abdomen  was greatly distended, perfectly  re-
lieved by this agent, after the most vigorous dissolvents,
even mercury, had proved abortive.—Iodine is also one of 
disorganizations, etc.
485
the most  efficient dissolvents;  but it is always an unsafe
remedy, apt  to operate destructively on the whole animal
economy and to leave bad consequences ; therefore it ought
to be used only  in  extreme cases and with caution, cor-
rected by alkalines  (vide No. 233).  If pains are present,
do not omit to apply leeches from time to time.
  Also external  embrocations of dissolvent ointments and
cataplasms, for  which all kinds of dissolvent herbs, parti-
cularly cicuta, may be used, are of great service.  Even
gentle rubbing, repeated several times a day, continued for
a length of time, is beneficial.   Of unguents the following
have proved  most efficacious : ammoniac, mercurial, digi-
talis, and  iodine ointments; I can particularly recommend
a mixture of castor oil and tincture of colocynth (vide No.
255), which is also very serviceable in external indurations.
—A  resolvent soap plaster, worn  constantly on the part,
has also a very good effect.
  2.  When such disorders are  located in  the chest,  and
especially in  the  lungs, great caution must  be observed in
the use of dissolvents, lest  they create too much irritation,
hemoptysis,  inflammation, increase of tubercles or suppu-
ration, terminating  in phthisis  (vide  phthisis tuberculosa.
As resards the treatment of organic disorders of the heart,
see asthma syncopticum).
   3.  Organic disorders  in  the  head can rarely be distin-
guished  with such  certainty as will justify a direct  spe-
cial treatment.   We must therefore be guided by the ge-
neral rules just stated ; treat the  dyscrasies which may ex-
ist,  and promote absorption.  The principal remedies for
these are derivatives, especially  by the intestinal canal and
the  skin; issues on the neck and arms are  to be kept open
for a long time, and abstractions of blood repeatedly made.
   In treating these  external disorders, we  must never for-
get  that they may be the depositories or secretory organs,
as it were the vicars or substitutes of internal diseases, and
that their retrocession, like the suppression of a cutaneous
eruption, create  an internal disease.  Derivatives therefore
are  to be resorted to only after the internal cause, the dys-
crasy, has been removed.   In general, we  ought carefully
to weigh  the difference between enduring the external dis-
order, ^and  the  danger of giving  rise to  a worse internal
one.—This precept is particularly to be observed  by the
surgeon before extirpating such evils.
   Finally, cases may occur, in  which a cure can be effect-
ed only by destroying the parasitic being, the pathological
 animal, as the scirrhus or cancer, by arsenic.
                            41* 
486                     worms.
  Two  diseases of this  class merit our  particular atten
tion, and must be  here specially treated  of, lithiasis an(
helminthiasis.
                        WORMS.

                     Helminthiasis.

  There is no  part  in the human  body, in which worms
or other imperfectly organized beings cannot be developed
or received.
  They are most frequently  found in  the intestinal canal,
but also in all the other viscera, in the liver, lungs, kidneys,
bladder, uterus, ovaries, even in the brain and eyes, espe-
cially the encysted tapeworms, tania hydatigena (viscerales),
or in the external parts and cavities (externi, superficiales).


        1.  Intestinal Worms, Vermes  Intestinales.

   The most common are mawworms (ascarides lumbricoi-
des);  the small white worm  (ascarides vermiculares); the
tapeworm,  of which  there are two species, the broad one
(tania lata), and the  catenated, or the pumpkin-seed-like
solitary worm  (tania solium); the hairworm  (trichuris,
trichocephalus).
   Besides, larva;  of various  insects  are frequently met
with.
   Diagnosis. General signs are : pale and changeable com-
plexion with livid circles around the eyes ; saliva accumu-
lates  in the  mouth  in the morning and in a fasting state ;
nausea, fetid breath,  irregular appetite, great hunger, fre-
quent itching in and on the dorsum of  the nose,  sneezing,
distended,  but not hard  abdomen, pain in the umbilical re-
gion, dilated pupils,  bleeding at the nose, frequent starts
and fright during sleep, grinding of the teeth, lying on the
belly,  somnambulism, unusual emaciation,  disposition to
spasms ; but the most important and only sure sign is the
discharge of worms or parts of worms.
   Special  signs of ascarides: troublesome itching in the
anus, particularly in the evening, dysury, strangury, tenes-
mus, apparent hemorrhoidal complaints, discharge of mu-
cus from the rectum, bladder, vagina, extraordinary dispo-
sition of the mind and periodical sadness.
   Of the mawworm: besides  the  general  signs, frequent 
WORMS.
487
bellyache,  and a vermicular sensation in the umbilical
region.
  Of the tapeworm : a sensation, as of something suddenly
rising from the left side into  the throat and falling back,
a feeling of a lump in one or the other side making an un-
dulatory motion, feeling of sugillation in the abdomen,
dizziness, creeping, surdity, numbness of the  fingers  and
toes,  sudden cessation of the  abdominal troubles suddenly
after a swallow of brandy or of essence of absinth.
  Effects:  The  worms may, by the irritation  they cause,
and the influence they exercise on digestion and assimila-
tion, have a very important influence on the human econo-
my, and on  all  the vital functions, even on the psychical;
hence they may produce great disturbances  and  conse-
quently manifold and dangerous maladies, especially most
strange nervous  diseases  (see pathogeny) ; therefrom re-
sults a momentous rule, to suppose the  presence of worms,
and to act accordingly in  all such diseases, especially at
the infantile age, where no other sure cause can be ascer-
tained ; for experience has shown that an anthelminthic
treatment has procured complete relief in very  serious dis-
eases, after all other methods had proved abortive.   This
applies  not only to cases, in which signs of worms are pre-
sent,  but also when there are none ; for worms may exist
without^any symptoms of them being perceptible.
  Pathogenesis.  We must view two things: the origin and
formation of worms, and that of verminous diseases.
  The generation of intestinal worms occurs in two ways.
Some are evidently brought in from without, as the larve
of insects and other imperfectly organized animals (snails),
which can live for some time in the intestinal canal. Others,
on  the contrary, are evidently products of the  human eco-
nomy itself.
  The  causes, which  favor  this creation (causa remota),
are : particularly the age of infancy on account  of the gene-
ral  predominance of nutrition (whence the intestinal canal,
being the receptacle  of nutriment, is  most disposed this
way), laxity and weakness of the intestines,  accumulation
of  mucus,  animal and farinaceous food, moist habitation
and a like epidemial constitution of the atmosphere, hence
verminous  maladies may become endemial and epidemical.
  Origin of verminous maladies, or of worms as cause of
disease. These  parasites  do not always cause  disease,
when they are not too numerous and remain in repose, but
they  must  always be considered  as  something  hetero-
geneous, as a morbid disposition; they may even become 
488
WORMS.
causes of the most dangerous maladies, or at least impart
the most dangerous complication to all diseases which af-
flict the patient.
  The manner and way,  in which worms create diseases
is :  they withhold the nutritive substance of the food (they
are co-eaters, parasites ; hence, where they exist in great
number, emaciation, and  finally fatal atrophy  ensue); they
create putrid and mucous impurities in the  intestinal ca-
nal, by their excrements and dead bodies; hence  gastric
putrescency in verminous fevers, and acrimony even in the
humors ; they excite  irritation, when  they are hungry or
stirred up by other causes, or gather on a  particularly sen-
sible part of the intestinal canal, or when the  sensibility of
the intestinal canal becomes  suddenly increased, as by
fever.  The irritation is partly local, partly consensual.  It
produces, locally:  pains, spasms, increased secretion, and
action of the intestinal canal, diarrhea, dysentery, spasmo-
dic incarceration,  ileus,  abscesses, through which  worms
are discharged. It affects the nerves by sympathy, causing
convulsions,  all kinds of spasms, particularly chorea,  epi-
lepsy,  somnambulism,  periodical paralysis, insanity, fury;
and operates on the vascular system, giving rise to  vermi-
nous fevers, sanguineous congestions, hemorrhages, blen-
norrheas, exanthemata.
  The effects of verminous irritation are not  always appa-
rent :  individuals may have worms and nevertheless feel
very well for a long time ; but suddenly verminous  attacks
may set in.  This happens by accessory causes, which ex-
cite them, as by ingesta disagreeable to them, by hunger,
by accumulation and sucking from a sensitive part of the
intestinal  canal, or by increased  sensibility of this gut,
which is the  case  in  every  fever;  hence every fever is
likely to give trouble to the worms.
  The treatment is double : palliative, soothing the worms;
and radical, annihilating the verminous disease  itself.
  Palliative treatment,
  Is of great importance, partly to remove the frequently
violent and dangerous symptoms of worms ; partly in fevers
associated  with verminous attacks, producing local pains
in the  abdomen, which may even cause inflammation, ab-  ^
scess  and perforation ; partly in  the treatment for worms,
when  they  become too much agitated.
  The indication is double : to appease the worms and to
soothe the spasm created by them.   The principal remedy
answering both ends, is milk, in all forms used,  as beverage,
injection, fomentation  on the belly.  Next  to it is oil, oily 
worms.                    489
emulsions (oil  at  once weakens,  kills  and prevents the
worms from  sucking), flores  zinci,  extract of  hyoscya-
mus,  mercurial  water (vide No. 234)  as a drink  and in
clysters; in obstinate cases, emetics, asa fetida, valerian.
In violent attacks of tenia, a tablespoonful of the tincture
of absinth is the best suppressive remedy.
  The radical treatment must tend to dislodge the existing
worms, and to prevent their reproduction.

               The Expulsion of  Worms,

  Can be effected in three ways ; by remedies which annoy
the worms, drive them downwards, debilitate and kill them
(anthelminthics, of which semen Santonici or  cine is the
most  common,  efficacious, and appropriate to all sorts of
worms),  followed  by  cathartics to purge out the  dead
worms;  or  the simultaneous  use  of anthelminthics  and
purgatives; or by strong drastics, which forcibly expel the
worms living or dead, by increasing the peristaltic  motion
of the intestines.—In all attempts to cure worms it  will be
well to take advantage of the declining of the moon  ; for at
that time the worms are weaker and less capable  of sucking ;
and it will also be  proper  to combine the anthelminthics
with such remedies, as dissolve mucus (neutral salts,  oxy-
mel scilliticum, and the like), since mucous accumulation is
always present, forms the lurking place  for the  worms, and
blunts the power of the anthelminthics.  Finally, I must ob-
serve,  that a patient may be  perfectly cured of worms,
though none may have appeared to be discharged; for when
killed by the anthelminthics, like all dead matter they may
be digested and evacuated as excrements.
  Every species of worms has its peculiar vermifuges.

                      Ascarides,

  Are efficiently destroyed by injections of a decoction of
tobacco,  oil, culinary salt, mercurial water, or  water with
a small admixture  of a weak  solution of corrosive subli-
mate, pills of extract of quassia and tansy (vide No.  235)
continued for several months.

                      Lumbrici.

  The most efficacious remedy is semen Santonici (vide
No. 237), which we may administer in the form of  elec-
tuary (vide No. 236),  or in substance with honey to  chil- 
490                     WORMS.
dren who dislike medicine. Let a teaspoonful be taken for
a fortnight every morning fasting during the decline of the
moon, and  be followed by a purgative of jalap and calomel.
The following remedies may also be used : tanacetum, ab-
sinth., rad. spigel.  anthelminth.  (vide  No.  239),  extract.
nucis juglandum, all  mercurial  and ferruginous prepara-
tions (vide No. 240),  aloes, fucus  helmintochortos (vide
No. 238), valerian root, pulp of carrots mixed with sugar,
taken fasting; also mechanical stimuli, as iron filings, doli-
chos pruriens.  One ought to be acquainted with several
kinds of anthelminthics, for that which is efficacious in one
case is not so in another.  External means also aid in dis-
lodging worms; as embrocations of oil of tansy, or petro-
leum on  the abdomen, cataplasms of tansy and absinth.
  At the same time a proper diet  must be enjoined.  Fari-
naceous  and glutinous food, as well as warm drinks must
be avoided ; a little culinary salt, occasionally a little wine
and much exercise are to be taken.

                       Tapeworm.

  There  are two methods of dislodging the tapeworm. One
is to weaken it gradually, to destroy it,  and remove it gra-
dually without any violent commotion ;  the other, to expel
it at once,  as if it were by storm.
  The first, gentle method,  is the safest, and ought to be
tried  before the other.  It is the only one,  applicable to
delicate  and sensitive patients.   It  consists in the perse-
vering use of such remedies as are troublesome, debilitating
and fatal to the worm.  Of this number are : Glauber's salt
and  Sedlitz salt taken  every morning; and several times
during the day elixir acid. Halleri, or pewter filings, 3 or 4
drachms a  day, mixed in conserves of roses; garlic stewed
in milk,  taken every  morning fasting ; also  the  bark of
pomegranate root (vide No. 241)  has proved very efficient
in my experience.   I  have succeeded without any  trouble
to expel  the tenia in a nervous woman  within eight days,
by the following combination : Tinct. absinth, asa fetid.
aa M. S.  60 drops 3 times a day.   Limatur. stanni 1 ounce,
pulv. rad. filicis maris  2 drachms,  conserv.  rosar., as much
as will make an electuary, 1 teaspoonful 3 times a day and
a tablespoonful of castor oil after every dose; meagre food
and more salted than usual.
  The second, the forcible  method, is of course more
prompt and efficacious, but also more dangerous ; is  capable
of producing all the consequences  of poisoning, and may 
WORMS.                    491
impair the digestive organs to such a degree, that the pa-
tient  for ever after feels its effects, suffering more from
the consequence of the treatment than he did by the tape-
worm ; it is, therefore, not applicable in feeble individuals.
When, however,  the  worm produces very  obstinate and
malignant disorders, as epilepsy, and the gentle method is
unavailing, no other expedient is left.
  The principles of  this method, which may be styled a
kind  of military  expedition  against the enemy,  are:  to
commence by weakening the foe, in order to deprive it of
the power of assugilating and creating spasms ; this is at-
tained by cold, oil, hunger ; to drive it down to the lower
part of the intestinal  canal, by  remedies offensive to  the
animal (of which the root of the genuine  malefern  is the
most efficacious of all) ; to prevent spasms during the ope-
ration, by  which the discharge might be stopped  and bad
symptoms  excited (which  is accomplished  by asa fetida,
hyoscyamus); and finally to enforce its discharge by dras-
tic  purgatives.  In obstinate  cases  the powdered seed of
Indian caustic barley is a very efficient  remedy;  from  10
grains to one scruple may be taken every morning mixed
in honey.
  The most efficient method, according to my experience,
is: in order  to ascertain the existence of the tapeworm,
when it is not positively known, is to give a  few days pre-
vious to the above course, resina guaiaci with bitter almond
water daily,  when pieces of the worm will  be discharged
by  stool.
  After this  the  patient is to live  for a few days on her-
rings, sardines,  and  similar aliments, and for supper only
panado, and before retiring, according to his capacity 1 or
2 drachms of malefern root in powder, or 30 drops of the
very efficacious ethereal oil of the same in pills.  On the
following morning he is to commence by taking a glass of
cold water, then  a powder of 6 grains gamboge, 1 grain of
calomel, 10 grains of magnesia, 1 grain of extract  of hyos-
cyamus; half an  hour  afterwards he  must swallow £ ounce
of castor oil and receive an injection of  milk,  and  the ab-
domen may be embrocated with petroleum.  If the worm
is not discharged, the same remedies are to be repeated
two hours afterwards, and if they again fail, the  purging
not being too strong, let them be  repeated once  more.
When the  worm is not completely discharged, but hangs
out of the rectum, caution must be used not to break it,
but wind it around a little piece of wood, to prevent it from
returning; the patient must sit in a vessel filled with warm 
492
LITHIASIS.
 milk, and the worm is to be gradually extracted by wind-
 ing it up.   It is  only when the pointed end or head has
 been evacuated, that we  are sure the whole is really ex-
 pelled.

          To Prevent the  Formation of Worms,

  Requires  fortification of  the intestinal canal by a nou-
rishing diet, more animal than vegetable ; a moderate use
of wine, much and vigorous exercise of the body, ferrugi-
nous remedies, as a small quantity of Pyrmont water, taken
every morning for a length  of time, or ferrum alcoholisa-
tum.  In children it is very salutary to give-every month,
at the decline of the moon, wormseed (semen Santon.) and
a dose of jalap after it.
                2.   Vermes Superficiales.

  Mercury,  and particularly the red precipitate ointment,
is the most sure remedy against  body and head lice and
other insects burrowed into the skin.  In phthiriasis, baths
of corrosive sublimate, and in an  extreme case a solution
of arsenic may be used against this formidable evil. When
worms are engendered in ulcers, the application of tar is
the surest remedy.
                       LITHIASIS.

  The formation of stone, under which head ossification is
also to be  classed, can take place in any part of the eco-
nomy;  they occur most frequently in the urinary passages
and gall ducts; they are also found in the intestinal canal,
lungs, brain,  salivary glands, blood vessels, especially in
the heart and the large  vessels.   Their formation is either
due to a tendency to  decomposition of the substance in
which they are found (as urine, bile,  saliva) ; or to a vitiat-
ed secretion  and  reproduction.   In  the latter respect old
age always favors ossification, by a defect in nutrition and
a prevalence of the earthy matter.—" Pulvis es, et in pulve-
 nm reverteris" 
URINARY CALCULUS.               493
                   URINARY/ CALCULUS.

                  Calculus Urinarius.

       Stone in the Bladder, Stone in the Kidneys.

  Diagnosis.  Stone in the bladder.  Constant urgency to urin-
ate, accompanied by the most violent pains, especially in the
glans ; sudden stoppage of the stream (all these accidents
are less  in the  recumbent than in the standing position);
strangury, dysury,  a  constant troublesome  itching and
tickling in the orifice of the urethra; slimy sediment in the
urine, frequently mixed with gravel or little stones,  some-
times with blood, especially after rough  exercise ;  sensa-
tion of pressure  and heaviness deep in the pelvis, alleviated
by lying down, aggravated by standing ; exploration, either
by the finger in the rectum and  vagina, or by a catheter.
The detection is often  very difficult, even by the catheter,
when the stones are encysted,—calculi cystici.  The dis-
ease is apt to be  confounded with vesical gout and vesical
hemorrhoids.
  Course.  Frequently returning spasms and inflammatory
attacks in the bladder, which terminate in disorganizations,
thickening and callosity,  spongy excrescences and suppu-
ration of the bladder, lingering fever, phthisis vesicalis,
and death by  emaciation.
  Nephritic Stone  is recognized by the permanent or pe-
riodically returning pains, or a sensation of heaviness and
pressure in the  region of the kidneys;  by colic occurring
from  time to time (colica nephritica), which is generally
followed by a discharge of gravel, by the red color of the
discharged gravel, a dull pressure felt in the leg of the side
affected, even weakness and lameness of it.  It is frequently
attended with nausea and vomiting in a fasting state, even
with vertigo.
  The calculary paroxysms or calculary colics  are vio-
lent, sudden, acute, extremely painful attacks, particularly
in nephritic calculus.   They are distinguished by the vio-
lence and the sudden occurrence of the pains in the region
of the kidneys or bladder, spreading  over the whole abdo-
men ;  by  the  vomiting and crying, which is always con-
nected with it, by spasmodic sympathetic sensations in the
cremaster, testicle, leg of  the same side, in the urethra ;
and especially  by a  previously existing lithiasis  being
known and  by  the exciting  causes.   These causes are: 
494                URINARY CALCULUS.
either increased irritation of the calculus (when it tends to
a new position,  or to pass through  the ureter  into  the
bladder), or increased irritability of the kidneys.  The first
may  be brought  on by rude motions,  as riding; the latter
by excessive use  of ardent  or diuretic beverages, violent
passions,  overheating of the body and  taking cold, me-
tastases.
  The effects of a nephritic stone, when it remains in  the
kidney, are: besides the pains it creates, disturbances of
urinary secretion, nephritic colics, inflammations, disorga-
nizations, induration, suppuration of the kidneys; and when
it is dislodged, passing through the ureter, pains, spasms,
inflammation,  colic,  frequently  also incarceration and
stoppage  in the  ureter, followed by adhesion.  It can  be-
come fatal by inflammation  and suppuration.
  Pathogenesis.  The formation of stone is a chemical pro-
cess,  which can  form under favoring circumstances in all
parts  of the body (even in the brain),  and from all the  hu-
mors  (even from saliva). The favoring circumstances are :
stagnation,  disorders of nutrition, and a condition  of  the
humor chemically inclined to concretion.
  In  the urinary ducts  this process is very apt to take'
place, for this fluid, by its very nature, contains more che-
mical affinities and materials for calculary formations, as is
seen in every  urinal.
 " The remote causes are :   either chemical  (lithiasis acci-
dentalis),  stoppage of the urine (in cavities, diverticles of
the bladder, chronic pressure on  the kidneys, etc.),  by
which decomposition of the urine is made  possible, the pre-
sence of a foreign body, which serves as centre of aggre-
gation (shot, ears of wheat, coagulated blood and  mucus);
certain kinds  of food, which particularly  favor the genera-
tion of calculus, especially  the use  of sour, acerb wines.
Beer  drinkers  are  less subject to  stone; it  is also evi-
dently more rare  since the introduction of tea, coffee, and
diuretic drinks, and  it  is  more  seldom met with in beer
than  in  wine-drinking  countries.—f)r organic  (lithiasis
constitutional's), a disorder of the secretion of the  kidneys,
which yields this  product.  It is either  congenital (lithiasis
congenita,  hereditaria), or acquired, in which case a  meta-
schematismus of other diseases, especially of gout, may  be
the cause (being very similar in both, stone in the kidneys,
in arthritis, concretion in the joints). Hence, both ahernate,
and gravel is often nothing but a metastasis arthritica ad
relnes.  Calculus and  diabetes have also some analogy:  in
the first, stone; in the latter, saccharine  matter  is  gene- 
URINARY CALCULUS.
495
rated ;  in  both a predominance of acidity is the base, en-
gendered  perhaps by the  same  process  differently  mo-
dified.
  The  chemical ingredients of urinary calculus are : phos-
phoric  acid, benzoid, oxalic acid, calcareous earth, mucus,
but varying in proportion ; sometimes ammoniacal calcu-
lary ingredients, but in by far the greater number of cases
acidity predominates.
   Therapeutics.  The treatment is palliative or radical.
   The palliative treatment has for  its end to soothe the ne-
phritic attacks  and  complaints, the cure  of the nephritic
colic-                      , ,   .  /,
   Inquire whether the attack be inflammatory or spasmo-
dic.  The first is recognized by its violence, pain, and du-
ration  (inflammation may associate as an accessory to the
spasmodic) ; by pain on pressure over the vesical region,
by a febrile pulse, and heat in passing urine.—Such a case
requires  the treatment  for cystitis: a venesection is to be
made immediately, leeches,  cataplasms of linseed and hy-
oscyamus are to be applied ;  and oily emulsions containing
extract of hyoscyamus, cooling purgatives must be admi-
nistered internally.
   The spasmodic state is recognized by the absence of in-
flammatory, and presence of the spasmodic symptoms-
Such  a  case calls for  the  most vigorous anodynes, oily
emulsions with opium, decoction of linseed  as beverage,
 also clubmoss seed made into an emulsion, embrocations
 of volatile liniment, of camphor with laudanum, oily injec-
 tions  of i of drachm of hyoscyamus herb or opium, narco-
 tic cataplasms, tepid hip-baths. It frequently  happens that
 the pains are so constant,  as to require the daily recourse
 to the use of opium.
    The radical  treatment has two indications :  to annihilate
 the formation of stone, and to dissolve the existing one.
    The first intention is to  bring the secretion of the kid-
 neys to its normal condition, and to take away the disposi-
 tion  to  that specific decomposition and combination  of
 those materials which originate stone.  In this respect the
 cure  is  very  similar  to that of diabetes mellitus.  That
 which produces a saccharine state of the urine in diabetes,
 in the latter produces stone.
    A  remedy, answering  both indications, and  which is
 therefore rightly styled  the principal  lithotripticum, is
 soda or alkali in general; and among all preparations known
 to me,  Carlsbad is the best; when the natural cannot  be
 procured, the artificial must be used.  In lack of this, soda 
496                   gall-stone.
dissolved in  carbonic  acid  water (the  soda water of the
English).  Next to it is  the kali causticum vel purum (10
drops twice a day in broth) ; soap, or limewater, taken by
the pint daily ; Harlem oil, and Loof's remedy. It is proved
by experience,  that  stone may be dissolved by these alka-
lies, and may be prevented from forming. It is a fact, that
alkali passes really  into the blood and  urine, and  may be
there made to effervesce by acids; the  urine thus is made
to receive a chemical  dissolving property, as alkaline wa-
ter possesses out  of the body.  I have seen myself stone
transformed into gravel,  which alone is a great advantage.
Carbonate  of magnesia,  £ drachm three times a day, the
pulvis aerophorus  natronatus (vide No. 243), 20 to  30
grains three  times a  day, the  carbonic acid soda water
(which  may  be easily made by dissolving  £ drachm  of
Si-carbonate  of soda, in a bottle of Selters' water),  the Fa-
chingen, Geilnau, and Wildungen  water, are all useful.
  Some  vegetables  also have  proved serviceable, as ra-
dishes, strawberries, red bilberries (vaccinium vitis idea),
honey, a powder composed of quince-seed, acin. cynosbat.,
juniper-berries, a teaspoonful three times a day ; especially
bear-berry leaves,  which possess also the advantage of al-
laying pain, £ drachm  3 or 4 times a day.
  A chemical examination of the  discharged  calculi  may
be profited of, in order to distinguish whether the stones
have more of an acid or alkaline base, and to determine on
the remedies accordingly.
  If all prove abortive, nothing  is left for the relief of the
poor sufferer, but the  operation of lithotrity, or of cutting
out the  stone.  The first may always be performed, but
the latter requires great precaution, and must never  be per-
mitted, when suppuration in the bladder or kidneys is ma-
nifest ; nor when gravel is simultaneously present.
                      gall-stone.

              Calculus Biliarius s. Felleus.

  Diagnosis.   Frequent pressure and complaints in the he-
patic and epigastric region,  especially spasms  of the sto-
mach with vomiting.  The principal signs are :  colics, re-
markable for this, that the patient is fr*om time  to time af-
fected with  most violent pains in the hepatic and epigas-
tric region,  accompanied with  violent vomiturition and
vomiting,  followed  by a yellow  color  of the skin, lasting 
gall-stone.
497
for a few days ; after which gall-stones are found discharg-
ed in the stool.
  Pathogenesis.  Gall-stone is not stone, but  a resinous-
earthy combustible mass, a concretion of bile. The exciting
causes are such as have a tendency to create a profuse and
viscid secretion of bile and  stagnations in the  liver,  as  a
choleric temperament, much heavy, fat, animal  food, omit-
ting fluids, sedentary life, lacing of the abdomen, long con-
tinued grief and sorrow,  especially suppressed  anger dur-
ing eating (therefore of frequent occurrence  in unhappy
marriages).
   Therapeutics.  The cure consists in that of the colic  of
biliary calculus.  It  is the same as that of nephritic colic.
Oleosa, narcotica, clysmata, semicupia,  and where there is
an inflammatory disposition, venesection, are chiefly to be
relied upon.
  The radical treatment  tends to dissolve and remove the
calculus and to prevent its regeneration.  For this alkalies
are also the principal remedy, especially soda, the Carlsbad
well, and when the natural cannot be  had the artificial one,
or other preparations of soda, also soap pills with bitter
extracts (vide No. 242),  continued for a long time, and
purgatives  given intermediately.  In great inclination to
vomit  I have  found the  combination of soda with pulvis
aerophorus  (vide No. 243) excellent.  Of a similar effect
is bi-carbonate of soda,  1 drachm dissolved in a bottle  of
Selters water drank  daily,  or the English soda water. The
turpentine in Durand's remedy  (vide No. 244), vegetable
diet, much drinking, exercise, in general the whole treat-
ment of visceral abdominal obstruction.
42* 
498
diseases of females.
DISEASES OF  FEMALES.
         SEXUAL DISEASES OF FEMALES,

  Do not comprise the general maladies to which a female
may be liable, but such as are  peculiar to the female sex,
or what is the same, diseases of the sexual system, of the
conceptive and productive functions.   It cannot, however,
be denied that this destination of the female imparts a par-
ticular character to the whole economy, and modifies all
her diseases, giving them, as well as the treatment, a fe-
male character.


         Physical Characteristics of the Female.

  To give birth to children is the destination of the female ;
therefore pregnancy, parturition, and nursing is her natural
state ;  while menstruation is a vicarious or surrogate con-
dition—a malady.
  The whole economy of the female is arranged and cal-
culated for reproduction and a double life. The sexual  func-
tion is in her a prevailing tendency, in man it is subordinate.
(This is made evident even by the  position of the genital
organs ;  in  the former they are placed internally, and are
intimately interwoven with the organism ; in the latter they
are external, and  as it were, only an addition.)  The  char-
acter of the  female sex is to receive, that of the male is to
give ; hence in  the former, passive life, susceptibility, flex-
ibility predominate ; in the latter, activity.
  The essential differences are  as follows :
  1. Greater laxity of the  fibre—hence a disposition more
to diseases of atony and relaxation.
  2. Greater irritability and sensibility of the nervous sys-
tem ; hence  sensibility is  very apt to  become  morbidly
increased; disposition to nervous diseases ;  little irritation
produces intense reaction, unusual sympathies. 
MENSTRUATION.
499
  3. Quicker and richer chylification and  sanguification ;
sanguification calculated to the nutrition of a second being,
hence a plethoric state, a disposition to congestions, hem-
orrhages.
  4. Greater productivity and plasticity ;  hence more in-
clination  to  abnormal  productions, especially  when  the
sexual production is interrupted or ceases.
  5. Great  influence of the uterine and gangliary system
on  the organism ; hence the hysterical state and character
frequently attendant on all the affections of females.
  6. Easy excitability, but less endurance  of energy, more
suffering than active power ; hence diseases are apt to pass
from the active into a passive state.
  7. On the whole, much resemblance to the character of
children.
                     MENSTRUATION.

            Menstruatio, Catamenia, Menses.

  It is the blossom of sexual life, the sign of aptness for
procreation, and at the same time a sign and a  general pre-
servative  of the health of the  female  economy (signum
et presidium sonitatis).  Therefore it is, that this function
is so important to the health and life of females.  The more
regular the menses are, the healthier is  the female.  These
monthly turns render females even less  liable  to some dis-
eases, and enable them to resist them longer than males, as
in consumption.
  Menstruation is owing to the double sanguification of
the female,  and to the necessity of evacuating from time
to time the abundance of  blood, which is  destined to the
formation and nutrition of the fetus.  Menstruation, there-
fore,  is only a surrogate of pregnancy, a temporary, a vica-
rious  secretion,  to  prevent the  danger  of  sanguineous
accumulation, but at  the same  time an  expedient, dispen-
sing woman of the physical  necessity of sexual gratifica-
tion,  and securing her moral freedom.
  The circumstance of this secretion being performed by
the uterus,  is  accounted for_ by the irritability being in-
creased by  the awakening of'sexual instinct.
  Menstruation, therefore, must not be  regarded as a mere
passive flowing, but as an active critical  periodical secre-
tion, not only to discharge the blood, but also as regards the
productivity connected with it.  Therefore its signal influ- 
500
MENSTRUATION.
 ence on the whole organism is not only an excitement and
 purification of the uterus, but arouses and purifies the whole
 economy, as  is sufficiently  manifest in  many  persons by
 the altered  smell of their breath, their dim eyes, slight cu-
 taneous eruptions, excitement, abnormal tone  of the ner-
 vous system and mind, even by actual nervous  attacks. In
 short, it is  a perfect monthly crisis.
   The conditions of it are : a proper quantity of blood dis-
 charged, properly irritating in its quality (cruor, warmth),
 a proper degree of  irritability and tone of the uterine sys-
 tem (middle  degree).

                 Diseases of Menstruation,

    May be  divided into disorders previous to the first de-
 velopment, during its course, and at its cessation.

 1. The First Development.  Puberty.  Morbid  Obstruction
                          of it.

   It is the  awakening of sexual life,  of a new (a parasitic)
 life, even of a system of the economy, developing new ir-
 ritations, new sympathies, new relations, impressing a new
 character to  the physical  as  well as to the mental  life;
 consequently one of the most important revolutions in or-
 ganic life.
   It sets in,  in  our climate, between the fourteenth and
 eighteenth  year  of  age, earlier in the south ; later in an
 active, industrious  mode of living, earlier in idle life ; in
 rare cases  only in the twentieth, even only after marriage.
 A premature  appearance is always significative of a weak
 constitution  and strong  sexual instinct.  It  is  better that
 it  appear too late than too early.   It is therefore of the
 greatest importance not  to  accelerate this period, nor to
 attribute all the affections of disease  and sickliness, which
 may occur in  a young girl at  this period, to that source, and
 try to  remove them  by promoting menstruation.   But  it is
 equally important to assist nature where there is a  morbid
 obstruction, to promote menstruation; for the consequen-
 ces  are: sanguineous congestions to  noble parts, as  the
 head lungs, stomach,  which often degenerate in  hemor-
 rhages of these organs ;  nervous fits, hysteria, spasms of
 all kinds, cachexy, particularly chlorosis, phthisis,  tabes,
 hydrops.
  The first and most momentous point of treatment conse-
quently consists  in  discriminating the  morbid  retention 
MENSTRUATION.                 501
from the natural  retardment; and the rule must be this:
to presume a morbid obstruction, a  retention, only  when
molimina  menstrua  and signs of puberty have  already
really set  in.  These are :  pains  in the small of the back
and in the abdomen  appearing from time to time, periodi-
cal distention of the belly,  development or painful tension
of the breasts.
   If these are  wanting, abstain  from medical acting, but
wait patiently.   There are  cases when  they never appear
(viragines).  When molimina are present, but nothing mor-
bid, it will be sufficient to assist nature occasionally. This
is done by foot baths, taken in the evening at the time of
the molimina, and a few grains  of the pilulae balsamice
Hofmanni (No.  171), along with chamomile tea.   The
same maxim is applicable to menstruation when it appears
once and then ceases, or when it is more watery than san-
guineous.
   It is only when the molimina menstrua are attended with
morbid  troubles, that morbid retention is supposed to exist
and is an  object of cure.
   It is then proper not to immediately attack with emmen-
agogues, but to investigate into the cause, which may vary
very much.
   1. Plethora,  over-filling  of the vessels, and a strong,
firm fibre may be the cause of obstruction, as this is often
the case with vigorous country women, also in the well-
fed inhabitants of towns.   Full pulse, strong development
of the body, a vigorous  habit, are the discriminative signs.
In such a case, which borders often on inflammation, the
intention  is to diminish and attenuate the quantity of blood,
to relax the fibre ; for which the principal means are a ve-
nesection in the foot at the time of the molimina, foot and
steam baths, effervescent powder.  Besides, vegetable diet,
borate  of soda, decoction  or extract of grass, powdered
madder, half a drachm three times a  day, tepid baths.  If
this do  not succeed, apply  leeches at the genitals, cups to
the internal side of the thighs at the  time of the molimina.
   2. Or a reverse state exists. The patient is pale, weakly,
more inclined to  cold than to warmth, lazy, inactive, her
pulse weak, and disposition to chlorosis is visible. In such
a case,  blood is defective of irritative power, and the ves-
sels, especially those of the uterus, lack irritability.   Fer-
ruginous and bitter  remedies, best combined  with oxygen
(chalybeate  waters), or flor. salis  ammoniaci  martiales
along with arnica (No.  127), sulphate of iron and the like,
are chiefly to be relied upon ; also the red cheek pills (No. 
502                  MENSTRUATION.
128), so called since they change very soon the pale coun-
tenance into  a florid complexion.   At the same time ani-
mal nutritive food, a motory  life, exciting corporeal and
mental activity,  walking, riding in a carriage, still  better
on horseback, and the balsamic pills at the time of the moli-
mina may be used.   In  this case, onanism and  irritated
sexual instinct must be well attended to and counteracted.
  3. It is a  middle  state.  Weakness combined  with  in-
creased  sensibility,  erelhismus.   Here  spasm  prevents
menstruation, and  the  antispasmodic  treatment is best,
especially by valerian,  asa fetida,  castoreum,  galbanum,
warm baths, steam  baths to the genitals.  Here also ple-
thora  of the  vessels may be combined with irritable weak-
ness, and besides the use  of the above mentioned  reme-
dies, topical, sometimes also general abstractions of blood
are called for.
   4.  Finally, material local stimuli  and  substances may
 exist  in the  body, which, by their operation, obstruct the
 uterine  function.  Of this  number are  worms, scrofulous
 diathesis, and glandular obstruction in the abdomen, espe-
 cially of a mucous character, dyscrasies, especially  psoric
 and syphilitic.   In such a case the treatment  must tend to
 remove  those irritatives, as worms, and  the obstruction by
 the continued use of resolvents, the dyscrasies, etc.
   If all  prove  abortive, the  patient must be  examined,
 whether it be due to a  mechanical obstruction, an  atresia
 vagine.  This may be suspected already at the commence-
 ment, especially in otherwise  healthy persons,  when very
 urgent  molimina menstrua appear  every four  weeks,  the
 abdomen swells very much, a sensation of fulness and pres-
 sure in the  depth is felt, and all other signs of puberty  are
 present.  I be?, never  to forget  this intimation.   In this
 case, the mechanical surgical process, the cutting of  the
 hymen  only affords relief.
    Only after being convinced that no remote causes of re-
 tention exist, or the same are removed, the menses never-
 theless  not appearing, have  recourse to the methodus
 emmenagoga (vide obstructio menstr.).
    In  the first appearance of menstruation, it is most impor-
 tant that it be not disturbed nor interrupted.  It is  of mo-
 ment for the whole life, for when it once has assumed  a
 proper  typical  order,  it is  not  easily interrupted after-
 wards ; bear in mind, that the menses are a monthly crisis,
 protective and conservative of the female healrji.
    Therefore the following 
MENSTRUATION.
503
                  Regimen  Menstruate

must be observed, not alone at  the commencement  of the
menstruation, but through the whole life..
  Avoid, during the menstruation, any kind of over-heat-
ing (especially dancing), and  taking  cold,  heavy meal-
meats,  particularly  fresh  baked  bread, violent  mental
affections, coition, medicines, especially  emetics and  pur-
gatives, and baths.
  This must be  adhered  to even  in  diseases,  medical
treatment, water-cure; and menstruation  is to be respected,
except in cases of diseases endangering life, when imminent
danger of life requires the use of remedies.

2. Suppression of Menstruation (Obstructio Menstruorum).

  Suppression of menstruation  is either a sudden stoppage
of its course (suppression properly so called), or a cessa-
tion of it (obstruction of the catamenia).
  The sudden stoppage during  its course, which may hap-
pen by taking cold (particularly on the feet),  or over-heat-
ing, or mental affections, or faults of diet, is an acute case,
often  rapidly dangerous, sometimes, however, only detri-
mental in its consequences.
  The  treatment depends  solely on  the circumstances,
causes, and phenomena.
   When violent  abdominal pain or congestions  to other
noble  parts set in from  the beginning, attended with a full
pulse, fever: there is an inflammatory state, and  we  must
guard to use emmenagogues. A venesection on the foot, or
when the state is not sufficiently plethoric for that, leeches
at the genitals and antiphlogistic medicines (internally),
foot and steam baths, warm, emollient narcotic cataplasms
on  the genitals and uterine  region, emollient injections re-
store  best  the flux and prevent danger.   Should these
means prove unsuccessful, administer borax, pulvis  aero-
phorus.  When  the  phlogistic state  has passed  by,  or
no  sign of  inflammation was present from the beginning,
but all point to a spasmodic state, foot and steam baths,
cataplasms, injections,  and  internally  pulvis aerophorus
along with extract, hyoscyami  and crocus, or extract, taxi,
one grain as a dose, also castoreum and chamomile tea are
serviceable.
  If this be too weak, add a few drops  of laudanum; the
same also to the  injection.
  But it is  otherwise when the menses  fail to appear (ob- 
504
MENSTRUATION.
structio).  In this  case the principal thing is to ascertain
the cause.  I cannot  sufficiently impress upon ihe mind
of the young practitioner, that his first suspicion must
be the most natural one—pregnancy.   This is often disbe-
lieved, even by married women,  and  is  often purposely
concealed, especially by unmarried persons.  If the physi-
cian is heedless of such a state and uses  emmenagogues,
he will  likely produce  abortus, and may lose not only his
professional  reputation, but cause—what  is still  worse—
bitter remorse.
  The physician is, assuredly, in a bad dilemma, for  it is
known that even exploration does not afford certain know-
ledge in  the early months of pregnancy. My advice, which
is that with which I  have always complied, is therefore as
follows : Never use in married  or in  unmarried  persons,
unless the suppression is due to a sudden interruption in the
first months, remedies which directly promote its flow ; but
temporize, and be  content with means directed against the
general causes or the actual urgent exigencies (as in violent
sanguineous congestions a venesection in the arm and cool-
ing remedies).  If  nothing is indicated, and  notwithstanding
the person asks for remedies (in order to obtain something
which may bring:  on abortion), give something  trifling, as
pills of bread and the  like, in order to prevent her from
procuring abortives  from a quack.   Thus delay, until the
three or four first  months are passed by, when, if pregnan-
cy  exists, more evident  vestiges appear,  and at  the  half
of the term the  motion of the child will remove all  doubt.
In this way reputation and conscience are  best secured.
  After  being satisfied that it is  not pregnancy  but a mor-
bid retention, relief is  necessary ; for the consequences are
very  serious,  as  hysterics,  epilepsy,  vomitus cruentus,
spitting  of blood,  consumption, dropsy.  First, try to re-
move the causes,  which  have produced and sustain  sup-
pression : this alone is often sufficient  to restore the cata-
menia.   They are  : debility, paucity of blood (brought on
by grief, want of  nutrition, severe  diseases, too many ab-
stractions of blood, and other evacuants, hard labor, as that
of harvest in country women, and fluor albus). Here the ma-
terial for menstruation is  wanting, and  to provoke the
latter would be foolish.  Nourish and well strengthen the
patient, after which the catamenia will come by itself.  If
it is due  to obstructions in the abdominal viscera, and  ute-
rine system (especially after  a  sedentary  life) ; vigorous
resolventia visceralia and uterina must  be used ; if due to
a spasmodic state, antispasmodics ; if to worms,  dyscra- 
MENSTRUATION.
505
sies, metastatic, frequently specific  irritatives, amongst
which  lurking  syphilis is particularly important, those
disorders must be attended to according to  their respect-
ive character.   Should the causal treatment  not suffice, or
when there is no indication for it, recourse must be had to
the direct emmenagogue method.  It comprises two kinds
of  remedies: pellentia, such as  produce from within a
stronger rush of blood to the uterus; and attrahentia, such
as attract it from without.  The latter are  more safe and
preferable in  all cases, where  congestions to  noble parts
are to be dreaded.
   The pellentia are :  aloes, myrrh, the balsamic pills, oxy-
gen, mineral  water, borax, iron, sulphur, tinct. fulig., mer-
cury, colocynthides,  crocus, guaiac,  hellebore, galbanum,
the strongest  is savin (No. 129, 130, 131, 132).
   The attrahentia are: foot baths and  steam baths  to  the
genitals, rubbing of the thighs, injections, cups on the inter-
nal parts of the thighs, leeches to the genitals, fontanels on
the internal parts of the thighs, kept open for a length of
time, especially electricity (sparks to the genitals and ute-
rinp region, shocks across the pelvis and directed from  the
sacrum to the os pubis), and the strongest of all, acupunc-
ture in the inguinal region.
   When molimina  exist, it is a good period for the appli-
cation of these remedies.


3. Immoderate Flow  of the  Menses, Hemorrhages from the
        Uterus.  (Menstrua Nimia,  Metrorrhagia.)

   It is  difficult to  say what is  profuse menstruation ; for
quantity  proves nothing;  some need  much, some only a
little.   It is the effect that furnishes  the measure.   When
there is a weak or even intermitting pulse, a general pros-
tration, cool  extremities, feeble  respiration, palpitation of
the heart on  exercise, want of appetite, and melancholy,
perhaps also  edema  of the feet in the  evening, menstrua-
tion is too profuse.  Likewise, when the catamenia last too
long (eight or  more days) ; when they return too often.
The case is called hamorrhagia uteri, when  feebleness in-
creases to fainting.   Hamorrhagii uteri chronica (stillici-
dium uteri) is a  constant discharge of blood,  confined to no
periods.
   The consequences  of too profuse menstruation are : gen-
eral debility, especially of  the  nerves, and  all  its effects,
hysterics, spasms of  all kinds—never forget in these  dis-
                           43 
506                  MENSTRUATION.

eases to inquire after this cause—cachexy, a disposition to
dropsy.
  The causes  are:  general laxity  and weakness  of the
fibre, sedentary life, especially high  living, increased sen-
sibility, particularly  of  the uterine  system,  morbidly in-
creased sexual instinct, too frequent coition, masturbation,
frequent childbeds, local weakness  of th- uterine system,
dissolved scorbutic blood, abdominal irritatives, especially
bile, local irritatives  of the uterus, metastases, polypus.
  The treatment  is  double : radical  and  palliative.  The
radical treatment  is guided by the causes. The most fre-
quent of all  is weakness and laxity of the uterus recogni-
zable by the  general  habit of the patient,  frequent parturi-
tion, sedentary life.  In such a case, the use of bitter,
astringent, aromatic  remedies gives the surest relief; such
as cinchona (No. 133, 134), cort. salicis, terra japonica,
kino,  cort. aurantiorum, cinnamon, sulphuric  acid, espe-
cially alum, given as alum whey  (No. 135); cinnamon tea,
made by infusing  one drachm of cinnamon in  two cups of
water, drank daily, is a very approved remedy.  In great
debility, ferruginous  remedies, combined  with acids ;  the
best  preparation  is  sulphate of iron (No. 136).  At  the
same time, all  debilitating  causes must be avoided, and a
cold diet observed.   When increased sensibility exists, an-
tispasmodics, particularly ipecacuanha in small doses ;  if in
a higher degree,  opium may be prescribed.   In  case of
plethora (which is very rare and only found in combination
with local uterine weakness), a venesection on the arm is
to be  made,  and tartaric acid, cooling purgatives and min-
eral acids must be given. In a scorbutic dissolution, scurvy
is to be attended to.  Look particularly for morbid  stimuli,
as bilious matter, abdominal  obstructions, worms, dyscra-
sies, especially the syphilitic, and remove them.   (I have
once seen the flux of menstrual  blood  stopped  by the  use
of guaiacum when arthritis was ihe remote cause  of the
disorder.)  If  these  means  prove  unsuccessful, it  is pro-
bable that a polypus of the uterus exists, when exploration
and  operation are  called for.
  The palliative  treatment, during  a dangerous  hemor-
rhage, calls for the  most  vigorous  astringents,  of which
alum ranks  first (ten grains in powder or half a  cup of
serum lactis  aluminat. every two hours),  besides too, sul-
phate  of iron (No. 137),  tincture of cinnamon,  thirty or
forty drops at  a dose,  cold fomentations  on the  uterine
region and genitals, cold injections, also injections of red
wine, or  alum, dossils impregnated with the same inserted, 
MENSTRUATION.
507
horizontal position, and extreme quietude, ligatures  round
the thighs.

  4. Difficult, Painful Menstruation, Menstrual Spasms.
            (Menstrua Dolorifica, Difficilia.)

   Diagnosis.  At every menstruation, violent colic,  throe-
like pains,  headache,  vomiting,  toothache,  or still more
violent and  general accidents, cholera, fits of fainting, con-
vulsions,  epilepsy, delirium,  melancholy, mania are ob-
served ; they occur only during  the flux, or several days
before or after it.
   The  consequences  are :  half  a life spent  in sickness
(every month for eight or fourteen days), and sterility.
   Pathogenesis.  The  proximate  cause is excessively in-
creased morbid sensibility of the uterine system, or  of the
whole nervous system, by which it happens that the local
irritation of the uterus appertaining to the menstrual pe-
riod degenerates into  spasm,  and which is communicated
to remote systems.
   The remote  causes are : local irritation and debilitation
of the uterine  system by onanism (physical and mental),
excesses in  venery, especially without satisfaction, general
hysteria, obstructions  of the abdominal viscera and infarcts
of the uterus itself, worms, specific,  frequently concealed
irritatives,  especially  latent syphilis, rarely plethora and
rigidity of fibre.
   Therapeutics.  The  cure is  most difficult.   First,  the re-
mote  causes must be  ascertained and removed, and if the
evil do not yield to such  treatment, the general spasmodic
disposition, and  the weakness of the uterine system must
be attended to.  The most  appropriate remedies  are:  a
long continued use of asa fetida, camphor, quassia, elixir
acidum, and of baths, tepid at first,  and  lastly cold, espe-
cially those containing iron (Pyrmont and Dryburg at the
well) ;  however, attention must always be paid to obstruc-
tions in the abdominal viscera, and even in the  uterine
vessels,  as  probable causes of this  troublesome evil, and
remedy them.  I have several times seen the Carlsbad water
effect a  perfect cure,  after all the foregoing remedies had
been administered without success.
   If  all these means fail, resort to magnetism, which may
pTOve very beneficial in  this case as well as in all other
nervous diseases, which are in causal connection with the
 menstrual function.                             .  .
    The palliative treatment consists merely in the mitigating 
508                 MENSTRUATION.

and antispasmodic method.  The most  reliance is to be
placed on the  internal use of opium, but in  an oily emul-
sion, combined with warm narcotic cataplasms on the gen-
itals and uterine region, antispasmodic ointments, emollient
injections, tepid hip-baths.   In plethoric individuals, and
where gastric  impurities are present, instead  of the opium,
extract of hyoscyamus must be given.

5.  Cessation of Menstruation, the  Dying of Sexual Life.
                  (Cessatio Mensium.)

   Takes place, in our climate, between the forty-fifth and
fiftieth year of age.   This, however, varies as well  as does
the first appearance of the catamenia, according to consti-
tution, climate, and mode of living.  The earlier they ap-
pear, the  more laborious and toilsome life  has been, the
colder  the temperament,  the sooner does  menstruation
usually cease.  The contrary conditions retard it.
   The  cessation happens in the  following manner.  It
ceases  either  suddenly and all  at  once, which is  always
hazardous; or decreases gradually, failing once or twice,
then  reappearing again, sets  in  at  greater intervals, and
finally disappears entirely.  This is the best and most harm-
less way.  In  some females the menses terminate with con-
siderable  hemorrhages.  In rare cases the menstrua con-
tinue alternating with interruptions up to the sixtieth year
and longer.   We farther perceive an essential difference.
In some, momentary flushes with passing sweats, cutaneous
eruptions also appear ; the impulse of the humors tends to
the periphery.  This is salutary, and guards against  bad
consequences.  In others, cold and chills occur, premoni-
tors of internal affections and congestions.
   This period is important, is even decisive of female life.
This period is therefore rightly styled the critical time of
female life, for mortality is then greatest.
   The effects are double.  In some the  change is for  the
better; they  become  healthy, robust, even  blooming and
vigorous,—it is to them a kind of regeneration.  In others
it is for the worse:  sanguineous  congestions to the head,
lungs, stomach, hemorrhages, particularly vomitus  cruen-
tus, serous and mucous profluvia supervene.
   Nervous diseases,  hysteria, spasms, especially cardial-
gia. Dyscrasies, acrimonies, especially cutaneous diseases
and arthritis.   Scrofula, which  existed  in infancy, reap-
pear.
   New formations, pseudo-organizations, scirrhus, cancer, 
MENSTRUATION.                 509
polypi uteri.  This is the period when long dormant indu-
rations begin to revive, become painful, larger, inflame, and
scirrhus passes into cancer.
  Therapeutics.  A correct idea of this state  is  of the
greatest  importance.   Three circumstances belon? to it,
and  which also  point out objects or leading principles of
cure.
   1. Continuation  of  the  double  sanguification, and  im-
peded  excretion—plethora.
  2. Productivity  still existing, but retiring inwardly, on
account of the dwindling away of the uterus—hence  the
disposition to  pseudo-organizations.
  3. Acrimony,  dyscrasy, owing  partly  to the  monthly
crisis now absent, which in many  serves to discharge  not
only blood, but also other morbid  matters; partly to  the
abundance of humors now suddenly arising.
  The chief indication is therefore :
  To derivate the congestion, to restore  the balance,  and
to compensate the menses.

                   Special  Treatment.

  Such persons as feel well, even better than they used to
do ;  such as are poor of blood, or who labored under too co-
pious catamenia—must be left alone ;  exercise and regular
diet are to be  enjoined, this is all that is  needed.
  But  when congestions and other morbid accidents  set in,
a venesection  is called for, and must be  repeated, accord-
ing to  the varying plethora, every six or twelve months ;
intermediately once in a while scarification may  be  useful
as a means of derivation.   Simultaneously cream of tartar
(one teaspoonful in a glass of sweetened water), serves best
against phlogoses; and  use every two  or three  weeks
Saidchutz  water or a  solution of Glauber's salt.   In very
plethoric persons,  or in great danger of congest'oas,  me-
tastases, especially scirrhus, a fontanel on the arm or foot
may be made  ; to nervous individuals, give the elixir  aci-
dum.  At  the same time, corporeal exercise, regular diet of
an antiphlogistic character.  Abstractions  of blood must
be continued as  long as indications of congestions exist;
but incrta-e the intervals, as time  advances.  This course
must sometimes be pursued for several years before the vas-
cular system becomes settled. It is advisable in most cases
to bleed  in the  first year three times,  in  the following,
twice,  and in the third, once.
                          43* 
510
PREGNANCY.
                      PREGNANCY.

  To be pregnant, to breed and to nurse, is a natural state,
and is therefore the healthiest one of  woman.   Woman is
to be blessed by  giving birth to  children, says the holy
writ.  The healthiest  women are those  in whom these
functions are regularly performed.  Menstruation is only
a surrogate, a  poor compensation of pregnancy, impor-
tant and  necessary to woman, whereby she maintains her
moral dignity, and ceases  to be the slave of brute  instinct;
but it is still an abnormal  morbid  state.  In well organized
constitutions, and when the  mode of  living accords with
nature, pregnancy produces  no morbid symptoms.
  The usual complaints which trouble  pregnant women are
the following:  nausea, vomiting,  headache and toothache,
spots on the skin, and eruptions, nervous attacks of all
kinds, hysterism, sometimes a peculiar change of mind and
temper, even delirium, mental derangement, melancholy,
and mania, which cease when pregnancy terminates.  The
most dangerous of all its accidents is abortion.
  The prompt diagnosis of pregnancy is  very important,
though very difficult in the  first  months, lest  we mistake
for disease that which  is only a symptom of this state, and
make use  of remedies productive of  the  greatest injury,
which  might even disturb pregnancy  by producing abor-
tus. The most common and surest signs are : absence of
the menses and  swelling  of  the breasts ;  in the  plurality,
but not universally, also nausea, vomiting, and some have
their peculiar sensations and  phenomena.  But sometimes
all  these symptoms are wanting, even the  catamenia con-
tinue.  The discrimination by the stethoscope (hearing the
fetus) does not apply to the  first  periods of pregnancy, it
is of use only in  the second period.   But, on the  reverse,
menstruation may stop, and nevertheless no pregnancy ex-
ist, but a morbid suppression which sometimes affects and
increases the breast.  It  is still worse in those who  con-
ceal pregnancy.
  In all  such  cases  1  cannot too  urgently enjoin  on the
young practitioner the  following as a golden rule : rather
to suppose  the existence of pregnancy, and to  act accord-
ingly;  that is, to  temporize rather than act  the contrary,
until the fourth month arrives, when the motion of the
child will remove all doubt.  The physician will  thereby
avoid much mischief, and  preserve his conscience as well
as his reputation. 
PREGNANCY.                   511
  Pregnancy is certainly not a disease by itself, but a nat-
ural state.   It can, however, give rise to many morbid at-
tacks,  especially  where great sensibility,  or  a  relatively
weaker part, or an idle life predispose to them ; therefore,
accidents are  met writh more frequently in the higher refin-
ed and effeminate classes, than in the lower and laborious.
  The essential  idea  of the pregnant  state is: a living
being within a living  being, a double life, increased pro-
ductivity and  sanguification.
  All  accidents  of pregnancy spring from four sources :
1, from  plethora, from the  suppressed  menstrual blood,
which in the beginning is not sufficiently consumed by the
fetus ;  hence  this class of accidents occur most frequently
in the first three or four months ; hence persons  poor in
blood feel better at this period of pregnancy ; 2, from ner-
vous, spasmodic  affections, from the  irritation of a foreign
body, and the nervous sympathy of the  revived and newly
excited uterus (similar to the verminous irritation) ;  3, or
from gastrosis, accumulation of gastric  impurities in the
stomach and intestinal canal, by  the perturbated secretions
and  excretions of the  intestinal canal, the liver, and  other
abdominal viscera ; or finally, 4, from mechanical pressure
effected by the distended uterus on the  blood and  lympha-
tic vessels, and on all the abdominal  viscera ;  hence in the
last half, especially in the last months of pregnancy, there
is retention of stool and urine,  hemorrhoidal complaints,
 obstruction to the lymphatic absorption, edema pedum et
 labiorum vulve, varices on the lower extremities.

            General Rules for Pregnant  Women.

   1. In all cases, the principal  and promptest means of
relief is horizontal position, persevered  in  for a few hours.
   2. Avoid tight lacing and tight dressing. ,
   3. Moderate exercise, and  the enjoyment of free air.
All  laboring  women  have an  easier parturition than idle
 ones.
   4. Mental discipline ; avoiding all violent  and injurious
 affections, on account  of their operation on the fruit; even
 good morals, tranquillity, and purity  of mind are influential
 in this regard.
   5. Avoid exertion and forced  motions, especially lifting
 and carrying  heavy loads.
   6. Constant respect  in selection  of  remedies,  to  avoid
 such as might operate injuriously on the fetus and its pre-
 servation and tend to abortus.   Drastic aloetic remedies 
512
PREGNANCY.
and oxygenated, especially chalybeate mineral waters and
warm baths are to be avoided, especially  during the  first
half of pregnancy.
  7. Regular stools, especially in the last months.  It  is
best to give for  that  purpose,  a purgative  every four
weeks.

                 The Special Treatment,

  Depends entirely upon the various  causes.
  If plethora is the cause, which may be recognized by a
full pulse, the constitution and the previous habitually co-
pious menstruation, a venesection in  the arm, antiphlogis-
tic  diet, and the use of cooling remedies, especially  No.
138 are indicated, and best  cure  headache and toothache,
spasms and other nervous attacks, arising from that source.
I would here enjoin one rule, which applies to every vene-
section, but especially to that made in pregnant women :
perform the venesection while the patient is lying and her
legs extended.   This is the  best means to prevent fainting
(on account of the blood having an easier reflux), which  is
of great importance in pregnant women, for a stagnation of
the circulation  is always dangerous, as regards mother and
fetus.
  But if it be owing to nervousness,  which is recognized
by the absence of plethoric  signs, by  the  sensitive consti-
tution, pale  urine, etc., antispasmodics are  proper; among
which, however, the hot  ones, particularly opium, are to
be avoided,  or at least not resorted to, except  in extreme
necessity.
  The cause is often only gastric, and then remedies to
cleanse the intestinal canal are needed, carefully avoiding,
however, all hot  drastics, aloetics, since they are apt to
produce  abortion ; and  cooling  neutral salts,  tamarinds,
sharpened by senna, are preferable.
  Finally, the effects of mechanical pressure can  be pre-
vented  by  a mechanical  expedient—horizontal  position.
It is the principal  means to  diminish  all these troubles in
the  last months of pregnancy.   Apply also remedies  to
soothe or remove the effects, injections, purgatives in con-
stipation, abstractions of blood in hemorrhoidal and vari-
cous complaints.
  In obstinate  constipation  or retention of urine  during
the  second  half, we must be  attentive  to examine whether
or not an inversion of the uterus  is the cause, which case
require the assistance of the obstetrician. 
HEADACHE, TOOTHACHE, VOxMlTING.         513
               HEADACHE AND TOOTHACHE,

  Particularly the latter, torment most in the first months.
There  is most commonly congestion of blood ; therefore
a venesection  in the arm, the powder No. 138, a sinapism
on the arm, and cooling purgatives afford the most sure
relief.   When the pains are violent, or a nervous state ex-
ists, give one dose of the powder every two hours, to
which  add half or a whole grain of hyoscyamus.  As an
external remedy cold water, taken into  the mouth, also
leeches on the gums are serviceable; and also the remedy
No. 139.
             VOMITING OF PREGNANT WOMEN.

  It is one of the most common and troublesome concom-
itant complaints  of  pregnancy, especially  in  the first
months, and sometimes through the whole period.  It gen-
erally  takes  place in  the  morning and  forenoon,  some-
times,  however,  at all  hours  of the day.  It  sets in soon
after conception, and is one of  the most common  signs of
pregnancy ; is insignificant and innoxious when it is not
too violent.  But when it becomes very violent  and con-
tinues, then it may not only weaken and impair nutrition,
but even give rise to hernia and abortion.
  It is impossible to cure vomiting perfectly ;  for it origin-
ates from pregnancy itself.   It is owing first to a  sympa-
thetic irritation, communicating by the fetus  to the uterus
and the new life of this organ to the stomach ; next, to local
plethora  of the stomach, caused by suppression of menstru-
ation and the too little consumption of blood by the fetus;
and  finally by the secretions of the stomach and the  biliary
system becoming  frequently  disordered by the new abdo-
minal affections.
  The treatment, therefore, must be confined to moderating
its violence and  duration, and art can indeed do much to-
wards that end.   First, a young plethoric person, who has
always had copious menses,  who now  has  a full pulse,
must have the plenitude of blood diminished by a venesec-
tion in the arm,  which alone will  often procure relief an I
prevent dangerous consequences.  When indications  >f
impurities, tardy  stool exist, use gentle purgatives a  1 I
antiphlogistic remedies, and  if all this be unavailing, ail
the person is nervous  and sensitive, antispasmodics, pi:- 
514             PREVENTION OF ABORTION.

ticularly such as counteract the inclination to vomit.   Ex-
perience has recommended  the following as very suitable
for that purpose:  the  most efficacious is  River's  potion,
with a little hyoscyamus (No. 140), (it  is better than the
effervescent powder, since the effervescence of the carbo-
nic acid gas might  operate as a pellens on  the uterus),
drinking of adecoction of cream of tartar,elixir acidum aro-
maticum c. tinctura. ambre (No.  141), embrocation on the
epigastric region with spirit, matrical., bals. vite Hofmaji-
ni, laudanum, epigastric  plasters of emplastr. arom. c. oleo
cajeputi and opium, cataplasms of mint steeped in wine,
emollient  clysters.  The latter are very important,  partic-
ularly during the second half, when feces  enormously ac-
cumulate  by the pressure of the  uterus on the colon.  This
accumulation  keeps up  the vomiting and cannot  be  dis-
lodged by a purgative.   In such a case, order three or four
emollient  injections to be given every day for a continuance
of several days.  In obstinate cases of vomiting I have ob-
served good effects from animal magnetism.
     PREVENTION OF ABORTION AND PREMATURE  BIRTH.

  Abortus is most apt to take place in  the third month.
The precursors are :  pain in the loins and in the abdomen,
softening of the breasts, chills,  cold in the back, sensation
of pressure in the pudendum, urgency to urinate, discharge
of mucus by the vagina—finally, when the abortion is near
at hand, and  can scarcely be prevented—slight sanguine-
ous discharge from the womb.  To  these signs are added
cessation  of the  motion of the  fetus after the  fourth
month.
  The usual  causes are : violent  fright or anger, a fall, a
push, over-heating, and taking cold, violent exercise, too
frequent or forced coitus, fever.
  The consequences are, besides  the loss of the child, the
risk of hemorrhages from  the  womb, sometimes also  in-
flammatory affections,  but particularly a  remaining weak-
ness of the uterus and a disposition to a repetition of abor-
tion at the same time in a future pregnancy.
  All must, therefore, he done  to prevent abortion, and it
can be prevented, if seasonable and sufficient  attention is
paid to the emergency.
  The means for attaining this  end are:  the first and most
important, without which all the  rest are  unsuccessful—
horizontal position and complete rest of  the body, contin- 
CONVULSIONS.
515
ued for several days, immediately after the first precursor,
until the  signs  have disappeared.   The se»ond  is a vene-
section in  the  arm ; and  when  too great  debility forbids
this  (which, however,  rarely happens), the application of
eight to twelve leeches to the breasts, being a locality to
which the most efficient derivation from the uterus may be
made. Give at the same time the powder No. 138, and or-
der the belly and sacrum to be washed with warm spiritus
matricalis. In the spasmodic state of "nervous persons, and
when  the  pains are violent, an oily emulsion containing
extract of  hyoscyamus, one  grain  every hour, and exter-
nally embrocations of  oil of hyoscyamus one ounce, tinct.
of opium one drachm,  curled mint half a scruple, are best.
   Should gastric crudities exist, gentle cooling cathartics
are of use.
   The disposition to abortion may become a real disease,
so  that  abortion  takes place in every pregnancy at the
same period.   I know of no better  remedy to  counteract
such a state, than Pyrmont water, used  as a  drink and
bath, or similar martial waters; in short, iron, internally as
well  as  in baths, which of course  is to  be  used during the
absence  of pregnancy. During pregnancy  such persons
have  to observe  for  the three or  four first months the
greatest repose,  horizontal posture, light  antiphlogistic
diet ; constipation of  the bowels must be  removed by in-
jections, plethora  by   venesection in the  arm ;  the belly
and sacrum are to be  washed  daily with spiritus matrica-
lis.   Also zinc has been found particularly useful to pre-
vent abortion, likewise a mixture of Haller's acid elixir,
 one  drachm,  essence of ambergris two  drachms, thirty
 drops of which in a cup of  water, to be taken three times
 a day.
           CONVULSIONS OF PREGNANT WOMEN.

  They break out either in the last months of pregnancy,
or at the  commencement of the pains  and during labor.
They are  generally accompanied with  loss of conscious-
ness and a soporous  state, and  are apt to  pass into com-
plete apoplexy.
  In the majority of cases,  they arise from  a  sanguine-
ous congestion of  the  brain, a  general plethora,  or  are
owing toan omission of venesection.  The exciting cause
is a violent excitement of the body or mind, a difficult par-
turition, or a faulty position  of the child. 
516                   PARTURITION.
   The  treatment consists in a prompt derivation of the
 blood  from- tire head by venesection, leeches, purgatives,
 cold fomentations on the head, sinapisms on the extremi-
 ties, and when the accidents do not abate after the proper
 abstractions of blood and diminution of the pulse, the^use
 of opium with calomel and a warm bath, must be resorted
 to.  An examination must be  made, to ascertain whether
 or not a mechanical impediment to labor exists, which must
 be removed ;  and in an extreme case, the birth must be
 accelerated by artificial  assistance.


               PARTURITION AND CHILDBED.

   Parturition is the object and concluding act to which all
 the organic functions and efforts of the female tend.  It
 must be regarded as the  most important moment of a  wo-
 man's life, not  only as an act productive of a new being,
 but also as the  most momentous crisis of the female econ-
 omy  itself.  It  possesses all  qualities of crisis ;  as  the
 restoration of equilibrium, secretion and  excretion.  The
 more complete it is, and the better attended to, the more
 perfect will be the health of the woman.

               Characteristics  of this State.

   It is the most sublime  act, and at the  same time the most
 extraordinary catastrophe and revolution of organic nature.
 An operation in which the self-preservative and  restoring
 principle,  the sanative power of nature is most  perfectly
 exemplified ; and that which will render it ever wonderful
 is, how an act which is connected with the most dangerous
 accidents, the most extraordinary metamorphoses and  the
 greatest peril to life is generally performed, even in millions
 of cases,  without injurious  consequences, still more,  fol-
 lowed by a complete restoration to health.
   The subject  is worthy of our highest  attention.  The
 investigation of the pathogenetic state previous  to birth,
as well as  of the pathogenetic state created by the very act
 of parturition, and of the  institutions and crises devised by
nature herself to guard against  accidents,  merit  our best
 regard, in  order that we may form a correct idea of  the
 deviations and diseases which are likely to occur,  and  to
 appreciate them the better.
  The following are the particular characteristics of partu-
 rition : 
PARTURITION AND CHILDBED.            517
  1. Plethora abdominalis, a natural effect of sanguineous
plenitude, attracted hither by  the  formative  process,  a
quantity which  is  no  longer consumed,  but  is  still in-
creased by the sudden removal of the uterine pressure.
  2. Abundance of plasticity and plastic lymph, which are
now deprived at once of an organ and an object to act on.
  3. Altered  circulation and retrograde motion of the blood
from below to above.
  4. Gastric  accumulations, especially of impurities which
have been retained  by the pressure of the last months, now
suddenly become free, giving rise to a true " turgescentia
sordium."
  5. Vulneration, irritation,  and debilitation  (by hemor-
rhage).  The act of parturition unites all the properties of
vulneration, irritation,  and bleeding; and  every puerperal
woman is to  be regarded as a wounded one. Consequently
there is a disposition to inflammation, but which  is of an
exsudatory kind, and likely to become asthenic.
  The sole means  by  which provident nature effects this
crisis, and causes this  perilous state in millions of women
to  pass imperceptibly and  easily  into  health, are  two
crises: the lochial  flux and lacteal secretion, both deriva-
tives of the abundance  and plasticity of the blood and re-
 storatives of the balance of organic  action.

                Treatment after Delivery.

  Above all  things, hold to the idea, that parturition and
 confinement  are not diseases, but are natural acts,  the most
 normal and necessary, for the happy termination  of which
 nature has taken wise  and wonderful care—a natural cri-
 sis. As a rule, therefore, nothing is wanted, but to abstain
 from disturbing the crises ordained by nature  (lochia and
 lacteal secretion), and to guard against all injurious influ-
 ences (taking cold, over-feeding, mental affection).
  The following are the general rules for the treatment of
the childbed  state.
  1. The whole term of confinement must be reckoned
six weeks.   Before that time, the organism, especially the
 uterine system is not entirely what  it has been and ought
to be.
  2. The lying-in woman must constantly be observed and
carefully attended to during the first twenty-four hours, lest
she  die by bleeding during sleep.
  3. The first fortnight must be carefully attended to ; that
is to say, she must lie in bed, avoid taking cold, mental af-
                            44 
518            PARTURITION AND  CHILDBED.
fections,  and dietetic disorders.   'Decubitus is required,
in order to  prevent prolapsus uteri and hemorrhages.  It
is also the period when puerperal fever is apt to set in.
   4. Diet and treatment must be antiphlogistic during this
period. Water gruel and barley-water, and panado are suf-
ficient.  To very weakly persons broth may be allowed a
little earlier;  but the days of lacteal fever, the first week,
must always be respected.
   5. Moderate temperature of the room, not too much bed
clothing, and the greatest possible cleanliness are also prin-
cipal conditions.
   6. Cleansing  of  the prime vie is necessary to every
lying-in  woman, and best prevents puerperal fever.  But
be careful not to purge strongly within the first three days,
for it might disturb the lacteal crisis.  Give,  therefore, in
in the first days, only a light  saturation (No. 1), and an
emollient injection every evening, in order to free the large
intestines ;  but after the fourth  or fifth day, a coolin^ lax-
ative continued for some days.   A spoonful of castor oil,
or the  mixture No.  6, answers this purpose  best.
   7. The child must be applied to the breast twelve hours
after birth, and so continually applied for a fortnight, whe-
ther the mother will nurse it or not. Her own preservation
requires this, in order to prevent puerperal fever and stag-
nations of the milk.
   8. Proper attention  must be paid to the  lochial flux, as
being the second principal crisis, designed for the diminu-
tion of local plethora.  A cup of chamomile tea occasion-
ally taken, best subserves this end in common cases, and it
most  effectually mitigates at  the same time, the after-
pains.
   9. In violent and very painful after-pains, an oily emul-
sion, which  may be  strengthened by a few grains of extract
of hyoscyamus (No. 142 a.), is the best and  safest remedy.
Some recommend opium, which is, however, not to be ap-
proved of, is even dangerous, as it  creates constipation, a
state much  to  be guarded against, and  increases the in-
flammatory  disposition, always  existing, and  most  to be
dreaded. 
PUERPERAL FEVER.                519
PUERPERAL  FEVER.
Phlegmasia exsudatoria abdominalis, puerperalis, Peritonitis
                      puerperalis.

  A lying-in woman may, like any other person, be affected
with any kind of fever and inflammation ;  such a one is dur-
ing childbed, but not a childbed (puerperal) fever.  Puerpe-
raf fever is a peculiar disease, distinguished from any other
by  particular symptoms, and by characteristics of its own.
  Its distinctive symptoms are : immediately from the be-
ginning, a violent pain in the abdomen, attended with  a
considerable distention of it, which is very apt to increase
to a tympanitic tension ; and  there is such sensitiveness,
that the patient cannot bear the slightest touch, not even
covering; the  pulse is very quick from the commence-
ment ; there is great prostration and low spirits, suppression
of the lacteal and  lochial  secretion, violent  thirst, usually
diarrhea, with frequent urgency to stool, also vomiting.
  It is rapid in its course,  terminating fatally  in three or
four days.  The favorable issue is either a perfect resto-
ration ;  or, what is more frequent,  a metastasis, as a mili-
ary eruption, a cerebral affection, milk abscess, leucophleg-
masia.  Dissection shows gangrenous inflammation of the
peritoneum, sometimes also of the intestines or the womb,
 with an unusually large quantity of coagulable or perfectly
 milk-like lymph effuded.
   Genuine puerperal  fever may prevail epidemically, be-
 come even contagious in houses where many lying-in wo-
 men are gathered together.   In some years it is rarely met
 with, in others a great many  women are affected by it.
   This fever occurs only in lying-in women ; its existence
 depends on the peculiar state of the human economy previ-
 ous to, and after parturition.
   Pathogenesis.  The proximate cause is an inflammatory
 state in the abdomen, sometimes located more in the perito-
 neum, in other cases more in  the intestines; sometimes
 affectino- all these parts together; attended with a great
 disposition to  a quick and large lymphatic  exsudation into
 the abdominal cavity (inflammatio exsudatoria).  But this
 local inflammatory state is of a particular kind, and is possi-
 ble only to recently delivered women, in the first week ot
 childbed, and  therefore dependent on the  peculiar state of
 the organism previous to, and after parturition.   In the last
 month's previous to parturition, the distended uterus presses 
520
PUERPERAL FEVER.
on all the systems of the abdomen, thereby impairing them
and disturbing their action ; to this is added a double san-
guification.   The consequence is an atony of the gastric,
sanguineous, and lymphatic systems of the abdomen, accu-
mulation  of  bilious matters and impurities in the  gastric
system, frequently even hardened excrements in the colon,
sanguineous  and lymphatic plethora of the abdomen.
  While the female economy is in this  state and disposi-
tion, the violent commotion of parturition, an act very sim-
ilar to  vulneration takes place, exciting more  or  less an
inflammatory state of  the  uterine and  abdominal systems,
but which,  by two  crises—the lacteal  secretion and the
lochial  flux, is brought back to the normal state  and has its
balance restored.  However,  the following accidents may
occur:  suppression of the lacteal secretion, suppression of
the lochia, taking cold, or over-heating by stimulant food,
too hot regimen, overloading  of the stomach, mental affec-
tion,  laborious  parturition with lesion.   Under such  cir-
cumstances  the inflammatory disposition  increases unto
real inflammation, which, however, has a peculiar  charac-
ter,  namely: it is  located, 1,  in an extremely impaired
part (like an inflammation "post commotionern"), of a ty-
phoid type, very liable to  pass rapidly into a nervous or
gangrenous  state ; 2,  it is attended with lymphatic pletho-
ra  of the abdominal  system, and  consequently is much
inclined to lymphatic  effusion ; 3, it is  accompanied with
great accumulation  of gastric impurities.   This is the es-
 sential character of puerperal fever.
   Therapeutics.  The  treatment may be  prophylactic or
 curative.  Reliance must  principally be placed  on  prophy-
 lactic  treatment.  It  consists in this: during  the  last
 months the patient  must take daily exercise and  procure
 regular  stools (for the  latter, electuarium lenitivum is
 best), and if she be  young, and to a certain degree pletho-
 ric, she must be bled  shortly  before delivery.  After deliv-
 ery the infant must be applied to the mother's  breast, and
 she must herself nurse it for  a few weeks,  even when it is
 the intention  not to  continue  nursing.  She must spend
 the first  nine days in her bed, and not  leave her room be-
 fore  a fortnight has  elapsed ;  observe  an antiphlogistic
 vegetable diet, avoid  external cold and  over-heating, and
 when she nurses her  child, use gentle cooling  evacuants,
 the best is citrate of potassa ; but when she does not nurse
 the child, after the  third  day, stronger cathartics, as sul-
 phate  of potassa (No. 142 b.), are to be taken, so as to pro-
 duce several fluid stools every day. 
          TREATMENT IN REGARD TO LACTATION.       521

                The Curative Treatment.

  At the first appearance of the disease, announced by
bellyache with febrile motions, use cooling laxatives, injec-
tions, frequently applying the child to  the breast, in order
to keep up  and increase the lacteal secretion;  when the
lacteal secretion has been suppressed,  the same remedies
must be used and dry cups applied on the breast, emollient
cataplasms.   In  case the lochia should stop, administer
borax, and  inject emollients into the womb ; if  this does
not suffice, apply leeches to the genitals ; in evident gas-
tric turgescence, an emetic of ipecac.   When the  disease
increases, and the inflammatory state is more pronounced,
a venesection must be  made ;  should  the pains continue
notwithstanding, leeches are to be applied, or what  is more
efficacious, eight to twelve cuppings on the  abdomen, an
oily emulsion with  aqua laurocerasi,  and cooling purga-
tives, calomel, embrocations of camphorated  oil and mer-
curial ointment with opium, emollient narcotic cataplasms,
in short, the  whole  treatment of enteritis,  having constant
regard to the liability the disease  has of passing into a
nervous or putrid state.  Should the first (nervous state)
take place, valerian, musk, and opium; in  the latter, Peru-
vian bark, camphor, and arnica must be resorted to. Gan-
grene of the uterus, indicated  by putridity of the lochia,
may set in, must not be lost sight of, and is to be counter-
acted principally by injections of arnica and cinchona into
the womb.   Every indication  of a lacteal  translation to
the surface must carefully be promoted.
  LACTEAL SECRETION AND ITS TREATMENT,  IN CASES OF SUCK-
                  "LING AND NOT SUCKLING.

    I would enjoin the following rules in regard to this im-
  portant function.
    1.  Before  the  time of lying in, the nipples ought to be
  prepared, and made fit for their  office,  which is done  by
  placing over them little hollow shields, made out of an ex-
  cavated nutmeg,  or a thimble of wax  or elastic gum.  Du-
  ring the last  months, they ought to be washed every day
' with  French brandy (the best preservative against  excori-
  ation).  If they are very much sunk in, the milk-pump may
  be used for drawing them out.
    2.  The child must be applied to the breast twelve hours
  after delivery, partly to promote the secretion of milk and
                           44* 
522               •  FLUX OF MILK.
prevent metastases ; partly to accustom the infant to suck
before the  breasts grow too hard  and large.   I  advise
suckling of the child for the first fortnight, even when the
mother is not to be the nurse.   To do so is advantageous
both for mother and child ; for  the  mother,  because it is
the best mode of relieving  the  breast; for the  child, be-
cause the mother's milk is the most  appropriate  nutriment
of the first days.
  3. Now, two cases may present themselves : the mother
intends to suckle the infant herself.  In such a case, the
principal thing to be done, is, to apply the child frequently,
and in order to promote  and  increase subsequent  secre-
tion, she may drink largely of fennel-tea, beer, and soups;
and she may be permitted to take substantial food earlier
than one who is not to nurse.  Or she is not able, oris not
willing to suckle the child.  In this case, three things must
be done :  the lacteal secretion must be prevented, the milk
already in the breasts discussed  and removed by discharge
and derivation.  The means for  accomplishing these  ends,
are:  the  application of cotton fumigated  with burning
sugar and ambergris, gentle support  of the  breasts; when
the milk accumulates,  it must be evacuated by  drawing;
the diet must be meagre and watery, cathartics adminis-
tered,  and perspiration favored.  A remedy particularly
suitable for consuming and removing the milk is sulphate of
potasse (formerly termed arcanum duplicatum, No. 142, b.),
one or  two  drachms  daily, so  that it  produce several
stools.
  4. When   swellings,  pains,  indurations  of the  chest
followr, use warm emollient cataplasms ; to make milk flow,
embrocations, and application  of spermaceti and almond-
oil, frequent sucking and pumping out, warm fomentations,
and low diet.
  In soreness of the   nipples,  a most tormenting  evil,
French  brandy, cacao-butter, lime-ointment (No.   143),
cacao-butter  with zinc, powder of gum-arabic,  1  ounce,
and flores cassie,  1 scruple, spread  on  the part may be
used.
                    FLUX  OF  MILK.

                    Galactorrhea.

  Sometimes the lacteal secretion does not stop with the
cessation  of suckling, but  continues to  an  inordinate 
         WHITE SWELLING OF LYING-IN  WOMEN.        523

degree.  This  creates, besides its  inconvenience,  great
weakness, even tabes.
  The cause is either a too  protracted lactation, or a non-
return of menstruation.
  The remedies  are :   to restore the  catamenia, and  to
apply externally aromatic herbs, especially camphor, to the
chest and in the axille ; also carrot herb in the axille.
          WHITE  SWELLING OF LYING-IN WOMEN.

           Phlegmasia alba dolens puerperalis.

  Diagnosis.  A white, rapidly formed, large leuco-phleg-
matic, very painful swelling of the thigh, which sometimes
extends to the whole regions of the pelvis and genitals, at-
tended with febrile  motions.   It  happens within  the  first
fortnight after  delivery, and  lasts eight to fourteen days,
and when relief is tardy, terminates in death by gangrene
or lacteal abscesses.
  It is an  analogous disease  to  the  puerperal fever.  It
consists in  a  lymphatic infiltration into the cellular tissue
of the pelvis and thighs, the effect of an inflammatory state
of the venous and lymphatic vessels of the pelvis dependent
on pressure during  pregnancy.   It is  puerperal fever with-
out the peritoneum, as this one is phlegmasia alba within
the peritoneum.  The exciting causes may be the same as
those which  create puerperal fever ; a suppressed  lacteal
and lochial secretion, taking cold, mental affections,  gas-
tric accumulation.  Death is owing  to lymphatic  inflam-
mation  extending to the abdomen.
  The  treatment consists in removing inflammation  as
quickly as  possible, and promoting absorption.  The prin-
cipal remedies  are,  first :  the application of leeches to the
thighs and groins, embrocations of  mercurial  ointment,
vesicatories to  the thighs  kept in suppuration, cooling pur-
gatives (sulphate  of potassa), calomel, digitalis; externally
dry cataplasms  of discutient herbs ; in violent pains,  fomen-
tations  made of a decoction of  hyoscyamus with a little
saturnine water.  In  some cases, emetics repeated for a
few days, are an efficacious remedy. 
524
WHITES.
                         WHITES.

                Leucorrhaa, Fluor  Albus.

   Diagnosis.  Discharge of mucus from the vagina, of a
 white  yellowish, or  greenish color;  puslike,  thin  and
 watery, or thick, gelatinous ; mild (fluor albus benignus),
 or acrid and corrosive (fluor alb. malignus, acris).  It may
 be permanent, or only periodical before and after the men-
 struation.
   When this  discharge is protracted or copious,  but espe-
 cially when it is acrid, it is injurious to the whole economy,
 and causes a pale color, a hysteric state, and bad digestion.
 When we meet with the latter symptoms, we must suspect
 the existence of leucorrhea, and discover whether  such is
 the concealed cause.  It may end in a  lingering fever or
 tabes.   Particular attention must be paid to the possibility
 of a scirrhus of the womb being the cause as well as conse-
 quence of fluor albus.  This is to be feared, when the  pa-
 tient feels pungent pains shoot  through the pelvis, or boring
 violent pains and a fetid, sometimes a blood-colored dis-
 charge, already  exist or  subsequently appear.  In such a
 case,  or even when there is only a suspicion of scirrhus,
 exploration is indispensable.
   (Syphilitic  fluor  albus  is a symptom of syphilitic infec-
 tion, and belongs to the head of syphilis.)
   Whites is one of the most protracted diseases, and hardly
 admits of a cure.  It is most curable when it is a precursor
 of the first  catamenia (of puberty), or  a consequence  of
 suppressed  menstruation,  when it is  removed  by the  ap-
 pearance of the catamenia.   When it is hereditary, consti-
 tutional, or the effect of an unalterable mode of  living, or
 a symptom of every menstruation, it is least curable.
   Pathogenesis.   The proximate cause is, as in all profluvia:
 either local irritation, or a local weakness, frequently both
act simultaneously.
   The remote causes are: most frequently a sedentary
life, and eating largely of rich food, excess in warm drinks,
especially of tea, fat, and rich milk; therefore it is more
rarely met  with in an  active, industrious mode of living,
in poor, than in an idle  state of life.  Farther, moist cli-
 mate, damp dwelling  (hence more  frequent on  the sea-
coast) ; chronic suppression of perspiration, hence, may be
due to too  light dress; local debility from too  frequent
coition, parturition;  also  the bad  habit of sitting over 
WHITES.
525
warming-pans ; increased and  unsatisfied sexual instinct,
excited imagination, sentimental  erotic readings, mastur-
bation, young widowship,  syphilitic infection,  metastases
of all kinds, especially catarrhal, rheumatic, psoric, scrofu-
lous, anomalous hemorrhoids, mucous hemorrhoids of the
vagina, a vicarious secretion in suppression of menstrua-
tion,  accumulations and obstructions  in the  abdominal
viscera, worms, local stimuli, infarcts, polypus,  scirrhus of
the uterus, even ascarides.  A lax, leucophlegmatic, lym-
phatic constitution,  and watery blood, predispose  to  the
disorder.
   Therapeutics.  The leading  idea in the treatment must
be to consider the disease as a catarrhus vagine vel uteri,
and to act accordingly.  Hence,  it is evident, how  absurd
and injurious the usual routine  is:  to view  the evil as
merely local,  and  try to suppress the flux by merely topi-
cal means, such as injections and the like.   What would
be thought of a physician, who would treat coryza by mere
topical  means,  cold water and astringents'?  And what
wouldjbe the  consequence 1  Remove therefore, above all,
the causes.  Too  light dressing  and sedentary life come
first into consideration ; in such a case, warm clothing and
daily strong exercise are the principal remedies, and often
perform a  cure.   Farther,  gastric impurities, worms, abdo-
minal obstruction, scrofulous and other dyscrasies must be
 attended to ; physical and mental sexual stimuli must be
 shunned, tonics must be taken when general debility exists,
 and  the  menstruation be promoted.   Of particular value
 are purgative, strengthening visceral remedies, especially
 rhubarb° in  small doses, aloes,  bitter extracts, balsamic
 pills, guaiac with calomel and sulphuret of antimony.
 They are  alone sufficient to effect a cure in many cases.
   When the discharge continues after the causes have been
 removed,  or when none can  be found, and the disorder is
 merely owing to a local weakness, the direct, that is, the
 local treatment, may be commenced, beginning with internal
 specifics first, remedies which, by their particular affinity
 to the uterus, operate directly on it and on this  anomaly
 of its action.  Of that number are:  balsam  of copaiva,
 30 drops three  times a day on sugar, savin, rhubarb (one
 grain morning  and evening), with prepared oyster-shells,
 mastic, terra catechu, alum (No. 144), cinchona, ratanhy,
 elm-bark, herba lamii purp. (both in  decoction, one ounce
 daily), sulphate of iron, muriate of barytes, a long^continued
 use of  ferruginous  water in  small  doses  (a  glass  every
 morning), especially Pyrmont, Driburg, and Spa water. 
526
BARRENNESS.
  Combine with the use of these medicines, external ablu-
tions of cold water and lime-water, also tepid baths.  This
is sufficient in the majority of cases.   It is only when this
treatment proves abortive, that  there is reason to suspect
a high degree of local weakness, or organic disorder of the
uterus, and then it is time to have  recourse to more vigo-
rous local applications in the way of injections.  However,
even here a graduation must be observed.  Commence by
cleansing,  alterative,  gently  strengthening remedies, as
lime-water, decoction of elm-bark, cicuta with laurel-water,
calomel; after these, sulphate of zinc, corrosive sublimate
in solution ;  finally, Peruvian-bark,  oak-bark, alum, sul-
phate of iron,  nitrate  of silver.  Farther, fumigations of
balsamic substances, as mastic, benzoin,  storax1,  baths of
oak-bark, sulphate of  iron, or chalybeate balls; also sul-
phur, sea and ferruginous baths.
                      BARRENNESS.

                       Sterilitas.

  Pathogenesis.  As little as we know, and ever shall learn
of the mystery of procreation, so much is certain, that a
sufficient degree of vitality, of excitability, irritability and
productivity of the female organs of generation is  requi-
site.
  Besides the foregoing causes of sterility, there are the
following:
  1. Mechanical  obstructions, which  prevent the  sperm
from  penetrating in the womb,  atresia, callosities  and a
spasmodic contraction of the vagina.
  2. Disorders of menstruation ;  absence of it prevents
conception (sine menstruis nulla conceptio) ;  therefore the
viragines (manly women), who never have catamenia, are
barren.  Profuse menstruation annihilates and washes the
germ  away (of that class are  the  imperceptible abortions
which are renewed  every four weeks).
  3. Fluor albus, and concretions in the uterus.
  4. What is called " cold temperament ;" that is, a defi-
ciency of irritability,  plasticity, animal warmth, watery
blood, phlegmatic temperament, lack of susceptibility.
  5. Want of nourishment and grief may  have the same
effect; as also will  the reverse, a too ardent temperament,
excess of excitability and sensibility may prevent concep-
tion ; the same is true of the erethic spasmodic state, which 
BARRENNESS.                  527
makes the  excitement during  coition  degenerate  into
spasm, even into violent  pains (though  productiveness
may be so great  in some,  that  neither insensibility, nor
aversion, nor pain during coition,  can hinder conception;
of which I have seen instances).
  6. Too frequent or forced coition, which makes concep-
tion so rare  in prostitutes.
  7. Finally, organic disorders of the uterus, scirrhosities,
polypus,  and dyscrasies, particularly affecting this part, as
the  scrofulous and syphilitic, though conception  is fre-
quently  possible  even iu these states.  Barrenness  may
therefore be absolute, relative, and temporary.   A woman
may be barren during a prevailing sickness, mental dispo-
sition, distress ; not so at other  times; she may be  barren
with the  same man when the temperaments differ,  at one
time, not so at a  later period.  This is owing to the ac-
commodation of temperaments  by time, when one part is
too ardent in proportion to the other, which decreases by
years  and  is equalized.   We  have observed marriages
barren for ten years, and longer,  become prolific later in
life.—Even change of climate, travels can contribute  very
much towards fruitfulness.   Thus, women who are  barren
in the north, become mothers in the south.
   Therapeutics.  It is very important, though very difficult,
to examine and discriminate,  whether the fault of barren-
ness lies with man or with woman.
   The treatment of barrenness  itself, must first begin by
removing the remote causes, the mechanical impediments,
the  amenorrhea, fluor  albus,  dyscrasies, constitutional
disorders ;  the cold atonic weakened state mus* be reme-
died by  strong nutriments, tonics, excitants; the nervous
spasmodic state by antispasmodics ;  the plethoric, phlogis-
tic,  by a moderate diminution of the blood, by limiting the
frequency   of  coition,  and  doing  away  with  unnatural
stimuli.  After this, the uterine system must be attended
to, by respecting the indication,  to impart to the  genital
organs that degree  of excitability and plasticity which is re-
quisite for the procreation of a  new being ; in short, to clear
the  ground  and  render it apt  for  fructification.  When
stagnations and infarcts of the uterus exist, which is recog-
nized by the menstrua, before and after they appear, being
attended with pains and spasms, by the discharged  matter
being mucous, or mixed  with membranous  and other con-
crements, and the lower abdominal region being distended,
the  uterus must be freed and cleared from those  foreign
substances, for which resolvents, bitter extracts, asa fetida, 
528
BARRENNESS.
 galbanum,  aloes,  soda  (Carlsbad),  even calomel and
 visceral  clysters, and warm  soap and  sulphur  baths are
 recommendable;  most efficient  are Ems and Wiesbaden
 springs.
   The second indication is to arouse the specific  sexual ac-
 tion in the uterus.  This end  is best attained by iron and
 baths,  still  more  by thermal baths.   Iron  is undoubtedly
 the greatest remedy to create productiveness,  and to in-
 crease  the-plasticity of the blood.  Among the  springs,  I
 can praise  most Ems (renowned for his boy-well already
 since  ancient  times), and Pyrmont.  I have undeniable
 proofs of their efficacy.   The former is more  suitable to
 delicate nervous persons, and who labor under infarcts ; the
 latter more to very debilitated, atonic persons.
  Also, some secondary considerations may have an essen-
tial influence in this matter; the time when coition is per-
 formed, immediately after menstruation  has terminated,
 during  a joyful excitement, in the morning ; position du-
 ring coition in case of a faulty position of the uterus. 
DISEASES OF CHILDREN.
529
DISEASES OF  CHILDREN.
   This is a very important part of the practice of medi-
 cine ;  for one third of all diseases belong to the age of in-
 fancy, and they constitute a particular branch of the heal-
 ing art, that requires a  special study.  One may be a very
 good physician for adults,  but a very unsuccessful one in
 the treatment  of children ; for  the difference does not lie
 in  a diminution  of  the strength of the doses, but in a dif-
 ferent semiology, a  modified pathology requiring corres-
 ponding therapeutics ; the character is quite different, and
 ought to be understood.
   We, therefore, shall here treat of the diseases which oc-
 cur in infantile age, and of the peculiar character which
 this age  imparts to all diseases and to the whole practice
 of this period.

       Characteristics of Infancy and its Diseases.

   1. The essential  character of this  period of life is: an
 unfinished state  of  existence, a continual development of
 the yet incomplete economy.  The first months after birth,
 the first  year of life, may especially be considered as a con-
 tinuation of generation, one half of which has taken place
 within, the  other without the womb.  New organs form,
 those already existing progress, are perfected, or altered ;
 others disappear, entirely new  spheres  of existence  are
 opened, first the sphere of atmospheric life, then that of the
 senses,  and  finally the  intellectual world.—The  life  of a
 child  is therefore not yet a normal state, but an effort to
become so, a morbid state, a crisis, and must be considered
and treated as such by the physician. Many a phenomenon,
which  we might  consider a disease under other circum-
stances, is the  effect and symptom of a continued critical
operation of nature.
  2. The first great step of infantile life is a transition frc-m
a dependent parasitic existence into an independent one.
We cannot sufficiently admire the wisdom of nature, which
has ordained this gradual transition, requiring the child to
                           45 
530
DISEASES OF  CHILDREN.
remain, by suckling, an integral part of the mother for six
months or  a year, receiving from her vitality and  nutri-
tion.  This period of transition, founded on the laws of na-
ture, is of the highest importance, and exerts a decisive in-
fluence on the whole  term of future  life.   Want of it is
most unnatural, and cannot be made good by any  thing.
  3. The vital operations of infancy are more  active than
those of the adult.  The  circulation is more rapid, inter-
stitial exchange of material takes place quicker, consump-
tion and  restoration  are  greater;  hence diseases run
sooner into danger; but their crisis and convalescence are
also sooner attained.   Hence also a great need of restora-
tion by sleep, and the more so the younger the child.
  4. Irritability  and sensitiveness  are greater.  There is
an especial preponderance of sanguineous life and produc-
tiveness; hence a great inclination to nervous affections,
spasms and inflammations.
  5. Predominance of vegetative life and nutrition, growth,
increase, and formation.   Hence  the great  importance of
the digestive and assimilative functions, but particularly of
the lymphatic and glandular system ; hence the great dis-
position to diseases affecting these systems.
  6. Unequal  and disproportioned  size and development
of the  organs, hence unequal distribution of the blood and
humors. " Brain, liver,  and intestinal canal are particularly
pathogenetic parts.
  7. Importance of the  periods of development.  They
may create diseases (often in appearance only)  and remove
them ; especially the period of dentition,  growth, and the
7th year.
  8. The sympathies are  numerous and strong, especially
that of the stomach and intestinal canal with the brain, to
which alone often the existence of various disturbances
and maladies, even their fatal issue, are owing.
   9. Infantile age may be divided into three essentially dif-
ferent  periods:
  The first, from birth to  the end of dentition.  It is a real
continuation of generation, the time of development, the
most  imperfect, but at the same time the most creative,
hence it is the most mortal.  (The third part of all born die
in this period.)  However, it is a wonderfully restorative
period, and terminates at the great crisis of dentition, which
brings with it a new mental life.
   The second, extends from the commencement of denti-
tion to the seventh year  ; it is the termination of genera-
tion the equilibrium is more perfect, there is less suscep- 
DISEASES OF CHILDREN.
531
tibilitv of diseases and less mortality, but a great tendency
to inflammation, especially to croup and exsudatory inflam-
mation  of the  brain.  The  seventh year commences a re-
markable section.   Croup,  asthma acutum,  and hydroce-
phalus  rarely occur after this age.  In this period gene-
rally the 6th part  of all  born die,  so that the half of man-
kind die before attaining  the 14th year.
   The  third, from the 7th to the 14th  year,  is one of  the
healthiest and least fatal  periods of life.

                 Diagnostics in  Children.

   Diagnosis, on the whole, is difficult and is quite pecu-
liar. For on one hand, we have  not the aid of language or
reason; a child is unable to describe  its sensations; even
the pulse is an unsure sign, on account of the great pre-
valence of irritability.  On  the  other hand,  the diseases,
like the organism itself,  are less distinctly characterized
and defined.
   The  principal signs,are :
   The  pulse.   In  the first year it generally beats 90  times
in a minute ; so that it is only when the frequency is higher
we may presume fever.
   Temperature. Increased  warmth of the head and fore-
head, is a chief sign of fever.  The same is true
   Of thirst, heat in  the mouth.
   Want of appetite,  is  indicative of impurities in the first
ways, or of fever.
   The excretions,  especially by stool, their color, consist-
ence, frequency or deficiency; eructation, discharge of
winds,  vomiting,  odor of the breath ; state of the tongue ;
of the urine, its color  in  the first periods of infancy ; open
or dry  skin, eruptions.
   Co?idition of the abdomen, especially of the precordia and
hepatic region.
   Respiration, coughing,  rattling in the throat, hot breath, a
chief sign of internal inflammation.
   Crying.  The  only expression of the sensations, which
a child is capable of uttering; we must, however,  under-
stand it and know how to interpret it.  Much crying  and
restlessness indicate disagreable sensations; crying  and
drawing the legs towards the belly, pains in the abdomen ;
crying  and carrying the  hands to the mouth, pains of den-
tition ; crying in coughing,  pains in the chest.
   Altered voice, hoarseness.
   Impediment in suckling and swallowing. 
532              DISEASES  OF CHILDREN.
   Sleep, too little or too much, quiet or restless, with con-
vulsions and starting up, are in general indicative of ner-
vous affections.
               Therapeutics for Children,

   Must be founded on  the foregoing characteristics of in-
fantile age.   The leading principles are as follows :
   As the diseases  of children in the first periods of life
have generally an indefinite and  undefined  character, the
best course is to treat them according to the principles of
general pathology  and therapeutics.   The most  simple
treatment is  the best.
   In treating diseases of children, we must be all fear and
all hope : this is to say, we  must always  be prepared to
meet with the occurrence of sudden and dangerous acci-
dents ; but we must  not despair  even in the greatest dan-
ger, since the creative power  of the organism is so power-
ful at this age, and can  do wonders at restoration.
   A chief rule with us must be, not to do too much, not to
be too active, for fear of the extreme irritability and sensi-
tiveness. The practical rule :  "Not to do harm in attempt-
ing to do good," is nowhere of greater  importance.   The
greatest caution is particularly due to the doses ; the small-
est being the best.  " Little, very  little can do very much."
This applies  to diagnosis as well as to therapeutics.  Very
trifling causes may  produce  the most violent effects; as
something acid in the stomach, or winds may produce con-
vulsions.  Hence it  is  that the weakest remedies, seem-
ingly insignificant,  may produce  great effects; as magne-
sia, and phosphate of lime, which soothe convulsions.  In
short, nothing must be regarded as trifling in children.
   In the first period of life the attention of the physician
must always  be directed, first, to the prime  vie.   Acidity,
mucosity, overloading of the stomach,  winds,  accumula-
tion of feces in the bowels are the most frequent causes of
morbid attacks in the first years.  Therefore we must be-
gin with magnesia,  rhubarb,  fennel seed (vide No. 256),
and injections, as they give prompt relief in all accidents.
By using these remedies at the onset of a disorder, we may
prevent a most severe disease, which will often form if this
timely assistance  be neglected. Rhubarb is the chief reme-
dy for infants. It  does not only cleanse the first ways, but
promotes also, what is so important here, the secretions of
the liver and  kidneys, and is not  weakening as other pur-
gatives are, but, on the contrary,  it is possessed of a tonic
virtue. 
DISEASES OF  CHILDREN.              533
  Next, the nervous system must be appeased and spasms
prevented ; for which purpose nothing is needed but mag-
nesia, prepared chalk,  rad. peoniee, small doses of vale-
rian, and emollient injections (vide No. 257).
  Constant attention is  to be  paid to congestions to the
head, which  are  likely  to happen.  They are recognized
by heat of the head, redness of the face, a soporous or con-
vulsive  state.   Derivations by  the intestinal canal, injec-
tions, and  in an obstinate case one  or two leeches behind
the ears (in the first  year) are the best remedies.
  Be very cautious  in the use  of  debilitating  remedies,
especially of evacua*nts ;  for a fatal exhaustion is apt to fol-
low them in the first periou - of life.  This is especially true
of the administration  of stiong emetics and cathartics.
Even nitre is too debilitating for  the stomach of little
children.   The same applies to  the treatment of profuse
morbid evacuations ; try to moderate them promptly.
  Equally great precaution is needed in regard of excitant
and  all volatile remedies, which deeply affect the organ-
ism ; they  are  very  apt  to create dangerous  congestions
to the head.  This  is especially true of the use of opium,
which, as a rule, never ought to be given in the first periods
of life,  for it may readily bring on apoplexy.  This drug
ought not to  be used even subsequently, except in extreme
danger  of life ; as in diarrheas,  which cannot be stopped
by  any thing else, and  also then only in the most minute
doses, i of a drop of the tincture of opium  (1 drop tritu-
rated witha drachm and a half of sugar, and  divided into
6 parts) ;  -6V grain is sufficient;  or what  is better, let  it be
applied only  externally,  or by injections.—In general it is
better to abstain from all kinds of narcotics, or when given
let it be with the greatest caution ; for there is always rea-
son to fear, that, while the formative process is active, they
affect and  disturb this important act (especially  the orga-
nization of the nervous system), and become as it were in-
corporated with it, leaving consequences pernicious to life
ever after.
  The application of medicinal agents through the skin is
of great importance in children, for  in infancy the skin has
a high  nervous susceptibility as well as  absorptive power,
and  many  an injurious influence, as that of#opium on the
stomach and  intestinal canal, can thus be avoided.
  A child has less power to live on itself than an adult has.
It consumes quicker and  requires a constant supply. There-
fore children require more sleep, more frequent nutrition;
to withhold food for  a long time, even in diseases, is there-
                           45* 
534              DISEASES OF  CHILDREN.
fore not advisable.  Air is  particularly  wanted, and  the
greatest care must be taken to provide it  pure.
  Great consideration is due to sympathetic connections
and their effects in the economy ; for, at no time is nervous
sympathy as great as in  infantile age. This is important,
partly,  because it interprets the  phenomena and morbid
accidents, especially as the cause must often be sought for
in quite a different location, than that in  which the disease
is seated,  as  when the cause of the most violent cerebral
affections may reside  in the stomach; partly,  for  the
treatment, since the  great use of antistimuli and of the de-
rivative method in the diseases of children rest on this ob-
servation, as  when antistimuli are used by the skin and the
intestinal canal.  A merely  emollient injection, an emol-
lient poultice, and fomentations of milk on the abdomen or
feet often work wonders.  In this respect, we cannot suffi-
ciently  recommend emetics, not only as  evacuants, but as
the best antispasmodics,  and as efficient to remove morbid
sympathies between  the  stomach, the brain, and  the lungs.
There is little danger in  their administration ; for children
throw up easily, especially when we use the linctus emeti-
cus (vide  No. 258).
  Be always attentive to respiration and the voice, in or-
der to discover in time the commencement of croup.
  Finally, I  add a general  admonition.   Do  not  believe
every affection to be a malady. Many complaints are only
symptoms of development, and are peculiar to this import-
ant process, which is not to be interrupted but only rightly
guided.  In children of more than 2 years of age, who are
plethoric, well fed, and are good eaters,  but  especially in
such  as have a scrofulous disposition, the old maxim of our
predecessors is highly important, and I can bear testimony
to its utility : purge  every 4 weeks by a dose  of rhubarb or
infusion of senna.   In such  children an  abundance of un-
digested,  unassimilated,  excrementitious matter is formed,
and if not evacuated, gives  rise to many diseases, or at
least  obliges  nature to throw it off by cutaneous eruptions,
boils, etc.  These evils,  and even inflammations and con-
gestions to the head,  are prevented by such purgation, to
say nothing  of worms,  which are readily generated, and
require to be^lischarged. Even moral education is thereby
facilitated, for I have found children become more gentle
and flexible after such purifications.  The great influence
of  abdominal accumulations on the character is  a  well-
known truth. 
DISEASES OF CHILDREN.              535
                 Regimen for Children.

                  Physical Education.

  The fundamental principles musJAe :  As the life of the
child  in the first period is a contirrrred generation and de-
velopment, it is most important that these acts should not
be disturbed.  Regard the child therefore in the first six
months as a vegetative being, which prospers best in a state
of rest and sleep.
  Try to effect the development of all the systems and fa-
culties as uniformly and successively  as possible.   No im-
pediment, no  disturbance must be caused, nor premature
activity and development; especially the premature excite-
ment and development of the sensual  and mental faculties
is to be avoided.
  Try to accustom the child gradually to the external in-
fluences, even to the injurious ones, to which it will be ex-
posed during life.  This is the system of a reasonable har-
dening.  This purpose is  answered by daily washing the
whole body with cold water, which may be commenced as
early as the sixth week after birth, gradually changing the
water from tepid to cold.  It is the most effectual  remedy
to invigorate  the nervous and  cutaneous system, and  to
guard against nervous as well as catarrhal and rheumatic
complaints.  The same  applies to the daily enjoyment of
free air.
   In general, air and water, as they are the fundamental
elements of organic life, are also the  principal elements of
a reasonable  physical  education.  Daily washing of the
whole body,  a tepid*bath a few times a week, daily expo-
sure  to free and*pure air, and its admission  into the dwell-
ing, especially into the sleeping room, are chief requisites.
   Cleanliness is a main condition  of a good education.
Pure air, removing all pernicious exhalations from the nur-
sery, cleansing the body by washing  and bathing,  frequent
change of linen and bedclothes must therefore be observed.
   Sleep during  the first 6 months is a sacred sleep.  It is
the laboratory of ever creative and"formative nature.  The
infant must sleep that the plant may  prosper, and must in
no way be disturbed.  The younger the infant, the  more
sleep it requires, and it must be left to the instinct of the
child itself to shorten sleep.
   Food must be digestible, assimilative, nourishing, and ap-
propriate to the constitution  of  the child, and according 
536
DISEASES OF THE NEW-BORN, ETC.
 with its various periods.  It is, therefore, most proper in
 the first periods of life,  the  period  of transition from the
 parasite to solitary  existence, that it be prepared by an-
 other being,  and full of her vital power, a mother's or a
 nursVs  milk  drawn  from the  breast (the vital fountain);
 when this  cannot be h4h use boiled milk diluted with half
 the quantity of water.^^t is best to give nothing but  milk
 during the first year ;  after the first 6 weeks it may occa-
 sionally be thickened with  meal or biscuit,  administered
 first once, then  twice,  and  finally three times a day.   To
 feeble children weak broth may be given after the first six
 months ; animal food must not,  however, be much used be-
 fore the dentition, since it is apt to inflame the blood and
 to give rise to inflammatory accidents. No solid food pre-
 vious to completed dentition.   After this period up to the
 seventh year, milk every morning and evening, for dinner
 a little meat, with easily digestible greens, carrots, scorzo-
 nera-roots,  spinage,  mashed potatoes, fruit;  no fat, no
 cakes, no confectionary, no spices,  no coffee;  water and
 milk as  beverages, wine is not allowed.   It is incredible,
 what advantage it is, to  be accustomed to water-drinking.
 It is the surest means to preserve a good  stomach, which
 can  bear and  digest  every kind of aliments, and an unim-
 paired digestive power ; whereas on the contrary, prema-
 ture drinking of wine deprives us of this advantage by over-
 irritation, and weakens instead of strengthening.
  Finally, premature exertion of the mental faculties must
be avoided. The body must  first have acquired its energy
and  development, lest we disturb them and predispose to
nervous diseases, even to stupidity.
  It is also an important rule to lead  the attention of  the
children not too much to their physical condition, nor to
make them  anxious or careful of  it; but rather to accustom
them to disregard little evils, indisposition, and pains.
         DISEASES OF THE  NEW-BORN AND INFANTS.

  Transition from  the womb into the world of light and
air, from a parasitic existence into a solitary one,  is so
important and extraordinary a step, that we are rather as-
tonished at, and admire the wisdom of nature, seeino- that
so many  children perform it without  suffering, than that
some  become affected with disease and die in  the attempt.
  Form a correct idea of this transition and the state of a
new-born child.   Transition  into  an entirely new world • 
ASPHYXIA OF INFANTS.               537
exposure to influences entirely novel ; unusual stimuli and
potences, light, air, change of temperature, irritation of the
senses, clothing; further, instead of the hitherto dependent
existence,  a  solitary one takes place,  living on and con-
suming itself, digestion,  the preparation of the food, san-
guification, generation of its own warmth. Finally, an en-
tirely new circulation, new functions, as that of respira-
tion, the most important of all vital operations; secretions,
and excretions.
   Generally, nature  alone conquers and succeeds in equal-
izing this first step into life ; and wants nothing but a uni-
form  support of warmth, a mother's or a nurse's milk ; and
rhubarb, mixed with  a carminative (vide No.J259), in order
to evacuate in the first days  the mecony, continued until
the discharged matter ceases to be black.  By this practice
jaundice, bellyache, acrimonies, even more dangerous evils
are prevented.  When infants cry and draw their legs to
the belly,  indicative of abdominal pain, the infantile pow-
der and an injection of a decoction of chamomile and gruel
with a little oil gives the surest relief.
  The diseases which  occur in the first days after birth,
some  of which, as trismus and erys'ipelas, are highly apt to
endanger life ; others, as ophthalmia, threaten blindness j
are the following:
                        ASPHYXIA.

   The first accident which  endangers life on its very en-
trance is asphyxia.
   Diagnosis.  Cessation of circulation and respiration, and
motion.   It is often a continuance of the fetal state (hy-
datic life), a  failure of the commencement of atmospheri-
cal,  independent existence.
   General causes :  congenital debility, difficult parturition,
violence committed during labor (by the forceps), the um-
bilical cord wound round the neck, accumulation of mucus
in the throat,  too  rapid separation  from  the mother  (by
tying the navel string), too hot or  too cool surrounding
temperature.  The state may differ according to the causes
and so will the treatment.
   1.  Real debility,  vital debility.  Pallor,  absence  of any
sign of life.
   In such a case excitants; as a warm bath, insufflation of
air into the mouth and anus,  injections, cold water or wine
dropped  on the pit of the stomach and chest. 
538             ICTERUS.  EXC0RATI0NS.
  2. Plenitude  of blood  in the heart and brain ;—recog-
nized by a red bloated face ;—causes : lengthened parturi-
tion,  coiling of the navel string round the neck, tying it
too soon.
  In such a case blood (one or two spoonfuls) must be ab-
stracted from the umbilical cord.
  3. Suffocation,  mechanical impediment  to  breathing
made by mucus.  The child endeavors, but cannot cry,
there is hoarseness, and rattling is often heard in the throat.
  The only salvative is an emetic, after which come exci-
tants.
  The chief remedies in every asphyxia neonatorum are :
animal bath, which consists in the close application of the
child to its mother, warming  it on her bosom, and a proper
covering.
                       ICTERUS,

  Arises from .retention of the meconium in the intestines,
and of bile in the liver; the meconium having been ab-
sorbed into the blood, and from the unaccustomed impres-
sion of air on the skin.
  It is without danger, and generally passes away in a few
days.
  The best medicine for it is the linctus of rhubarb (vide
No. 259).
                     EXCORATIONS.

  Chafing between the  legs  and arms is a very common
accident to infants during the first weeks of their life.  It
usually yields to cleanliness, to frequent washing with fresh
water, and the  use of some drying powder continued for a
few days. Salves and greasy substances must be avoided ;
they are apt to cause ulceration ; topical repellent reme-
dies, as lead, which may produce fatal spasms, are also ob-
jectionable.  In  order to prevent adhesions, order the parts
to be  strewed with lycopodium.  Should  this simple treat-
ment  be of no avail, and the excoriations pass into ulcers,
becoming deeper  and phagedenic,  an internal dyscrasy,
scrofulous or syphilitic, is to be supposed, the latter either
in the child itself or in the nurse ; and cautious use of mer-
cury  is the only and the surest remedy ;  commence with
ethiops mineralis,  and if this do not take effect, give mer- 
        THRUSH.  OPHTHALMIA, BLEPHAROPHTHALMIA.    539

curius solubilis Hahnemanni, -,-V grain  a day, along with
magnesia.  In obstinate ulceration zinc-ointment is the best
external  application.   Sometimes  the  excoriation  of the
anus is of an aphthous character, and attends thrush in the
mouth.   This requires the treatment of aphthe.
                        THRUSH.

                   Aphtha  Infantum.

  Diagnosis.   Spongy  little ulcers in  the mouth, throat,
and anus (vide aphthe).
  They often appear during the suckling of infants, and ge-
nerally  in consequence of a neglect of cleanliness.   Fre-
quent washing of the mouth, and on the least appearance
of them, rubbing them  with fine pulverized sugar  prevents
and heals them best in  the commencement;  let also laxa-
tives be given.  When they increase, borax (vide No. 260)
will cure them.
            OPHTHALMIA, BLEPHAROPHTHALMIA.

  A redness of the eyelids with discharge, appearing im-
mediately after birth, or a few days later, but always with-
in the first eight days.   The phenomena increase in a few
days, especially the discharge of a yellowish-white puslike
matter.  The eyelids swell and are glued together by the
matter. The duration varies from 8 days to 3 weeks. The
issue, if proper assistance is not procured in time, is opa-
city of the cornea, suppuration, adhesion, and destruction
of the  eye.
   Causes : Too  bright light  in the first days after birth;
fluor albus of the mother, neglect of cleansing the eyes and
the whole body, dust, impure  air, too warm covering of the
face, meconium, congenital dyscrasy, scrofulous or syphi-
litic.
   Therapeutics.  Preservative treatment.  Keep the infants
away from too bright a light during the first days ; the eyes
must be carefully and frequently washed.   General clean-
liness and pure air; the meconium must be purged off.
   Curative treatment. The principal things to be done are :
constant and frequently repeated fomentation and washing
of the  eyes with tepid water  and milk,  or  elder tea, by
means of a  sponge or iag,  to prevent the accumulation of 
540
ERYSIPELAS, TRISMUS, ETC.
acrimony under the eyelids.   In the  same way a  weak
solution  of vitriol or lead may be frequently used ; in ob-
stinate cases a very weak solution of corrosive sublimate, a
collyrium of zinc and mercury on the eyelids.  Give at the
same  time internally pulvis puerorum as a laxative; and
should the complaint not yield, add  ft  grain of^alomel to
it, twice  a day.  Tepid baths.
                      ERYSIPELAS.

                Induratio Tela Cellulosa.

   Diagnosis.  Within the first 6 or 8 weeks, fever, thirst,
red spots appearing, first on the extremities, then on the
abdomen and genitals, with induration of the skin.  Some-
times the induration is unaccompanied with fever, heat,
redness, but rather with increased cold. The infant is un-
able to cry; utters only dull sounds, on account of the in-
duration of the  maxillary muscles.  Finally, the skin be-
comes as dry as wood.
  The duration  of the disease is 4, 7, or 14 days.   Death
ensues by gangrene or by suffocation.  Dissection shows
an effusion of yellowish lymphatic fluid in the cellular tis-
sue, swelling of the glands, of the lymphatic vessels, and
of the liver.
  Pathogenesis.  Taking cold,  neglected cleansing of the
intestinal canal,  impurity, dyscrasy of the mother.
   Therapeutics.  Cleansing of the prime vie by evacuants
and injections, warm baths, small doses of calomel; exter-
nally powder of bean-meal, elder flowers,  and roses.—As
soon as  the redness changes to livid, or spasm sets in, an
infusion of valerian, flores zinci, and musk, are to be ad-
ministered ;  externally fomentations of cinchona and arni-
ca are to be applied.
                  TRISMUS  ET  TETANUS.

  Diagnosis.   These  affections  happen only in the first
days of life.   The child cries, wants to suck, and is not
able ; the milk chokes it, and it is returned.  On  examina-
tion, the masticator muscles  are  found stiff, the  lower
maxilla cannot be depressed;  the jaws gradually  close,
the abdomen swells, the whole body stiffens, and an apo-
plectic death follows. 
ASTHMA THYMICUM.   SYPHILIS.           541
  Duration  is from two to four days.  The disease is.  in
most cases,  incurable; mortality is in proportion of one to
fifty-
  Pathogenesis. Vitiated milk, accumulation of meconium
confined vitiated  air,  local irritation, especially from the
navel-string being too closely tied, taking cold.
  Therapeutics.  An emetic and change of milk, injections
and warm baths  must immediately be resorted  to; inter-
nally, zinc (No. 261), and linctus (No. 262), is to be given.
I once succeeded in saving a child by these united means.
  The ointment, No. 263, is to  be  rubbed into the gums,
spine, and abdomen.   If this is unavailing, try injections,
with six drops of laudanum, every four hours, and frictions
of ointment of cantharides on the back and chest.
                   ASTHMA  THYMICUM.

  Diagnosis.   Attacks  of short whistling, imperfect in-
spiration ;  sometimes a complete stoppage of respiration ;
spasmodic  motions of  the  limbs,  cold extremities, red
face ; these symptoms last for some minutes and then pass
off, leaving the patient perfectly well and breathing freely.
Children are liable to this complaint from the first weeks
to the second year.   The attacks most commonly happen
at the time of awakening in the morning, or after excite-
ment and anger.  They may, though rarely, terminate  in
fatal  suffocation, but more  frequently they are free  from
danger, gradually decrease,  and finally cease entirely.
   The cause seems to be a too large and firm thymus, and
its tardy absorption, connected with great irritability and
sensibility of  the pectoral nerves.
   A  cure, therefore, can only take place by a gradual
diminution of this  gland, an operation which is  the  work
of nature.   Art can do nothing more  than  promote this
process by low diet  and frequent  purgatives; and, as a
palliative, diminish  the  spasmodic  action of  the pectoral
nerves and fits  of spasm.  This is best effected by phos-
phate of lime, valerian  (pulvis antispasmodics, No.  257),
small doses of zinc,  and, in more violent degrees, musk
and warm baths.

                        SYPHILIS.

   Diagnosis.  Ulcers or eruptions  which exist at the time
of birth, or come on a few  days after, the parents  being
evidently infected with syphilis.
                            46 
542                  DIARRHOZA.
   Therapeutics.  The treatment must be mercurial, but in
 the mildest forms and doses.   Aethiops mineralis, half or
 one grain a day, along with pulvis puerorum and baths, are
 generally sufficient; in obstinate cases, mercurius solubilis
 Hahnemanni or calomel is to be administered.  If a syphi-
 litic  mother  nurses the  child, she  is to undergo the same
treatment. Syphilitic ulcers in the  mouth of the child may
be moistened with a diluted solution of corrosive sublimate
and lime water (|  grain  of corrosive sublimate to  three
ounces of aqua calcis).
                      DIARRH03A,

  Is one of the most common accidents of this period.  It
may be attended with or without pains, which are recog-
nized by the child drawing its legs up to the abdomen.   It
is generally without any danger, is even salutary, and must
not be stopped. It becomes dangerous only when it causes
exhaustion by its copiousness and long  continuance,  or
when it is suddenly stopped.
  The most common cause in suckling infants is acidity in
the first ways, or taking cold;  when  older, irritation by
dentition,  overloading of the  stomach, also worms.   Fre-
quently returning diarrhea creates weakness of the diges-
tive organs, and thereby  a  disposition to its return.  The
worst cause is obstruction of the pancreatic and intestinal
glands (vide Atrophia).
  The  treatment depends altogether on the causes, which
are:
  1. Acidity.  Is recognized by green stools, having the ap-
pearance of chopped eggs, and the sour breath of the child.
Such a case is promptly remedied by magnesia, with rhu-
barb (pulvis puerorum), and, if this is ineffectual, by lapides
cancrorum (No 264).   When the bellyache is violent, an
injection  of chamomile tea, with gruel, and a teaspoonful
 of  oil  gives relief.   When the diarrhea ever and anon re-
 turns, the cause lies in the food, which inclines too much
 to  acidity.  If the  child is at the breast, the nurse must
 take  more exercise, eat  animal food, and  take the milk-
 powder (No. 265).   When this course will not do, change
 the nurse. Diarrhea is more  frequent in dry nursing, when
 faulty diet, acesceucy of the aliments, and using milk or
 gruel kept too long are the causes.  This must be carefully
 attended to.         , ,   ,   . .    T  .        .   , ,   ,
    2. Irritation caused by dentition.  It is recognized by the 
DIARRHCEA.
543
respective  signs (vide dentition), and the stools generally
being watery.   If the diarrhea be moderate, do not inter-
fere.  It is the best derivative from the head and preserva-
tive  against dangerous accidents,  as  spasms,  fever, &c,
and  saves the use of purgatives.   But when  it  becomes
violent, nothing else can be  done than to  moderate the
irritation ; for we cannot do away with the stimulus itself.
This end is usually attained by absorbents and mucilages,
as prepared chalk, or pulvis puerorum, in small doses; or
the antispasmodic  infantile powder (No. 257), salep, muci-
laginous injections.   But  if  it becomes so violent that
spasms set  in, then strong astringents are needed, the
surest of which is opium.  The greatest caution,  however,
must be observed in its use ;  and I cannot sufficiently in-
culcate prudence ;  for if the  dose is only a little too strong
or improperly prescribed, it will create a sudden stoppage,
which may be followed by instantaneous death,  in conse-
quence of apoplexy.  For, in the first place, this immoder-
ate diarrhea may  be the effect of the dental irritation, ac-
companied by too  great  a sanguineous congestion to the
brain,  to  which are also due the  concomitant  nervous
attacks.  It is, therefore, not owing to weakness.  It may
easily be conceived, that  opium, given in such a state, must
produce apoplexy.  This must be presumed to be the case
in a plethoric well-fed child, or when the head is hot and
the face flushed. The first thing to be done is to apply two
leeches behind the ears, after which the diarrhea will often
cease  of itself; or,  if that does not suffice, we may have
recourse, with safety, to laudanum.
   The  second case is when no signs  of congestion are
present. The child is not plethoric, but rather weakly and
ill-fed, and nervous  fits  set in.  It allows opium to be ad-
ministered immediately, but only in the most minute doses,
for a small dose is sufficient to attain the end sought, and
avoids  the injurious influence on  the brain.  It is to be
given as directed in No. 266.  Commence by giving one of
these powders (containing \ drop or -ft grain of opium), and
wait  for the  effect, which often suffices to  moderate
the  discharges; repeat it only when they  again become
frequent.   But if  the  first  dose takes no  effect, give a
second powder four hours after, and continue so until the
violence of the diarrhea is diminished,  when the use of it
is to be stopped,  or longer intervals made.   Give, at the
same time, an injection of starch, of salep, rice, or egg-
water ; and make an embrocation of the ointment, No. 267,
on the abdomen. In great weakness and continual diarrhea 
544
VOMITING.
the simultaneous use of extract of cascarilla (No. 268) is
an  excellent and really  a specific remedy.  Also warm
baths are of great use.
  3. Finally, merely a cold can be the cause,  owing  to
too light clothing, lying exposed during the night, leaving
the infant wet; causes into which the physician  must par-
ticularly inquire, since they are often totally disregarded.
In  such cases,  wrapping  the belly  in flannel, a warm
regimen, elder tea, and injections of starch generally are
sufficient for a cure.
  Does diarrhea become chronic with children,  or does it
return on the least occasion, the continued use of extract
of cascarilla is  the best  remedy; besides warm  baths,
covering the abdomen and back with flannel, embrocations
of the strengthening ointment, in both regions, warm baths
with chamomile, strict animal diet.  In  children of more
advanced age, acorn coffee is also recommendable.
  One cause more  of diarrhea remains to be mentioned,
which sometimes occurs  in children,  and calls for our at-
tention.   Softening of the  membrane   of  the  stomach,
which may increase to perforation.  Its signs are :  sudden
appearance, rapid decay  of the countenance, and  quick
emaciation,  discharge  of mucous water, sometimes also
vomiting of acid-smelling matters, of food, frequent whim-
pering,  inflation of  the epigastric region, coma ;  pulse ex-
tremely quick and small, much thirst. The best treatment
is,  application of two  or three leeches to  the epigastric
region,  warm  fomentations of a decoction  of balm-mint,
elder-flowers on it, tepid baths twice every day: internally
a teaspoonful of a mixture of  aqua chlorin. in  six  ounces
of water, with mucilage of gum arabic,  to be taken every
two hours,  mucilaginous injections, milk as a beverage ;
cold fomentations on the head.
                       VOMITING.

                       Vomitus.

  The principal rule here is also: Vomitus vomitu curatur.
In most cases the vomiting of children is  nothing but a
salutary attempt of Nature, to rid herself of injurious mat-
ters  contained  in the  stomach.  It  is, therefore, best to
promote vomiting, so as to attain that end.  In little deli-
cate infants, frequent drinking of chamomile tea,  and a
teaspoonful  of oxymel scilliticum is sufficient,   In more 
         NERVOUS  ATTACKS, SPASMS,  CONVULSIONS.      545

grown infants, a  teaspoonful  of the linctus  emeticus.
After vomiting a few times, follow up the treatment with
rhubarb or pulvis puerorum, which will appease the throw-
ing up and evacuate the remaining impurities by the intes-
tinal canal;  at the same time give mucilaginous beverages,
and when the vomiting is violent and  the bowels  consti-
pated, a mucilaginous injection.
  But never forget that vomiting may have important and
remote causes.   The  following cases deserve  attention.
If vomiting  is attended with  fever, the epigastric  region
distended, and painful on the pressure, causing the child to
cry, an inflammatory state of the stomach is to be feared;
for which the application of some leeches to that region,
and the use of mucilaginous beverages and gentle  purga-
tives are required.  When fever is present with sopor and
costiveness, vomiting  is sympathetic of  an  inflammatory
state of the brain, which must be removed. Does it return
chronically, it may point to a chronic affection of the head,
or softening of  the stomach, also to worms.
         NERVOUS  ATTACKS, SPASMS,  CONVULSIONS.

                       Eclampsia.

   In all spasms and convulsions of infants we are to look
particularly to the cause.  It lies most frequently in the
stomach and intestinal  canal. Acidity in  sucklings, over-
loading, sordes, worms, constipation of the bowels,  even
mere accumulation of winds may produce them.  In such
cases, cathartics, injections,  absorbents (magnesia, lapid.
cancror.), also the very efficacious antispasmodic infantile
powder (No.  257), and carminatives are  the best means
of relief; vomits, when  they are indicated.  I have seen in
the most violent and continuous convulsions, with sopor ap-
parently apoplectic, after all antispasmodics had been used,
and when it was ascertained that an overloading of the
stomach had preceded, one single emetic immediately and
completely remove spasm and sopor, and restore  perfect
health.—At  a later period, the irritation of dentition may
be the  cause (vide dentition).  In this and also in other
cases, not seldom occurring, spasms are owing to sanguine-
ous congestion or  inflammatory  affections of the brain,
which are recognized by the  redness of the face, heat of
the  head and forehead, and a  soporous state  (vide hy-
drencephalon acutum).   Such a case calls for the applica*
                          46* 
546                     FEVERS.
tion of a few leeches on the temples and behind the ears,
and for purgatives and  injections.   When signs of conges-
tion are absent,  in  weakly, nervous subjects, when the
spasms continue, after the removal of the gastric  causes,
the use  of direct antispasmodics is needed, of which the
animal earths, flor. zinci, valerian, clysters, antispasmodic
embrocations, and tepid baths are the principal ones to be
mentioned.
  Be cautious in using stronger  excitants,  for they are
likely to create over-irritation and  apoplexy.   Only in ex-
treme  cases  resort to musk and opium; the latter is best
used in injections, and in minute doses.
                        FEVERS.

                        Febres.

  Diagnosis.  Thirst, heat in the mouth, hot  breath, hot
forehead, accelerated pulse.  These signs suffice ; for the
pulse is fallacious in children.
  Pathogenesis.  The causes are usually a gastric, a catar-
rhal, or a dental irritation ; therefore, in  slight cases, no-
thing more  need be done than to give a few doses of the
infantile powder, and  to  confine the child to the room.
Should this  treatment fail, distinguish the different species
of fever.

      1. Gastric Fever,  the most common  in children.

  Diagnosis.  Want of appetite, nausea,  eructations, bad
breath,  furred  tongue; also  spontaneous  vomiting ;   fre-
quently there is rattling  in the  throat, and oppression of
the  chest.   Sometimes slight  convulsions, particularly,
starting up during sleep.
  Therapeutics.  Commence  by  giving the linctus  eme-
ticus, until three rejections have been effected  (in case of
constipation an injection must be previously administered),
then injections and a purgative, antiphlogistic linctus, No.
269.  No broth, no eggs.
  In all fevers  of  children, when they are accompanied
with an aversion of food, I advise the linctus emeticus, at
the commencement. It will frequently annihilate the  fever
at its very  origin;   it will give to the disease  and subse-
quent treatment a more favorable turn, even if the fever be
premonitory of an exanthema. 
FEVERS.
547
          2. Cold in the head, Catarrhal Fever.

  Sneezing, discharge  from the nose  and eyes, cough,
hoarseness; in infants there is commonly a rattling in the
throat, because they cannot throw up the phlegm.
  In this fever also it is best to commence the treatment by
the linctus emeticus, partly in order to evacuate the gastric
irritants  which are  generally present,  partly to free  the
lungs from  phlegm, partly to prevent croup.   After this,
an antiphlogistic diaphoretic linctus  (No.  270), gruel with
sugar-candy, and occasionally light elder-tea.

                 3. Fever from Teething.

   Fever with  all the signs of dentition  (vide below).

   4. Worm Fever (in children of more advanced age).
  Fever with verminous symptoms,  especially bellyache ;
a distended  but not  hard abdomen.
  Antiphlogistic treatment, joined to the palliative method
of cure of worms, especially milk taken internally, and by
injections ;  oily remedies, mercurial water ; calomel (vide
helminthiasis).

    5.  Inflammatory Fever, Pectoral Fever,  Brain Fever.

  An inflammatory local affection of a noble viscus, espe-
cially  of the lungs  (pectoral fever), and  of the  head (brain
fever).  The first is recognized by a short rattling respira-
tion, with a constant  irritation, producing coughing ;  and
constant crying (evidently caused by pains) :  the latter by
a soporous  state, and occasional convulsions.  Local in-
flammation may also be generated in  the abdominal viscera,
especially in the liver, which is  recognized by distention
of  the abdomen, heat at the part affected, and the expres-
sion of pain or pressure.  The before-mentioned linctus,
mixed with  half a drachm of nitre ; the application of some
leeches on  the chest, head, or abdomen  ; small doses of
calomel;  injections ; when sopor continues  (hydrocepha-
lus acutus),  cold  fomentations on the head are of use. In
pulmonary inflammation, when the above-named remedies
are unavailing, and the rattling threatens to suffocate the
child,  the linctus emeticus, sulphur antimonii aurat. in
small doses, triturated with sugar, may  be resorted to.
  In abdominal inflammations apply, besides leeches and
general antiphlogistics, fomentations of  warm milk  and
tepid baths. 
548
DIFFICULT TEETHING.
  But even in the apparently cerebral and pectoral affec-
tions  of children, I cannot too strongly recommend atten-
tion to the probable existence of a gastric source.  I have
seen children lay for days in a soporous state, and all anti-
phlogistic remedies proving useless, when, finally, a single
emetic has removed the whole disease.  It was ascertained
that a mere surcharge of the stomach with indigestible food
was the sole cause of sopor and cerebral affections.

6.  Exanthematic Fevers  (see Variole, Morbilli, Scarlatina).

  They hardly admit of recognition in the first stage ; and
it is best  to  treat them according to general rules, and,
particularly,  not to  neglect  cleansing  of  the  intestinal
canal and  the stomach by emetics.
                   DIFFICULT TEETHING.

                    Dentitio difficilis.

   Dentition, by itself, is  not a disease, but belongs to the
 natural developments, as birth does.   But, as parturition
 by accidental and accessory causes may bring on maladies
 and danger to life, so may dentition. Thus it becomes one
 of the most frequent causes of the diseases of children, to
 which the physician cannot too earnestly direct his atten-
 tion.
   Diagnosis.  The  period of life  (from the fifth to the
 twelfth or fourteenth month), the  infant salivates much ;
 constantly carries things  to  its mouth,  on which it  may
 bite ; the mouth is hot, likes to have it touched ; frequently
 laments and cries; the gums are swollen.
   At the  same  time the following concomitant symptoms
 appear : most frequently there is diarrhea ; in some there
 is costiveness ; fever, cutaneous eruption, heat of the head,
 coughing, rattling in the throat,  difficulty of breathing,
 spasms, convulsions, local inflammations, especially of the
 brain and of the lungs.   The accidents cease and return
 periodically ; cease entirely when the tooth has pierced the
 gum, but  when  the  tooth has  not  pierced,  they become
 more violent, and end fatally by convulsions, apoplexy, and
 suffocation.
   The most favorable symptom is diarrhea.  It serves as
a natural  derivative, and  prevents fever, spasm,  cerebral
affections, and all other dangerous accidents. 
DIFFICULT TEETHING.               549
  Course.  Dentition commences about the fifth month, by
an internal  development  at first,  which  is imperceptible
externally.  The tooth grows in all its dimensions, creating
irritation  by  its pressure  within the maxilla.  This is
generally  made known only by increase of the  salivary se-
cretion ;  but it  also frequently excites very  violent con-
sensual accidents.  Next  comes the cutting through of the
teeth; the  incisors appear first,  then the first grinders,
afterwards  the  eye-teeth (dentes  canini).   This process
generally commences  at the  seventh up to  the  twelfth
month, in rare cases earlier, even before birth.  Tardy den-
tition is always  better than too early.
   Pathogenesis.   It is not only the cutting of the teeth, but
the acquisition  of  language, and  its  associate reason, the
first appearance of mental existence,—the greatest revolu-
tion in life,—which are the causes that render  this  period
so  important and dangerous,  and give particularly  rise to
great congestion to the brain.
   The effects of dental irritation  are double,—local and
consensual.   The  local  effects are:  inflammation, swel-
ling, pains, salivation, trismus, even sometimes suppuration
and gangrene.   The sympathetic effects are: first and
most frequently, irritation of the intestinal canal; diarrhea,
even discharge  of  blood (teething dysentry), sometimes
obstruction—ileus ;  irritation  of  the vascular system,—
fever; irritation of the skin,—eruptions; irritation of the
chest —cough,  accumulation of phlegm, rattling; of the
 mucous membranes,—ophthalmia, otorrhea ;  of the nerv-
ous system,—spasms, affections of the brain.
   The accessory causes, which render  this  development
 difficult and make  dentition a disease, are : the form of the
piercing tooth ; the eye-teeth, therefore, give most trouble,
 since  they  are pointed and increase conically  in thickness,
first break  and  then keep continually stretching ; too large
a number of teeth cutting at once, which may be particu-
larly  accelerated  by  fevers, as  by  exanthematic  fevers
 (measles and small-pox may thereby terminate fatally) ; the
 complication  of other diseases; and, finally,  the  constitu-
 tion, the  individual as  well as  the general  (scrofulous,
 rachitic nervous constitution renders dentition difficult;.
 Difficult  dentition may,  therefore, prevail even epidemic-

 a Therapeutics.   The irritative, the exciting cause  the cut-
 tin^ tooth, cannot of course be done away with.  I heretore,
 nothing  can be done but appease the effects  of the irrita-
 tion _the  spasms, congestion, and thereby prevent danger. 
550
CUTANEOUS ACRIMONY, ETC.
The  principal means for accomplishing this end is deriva-
tion by the intestinal canal (a remedy which Nature herself
indicates by diarrhea) by gentle laxatives and injections.
In congestions to the head, one or two leeches on the head ;
in nervous irritation, spasms—flores zinci, valerian; when
they appear very intense—musk, tepid baths, antispasmo-
dic injections ; locally, means which soften and wear away
the gums,  as  by  chewing marshmallovv root and similar
substances.  In an extreme case, when the point of the
tooth is still retained by a tender skin, cutting of the gum
may be  resorted to, but not  too  early, since  this  might
rather prevent than promote its breaking through.
  CUTANEOUS ACRIMONY, BILES, CRUSTA LACTEA, SCALDHEAD.

  These disorders occur frequently in children.  Often they
are owing  merely to abundant, especially too nutritious
(animal) food, to plethora, or to injurious acrid and irrita-
tive  aliments.   They may also be  caused  by neglect of
cleanliness,  by corrupt,  moist  air, too warm  regimen.
They may, however,  also be a symptom of a scrofulous
diathesis.
  In common cases nothing is wanted for a cure but regu-
lation of diet, diminution of food, avoiding all fat, acrid,
salted,  heating meals, living on vegetables;  cleanliness,
frequent change of linen and air ; tepid bran baths, the use
of rhubarb and magnesia, or pulvis puerorum, along with
infusion of pansy,  continued  for  some time.   If the
complaint does not yield, add a few grains  of aethiops
mineralis  (£■ grain  for each year  of  the child's age);  it
generally suffices. The doses of the powder must be made
so as to purge several  times  a day.  In very obstinate
cases add (instead  of aethiops) Plummer's powder (calo-
mel, sulph. antim. aurat. 3 or £ grain of each every twenty-
four hours), and  sassafras-tea (No  271). When the dis-
order is of a scrofulous nature, which is  recognized by the
symptoms of scrofula, especially by glandular swellings on
the  neck  co-existing, the treatment  of scrofula must be
pursued (vide  Scrophulosis).
  The  same treatment is the best  for  crusta lactea and
scaldhead.  In the first case, when it is obstinate, the nurse
must be changed.  In tinea capitis the hair must be cut,
but not  too short, and frequently combed and washed with
tepid soapwater.
  The use of external topical remedies is in general wrong, 
croup.                     551
for they are apt to produce a retrocession and metastasis
of the acrimony to noble parts; while the use of the above
remedies is sufficient in most cases (vide Tinea).
  In obstinate cutaneous diseases of children at the breast,
the case must always be investigated, to know whether it
be  not owing to  a concealed syphilitic dyscrasy of the
nurse.
                        CROUP.

 Angina polyposa, membranacea, Laryngitis exsudatoria.

  Diagnosis.  Hoarseness,  short, difficult respiration, ac-
companied by a whizzing, or whistling,  or rattling sound,
cough with hoarse, whistling, croaking, barking tone; when
the oppression of the chest increases, the child makes at-
tempt to stretch the throat and  extend it upwards (not to
shorten it by bowing forwards, as in pulmonary inflamma-
tion) ; violent fever ; in bad'cases—sopor.
  A prompt diagnosis is momentous on account of the
great danger and rapid fatality of this disease.   There are
two diseases, with which it may  be confounded:—the first
is a violent catarrh of the throat.  There are  some kinds
of this catarrh, in which hoarseness and a barking cough
(the so called  sheep cough) are present.—The second is
the asthma  acutum Millari.  To confound croup with this
affection  is the more dangerous, since it calls for quite a
different treatment, antispasmodic remedies, musk, asa fe-
tida ; croup on  the  contrary  for antiphlogistics and  ab-
stractions of blood.   They are distinguished by this: that
asthma sets in  all of a sudden, croup appears always after
catarrhal symptoms have  preceded; the croup is always
attended with fever, and usually  a very violent  one ; the at-
tacks of asthma, as of a spasmodic disease, are periodically
violent or weak, even cease entirely for hours; the symp-
toms of croup are always present with equal intensity, and
in croup the urine is feverish, inflammatory, red; in asthma
spasmodic and pale.                                  #
   Its course is very  rapid.  The disease terminates within
two, three,  at most six days.  Death ensues by suffocation
or by apoplexy, sometimes even after respiration has be-
come free,  in consequence of congestion and paralysis of
the brain thereby  created.
   Pathogenesis.  The proximate cause is  inflammation of
the mucous membrane  of the larynx,  with the peculiarity 
552
CROUP.
of coagulable lymph being extremely rapidly effused, thick-
ening °the membranes, and forming polypous concretions,
which straiten, even mechanically close up the trachea.
   The predisposing causes are :  the infantile age up to the
7th year, on account of the great plasticity at that time of
life ; farther, a too nutritious and heating diet, animal food
and wine, therefore it occurs now-a-days more frequently,
on account of this unreasonable but fashionable change.
   Exciting causes : Influence of cold,  east and north-east
air blowing  into the open mouth, catarrh.
   Therapeutics.  The  inflammation must be resolved as
promptly as possible,  and the thickened lymph or  new-
formed tissue be  discussed  and dislodged.   Assistance
must be prompt, and remedies administered with all haste.
The treatment,  therefore,  consists  in  using  the  linctus
emeticus and warm vapors, as  soon as the characteristic
symptoms of the disease appear ; and, if this be of no avail,
in applying leeches to the throat, 1 to 3 for children of
less than one year of age, 4 for those of two years, increas-
ing the number in proportion to  the years  (12 leeches
kill a child of six months ; of this I have seen an instance) ;
and administering a dose of calomel, in infants £ grain, in
more grown children up to 2 grains ; intermediately a linc-
tus containing nitre,  and inhalations of warm vapors  (of
elder flowers steeped in water) and injections with a table-
spoonful of  vinegar, in order to effect a proper discharge
from the intestines, which  is here highly useful, even in-
dispensable to salvation.  If no improvement follows with-
in 24 hours,  give sulphurate of copper, a most efficacious
remedy for removing the spasmodic state, which keeps up
the disorder.  It may  be triturated with sugar and admin-
istered with water or  in a linctus,  first  in  such  doses as
to create vomiting (1 to 4 grains according to the age), then
■J- of a grain  every 2 hours; when the  suffocative  fits  re-
turn, resort again to the former dose,  which creates vom-
iting, and cause mercurial ointment to  be  rubbed  on the
neck, and sinapisms and vesicatories on the throat. When
rattling continues, a vomit is the best remedy to clear the
larynx from  the formed concretions. Sulphurous remedies
are likewise serviceable.  Give musk when weakness and
spasm increase.  If, as sometimes happens, sopor and con-
gestion to the head remain,  in  consequence of the loner
strangulation,  leeches must again  be  applied to the neck
and the  temples.  If all these  remedies fail,  a paralytic
state must be supposed, then cold lotions to the head, and
even affusions have yet proved useful. 
Millar's asthma.
553
  Be, however, careful not to take every hoarseness, at-
tended with a barking cough, for an  incipient croup,  as
is now too frequently the case, and to proceed immediately
to this harsh treatment. Administer the linctus emeticus.
I have often  seen all the symptoms of apparent or begin-
ning croup entirely disappear after a strong vomit.  Such
a catarrhal state  may  be the  beginning of croup, which I
have often removed by an emetic seasonably administered.
The same applies to the uncertainty, whether we have  to
do with croup or a spasmodic asthma.   Also here an eme-
tic is the best means, and is suitable to all cases.


                   Millar's  asthma.

               Asthma acutum infantile.   ■

  Diagnosis.   Sudden  attack of short breath, usually at
night; the respiration is gasping, whistling, approaching to
suffocation; attended  with great anxiety; barking cough,
in the tone of a large  dog;  no fever; after 6 or 8 hours
the symptoms entirely  cease; the  child feels well during
the day ; in the next night the same accidents return with
still more violence, again entirely cease, and so on.   Death
generally  ensues  by suffocation on the third day.   Some-
times it finally becomes permanent. It may be easily con-
founded with angina membranacea; which is a dangerous
mistake, for this is an inflammatory, the asthma a spasmo-
dic disease, and each must be treated differently.
  The discriminative  signs  are : In asthma there is a re-
mission, even intermission of the dyspnea; in angina it
continues permanently; in asthma there is no fever,  in
croup  inflammatory  fever; in asthma pale, in croup red
urine ; it attacks only children from 2 up to 8 years of age.
  Pathogenesis.  Causes:  Taking cold,  damp air,  and
moist dwelling.
  Therapeutics.  The only indication is to remove most vi-
gorously and promptly the  spasm.   Commence with  an
emetic, then  give asa fetida  internally (vide No. 272) and
in injections,  musk in large doses, antispasmodic embroca-
tions to the chest, abdomen and spine, sinapisms and can-
tharides on the chest.
47 
554
hydrocephalus.
    HYDROCEPHALUS ACUTUS.   ENCEPHALITIS EXSUDATORIA.
   HYDROCEPHALUS  chronicus.  hydrocephalus exterhus.

           Actkte  and Chronic Hydrocephalus.

                      spina bifida.

                 Hydrocephalus Acutus.

   Diagnosis. The precursors are the most important. They
are: the fontanel  remaining too long open, a head of dis-
proportioned size (too large), especially the forehead;  un-
usual vivacity and prematurity of mind ;  or stupidity, dul-
ness of the mental faculties,  great drowsiness;  or falling
asleep amid  play,  dilated pupil, squinting,  very frequent
falling down,  want of strength of the feet,  frequent head-
ache, lying on the  belly and forehead during sleep.
   Signs  of  the  formed disease :—It  may be divided into
two  stages, stadium irritativum  and paralyticum.   In  the
first stage sopor and convulsions occasionally, sometimes
even violent epileptic spasms, vomiting, especially  in an
upright position of the head, obstructio alvi, inclination to
lean the  head, falling of the head forward or sideways, a
peculiar staring and at the same time squinting look of the
eye, with trembling of the pupil.  The pulse is  very une-
qual, sometimes frequent, at other times slow.
   In the second paralytic  stage:  deep sopor, not  to be
awakened,  paralysis  of single  limbs,  finally apoplectic
death.
   The diagnosis is sometimes difficult at the commence-
ment.  The disease admits a possibility of being confound-
ed with worm fever and dental affections.  The  most  im-
portant distinctive  sign is vomiting and constipation of  the
bowels, which are not  present  in other affections of  the
head.
   The disease lasts 8  to 21  days.  It is met with  most fre-
quently from the 1st to the 7th year, more frequently since
thirty years past than  formerly.
   It  may be primary or secondary, as a consequence of
another disease, especially  of a febris acuta or of another
internal inflammation.
   Dissection  shows accumulation of blood in the cerebral
vessels and serous effusion in the cavities of the brain and
spinal marrow. 
HYDROCEPHALUS.                 555
  Pathogenesis.  The causes are: Congenital disposition,
children with an unusual large head, with congenital weak-
ness of the brain ;  there are families, in which all the chil-
dren become affected with hydrocephalus (sometimes only
those of one sex,  sometimes at  a certain period of life),
scrofulous disposition,  all that  can keep up a permanent
congestion to the brain or exaltation of imagination, wine,
spiced diet for children, dentition. Thus every acute fever,
every cerebral inflammation may pass  into this disease ; a
stroke, a fall on the head  (also the influence of the sun-
beams on the bare head during the summer, the influence
of rigid  cold in the winter, particularly the sudden omis-
sion of warm covering of the head ; likewise cutting the
hair short in winter can give rise to the malady).  Metas-
tases to  the brain, especially scrofulous and psoric (a ra-
pidly suppressed  scaldhead or  otorrhea, and the  like).
Thus the modern fashion of leaving  the  head bare and
wearing  the hair  short in children, which, no doubt,  has
diminished  the frequency of scaldhead, may  have given
occasion  to1 the more frequent formation of this disease,
even by  preventing  the  scrofulous acrimony,  formerly
created by  warm caps, to  deposite on the  skin as tinea
capitis.
   Therapeutics.  In  acute hydrocephalus an inflammatory,
at least a congestive state of the brain must generally be
suspected,  the speedy removal  of which best prevents ex-
sudation.   Therefore, leeches are to be applied behind the
ears and on the temples,  and calomel,  i to 1 grain, accord-
ing to the difference of age, is to be administered every 2
 or 3 hours, irritant injections, particularly with an addi-
 tion of vinegar,  are to be given, so that three or four dis-
 charges  from the bowels be produced.  This discharge is
 indispensable, and if calomel alone is insufficient, jalap must
 be added;  the  hair must be shaved off, and cold fomenta-
 tions or bladders  filled with ice applied to the head; small
doses of digitalis  to be given, and sinapisms to the soles of
the  feet; in infants, the feet are to be  enveloped in a cloth
wetted with decoction of mustard. This often suffices for a
cure, which is recognized by cessation of the sopor and con-
vulsions.—But, should the sopor continue,  as well as the
.redness of the face and the heat of the forehead, applica-
tion of leeches and affusions of the head with cold water
are the  only salvatives.   The leeches are to be repeated
 every 2 hours, the intervals shortened and the water poured
 down from a greater height, until the child manifests a re-
 turn of sensation by crying.  Then  the frequency of the 
556                HYDROCEPHALUS.
 applications may be  gradually  decreased.   In obstinate
 sopor a vesicatory applied to the neck is of extraordinary
 efficacy,  likewise the concomitant use of diuretics, as di-
 gitalis, oxymel scilliticum, decoction of rad. levistic, ni-
 trous ether.
   The disease is apt, especially in scrofulous individuals,
 to leave a disposition to recidives, for which the best pre-
 servative is a fontanel on the arms, cold washing and affu-
 sion of the head every morning and evening, and a cathar-
 tic of calomel and jalap every fortnight; the efficiency of
 which experience has confirmed to me in several cases.
  In chronic hydrocephalus the same treatment, only less
 active, but continued for a longer time, must be followed.
Also fomentations of the head with acetum scille, mercu-
rial  inunctions in the neck, artificial ulcers on the neck
kept in copious suppuration, may here be of use ; but above
 all, the remote cause, as scrofula or psora, is to be attend-
 ed to.
   Other  organic diseases  of the  brain, as  hypertrophia,
 hydatides, tubercles, indurations, suppurations, softenings,
 hardly admit of diagnosis, and still less of a cure.  The signs
 distinguishing them from hydrocephalus  are,  that  sopor
 is absent,  or at least  happens only periodically in those dis-
 eases, whilst the other symptoms resemble those of dropsy.
 The treatment is the same as that stated under hydrops,
 which is frequently associated here.  Softening of the brain
 is remarkable for this, that the children are able to walk
 about until the last moment; it is  only indicated by  weak-
 ness of the extremities,  weakness of memory and other in-
 tellectual  faculties,  sudden attacks of  violent  headache,
 sometimes also transient spasms, and a nervous apoplectic
 fit suddenly terminates life.

                Hydrocephalus Externus.

   Accumulation of water between the brain  and the cere-
 bral membranes—is generally a congenital  disease.  The
 fontanels will not close at all, but rather dilate more and
 more with the increasing distention and attenuation  of the
 cranial  bones and enlargement of the whole head, which
 may become enormous; in the fontanels an  elastic disten-
 tion with  fluctuation is perceived.   A child may live in
 this state to  its 14th or 18th year, whilst its organic life
 is otherwise progressing, even growth and development are
 undisturbed.  A cure is rarely possible, and may only suc-
 ceed in the first years of life.  The treatment consists in a 
DECAY OF CHILDREN.
557
vigorous application of mercurials, drastic purgatives, diu-
retics, artificial ulcers, daily cold affusions of the head, fo-
mentations of the head with acetum scilliticum, also a gra-
dual and moderate compression by agglutinative plasters.
Even a cautious puncture with needles occasionally per-
formed, followed by immediate compression has sometimes
proved useful.
  Spina bifida, hydror-rhachitis  is the same disease  oc-
cupying the lower part of the  spine, and exhibits an elastic
tumor appearing through a cleft  of the vertebral column.
It is incurable ; cautious acupuncture repeated from time to
time combined with compression,  may be tried; the issue
has hitherto been fatal in most cases.
                 DECAY OF CHILDREN.

            Atrophia mesenterica Infantum.

  Diagnosis.   Distended, hard abdomen, on which hard
nodes are frequently perceived, and total emaciation of the
extremities.  It is attended with the greatest,  often insa-
tiable appetite (which gave rise to the superstition of witch-
craft, in order to account for the constant eating and be-
coming more  and more meagre),  usually there is costive-
ness, intermediately also diarrhea, pain in the  belly ; old,
wrinkled, disfigured  countenance; the skin is in  general
inactive, flaccid, and often exhibiting comedones.
  Pathogenesis.  The proximate  cause is obstructed chyli-
fication and  impeded passage of the chyle into the blood
by  obstruction in the mesenteric glands.  Remote causes:
sickliness, weakness, old age, syphilis, scrofula of the pro-
genitors.   Want of mother's milk or unhealthy nurse s
milk, most of all artificial nutrition by heavy pastry or sour
aliments,  heavy farinaceous  meals, potatoes  in infancy;
overfeeding in general, worms, neglect of cleanliness and
cultivation of the skin; closed,  corrupt, damp air,  tight
lacing of the abdomen, spirits, opiates.
  The  disease  is most frequent from  the first  to the  third
year ; it may however befall adults as a symptom  of  scro-
phulosis.
   The  disease admits easily of a cure, when the necessary
remedies are used in time.   But, if neglected, it becomes
fatal, either by total induration of all the mesenteric glands,
which  withholds from the system access to nutrition, or
                          47* 
558
LIMPING.
by chronic inflammation and a gradual suppuration of the
mesenteric glands.
  The indication  of cure is  to restore the  obstructed
glands, to restore  and strengthen the digestive system as
well as the whole body.   In the first year, and where want
of mother's milk and bad food are the cause, usually no-
thing  else  is needed but a good wetnurse, or, when this
cannot be had, fresh goat's milk or egg-water as a bever-
age, and-tepid baths  of malt, intermediately the powder for
children.
  In great intensity  of the disease and in more advanced
age,  likewise egg-water, especially acorn coffee (a  true
specific for discussing  the hard,   distended belly, malt-
baths,  cleanliness, daily  new  linen, which contributes
essentially towards the cure, and may be made still more
effectual by  fumigating  it with ambergris  or  other  bal-
samics), dry dwelling,  residence  in  free salubrious air.
At the  same time use first magnesia, rhubarb with calo-
mel, or ethiops mineralis, by which also worms, which
frequently exist, simultaneously are removed;  extract, of
dandelion with Peruvian  bark  (vide No. 273); afterwards,
ferruginous medicines,  in which most reliance  must be
placed, since also the glandular obstructions are dependent
on weakness, best  alcoholized  iron (ethiops martialis,  flor.
sal. ammon. martial.), or mild  chalybeate waters, as those
of Fachingen, Geilnau. Do not neglect to make at the same
time inunctions into the abdomen of roborant dissolvent
ointments, this promotes exceedingly the resolution. Malt
baths are  a principal remedy,  even when a lingering fever
is present, which they most efficiently remove.
   Of great importance is the consideration,  whether chro-
nic inflammation of the mesenteric  glands exists,  and if so,
to remove it promptly that it may not pass into suppura-
tion,  which  renders the  disease incurable.  As soon as
pains in the abdomen supervene, the application of 3 or 4
leeches is indispensable,  and  produces the  most salutary
effect.^
                       LIMPING.

       Claudicatio spontanea, Coxalgia infantilis.

  Diagnosis.  Limping,  which comes on gradually, and
sometimes suddenly, without an external cause ; no pain is
felt while lying or at rest, but it is attended with pain  on 
LIMPING.                    559
ste  ping, walking, or moving the foot, also by pressure on
the  hip-joint.  It generally appears between  the third and
seventh year.  After longer or  shorter time,  sometimes
after a few days, an elongation of the affected leg and pro-
minence of the trochanter is manifest.
  Pathogenesis.   The proximate  cause is an  inflammatory
affection of the hip-joint.  The most usual remote causes
in children are : a scrofulous or rheumatic metastasis; and
this cause may associate with an external lesion, as a fall.
  Therapeutics.   The best and generally successful treat-
ment is the application of leeches to the joint, a warm bath
with  soap  daily, mercurial ointment rubbed morning and
evening on the hip-joint, and  calomel (1 or 2 grains, ac-
cording to the age) taken three times a day; intermediately
a cooling  purgative, so that a few fluid stools are daily
evacuated.  If improvement succeeds, which is perceived
by  the diminution of pain and  gradual shortening of the
foot,  this method is to be persevered in, and nothing else
need be done.  If the disease does not abate after 8 days,
n vesicatory is to be applied  to the hip-joint.
  This gentle method is often of service, even when the
disease is  advanced ; and it is with it, that we are always
to  commence.  Whe,n it is abortive,  and only  then, re-
course may be had to the cauterium, either the actuate or
potentiate. 
 
FORMULAS  OF  PRESCRIPTIONS.
                         No. 1.
                   Potio  Riveri.
B Potasse carbonatis 3ij.     Take  of carbon, of potassa
Succi citr. rec. expressi q.
  s. ad perfect, saturat.

Aque distillate giij.
Syrupi rubi idei £i. M.
                               two drachms.
                             Recently  expressed lemon
                               juice, as much as will sa-
                               turate the potassa.
                             Distilled water three ounces.
                             Raspberry syrup one ounce.
                               Mix.
          Two tablespoonfuls every two hours.
                         No. 2.
                 Aerated  Powder.
B Magnesie carbonatis 3i.   Take of magnesia one scru-
                               ple.
  *(Velbicarbonatisgr.xv.)  (Or  of bicarbonate of mag-
                               nesia fifteen  grains.)
  Acidi tartari, sacchari, aa  Tartaric acid and loaf sugar
     3i. M.                     of each one scruple.

  # When a brisk effervescence is wanted.—Made into a powder, and
mixed in a glass of water j the whole taken at once in a state of effer-
vescence.
                         No. 3.
fi Potasse bitartrat. Jss.     Take of cream of tartar half
                               an ounce.
  Coque in  vase  terreo cum  Spring water 5 pints.
    aque fontane ftv.          Boil together in an earth-
  Adde pom.im citron, con-    en vessel, and add one le-
    cis. No. i.                 mon bruised.
  Sacchari albi gvi.          White sugar six ounces.
               Mix and strain for a drink.
                     ERRATA.
 Beside one or two misprints of spiriti for spiritus, and a few ablatives in
ill place of genitives in <e. the following corrections must he m.ide :
     Rjk-ipe No. 83. add, Three powders, daily.
       "   "  90. for every two hours, read every hour,
       "   " 110, for Tincture of cinnamon 1 oz. read 1 drachm.
                         4,7** 
562
RECEIPTS.
                        No. 4.
B Nitratis potasse 3 ij-iij.    Take of nitre 2 to 3 drachms
Antimonii tart. gr. l.
Aque fontane gvij.
Syrupi hordeati s. amyg-
  dal. gi.
Emetic tartar  1 grain.
Spring water 7 ounces.
Barley-sugar  or almond sy-
   rup 1 ounce.
   Two tablespoonfuls every two  hours.  In irritable pa-
 tients  substitute a decoction of mallows for the water.
                         No. 5.
 B Potasse nitratis 3ij.        Take of nitre 2 drachms.
   Sode sulphatis gi.          Sulphate of soda 1 ounce.
   Antimonii tartarisati gr. i.   Emetic tartar 1 grain.
   Aque fontane  gvij.         Spring water 7 ounces.
   Syrupi rubi idei gi. M.     Raspberry syrup 1 ounce.
           Two tablespoonfuls every two hours.

                         No. 6.
 B Fruct. tamarindorum,       Take of tamarinds  and of
   Manne elect, aa gss.         flake manna each j- ounce.
   So<le sulphatis gi.         Sulphate of soda 1 ounce.
   Coque cum aque fontane   Spring water 12 to 8 ounces.
     gxij.-viij.               Boil and  add to the strained
   Colat. adde                  liquor
   Syrupi rubi idei gi. M.    Raspberry syrup 1 ounce.
   Two tablespoonfuls every two  hours, until  it produces
 effect.
                         No.  7.
 B Aque chlorin. gss.-i.       Take of liquid chlorine \ to
                              1 ounce.
     "   distillate gvij.      Distilled  water 7 ounces.
   Syrupi rubi idei gi. M.    Syrup of raspberries  1 oz.
           Two tablespoonfuls every two hours.
                         No.  8.
B  Radicis   valeriane  con-   Take of  valerian in  coarse
                              powder half an ounce.
                            Boiling  water,  a sufficient
                              quantity to leave 8 ounces
                              of clear liquor  after half
                              an hour's digestion.   To
                             which add
                           Liquid acetate of ammonia
                             6  drachms.
                           Sulphuric ether \ of a dr.
                           Common  syrup -J- ounce.
  tuse gss.
      digere cum
Aqua fervida  per hor. di
  mid. in vase clauso. Co
  lat. gviij.  Adde
Liquoris ammonii  acet
  3vi.
Spiriti sulphur, etheri. 3\
Syrupi communis gss
One tablespoonful every two hours. 
RECEIPTS.
563
 Radicis  valeriane
  tuse gss.'
    "   angelice
Flor. arnice aa 3ij.
      digere cum
Aqua fervida per hor. di-
  mid. in vase clauso. Co-
  lat. gviij. adde        .

Liquoris ammonii anisat.
Spiriti etheris  sulph. aa
   3i.
Syrupi communis gss. M.
   No. 9.
con-  Take  of valerian, in coarse
        powder, £ an ounce.
              angelica
      Arnica flowers  of  each 2
        drachms.
      A sufficient quantity of boil-
        ing  water to leave 8  oz.
        after boiling half  an hour
        in a closed vessel.  To
        which add
      Aromatic spirit of ammonia,
      Sulphuric  ether, of each 1
        drachm.
      Common syrup £, an ounce.
Two table spoonfuls every two hours.
              No. 10.
B Pulver. rad. arnice gss.

  Coque cum aqua font. gx.
    ad gviij.  Adde
  Pulver.  rad.  serpentariae
    5ij.

    digere.  Colat. adde
  Liquoris anodyn Hofman-
    ni. 3i. M.
  Syrupi cort. aurant. gi
Take of the powdered root
  of arnica \ an ounce.
Boil in 10 ounces of water to
  8. Add to the clear liquor
Powdered root of serpenta-
  ria 2 drachms.
Digest and add to the strain-
  ed liquor
Anodyne liquor of Hofmann
  1 drachm.
Syrup of orange-peel 1 oz.
Two tablespoonfuls every two hours.
             No. 11.
B Olei cinnamomi gutt x.

         ambre  s.  moschi
Essen.
  3ss.
Balsami vite Hofm.
3i.
iEtheris sulphurici " iss.
Laudan.  liquidi Sydenh.
  3i.
Take of oil of cinnamon 10
  drops.
Essence of amber or  musk
  £- a drachm.
Hofmann's balsam of  life  1
  drachm.
Sulphuric  ether \\ drachm.
Liquid laudanum of Syden-
  ham \ of a drachm.
   Thirty drops to be taken every two or three hours.
                       No.  12.
B Pulver. cort. cinchone gi.   Take of Peruvian bark 1 oz.
  Coque cum  aqua fontana   Spring water 16 ounces. #
    gxvi. ad viij.            Reduce by boiling to 8 oz. 
564
RECEIPTS.
          adde
Pulver. radicis serpentarie.
   "     " Arnice, aa 3ij.
   digere. Colat. adde

 Tinct. cinch. Whyttii 3iij.

 Aluminis crudi 3ij.
 Liquidi  anody. Hofm. 3i.

 Syrupi cinnamomi gi. M.
Add serpentaria
     Arnica root, in powder,
       of each 2 drachms.
Digest, and add to the strain-
  ed liquor
Whytt's tincture of bark 3
  drachms.
Crude alum 2 drachms.
Liquid  laudanum   of  Hof-
,  mann 1 drachm.
Syrup of cinnamon 1 ounce.
Two tablespoonfuls every two hours.
              No. 13.
B Antimonii  tartarisati gr.

  Pulver. rad. ipecacuanhe
    3i.
  Oxymellis scille gss.
  Aque fontane gij. M.
Take of tartrate of antimony
  2 grains.
Powdered ipecacuanha  one
  scruple.
Oxymel of squills £ ounce.
Spring water 2 ounces.
  One tablespoonful every quarter of an hour, until vomit-
ing be produced.
                       No. 14.
B Sulphate of soda gi.       Take of sulphate of soda 1
                              ounce.
Mrnne elec*e
Fruct.  tamarindorum aa
   gss.
Foliorum senne 3ij.
Ebull. cum aqua font. q. s.
Colat. unc. gvij.   Adde

Syrupi rubi idei gi. M.
Best manna, and
Tamarinds, of each £ ounce.

Senna leaves 2 drachms.
As much spring water as will
  leave after boiling 7 oz. of
  strained  liquor, to which
Add raspberry syrup 1 oz.
  Two tablespoonfuls every two hours, until it produce
snfflcient effect.
No. 15.
B Extracti taraxaci
    "  Trifol.  fibrin, aa 3ij.

  Elixirii visceral. Hofm.
  Tinct. rhei vinose aa 3iij.
Take of extract of dandelion,
Tincture of trefoil, of each
  2 drachms.
Visceral elixir of Hoffmann.
Vinous tinct. of rhubarb, of
  each 3 drachms.
Peppermint water 4 ounces.
Aque menthe piper,  giv
. M.
         A tablespoonful four times a day. 
RECEIPTS.
565
                        No. 16.
B Rasuri ligni quassie gss.   Take of rasped quassia -1
  Ebulli cum aque font. q. s.
    digere per -£• horam, co-
    lat. gviij.
           adde
  Tincture rhei vinos  3iij.
anodyni  Hofm.
3ss.
                      „ oz.
Boil it for a quarter of an
  hour  in  as much spring
  water as will leave 8 oun-
  ces of strained liquor ; add
Vinous tincture of rhubarb 3
  drachms.
Hofmann's andoyne tincture
  half a drachm.
Syrup of orange-peel 1 oz.
Syrupi corticis aurant. gi
  M.
        Two tablespoonfuls four times a day
                     No. 17.
B Spiritus Mindereri gi.

  Vini antimonii 3i.
  Aque florum sambuci,
    "   distillate, aa giv.
  Syrupi flor. aurantii gi.
                            Take of spirit of Mindererus
                              1 ounce.
                            Antimonial wine 1 drachm.
                            Elder-flower water,
                            Distilled water, of each 4 oz.
                            Syrup  of  orange-flowers  1
                              ounce.
  Two tablespoonfuls every  two hours.—When fever  i^
high, add 2 drachms of nitre.
  5                     No. 18.
B  Camphore gr. vi.          Take of camphor 6<frains.
  Potasse nitratis  3i.         Nitre 1 drachm.
  Sacchari albi 3ij. M.       White sugar 2 drachms.
  Fiat pulvis dividendus in  Mix, make a powder to be di-
vi. partes equates.
vided into 6 equal parts.
    One portion to be taken every two or three hours.
                        No. 19.
B Extracti aconiti gr. viij.    Take  of  extract of aconite
                              8 grains.
  Vini antimonii 3ij. M.      Antimonial wine 2 drachms.
 From ten to t-.venty drops to be taken every three hours.
                        No. 20.
 Pulvis Pectoralis.     Pectoral Powder.
B Flor. sulphuris  giss.       Take  of flowers of sulphur
Seminis feniculi,
Rad. iridis Florent.,
  "  liquiritie, aa gi
Foliorum senne  3vi.
Fiat pulvis.
M.
  \\ ounce.
Fennel seed,
Florentine iris,
Liquorice root, of each 1 oz.
Senna leaves 6 drachms.
Mix and make a powder.
A" teaspoonful to be taken every three or four hours.
                      48 
566
RECEIPTS.
No. 21.
  Thea Pectoralis.
B Florum verbasci,
  Herbe tussilaginis,
  Florum sambuci,
  Radicis glycyrrhize,
     "    althee, aa gi.
  Iridis Florentine,
  Semin. feniculi, aa 3vi.
  Conseca, contere, misce.
Pectoral Tea.
Take of mullen flowers,
Tussilage,
Elder flowers,
Liquorice root,
Mallow root, of each 1 oz.
Florentine iris,
Fennel seed, of each 6 dr.
Cut up, bruise, mix.
No. 22.
B Emplastri hyoscyami gi.

  Opii 3ss.
  Malax.
Take of hyoscyamus plaster
  1 ounce.
Opium -J- drachm.
Knead them together.
                       No. 23.
B Corticis cinchone pulv. gi.   Take of Peruvian bark pow-
                              der 1 ounce.
  Dividendus in viij. partes   Let it  be  divided  into 8
    equales.                  equal parts.
  The half of one of these parts to be  taken every two
hours. A
                       No. 24.
                     pulv.   Take of Peruvian bark pow-
                              der 1 oz.
                            Syrup of cinnamon, as much
                              as will make an electuary.
B Corticis  cinchone
    gi.
  Syrupi cinnamomi q. s. ut
    f. electuarium.
A teaspoonful every two hours.

           No. 25.
B Quinini sulphatis 3i.
Succi glycyrrhize q. s
  fiant pilule, No. xx.
ut
                           Take of sulphate quinine 20
                              grains.
                           Extract of liquorice, a suffi-
                              cent  quantity, and  let 20
                              pills be made.
       One to be taken every two or three hours.

                       No. 26.
B Phosphori gr. i.           Take of phosphorus 1  grain,
    Solve in                   and dissolve it in spirits of
  Olei terebinthine 3i.          turpentine 1 drachm.
        Ten drops to be taken four times a day.    * 
RECEIPTS.
567
No. 27.
B Resine guaiaci 3ij.
  Mucil. gum. acacie q.  s.
    ut f.  c. aque distillate
     gv. emulsio, cui adde

  Syrupi amygdalarum g
                Take of resin of guaiac 2 dr.
                Mucilage of gum  arabic, as
                  much as will  make  an
                  emulsion with five ounces
                  of distilled water, to which
                  add almond syrup 1 oz.
A°tablespoonful four times a day.
            No. 28.
                Take of resin of guaiac $ dr.
                Extract of  aconite 2 grains.
                Lemon syrup  20 grains.
                Cream of tartar 40 grains.
                Mix, make into a powder.
B Resine guaiaci 3ss.
  Extracti aconiti gr. ij.
  Eleosacchari citri 3i.
  Potasse bitartrat. 3ij.
M. fiat pulvis. dispens. dos
  Take one third in the morning,  one other at  noon, the
rest at night.
                       No.
B Resine guaiaci 3iij.
  Lactis sulphuris,-
  Saponis medicati aa 3i.
  Extracti dulcamare q. s. ut
     fiant pil. gr. ij.
antim.
Calcis
  3ij.
Coque cum aque fontane
  lb v. ad iv.
Serva in lagenis bene ob-
  turatis.
          29 a.
           Take of resin of guaiac 3 drs.
           Milk of sulphur,
           Medicinal soap, of each 1 dr.
           Ext. of bittersweet a  suffi-
             cient quantity.  Let it be
             made into pills of two gr.
      No. 29 b.
sulphureti  Take  of  antimoniated  sul-
             phuret of lime 2 drachms.
           Spring water 5 pints.
B  Ligni guaic rasi gij.
  Stipitum dulcamare gss.
  Coque cum aque font. ftij.
    ad ftiss.
    Boil down  to 4  pints,  and
      preserve  in well stopped
      bottles.
No. 30.
    Take of rasped guaiac. 2 ozv
    Tops of bittersweet £ ounce.
    Spring water, 2 pints.
Colature  adde  mercurii
  sublimat. corros. gr.ss.
Syrupi althee,  gij. M.
Boil down to one pint and a
  half; add corrosive subli-
  mate \ grain,
Syrup  of mallows, 2 ounces.
  Take half a cupful every  two hours, so as to drink half
in one day.
                        No. 31.
B Mercurii sublim. corros.  Take of corrosive sublimate
     gr.ij.                      2 grains. 
568                    RECEIPTS.
Solve  in  aque distillate,
    q. s. adde
Opii gr.ij.
Mice panis albi, mellis pu-
  rificati aa q. s. ut fiant
  pilule No. lx
Distilled water,  a sufficient
  quantity to dissolve the
  salt ;  add opium 2 grains.
Crumb of white bread, clari-
  fied honey,of each enough.
  Let 60 pills be made.
From three to five to be taken twice a day.
                 No. 3,2.
B Resine guaiaci 3ss.
  Lactis sulphuris 3ss.
  Potasse bitartratis 3i.
  Eleosacchari citri 3i.
  Misce, fiat pulvis.
Take of resin of guaiac ■£ dr.
Milk of sulphur  10 grains.
Cream of tartar  1 drachm.
Lemon syrup 20 grains.
Mix and make a powder.
Take half in the morning, and the rest at night.
                   No. 33.
B Florum sulphuris
  Potasse bitartratis aa gss.
  Radicis glycyrrhize 3ij.
  Eleosacchari anisi 3i.
  Foliorum senne 3ij.
  Antimonii sulphureti (au-
    rat.) gr.vi.
  Misce, fiat pulvis.
Take of flowers of sulphur,
Cream of tartar, of each }oz.
Liquorice root  2 drachms.
Syrup of anis 1 drachm.
Senna leaves 2  scruples.
Golden sulphuret of antimo-
  ny 6 grains.
Mix. make a powder.
            A teaspoonful three times a day.
                       No. 34.
B Stipitum  dulcamare gss.  Take of twigs of bittersweet
Coque cum aque font.
  ad vij. adde
Potasse tartratis 3 ij.

Vini antimonii guttas
Syrupi glycyrrhize  gi
LX.
M.
  $ ounce.
Spring water 10 ounces, boil
  down to 7  ounces ;  and
  add  tartrate of potassa 2
  drachms.
Antimonial wine 60 drops.
Syrup  of liquorice 1 ounce:
Two teaspoonfuls four times a day
             No. 35.
ft Spec, pectoral gij.
Take of pectoral species* 2
  ounces.
Hoarhound 1 ounce.
For a tea in the morning.
  Marubii gi.
  C. M. S.  pro  thea  c:
    mane sumenda.
  * Ingredients that vary in different countries, and generally are
very numerous.
                       No. 36.
B Extracti graminis gss.     Take of extract of dog grass
                              £ ounce, 
RECEIPTS.
569
Extracti marubii.
Potasse acetalis aa 3ij.

Vini antimonii,
Aque laurocerasi aa 3i
Aquefeniculi gvi. M
Extract of hoarhound.
Acetate of potassa, of  each
  2 drachms.
Antimonial wine,
Laurel water, of each 1 dr.
Fennel water 6 ounces.
A tablespoonful every three hours.
No. 37.
B Lichenis Islandici 3vi.
  Stipitum dulcamare 3iij.
  Coque  cum aque  font
     gxvi. ad viij.
  Coletur. Adde
Syrupi balsamici gi. M.
Take of Iceland moss 6 drs.
Twigs of bittersweet 3 dr.
Spring  water,  16  ounces,
  boil  down  to 8  ounces,
    and add
Syrup of balsam 1 ounce.
         Two tablespoonfuls four times a day

                        No. 38.
B Hydrargyrii  submuriatis  Take of calomel 2 grains.
    gr-ij
Foliorum digitalis purpur.
  gr.ss.
Sacchari albi 3i.
Misce, fiat  pulvis.   Divi-
  dendus   in  iv.  partes
  equales.
Digitalis £ grain.

White sugar 1 drachm.
Mix. Let a powder be made,
  to be  divided  into four
  equal parts.
  One to be taken every three or four hours,—for a child
of two years of age.
                       No. 39.
                   sambuci  Take of infusion of elder-
                              blossoms 10 ounces.
                            Nitre or  sal ammoniac  1£
                              drachm.
                            Oxymel 2 ounces.
             Mix for a gargle and injection.

                       No. 40.
B Oxymellis simplicis gi.    Take of oxymel 1 ounce
  Syrupi mororum gij. M.   Syrup of blackberries 2 oz.
           A teaspoonful frequently repeated.

                        No. 41.
 B Herbe salvie
B Infusionis  flor.
     gx.
  Potasse  nit. vel  ammon.
     muriat. 3iss.
  Oxymellis simplicis gij.M
Florum sambuci aa  gss.
  ebulli  cum  aque  font
  ftij. coletur. Adde
  Take of sage,
  Elder blossoms, of each £ oz.
    boil  in 2  pints of spring
    water ; add to the strained
    liquor,
48* 
570
RECEIPTS.
  Essentie pimpinelle gi.     Essence of pimpinel 1 oz.
  Aluminis crudi 3iij. M.     Crude alum  3 drachms.
          To be used as a gargle and injection.

                       No. 42.
B Essentiepimpinelle 3 iss.   Take of essence of pimpinel
                              lj- drachm.
  Syrupi althee giij. M.      Syrup of mallows 3 ounces.
            A tablespoonful every half hour.

                       No. 43.
ft Essentie pimpinelle 3ij.   Essence of pimpinel 2 drs.
Fifteen drops on sugar:  suffered to dissolve in the mouth.
No
44.
ft Antimonii  tartarisati  gr.  Take of emetic tartar  3 grs.
"J-
Potasse nitratis 3ij.        Nitre 2 drachms.
Aque fontane giv.         Spring water 4 ounces.
Syrupi althee,             Syrup of mallows,
  " glycyrrhize aa gi. M.     "   liquorice, each 1 oz.
        Two tablespoonfuls every two hours.
                       No. 45.
B Hydrargyrii  submuriatis  Take of calomel 6 grains.
    gr.vi.
  Opii gr.ij.
  Sacchari albi 3ij.
  Misce  fiat pulvis.  Divi-
    dendus  in  vi.  partes
    equales.
One every two hours.
Opium 2 grains.
White sugar 2 drachms.
Mix. Let a powder be made,
  and divided into six equal
  parts.
No. 46.
B Radicis senege 3ij.
  Coque cum aque fontane
     gxiv.  ad viij.

  Colature adde
  Ammonie muriatis,
  Vini antimonii,
  Aque laurocerasi aa 3i.
  Syrupi althee,
  Mellis puri  aa gi. M.
          Two tablespoonfuls
Take of senega 2 drachms.
Spring water 14 ounces.

Boil down to 8 ounces ;  let
  it be strained, add
Muriate of ammonia,
Antimonial wine,
Laurel water, of each 1 dr.
Syrup of mallows,
Clarified honey, of each 1 oz.
every two hours. 
RECEIPTS. -
571
                       No. 47.
B Olei amygdala, dulc. s. pa-  Take of sweet oil of almonds
  paver, rec. express, gi.
Aque fontane gviij.
Mucilaginis gum. acacie
  q. s. ut fiat emulsio, adde

Extracti hyoscyami gr. vi.
Syrupi gss. M.
  or fresh poppy 1 ounce.
Spring water 8 ounces.
Mucilage of gum arabic, as
  much  as will make  an
  emulsion; add*
Extract of henbane 6 grains.
Syrup \ ounce.
A tablespoonful every hour.
         No. 48.
B Magnesie carbonatis,
Potasse sulphatis,
Radicis rhei,
Eleosacchari menthe aa
  partes  equales ;  misce
  fiat pulvis.
             A teaspoonful for a dose

                     No. 49.
Take equal parts of magne-
  sia,
Sulphate of potassa,
Rhubarb,
Syrup  of  mint;  mix  and
  make a powder.
                           Take of roots of dandelion,
                                     "     saponaria,
                                  flowers of mullen,
                                     "      chamo-
                             mile, of each equal parts.
                           Mix for an enema  in  the
                             morning.
Make a decoction by boiling 2 spoonfuls with a little bran.

                       No. 50.
B Radicis taraxaci,-
     "   saponarie,
  Florum verbasci,
     "   chamomill
  C. M. S.
Liquor Belladonna;
       cyanic us.
B Extracti belladonne gr.iv.
    solve in
  Aque laurocerasi gss
Cyanuretcd Liquor
   of  Belladonna.
Take of extract of belladon-
  na 4  grains, dissolve in
Laurel water i ounce.
Twenty to thirty drops four times a day.

               No. 51.
Herbe digitalis 3ss.
  digere cum aque font.
  per i horam, usque gvi.
  coletur adde
Take of digitalis \ drachm,
  digest in as much spring
  water for -J- of an hour, as-
  will leave 6 ounces of clear
  liquor;  add 
572
RECEIPTS.
Aque laurocerasi 3ij.      Laurel water 2 drachms,
Potasse nitratis 3iij. M.   Nitre 3 drachms.
          A tablespoonful every two hours.
B Ext. taraxaci,
    "  graminis, aa gss.

  Potasse tartratis 3iij.
     (vel potasse carbonatis
     3iij.) solve in
  Aque menth. piperite,
     "   distillate, aa giij.M.
No. 52.
    Take of extract of dandelion,
              "      dog grass,
       each J- ounce.
    Tartrate of potassa 3 drs.
      (or carbon, of potassa 3 dr.)
      dissolve in
    Peppermint water,
    Distilled water, of each 3 oz.
A tablespoonful four times a day.
No. 53.
B Gummi ammoniaci 3iij.

  Saponis med. 3ij.
  Lactis sulphuris,
  Pulveris radicis rhei,
    (vel foliorum  senne,)
    aa  3i.
  Extracti  taraxici  q. s. ut
    fiant pilule gr.ij.
ammoniac  3
Take of gum
  drachms.
Soap 2 drachms.
Milk of sulphur,
Rhubarb powder,
  (or senna,) of each 1 dr.
              Extr. of dandelion, as much
                 as will suffice.  Let pills
                 be made of 2 grains.
Ten pills, three times a day.
No. 54.
B Potasse carbonatis,
  Ammonii  muriatis, aa 3i.
  Solve in aque menthe pip.
     giij. adde
  Aloes,
  Myrrhe,
  Resine guaiaci,
  Radicis rhei aa 3ss.
  Croci 3i.
  Digere, 1.  a. ut. f. E.
 Take of carbonate of potassa,
 Muriate of ammonia ea. 1 dr.
 Peppermint  water, 3 ounces.
   dissolve and add
 Aloes,
 Myrrh,
 Resin of guaiacum,
 Rhubarb, each £■ drachm.
 Saffron 1 scruple,
Let it digest to make an elixir.
         Forty to sixty drops three times a day.

                        No. 55.
B Elixirii acidi Halleri 3 ij.    Take of acid elixir of Haller
                              2 drachms. 
                       RECEIPTS.                   573

  Tincture cinchone Whyt-   Whytt's tincture of bark 6
    tii 3vi.  M.               drachms.
Sixty  to eighty drops three times a day in a cup of water.
                       No.  56.
ft Aluminis crudi,            Take of crude alum,
  Terre catechu,            Terra catechu,
  Extracti  cinchone,  aa   Extract of bark, of each equal
    partes equales.  Misce     parts.  Mix.  Let pills of 2
    f. pil gr. ij.  Consperge     grains be made, sprinkled
    pulvere cinnamomi.        with  cinnamon powder.
                Ten night and  morning.
                       No.  57.
B Foliorum aurantii viridis,   Take equal parts of green
                              leaves of orange,
  Radicis valeriane,         Valerian root,
  Caryophillate,             Cloves,
  Herbe melisse, aa partes   Melissa.
    equales.
  Infuse over night, 1 to 2 spoonfuls  in 2 cups of water ;
which is to be taken cold,  half every  morning, the rest  in
the evening.
                       No.  58.
B Radicis columbo  gss.       Take of columbo root £ oz.
  Coque   cum aque font.     Boil in 12 ounces down to
    gxij.  ad gviij.             8, let it  be  strained, and
  Coletur.  Adde              add
  Tincture  ferri etheris,     Ethereal tincture of iron,
      "     valeriane,        Tincture of valerian,
      "     cort.   aurantii,       "      orange peel,
    aa 3i.  M.                each 1 drachm.
          Two tablespoonfuls four times a day.
                       No.  59.
B Zinci oxidi 3ss.            Take of flowers of zinc i dr.
  Succi glycyrrhize q. s. ut   Liquorice, a sufficient quan-
    fiant pilule No. lx.         tity; let  it be made into
                              60 pills.
Take  2 morning and evening; adding one every two days.
                       No.  60.
 I»nlvis Antipilepti-   Powder against Ep-
           cus.                      ilepsy.
B Zinci oxidi,                Take of flower of zinc,
  Extracti  hyoscyami,  aa   Extract of henbane, each 1
    gr. i.                     grain. 
574
RECEIPTS.
  Olei  valeriane etherei,  Oil of valerian 1 drop.
    guttam  i.
  Radicis valeriane 3ss.      Root of valerian £ drachm.
  Misce, fiat pulvis.          Mix.  Make a powder.
  Morning and evening.  In obstinate cases add $ grain of
ammonia of copper.
No. 61.
ft Radicis valeriane 3ss.
  Olei valeriane eth. guttas

  M.  fiat pulvis.
              Take one three times a day
                       No. 62.
Take of valerian root £ dr.
Ethereal oil  of valerian  2
  drops.
Make a powder.
                            Take of nitrate of silver  10
                              grains.
                            Extract of cicuta 2 drachms.
                            Opium 5 grains.
                            Liquorice  1 drachm.
                            Mix.  Let pills of 2 grains
                              be made.
  Two morning and  evening, at first,  afterwards three,
gradually increasing to five.
& Argenti nitratis gr. x.

  Extracti cicute 3ij.
  Opii gr. v.
  Succi glycyrrhize  3i.
  Misce, fiant pilule gr. ij.
No. 63.
B Essentie castorei,
Liquoris anodyni  Hofm.
  aa 3i.
Olei menthe pip. guttas vi.
Laudani  liquidi  Syden-
  hami gr. xx.
B Gummi ammoniaci 3ij.
    mucilaginis acacie q. s.
    ut fiat cum aque feni-
    culi  gvi. emulsio. Adde
ammonii  anisate
               Take of  essence  of casto-
                 reum,
               Anodyne  liquor of  Hofm.
                 each 1 drachm.
               Oil of peppermint  6 drops.
               Liquid  laudanum of Syden-
                 ham 20 grains.
Forty drops every two hours.
          No. 64.
               Take of  gum  ammoniac 2
                 drachms, as much muci-
                 lage  of gum arabic, with
                 fennel water as  will make
                 6 ounces of emulsion, add
               Aromatic spirit of ammonia
                 half a drachm.
               Oxymel of squills,
               Liquorice, each 1  ounce.
Aque
  3ss.
Oxymeiis scille,
Syrupi glycyrrhize aa gi.
  M.
            A tablespoonful every hour 
RECEIPTS.
575
No. 65.
B Asa fetide,
  Gummi ammoniaci,
  Saponis med.,
  Extracti taraxaci, aa 3ij.

  Antimonii sulphureti (au-
    rat.) gr. xx.
  Misce, fiant pilule gr. ij.
  Consperge semine lyco
     podii.
                 Ten three times a day.

                        No
B Extracti quale 3 ij.
Take of asa fetida,
Gum ammoniac,
Soap,
Extract of dandelion, each
  2 drachms.
Golden sulphuret of antimo-
  ny 20 grains.
Mix.   Let pills  of 2 grains
  be made.
Sprinkle it with  club moss
  seed.
Aque  ammonii  anisate
  3iss.            .
Aque feniculi gij. "M.
66.
Take of extract  of elecam-
  pane 2 drachms.
Aromatic spirit of ammonia
   ltj- drachm.
Fennel water 2 ounces.
Eighty drops every two hours.

           No. 67.
ft Gummi ammonii,
  Extracti arnice,
     "    polygale,
     "    quale, aa 3ij.
  Pulveris rad. scille,
  Antimonii sulphureti (aur.)
    aa gr. xx.
  Misce, fiant pilule gr. ij.
Take of gum ammoniac,
Extract of leopard's bane,
Rattlesnake herb,
Elecampane, each 2 drs.
Powder of squills,
Golden sulphuret of antimo-
  ny, each  20 grains.
Mix, make pills of 2 grains.
Eight to ten three times a day.
No. 68.
B Specierum pectoralium gij.
  Herbe chenopodii,
    "_   marubii, aa gss.
  C. M.  S. thea.
Take of pectoral species 2 oz.
Worm seed,
Hoarhound, each ^ ounce.
Infuse for a tea.
No. 69.
B Radicis quale,
    "     iridis,
    "     scille, aa gi.
  Benzoes,
Take of elecampane,
Florentine iris root,
Squills, each 1 ounce.
Benjamin, 
576
RECEIPTS.
Myrrhe,
Seminum anisi,
Succi glycyrrhize,
Gummi ammoniaci aa gss.
Croci 3iij. M.
f.c. spiritus vini rectificat.
  libra una.
L. a. elixir.
Myrrh,
Anis,
Liquorice,
Gum ammoniac, each f oz.
Saffron 3 drachms.
Rectified spirits of wine, 1
  pint.
Make an elixir.
Sixty to eighty drops several times a day.
B Extracti digitalis,
     "     hyoscyami,
  Pulv. digitalis,  aa partes
    equales.
  Misce, fiant pilule gr. i.
No. 70.
    Take of extract of digitalis,
    Henbane,
    Powder  of digitalis, equal
      parts.
    Mix, make pills of 1 grain.
  One morning and evening.—In obstinate cases, three or
four times a day.
                       No; 71.   #
                           Take of sal ammoniac 2 dr.
B Ammonii muriatis 3ij.
  Succi glycyrrhize gss.
  Aque feniculi,
    "   fontane, aa giv.
  Syrupi althee gi.
  Vini antimonii, gut. xl.
M.
Liquorice half an ounce.
Fennel water,
Spring water, each 4 ounces.
Syrup of mallows 1 ounce.
Antimonial wine 40 drops.
A tablespoonful every hour.
No. 72, a.
B Extracti dulcamare 3i.

  Florum  sulphuris 3ss.
  Misce, fiant pilule gr. i.
Take of extract  of bitter-
  sweet 1 drachm.
Flowers of sulphur £■ dr.
Mix, and make pills of 1 gr.
Four, five to eight pills four times a day.
No. 72, b.
Elixir Anticatarr-
          hale.
B Extr. card, benedicti 3i.

   "   dulcamare gr. xx.
  Aque feniculi gi.
   "    laurocerasi 3i.
   Anticatarrhal
         Elixir.
Take of extract  of blessed
  thistle 1 drachm.
Bittersweet 20 grains.
Fennel water 1  ounce.
Laurel water 1 drachm.
Sixty drops four times a day. 
RECEIPTS.
577
No. 73
ft Lichenis Islandici,
  Stipitum  dulcamare,  aa
     gss.
  Coque cum aque fontane
     gxiv. ad viij.
  Colature  adde
  Liquoris ammonii anisati
     gutt. LX.
  Syrupi glycyrrhize gi. M.
          Two tablespoonfuls four times a day

                        No. 74
 B Potasse tartratis 5i.
Take of Iceland moss,
Twigs of bitter-sweet, each
  £■ ounce.
Boil in 14 ounces of spring
  water down to 8.   Let it
  be strained.  Add
Aromatic spirit of ammonia
  60 drops.
Syrup of liquorice 1 ounce.
Take of tartrate of potasse
  1 drachm*
Fennel water \ ounce.
Syrup of manna 1 ounce.
Oxymel of squills 2 drachms.
Antimonial wine 20 drops.
Extract of henbane 2 grains.
  Aque feniculi gss.
  Syrupi manne gi.
  Oxymellis scille 3ij.
  Vini antimonii guttas xx.
  Extracti hyoscyami gr. ij.

  A teaspoonful every  two hours (for children of two to
four years of age).
                       .No. 75.
B  Radicis belladonne gr. i.   Take of nightshade root 1 gr.
  Sacchari albi 3i.           White sugar 1 drachm.
Misce, fiat pulvis dividendus  Mix. Let a powder be made,
  in viij. partes equales.       to be  divided into 8 equal
                              parts.
   One morning and evening (for children from 2 to 4 years
of age).
No. 76.
R Magnesie carbonatis
  Florum sulphuris aa gr. iv.

  Laudani liquidi Sydenha-
    mi guttam 1.
  Sacchari albi 3l.
  Misce, fiat  pulvis.   Dis-
    pens. dos. iv.
         One to be taken morning and evening.
                       No. 77.
B  Antimonii tartarisati 3i.   Take of emetic tartar 1 dr.
  Axungie pore.  gss. M.     Lard £ ounce.
     Used in friction.  The size of a bean at a time.
                          49
Take of magnesia
Flowers of sulphur each 4
  grains.
Liquid laudanum  of Syden-
  ham 1 drop.
White sugar 20 grains.
Mix.  Make a powder, and
  divide it in 4 doses. 
578                    RECEIPTS.

                        No. 78.
B  Gelatine lichen.  Island.  Take of Iceland moss jelly
     gss.                      £ ounce.
  Syrupi glycyrrhize gi.    Syrup of liquorice  1 ounce.
            A teaspoonful every two hours.
                        No. 79.
ft Tincture cort. aurantii 3ij.  Take of tincture of orange-
                              peel 2 drachms.
      "    castorei,         Castoreum,
      "    aloes, aa 3i. M.   Aloes, each 1 drachm.
                Sixty drops twice a day.

                        No. 80.
B  Potasse carbonatis 3ij.    Take of carbonate of potas-
                              sa 2 drachms.
   Succi citri rec. expr. q. s.  Lemon juice as much as will
     ad saturationem,          saturate.
   Aque melisse  giij.        Melissa water 3 ounces.
   Extracti hyoscyami gr. vi.  Extract of henbane  6 grains.
     M.
   A tablespoonful every hour.   (If it produce no effect,
add 8 drops of laudanum to each dose.)
                        No. 81.
B  Spiritus rnatricalis gvi.    Take of compound spirit of
                              mastic 6 ounces.
   Bals. vite Hofmanni  gss.  Hoffmann's  balsam  of life \
                               ounce.
   Tincture opii 3 ij. M.      Tincture of opium 2 dr.
                 To be used in friction.
                        No. 82.
            Spiritus carminativus, in flatulency.
B Spiritus rnatricalis,        Take of spirit of mastic,
     "   serpylli,           Thyme,
     "   ror. marini,        Rosemary,
     "   menth.  pip. aa pp.  Peppermint, each alike.
   e.
     To wash the hypogastrium morning and evening.
                        No. 83.
B Magnesie carbonatis,      Take equal parts of magne-
                              sia,
   Potasse sulphatis,         Sulphate of potassa,
   Radicis rhei,              Rhubarb, 
RECEIPTS.
579
Pulveris aromatici aa pp.
  M
                   Aromatic powder, mix.

A teaspoonful three or four times a day.
               No. 84.
                   Take of compound galban-
                      um plaster 1 ounce.
                   Camphor,
                   Carbonate of ammonia,
                   Opium, each £ drachm.
                   Oil of cajeput,
                   Peppermint each 20 drops.
B Emplastri de galbano croc.
     §i.
  Camphore,
  Ammonie carbonatis,
  Opii, aa 3ss.
  Olei cajeputi,
   "  menthe pip. aa guttas
     xx.
  Malax.
B  Pulveris  cort
    regalis 3ss.
  Ferri sulphatis gr. i.
  Cinnamomi gr. ij.
  Misce, fiat pulvis
           Knead together.
      No. 85.
cinchone   Take of powdered bark % dr.
Sacchari alb. gr. xx
Misce, fiat pulvis.
               Green vitriol 1 grain.
               Cinnamon 2 grains.
               Mix, make a powder.
Take one morning and evening.
           No. 86.
               Take of resin of guaiacum £
                  drachm.
               Golden sulphuret  of  anti-
                  mony,
               Calomel,
               Extract of aconite, each 2
                  grains.
               Essential oil  of valerian 2
                  drops.
               White sugar 20 grains.
               Mix, make a powder.
B Resine guaiaci 3ss.

  Antimonii sulphureti(aur-)

  Hydrargyri submuriatis,
  Extracti aconiti, aa gr. ij.

  Olei valeriane ether, gutt.
    ij-
Half to be taken in the morning, the rest at night.
    No. 87.
Pulvis errhinus.
B Florum lavendule,
  Herbe majorane aa 3iss.
  Sacchari albi 3i.
  Saponis,
  Flor. convallarie majalis,
     aa 3ss.
  Olei caryophyllate guttas
     iv.
  Misce, fiat pulvis.
Take lavender flowers,
Marjoram, each  1^ drachm.
White  sugar 1 drachm.
Soap,
Flowers of lily of the valley,
  each £ drachm.
Oil of  cloves 4 drops.

Mix, make a powder. 
580
RECEIPTS.
                       No. 88.
B Bismuthi subnitratis gr. ij.  Take flowers of bismuth 2
Extracti hyoscyami gr. i.
Magnesie carbonatis gr. x.
Olei cajeputi guttam i.
Sacchari albi gr. xx.
M. f. pulvis.
  grains.
Extract of henbane 1 grain.
Magnesia 10 grains.
Oil of cajeput 1 drop.
White sugar 20 grains.
Mix, make a powder.
No. 89.
Linimentum  Anti-
    spasmodicuin.
ft Linim. volat. camphor, gi.
  Olei cajeputi,
   "  menthe crisp, aa gr.
    x.
  Tinct. Thebaiee  3i. M.
Antispasmodic Lin-
         iment.
Take of camphorated vola-
  tile liniment 1 ounce.
Oil of cajeput,
Crisp, mint, each 10 grains.
Tincture of opium 1 drachm.
No. 90.
B Olei amygdal. dulc.  gi.

  Aque fontane gvii.
  Mucilaginis g. acacie q. s.
    f. emulsio, adde

  Manne electe gi.
  Potasse tartratis 3 iij—iv.
Syrupi emulsivi gss.
Extracti hyoscyami gr. vi
  M.
        Two tablespoonfuls every two hours
Take of sweet oil of almonds
  1 ounce.
Spring water 7 ounces.
Mucilage  of   gum  arabic,
  enough to make an emul-
  sion, add
Chosen manna 1 ounce.
Tartrate of potassa 3 to 4
  drachms.
Syrup £ ounce.
Extract of henbane 6 grains.
No. 91,
B Florum sulphuris,
  Magnesie carbonatis  aa
    5ij.
  Opn,
  Rad. ipecacuanhe aa gr.
    ."j-
  Misce, fiat pulvis dividend-
    us in xij. partes equales.
Take of flowers of sulphur,
Magnesia, each 2 drachms.

Opium,
Ipecacuanha, each 3 grains.

Mix. Let a powder be made
  and divided  into 12 equal
  parts. 
RECEIPTS.
581
                       No. 92.
Piluke Resolventes.    Discutient Pills.
B Gummi ammoniaci 3iij.   Take  of gum ammoniac 3
                              drachms.
  SaponisSij.               Soap2drachn,S.
  Pulv. radicis rhei 3i.       Rhubarb 1 drachm.
  Extracti  taraxaci q. s. ut.  Extr.  of dandelion  enough.
     fiant pilule gr. ij.        Let pills of 2 grains be made.
          Ten to fifteen, take three times a day.
                        No. 93.
 B Fellis tauri inspissati,     Take of dry ox gall,
   Extracti rute,             Extract of rue,
   Sanonis                  Soap,
   Lactis sulphuris, aa 3ij.    Milk  of sulphur, each 2 dr.
   Misce, fiant pilule gr. ij.   Mix.   Let pills of  2 grams
                               be  made.
   Ten morning  and  evening,  with  infusion of melissa,
 chamomile, millefoil, arnica.
                        No. 94.
 B Foliorum senne 3ij.       Take of senna leaves 2 dr.
   Soda sulphatis  gi.         Sulphate of soda I ounce.
   Coque cum aque fontane  Boil in as much water as will
     q. s. colat. *vij.            leave 7 ounces of strained
            Adde              liq»or-  Add
   Antimonii tartarisatagr. ij.  Emetic trrr*ar 2 grains.
   Syrupi  manna gi-  M.      Syrnp of marina 1  ounce.
           One or two tablespoonfuls every hour.

                         No. 95.
  B Pulv. rad.  valeriane gss.  Take  of powdered valerian
                                root .2 ounce.
    Florum arnice  'ij.        Flowers of arnica 2drachms.
    Diaerecumaqnefervente  Digest \ of an hour in as
      q. s.  per horam \, colen-     much boiling water as will
      tur.  gvij.   Adde           leave 7 ounces  of clear li-
                                quor.  Add
    Sode sulphatis gss.        Glauber salts | ounce.
    Liquoris cornu cervi sue-   Succinated spirits of harts-
            cinati              horn,
        "   anody.' Hoffm. aa  Anodyne liquor of Hoffman,
       guttas xl.                 eacn ^ drops.
    Syrupi' cort!  aurantii  gss.   Syrup of orange bark \ oz.
                 A tablespoonful every hour.
                           49 = 
582
RECEIPTS.
                       No. 96.
B Resine guaiaci 3ss.        Take  of resin of guaiacum
                              | drachm.
  Potasse bitartratis 3i.      Cream of tartar 1 drachm.
  Sacchari albi 3ss.          White sugar  ± drachm.
  M. f. pulv.                Mix, make a powder.
  Half in the morning, the rest in  the evening.   (To be
continued several days.)

                        No. 97.
B Antimonii tart. gr. xv. in  Take  of emetic tartar 15 gr.
    aqua solut.                dissolved in water.
  Galbani,                  Galbanum,
  Gummi ammoniaci,        Gum ammonia,
  Extracti arnice, aa 3i.     Extract of arnica, each 1 dr.
  Castor. 5ss.               Lastor oil  •£ dr.
  M. f. pil. gr. i.             Mix, make pills of 1  grain.
  Eight 4 times a day, continually augmenting the number
until nausea supervene.

                       No. 98.
B Olei cajeputi gr. xx.       Take of oil of cajeput 20 grs.
  Liquoris anod. Hofm.      Anodyne liquor of Hofm.,
     "   cornu  cervi sue-  Succinated spt. of hartshorn,
     cinati aa 3i. M.            each 1 drachm.
            Thirty drops every three hours.

                       No. 99.
B Florum arnice  gr. xx.      Take  of flowers of arnica 20
                              grains.
  Olei valeriane etherisgut-  Essential  oil  of valerian  1
    tarn  i.                    drop.
  Sacchari albi gr. x.        White sugar ten  grains,
  M. f. pulvis.               Mix, make  a powder.
           One to be taken every three  hours.

                       No.  100.

B  Extracti  nucis  vomice  Alcoholic  extract of  nux vo-
     spirituosi.                mica.
     f.  pilule gr. i.           Made into  1 grain pills.
  One three times a day j gradually augmenting to two- or
three. 
RECEIPTS.
583
No. 101.
B Spiritus rnatricalis,
  "    serpylli,
  "    formicarum,  aa
          gij-
  ,c    camphorati gi.
Balsam vite Hofm.,
Linimenti volat. aa gss.
Olei cajeputi 3i. M.
Take of compound spirit of
  mastic,
Thyme,
Ants, each 2 ounces.

Camphorated spirit 1 ounce:
Hofmann's balsam of life,
Volatile liniment, each half
  an ounce.
Oil of cajeput 1 drachm.
Used as a lotion.
No. 102.
oleo
B Olei cajeputi 3i.
  Linim.  volat.  cum
    camph.  gi.
  Bals. vite Hofm. gss.  M
           Take of oil of cajeput 1 dr.
           Camphorated  volatile  lini-
             ment 1 ounce.
           Hofmann's balsam  of  life
             half an ounce.
To be used in friction.
                       No. 103.
R Phosphori gr. v.           Take of phosphorus 5 gr.
  Olei animalU Dippelii 3ij.  Animal oil of Dippel 2 dr.
   "   papaveris gss.         Oil of poppies half an ounce.
                To be used in frictions.

                       No. 104.
./Ether ITIercurialis.    Mercurial iEther.
B Hydrargyri  chloridi cor-  Take of corrosive sublimate
    ros. gr. ij.                 2 grains.
  iEtheris sulphurici 3ij.     Sulphuric ether 2 drachms.
  Solve.                    Dissolve.
         Ten to thirty drops, three times a day.

                       No. 105.
B Baryte muriatis 3i.        Take of muriate of baryta 1
                              drachm.
                            Distilled water 2 ounces.
                            Extract of cicuta 1 drachm.
                              M.
  Thirty to forty drops four  times a day, with decoction
of bittersweet.
Aque distillate gij.
Extracti cicute 3i. M. 
584
RECEIPTS.
       No. 106.
Chalybeate Wine.
Ligni quassie,
Trifolii, aa  3 vi.
Radicis zedoarie,
  "    galange, aa 3ij.
  "    gentiane,
Corticis aurantii, aa gss.
  "     cinchone gij.
Limat. ferri 5vi.
Infunde vini Rhen. opt. s
  Tokay, fcviij
Take of quassia,
Trifolium, each 6 drachms.
Zedoary,
Galanga, each 2 drachms.
Gentian,
Orange bark, each £ ounce.
Peruvian bark 2 ounces.
Iron filings 6 drachms.
Rhenish  or  Tokay wine  8
  pints.
Stent in digestione in loco  Digest in a warm place.
  calido.
     A wine glass full three or four times a day.
                     No.  107.
ft Elixir, visceral. Hofm. gi.

  Tincture cort. aurantii 3i.

  Extracti columbo gr. xx.
Take of Hofmann's visceral
  elixir 1 ounce.
Tincture of orange peel  1
  drachm.
Extract of columbo 20 grs.
Eighty drops morning and evening.
No. 108.
ft Tincture absinthii,
                 Take of tincture of worm-
                   wood,
                 Compound  elixir  of orange
                   (Prussian pharmacopeia),
                   of each equal parts.
Eighty drops morning and evening.

            No. 109.
                 Take of extract  of hops  1
                   drachm.
                 Peppermint water 1 ounce.
                 Cinnamon half an ounce.
Elixir, aurantii comp. (Ph
  Borus.) aa pp. equales
ft Extracti lupuli 3i
Aque menth. pip. gi.
  "   cinnamomi gss
M.
             Sixty drops three times a day.
                      No. 110.
ft Pulver. rad. columbo gss.  Take of powdered root of
Coque cum aque font.  gx.
  ad vi.
Coletur, adde
Spiritus sulph. eth. marti-
  alis 3ij.
  columbo half an ounce.
Boil in 10 ounces of spring
  water to 6.
Let it be strained, a 'd
Martial  sulphuric  ether  2
  drachms. 
RECEIPTS.
585
Tincture cinnamomi 3i.    Tincture of cinnamon 1 oz.
Syrupi cort. aurantii gi.    Syrup of orange peel 1 oz.
         A tablespoonful every three hours.

                     No. 111.
                          Take of extract  of  quassia
                            half a drachm.
                          Hoffmann's viscer. elixir,
                          Whytt's  tincture of  bark,
                            each half an ounce.
                          Martial sulph. ether  2 dr.
ft Extracti quassie 3ss.
Elix. viscer. Hoffm.,
Tinct.  cinchone Whyttii,
  aa gss.
Spiritus eth. sulph. mart.
  3ij. M.
          Eighty  drops three times a day.

                     No. 112.
B Extracti quassie gss
                 Take of extract of quassia
                   half an ounce.
                 Green vitriol 20 grains.
                 Cinnamon powder ■£- drachm.
                 Mix.  Let two grain pills be
                   made.
Ten pills two or three times a day.
Ferri sulphatis gr. xx.
Pulver. cinnamomi 3ss.
Misce, fiant pilule gr. ij.
                       No.
B Spiritus Formicarum gij.
  Liquoris anodyn. Hoffm.,
  Bals. vite Hoffm. aa gss.
Aque menthe pip.,
  "  serpylli, aa giij.
M.
113.
 Take of spirit of ants 2 oz.
 Hoffmann's liquid anodyne,
     "     balsam  of  life,
   each \ ounce.
 Peppermint water,
 Thyme, each 3 ounces.
          As a lotion to the sacrum and genitals.

                        No.  114.
ft Resine guaiaci 3ss.       Take of resin of guaiacum \
                              drachm.
   Hydrargyri submuriatis,   Calomel,
   Antimonii sulph. (aur.) aa  Golden sulphur, ant. each 2
    gr. ij.                    grains.
   Sacchari albi gr. xx.       White sugar 20 grains.
   M. f. pulvis.               Mix, make  a powder.
              Half,  evening and morning.

                        No.  115.
B  Olei amygdal. dulc. 3i.    Take of sweet oil of almonds
"  camphorati gr. x.
  1 drachm.
Camphorated oil 10 grains. 
586
RECEIPTS.
  Fellis tauri 3ss.            Ox gall $ drachm.
  Olei cajeputi guttas ij. M.  Oil of cajeput 2 drops.
      To put into the ears; applied on cotton wool.

                       No. 116.
B Fol. digitalis purp. gr. i.    Take of red foxglove 1 gr.
  Potasse nitratis,           Nitre,
  Pulveris  gummosi, aa gr.  Gum powder, each 20 gr.
    xx.
  Misce, f. pulvis.            Mix,  make a powder.
           To be taken morning and  evening.
No. 117.
B Calcii chloridi 3i.
                            Take of chloride of lime 1
                              drachm.
   Aque laurocerasi 3jj.      Laurel water 2 drachms.
     "  distillate gss. M.     Distilled water 4 drachms.
          Forty or fifty drops four times a day.

                       No. 118.
B  Plumbi  acetatis gr. i.       Take of acetate of lead 1 gr.
  Extr. opii. aquosi gr. ss.    Watery extract of opium ±
                              grain.
 . Sacchari albi gr. xx.        White sugar 20 grains.
  M- f- PuI^.                 Mix, make a powder.
            Take  one morning and evening.

                       No. 119.

B Myrrhe 3ss.              Take of myrrh £ drachm.
  Sacchari albi gi.            White sugar 1 ounce.
  M- f- Pulv.                 Mix, make a powder.
           A teaspoonful several times a  day.
No. 120.
B Crete preparate 3ij.

  Succi citri  q. s. ad satu-
    randum.  Adde
  Aqua florum tilie gvi.
  Syrupi glycyrrhize gi.
  Misce.
Take of  prepared chalk 2
  drachms.
Lemon juice, enough to  sa-
  turate.   Add
Linden blossom water 6  oz.
Syrup of  liquorice 1 ounce.
Mix.
Two tablespoonfuls every two hours. 
RECEIPTS.
587
B Zinci sulphatis gr. x.
  Extracti catechu 3ss.
  Syrupi althee gi. M.
B
                    No.
Gelatin, lichenis Isl. gi.

Extracti dulcamare gr. x.
Syrupi glycyrrhize gi.
Liquor,  ammon.  anisati
  guttas xx. M.
No. 121.
     Take of white vitriol 10 grs.
     Extract of catechu ■£- dr.
     Syrup of mallows 1 ounce.
    122.
     Take  Iceland moss jelly 1
       ounce.
     Extract of  bittersweet  10
       grains.
     Syrup of liquorice 1 ounce.
     Aromatic  spirit of amm. 20
       drops.
Take it daily by teaspoonfuls.
          No.  123.
B Extracti myrrhe  aquosi
     3j-
  Liquoris potasse tartaris-
     ati gij. M.
Take  of  watery extract  of
  myrrh  1 drachm.
Solution of tartrate of potas-
  sa 2 ounces.
Forty drops every three hours.

           No. 124.
B Pulveris corticis cinchone
  Rad. ratanh.  aa gss.
  Coque cum aque fontane
     gxij. ad viij.
  Coletur.  Adde
  Aluminis crudi 3ss.
  Syrupi althee giss. M
Take of Peruvian bark,
Ratanhy root, each \ ounce.
Boil in 12 ounces of water
  down to 8.
Let it be  strained ;  and add
Crude alum £ drachm.
Syrup of mallows 1^ ounce.
Two spoonfuls every two hours.
           No. 125
B Calcii chloridi 3ss.
  Extracti  hyoscyami
    viij.
  Aque laurocerasi gi. M
     Take chloride of lime \ dr.
gr.   Extract of henbane 8 grains.

     Laurel water 1 ounce.
Twenty drops three times a day.
           No. 126.
B Sacchari lactis gi.
  Extracti myrrhe aquosi 3 i.

  Florum sulphuris 3iss.
  Extracti   hyoscyami   gr.
    xx.
  Misce, f. pulvis.
Take of sugar of milk 1 oz.
Watery extract of myrrh 1
  drachm.
Flowers of sulphur \\ dr.
Extract of  henbane 20  grs.

Mix, make a powder.
A teaspoonful morning and evening 
588
RECEIPTS.
                       No,

B Radicis arnice 3iij.
  Coque cum aque font. gx.
    ad vi.
  Coletur.   Adde
  Extracti chamomille,
     "    rute, aa 3iss.
  Ferri tartaris.  3i.
  Aque menthe pip.  gij.
  Syrupi cort. aurantii gi.
    M.
127.
 Take of arnica root 3 drs.
 Boil in 10 ounces of spring
   water to 6.
 Strain, and add
 Extract  of chamomile,
 Rue, each 1£ drachm.
 Tartrate of iron 1 drachm.
 Peppermint water 2 ounces.
 Syrup of orange peel 1 oz.
Two tablespoonfuls three or four times a day.
No. 128.
B Gummi galbani,
  Extracti arnice,
     "    chamomille,
  Florum salis  ammoniaci
    mart, aa pp. eq., fac pil-
    ulas gr. ij.
Take galbanum,
Extract of arnica,
          chamomile,
Flowers of sal ammoniac, of
  each equal  parts.  Make
  pills of 2 grains.
Ten, three times a day.
No. 129.
B Sode boracis 3ss.
                          Take of borate of soda half
                            a drachm.
Croci gr. viij.              Saffron 8 grains.
Flor. sulphuris,            Flowers of sulphur,
Eleosacchari  menth.  aa  Mint-sugar, each 20 grains.
  gr. xx.
M. f. pulvis.               Mix, make  a powder.

       One-third, morning, noon, and evening.
No. 130.
B Myrrhe,
  Galbani,
  Extracti hellebori  nigri,
    aa 3i.
  Aloes gr. x.
  Castorei gr. xx.
  Misce, f. pil. gr. ij.
Ten, two or three times a day
Take of myrrh,
Galbanum,
Extract of black hellebore,
  each 1 drachm.
Aloes 10 grains.
Castoreum 20 grains.
Mix, make two grain pills. 
RECEIPTS.
589
No. 131.
     Take of chamomile,
     Melissa,
     Crisp mint, each 2 drachms.
B Flprum chamomille,
  Herbe melisse,
    "    menthe crispe, aa
    3ij.
    "    sabine 3i.          Savin 1 drachm.
  C. M.  S.   Infused in two cups of boiling water.
to be taken morning and evening.
Half
                       No. 132.
B Magnesie  carbonatis gr.   Take of magnesia'20 grains.
    xx.
  Acidi tartarici gr. xvi.      Tartaric acid 16 grains.
  Herbe sabine,             Savin,
  Sacchari albi, aa gr. xx.    White sugar, each 20 grains.
  Misce, fiat pulvis.          Mix, let a powder be made.
  To  be taken three times during the day, in a cup of
water.
                       No. 133.
B Elix. acidi Halleri 3ij.      Take of acid elixir of Haller
                              2 drachms.
  Tr. cinchone Whyttii  gi.   Whytt's tincture of bark  1
                              ounce.
                            Tincture of orange peel  1
                              drachm.
" cort. aurantii 3i. M.

 Eighty drops three times a day in a cup of water.
No. 134.
ft Pulveris cort.  cinchone
    &•              ..  ..
        "      aurantii 3ij.
  Coque in aqua font. gxij.
    ad viij.
  Coletur.  Adde
  Elix. acidi Halleri 3ss.
  Tincture cinnamomi 3ij.
  Syrupi  cort.  aurantii gi.
Take of powdered hark  1
     ounce.
Orange peel 2 drachms.
Boil in 12 ounces of  water
  down to 8.
Let it be strained ; add
Haller's acid elixir £ dr.
Tincture of cinnamon  2 dr.
Syrup of orange peel 1 oz.
       Mix two tablespoonfuls every three hours.

                       No. 135.
B Lactis vaccini fciss.        Take of cow's milk 1^ pint.
  Coque cum aluminis 3ij.
Boil with two
  alum.
drachms  of
50 
590                   RECEIPTS.

  Fiat serum.  Adde        Make whey.  Add
  Syrupi cinnamomi gi.      Syrup of cinnamon 1 ounce
         Half a cup full every hour or two hours.

                       No.  136.
B Extracti cinchone,        Take of extract of bark,
      "    ratanhe,          Ratany,
      "    salvie,           Sage,
      "    catechu, aa 3ij.   Catechu, each 2 drachms.
  Ferri sulphatis gij.         Green vitriol 40 grains.
  Misce.  Fiant pilule gr. ij.  Mix.  Let pills of 2 grains
                              be made.
            Ten to fifteen, three times a day.
                       No.  137.
B Cinnamomi gr. x.          Take of cinnamon 10 grains.
  Ferri sulphatis gr. i.        Sulphate  of iron  1 grain.
  Sacchari albi gr.. xx.       White sugar 20 grains.
  M. f. pulvis.               Mix.  Make a powder.
  One powder to be taken every two hours, or oftener.
                       No. 138.
B Potasse bitartratis gi,      Take of cream of tartar 1 oz.
      "   nitratis,           Nitre,
  Sacchari albi, aa 3ij.       White  sugar, each 2  dr.
  M. f. pulvis.               Mix.  Make a powder.
   A teaspoonful  two to three times a day, in a glass  of
sweetened water.

                       No. 139.
B Aque fontane gvij.        Take of spring water 7 oz.
  Spiritus cochlearie giss.    Spirit of cochlearia 1 £ oz.
  Aque laurocerasi,          Laurel water,
  Potasse nitratis^ aa 3i.     Nitre, each 1 drachm.
  Extracti hyoscyami gr. x.   Extract of henbane  10  grs.
  M.                  As a gargle.

                       No. 140.
B Potasse carbonatis 3 ij.     Take of carbonate of potassa
                              2 drachms.
  Succi citri  q. s. ad satur-   Lemon juice as much as will
     andum                    saturate.
  Aque melisse giij.         Melissa water 3 ounces.
  Extr. hyoscyami gr. iv. M.   Extract of henbane 4 grains.
      Two tablespoonfuls every two or three hours. 
                      RECEIPTS.                  591

                      No. 141.
ft Elixir acidi sulphur, ar.,    Take equal parts of elixir of
                             vitriol,
  Tincture ambre,  aa pp.  Tincture of amber.  Mix
    eq.
            Forty drops three times a day.

                     No. 142, a.
ft Olei amygdal. dulc.  gi.     Take of oil of almonds 1 oz.
  Aque fontane gvij.        Spring water 7 ounces.
  Mucilaginis g. acacie q. s.  As much mucilage of gum
    ut fiat emulsio. Adde       arabic as will make emul-
                             sion.  Add
  Extracti hyoscyami gr. vi.  Extract of henbane 6 grains.
  Syrupi gi. M.             Syrup 1 ounce.
            Two tablespoonfuls every hour.

                     No. 142, b.
ft Potasse sulphatis  gss.      Take of sulphate of potassa
                             \ ounce.
  Aque distillate  gvj.        Distilled water 6 ounces.
  Syrupi rubi idei giss.M.   Raspberry syrup l\ ounce.
          Two tablespoonfuls four times a day.

                      No:  143.
 ITngucntum  Calcis.     Eime Einiment.
ft Aque calcis vive,          Take equal parts of lime wa-
  Olei papaveris aa pp. eq.     ter and poppy oil.

                      No.  144.
Pilulae Adstringentes Astringent or Styp-
      s. Stypticae.              tic  Pills.
ft Extracti catechu,          Take of extract of catechu,
  Aluminis crudi,            Crude alum,
  Extracti cinchone, aa pp.   Extract of bark, equal parts.
    eq.
  Misce f. pilule  gr. ij.       Mix.  Let pills of two grains
                              be made.
                 Ten, three times a day.

                      No.  145.
B Potasse nitratis 3iij.       Take of nitre 3 drachms.
     "    bitartratis 3ij.      Cream of tartar 2 drachms.
  Aque fontane gvi.         Spring water 6 ounces. 
 592                   RECEIPTS.

   Extracti digitalis gr. i.-ij.  Extract of digitalis 1 to 2 gr.
   Syrupi althee giss. M.     Syrup of mallows 1£ ounce.
   Two tablespoonfuls, at first every half hour, afterwards
 every hour, at last every two hours.
                       No. 146.
 B  Radicis ipecacuanhe gr. i.  Take ipecacuanha  1 grain.
   Sacchari albi 3ij.          White  sugar two drachms.
   Misce.   Fiat pulvis  divi-  Make  a  powder,  to be di-
     dendus in viij. partes    vided into 8 equal parts.
     equales.
             One every quarter of an hour.
                       No. 147.
 ft  Acidi tartari. gr. xx.        Take of tartaric acid 20 grs-
   Extracti  hyoscyami  gr.  Extract of henbane 8 grains.
     viij.
   Aque fontane giv.         Spring  water 4 ounces.
   Syrupi althee giss. M.     Syrup of mallows 1^ ounce.
           A tablespoonful every half hour.
                       No. 148.
 B  Elix. acidi  Halleri gutt.  Take of Haller's acid elixir
     lx.                       40 drops.
   Laudani  liquidi Sydenh.  Laudanum of Sydenham 20
     gutt. xx.                   drops.
   Aque fontane giv.         Spring  water 4 ounces.
   Syrupi papaveris  rhead.  Red poppy syrup 2 ounces.
     gij- M.
           Two table spoonfuls every half hour.

                       No. 149.
B  Foliorum digitalis purp.    Take of leaves of digitalis^
     3ss.                      drachm.
   Ebulli cum  aqua font. q.  Boil in  enough spring water
     s.  Colat.   gvij.  adde       to leave strained 7 ounces.
   Acidi muriatic, oxygenat.  Add strong muriatic acid 2
     3 ij.                       drachms.
   Aque laurocerasi 3i. M.    Laurel water 1 drachm.  M.
           A tablespoonful every two hours.
                       No. 150.
B  Olei amygdalar. dulc. gi.   Take of almond oil  1 ounce.
  Aque fontane gxvi.        Spring water 16 ounces.
  Gummi acacie giss.        Gum arabic 1^- ounce.
  F. emulsio.  Adde         Let an emulsion be made.
  Syrupi  gi. M.              Add syrup 1 ounce.
              Half a cup full every hour. 
RECEIPTS.
593
Diuretic Infusion.
        No. 151.
B Radicis levistici,
     "    ononis  spinose,
    aa gss.
  Baccarum juniperi gij.
  Rad. glycyrrhize gss.
                       No.
B Pulveris rad. scille,
     "     herbe  digitalis,
    aa gr. xx.
  Corticis cinnamomi 3iss.
  Extracti quale q. s.  ut f.
    pil. No. lx.
 Take of lovage root,
 Rest-harrow,— each £ oz.

 Juniper berries 2 ounces.
 Liquorice root £ ounce.
152.
 Take powder  of squills,
 Digitalis, each 20 grains.
                            Cinnamon 1£ drachm.
                            Extract  of elecampane as
                              much as is sufficient.  Let
                              60 pills be made.
  Two or three, three times a day, increasing to six and
more, with diuretic infusion.

                       No. 153.
                            Take of oil of juniper \ dr.
                            Tincture of digitalis 1 dr.
                            Nitrous ether 2 drachms.
Olei juniperi 3ss.
Tincture digitalis 3i.
iEtheris nitrosi 3ij.
         Thirty to sixty drops three times a day.
                       No. 154.
B Succi spissatijuniperi giss.  Take of inspissated juice of
  juniper 1^- ounce.
Tartrate of potassa 2 dr.
Water of petroselinum 7 oz.
Nitrous ether 2 drachms.
Oxymel of squills 1 ounce.
  Potasse tartratis 3ij.
  Aque petroselini gvij.
  iEtheris nitrosi 3ij.
  Oxymellis scille gi. M.
         Two tablespoonfuls  every two hours.

                        No. 155.
B Olei terebinthine,          Spirit of turpentine,
  Aceti scille, aa gij.       *  Vinegar of squills, each 2 oz.
  Spiritus serpylli giij. M.    Spirit of thyme 3 ounces. M.
                Lotion for the abdomen.
No. 156.
B Gambogie,
  Pulver. scille,
  Digitalis,
  Antimonii sulphuret (aur.)
  Take of gamboge,
  Squills,
  Digitalis,
  Golden sulphuret of  anti-
     mony.
50* 
594                    RECEIPTS.
  Extr. pimpinelle, aa pp.  Extract of pimpinella equal
    a>q/  F                  parts.    Let  pills  of 2
  Misce. Fiant pilule gr. ij.    grains be made.
  One every two or three hours, gradually increasing the
number until effect be produced.

                       No. 157.
B. Radicis bryonie albe gi.  Take of white bryony root
                               1 ounce.
  Infunde  vino Rhenan. Ibij.  Rhenish wine 2 pints.
  Digere  leni  calore  per  Digest  for two  days,  at  a
     duos dies.  Colentur.       moderate temperature.
  One or two spoonfuls every morning ; increasing to half,
even to a whole cup full, according to the effect.
No. 158.
B Potasse carbonatis gi.

  Aceti scille  q. s.  ad sa-
    turand.
  Extracti fumarie,
     "    centaurii min.,
     "    gentiane,
     "    trifolii, aa gss.
  Infus. baccarum  juniperi
    fciv.
  Tincture martialis aperit.
     "     antimonii Jacobi
     aa. gi. M.
Take of carbonate of potassa
  1 ounce.
As  much vinegar of squills
  as will saturate.
Extract of fumitory,
Centaury,
Gentian,
Trefoil, each £ ounce.
Infusion  of juniper berries
  4 pints.
Laxative tincture of mars.,
Antimonial  tinct. of James,
   each 1  ounce.
A tablespoonful every two hours.

           No. 159.
B Elaterii gr. i.
  Aque petroselini gvi.
  iEtheris nitrosisi 3 ij.
  Oxymellis scille,
  Syrupi de spina cervina,
    aa gi.
  Tincture  aromatice  3ij.
    M.
  A tablespoonful  every two
the effect.
Take of elaterium 1 grain.
Water of petroselinum 6 oz.
Nitrous ether 2 drachms.
Oxymel of squills,
Syrup  of  cathartic  buck-
  thorn, each 1 ounce.
Aromatic tincture 2 drs.


or three hours, according to 
REGEIPTS.
595
B Syrupi de spina cervi,
No. 160.           «
     Take equal parts of syrup of
       buckthorn,
     Inspissated juice of juniper,
     Elder flowers.
  Succi spissati juniperi,
               sambuci, aa
    pp. eq.
             A spoonful every three hours
                       No
B Scammonii 3i.
  Antimonii crudi,
  Croci martial, aperit. aa.
    3ss. M.
161.
 Take of scammony 1 dr.
 Crude antimony,
 Aperitive  martial   crocus,
   each -k drachm.
Twenty grains in pills for a dose.
B Resine guaiaci 3i.
Gambogie gr. xx.
Rad. scille gr. xij.
Hydrargyri nitratis gr. ij.
Extr. levistici 3i.
Misce.  Fiant pilule No
  LX.
No. 162.
     Take of resin of guaiacum 1
       drachm.
     Gamboge 20 grains.
     Squills 12 grains.
     Nitrate of mercury 2 grains.
     Extract of levisticum 1 dr.
     Mix.  Let 60 pills be made.
Five, three times a day, taken in diuretic infusion.

                   No. 163.
B Hydrargyrii nitratis gr. vi.
    in aque q. s. solutus.

  Extracti levistici,
     "    pimpinelle, aa 3i.
  Olei juniperi guttas xxx.
  Pulv. rad. althee q. s. ut

  Fiant pilule No. lx.
Take nitrate of mercury  6
  grains.  Dissolved in a suf-
  ficiency of water.
Extract of levisticum,
Pimpinella, each 1 drachm.
Oil of juniper 30 drops.
Powdered  mallow  root,
  enough.
Let sixty pills be made.
                 One every two hours.

                       No.-164.
B Olei menthe pip. guttas x.  Take of oil of peppermint 10
                              drops.
  Solve in                  Dissolve in
  Liquoris anodyni Hof. 3i.  Anodyne liquor of Hofmann
                              1 drachm.
     "   ammonie anisati,  Aromatic spirit of ammonia, 
596                   RECEIPTS.

   Tincture ^valeriane  aa   Tincture of  valerian, each
     3iss. M.                   1| drachm.
        Thirty to forty drops in infusion of cumin.

                       No. 165.
B  Essentie menthe pip.,     Take of essence  of pepper-
                               mint,
      "     castorei,         Castoreum,
   Liquoris anodyni Hof. aa  Anodyne liquor of Hof. each
     3i.                        1 drachm.
   Laudani liquidi  Sydenh.  Liquid laudanum  of Sydenh.
     3ss. M.                    half a drachm.
                Thirty drops for a dose.

                       No. 166.
B  Tincture absinthii,        Take tincture of  absinth,
   Elixir aurantii co. aa  gss.  Compound elixir  of orange-
                               peel, each half  an ounce.
   Essentie menthe  pip. ij.  Essence  of  peppermint  2
     drachms. M.               drachms.
             Sixty drops three  times a day.

                       No. 167.
                                         i
B  Ase fetide,              Take of asa fetida,
   Fellis tauri inspissati,      Dry ox-gall,
   Extracti absinthii,         Extract of absinth,
      "   quassie,           Quassia,
      "   cort. aurantii  aa  Orange-peel, each 1 drachm.
     3i.
   Olei cajeputi gr. x.         Oil cajeput 10 gr.
   Misce. Fiant pilule gr. ii.  Mix.  Let pills of 2 grains
                               be made.
           Ten to fifteen morning and evening.

                       No. 168.
B  Extracti graminis,         Take of extract of dog-grass,
      "     taraxaci,          Dandelion,
  Potasse tartratis, aa gss.   Tartrate of potassa, each  ±
                              ounce.
   Aque distillate,            Distilled water,
    "  menthe pip. aa giij.   Peppermint, each  3 ounces.
    M.
            A tablespoonful  four times a day. 
RECEIPTS.
597
                       No. 169.
B Potasse bitartratis gi.      Take of cream of tartar 1 oz.
  Florum sulphuris  gss.      Flowers of sulphur £ ounce.
  Misce.  Fiat pulvis.        Mix. Let a powder be made.
  A teaspoonful once or twice a day, for a few days, so as
to produce one or two loose stools.

                       No. 170.
                            Take of milk of sulphur,
                            Magnesia,
                            Tartaric acid,
                            Citron sugar, each 20 grains.
Mix. Let a powder be made.
B Lactis sulphuris,
  Magnesie carbonatis,
  Acidi tartari,
  Eleosacchari citri, aa gr
    xx.
  Misce.  Fiat pulvis.
       A powder in a cup of water every evening

                       No. 171.

 Pilula3 Balsamicae
      Hofmanni.
B G. Myrrhe,
  Aloes,
  Ext. hellebori  nigri
     3v
aa
     cardi benedicti,
 "   absinthii,
 "   fumarie,
 "   centaurii,
 "   millefolii, aa gi.
Terebinthine,
Benzoes,
Resine juniperi,
  "    hedere, aa gss.
Croci orientalis,  3i.
Misce.  Coque in balnea
  mar.  ad   consistatem
  massule pilule.  Dosis
  gr. iv. ad xij.
 Balsamic  Pills of
      Hofmann.
Take of myrrh,
Aloes,
Extract of black hellebore,
  each 5 drachms.
Cardus benedictus,
Absinth,
Fumitory,
Centaury,
Millefoil, each 1 ounce.
Turpentine,
Gum benjamin,
Resin of juniper,
Ivy, each £ ounce.
Saffron 1 drachm.
Mix.   Boil in a water bath
  to the consistence of pill-
  mass.  Dose from 4 to 12
  grains.
No. 172.
 Pulvis Aerophorus.
$ Sode bicarbonatis Si.

  Acidi tartari gr. vi. M
  Aerated Powder.
Take  of carbonate of soda
  20 grains.
Tartaric acid 6 grains.
To be taken two or three times a day. 
598
RECEIPTS.
No.
                           173.
                           Take of Haller's acid  elixir
                              4- ounce.
                           Whytt's tincture of bark  1^
                              ounce.
Fifty to eighty drops in a cup of water three times a day.
                       No. 174.
B Pulv. radicis columbo gss.  Take of columbo .} ounce
B Elix. acid Halleri gss.

  Tincture cinchone Whyt-
    tii giss.
Coque in aqua fontana gx.
  ad vi.
Colature adde
Tincture cort. aurantii 3ij
Syrupi    "     •« gi. M.
Boil in 10 ounces of water
  to 6.
To the strained liquor,add
Tincture of orange peel 2 dr.
Syrup of     "     " 1  oz.
A tablespoonful every three hours.
            No.  175.
B Extracti catechu,
  Aluminis crudi,
  Corticis cinchone,
  Extracti quassie, aa 3i.
  Ferri sulphatis gr. x.
  Misce. Fiant pilule gr.rj.
Take of extract of catechu,
Crude alum,
Bark,
Ext. quassie, each 1 dr.
Green vitriol 10 grains.
Mix.  Let pills of 2 grains
  be made.
Ten every morning and evening, increasing.
                       No.
  Liquor Anterethi-
          cus.
B Aque laurocerasi,
  Liquoris plumbi  subace-
    tatis aa gij.
  Aque rosarum giv. M.
176.
  Anterethic  Iiiquor.

 Take of laurel water,
 Goulard's water, each 2 Oz.
                           Rose water 4 ounces.
              For an external  application.
                       No. 177.
                           Take wheaten bran 2 ounces
                           Camphor 2 drachms.
                       No. 178.
B Tincture rhei aquose gi.
B Furfure tritice gij.
  Camphore 3 ij. M.
Aque menthe pip. gij.
  "   distillate giv.
Ammonie muriatis 3i.
Syrupi althee  gi. M.
Take of aqueous tincture of
  rhubarb 1 ounce.
Peppermint water 2 ounces.
Distilled     "   4 ounces.
Muriate of ammonia 1 dr.
Syrup of mallows 1 ounce.
Two tablespoonfuls every three hours. 
                       RECEIPTS.                    599

                       No. 179.
B Olei amygdal. dulc.  gi.     Take of oil of almonds 1 oz.
  Ammonii muriatis 3ij.      Sal ammoniac 2 drachms.
  Mucilaginis gum. acacie   Mucilage of gum arabic^- oz.
     gss.
  Aque fontane gvi.         Spring water 6 ounces,
  Extracti hyoscyami gr. vi.  Extract of henbane 6 grains.
  Syrupi amygdal. gi. M.     Syrup 1 ounce.
          Two tablespoonfuls every two hours.

                       No. 180.
B Radicis rhei gr. ij.          Take of rhubarb 2 grains.
     "     ipecacuanhe gr. }.  Ipecacuanha 4/ grain.
  Crete preparate gr. 10.    Prepared chalk 10 grains'.
  Misce fiant pulv. Dispens.  Make a powder of it.  Give
     viij. doses.                8 doses.
               One dose every half hour.

                       No. 181.
B Bol. Armenian, gr. x.      Take of  Armenian bole 10
                              grains.
  Nucis moschat. gr. iij. M.  Nutmeg 3 grains, mix it into
  Misce fiant pulveris dis-    powder.   Give 6 doses.
     pens. dos. vi.
         One dose to be taken every three hours.

                       No.  182.
B Extracti cascarille 3i.     Take of extract  of casca-
                              rilla 1 drachm.
  Aque menthe,            Peppermint  water,
     "   chamomille aa 3ij.  Chamomile water each 2 oz.
  Mucilaginis gum. acacie  Mucilage of gum-arabic £ oz.
     gss.M.
            A tablespoonful every two hours.

                       No.  183.
 B Radicis rhei gr. ij.         Take of rhubarb 2 grains.
  Crete preparate,          Prepared chalk,
  Pulveris gummosi  aa gr.  Gum-powder, each 20 grs.
     xx.
   Laudani liquidi Syd. gtt.  Liquid laudanum of Sydenh.
     jj.                        2 drops.
   Nucis moschate gr. iij.     Nutmeg 3 grains.
   Misce, fiat pulvis.          Mix. Let a powder be made.
          To be taken two or three times a day. 
600
RECEIPTS.
                      No. 184.
B Pul. rad. columbo gss.     Take of powdered columbo
Boil in 12 oz. of water to 6.
Add to the strained liquor
Syrup of orange peel 1 oz.
Liquid laudanum of Syd.  10
  drops.
peachy wood £ oz.
Cam-
  Coque cum aq. gxij. ad vi.
  Colature adde
  Syrupi  corticis  aurantii

  Laudani  liquidi  Sydenh.
    guttas x.  M.
           One tablespoonful every two hours.
                       No. 185.
B Pulveris  ligni Campech.  Take  of powder of
  . gss.
  Cort. aurantii 3iss.
  Coque cum aqua font. gxii.
    ad viij.
  Colature adde
  Syrupi cort. aurantii. gi.
    M.
         Two tablespoonfuls every two hours.
                       No.  186.
B Tincture macis gss.       Take of tincture of mace
                                ■%■ oz.
  Laudani  liquidi  Sydenh.  Liquid laudanum of Sydenh.
    3ss.  M.                 £  drachm.
        Thirty drops, three  or four times a day.
                       No.  187.
Orange peel \\ drachm.
Boil in 12 ounces  of water
  to 8.
To  the  strained  liquor add
Syrup of orange peel, 1 oz.
B
Take nux vomica 3 grains.
Prepared chalk 10 grains.
Nutmeg 4 grains.
  Nucis vomice gr. iij.  :
  Crete preparate gr. x.
  Nucis moschate gr. iv,
  Misce.  Fiant pulvis.
         To be taken two or three times a day.

                       No. 188.
B Radicis arnice 3iij.
  Corticis cascarille 3ij.
  Coque cum aqua font.  gx.
    ad vi.
  Colature adde
  Tincture catechu 3ij.
  Laudani liquidi Sydenh.
    gutt. xij.
  Syrupi althee gj.   M.
         Two tablespoonfuls four times a day.
Take of arnica root, 3 dr.
Cascarilla bark 2 drachm.
Boil in 10 ounces  of water
     to 6.
Add to the strained liquor.
Tincture of catechu 2 dr.
Liquid laudanum of Syd. 12
  drops.
Syrup of mallows 1 oz. 
                        RECEIPTS.                    601

                        No.  189.
                             Take equal parts of
 B Extracti arnice            Extract of arnica,
     "     columbo                      columbo,
     "     millefolii          Extract of millefoil,
   Florum sulphuris  aa pp.  Flowers of sulphur.
     aq.
   Misce. Fiant pilule gr. ij.  Mix. Let 2 gr. pills be mide.
                 Ten three times a day.

                        No. 190.
 B Mucilaginis g. acacie gi.  Take of mucilage of g. ara-
                               bic 1 oz.
   Aque fontane gvij.       Spring water 7 oz.
   Laudani   liquidi  Syden.  Liquid laudanum of Syd. 16
     guttas xvi.                 drops.
   Syrupi althee gi.   M.    Syrup of mallows 1 oz.
   A tablespoonful  every  two hours,  and in urgent cases
 every hour.
                       No. 191.
 B Tincture rhei  aquose 3vi.  Take watery tincture of rhu-
                               barb 6 drachms.
   Ammonie muriatis 3ij.    Sal ammoniac 2 drachms.
   Aque cerasorum gvij.     Cherry water 7 ounces.
   Laudani  liquidi  Sydenh.  Liquid  laudanum of Syden.
     guttas xx.                 20 drops.
   Syrupi althee gj.  M.     Syrup of mallows 1  ounce.
          Two tablespoonfuls every two hours.

                       No. 192.
 B Fellis tauri inspissati      Take of dry ox gall,
   Saponis                  Soap,
  Pulv. rhei  aa  3j.           Rhubarb each 1 drachm.
  Extracti taraxici q. s. ut  Enough extract of dandelion.
    fiant pilule  gr. ij.         Let pills of 2 grs. be  made-
                 Ten night and morning.

                       No. 193, a.
B Aloes vel scammonii.       Take of aloes or scammony,
  Ferri alcoholisati aa pp. eq.  Iron filings equal parts.
  Misce.  Fiat pilule gr. i.    Mix.  Make into pills of 1
                               grain each.
                    One at bed-time.
                          51 
602                   RECEIPTS.
                      No.

B Colocynthidis pulpe gvi.

  Aloes  spicate  extracti
    gxii.
  Scammonii giv.
  Cardamomi seminum gi.
  Saponis giij.
  Spirit, tenuioris congium.
  Maceracolocynthidis pul-
    pam  in  spiritu, leni ca-
    lore, per  quadriduum.
    Liquorem  cola,  eique
    adjice  aloen, scammo-
    nium et saponem ; dein
    spiritunv consume, do-
    nee idoneam cessitudi-
    nem  habeat et, sub fi-
    nem, cardamomi semina
    admisce.
193, b.
 Take of pulp  of  colocynth
   6 ounces.
 Extract of aloes 12 ounces.

 Scammony 4 ounces.
 Cardamom  seed 1 ounce.
 Hard soap 3 ounces.
 Weak spirits 1 gallon.
 Digest the  colocynth in the
   spirit, for four  days, at  a
   moderate heat, add to it
   the aloes, scammony, and
   soap,  evaporate to a pro-
   per consistence, and add
   the cardamoms.
                      No. 194.
B Pulv. foliorum senne 3ij
Extracti taraxici q.  s.
  fiant pilule No. lx.
    Take of powder of senna 2
      drachms.
ut  Extract of dandelion a suffi-
      ciency.  Let sixty pills be
      made.
Five to ten a day.
No. 195.
  Species Fhea  St.
      Oermani.
ft  Foliorum senne  giv.

  Digere cum spiritu vini
    rectif.  per horas  xxiv.
    Post digestionem  ex-
    sicca sine calore. Adde
  Florum sambuci giiss.
  Seminum feniculi,
   "     anisi, aa gi.
  Potasse  bitartratis  3vi.
  M. C. M.
Ingredients for the
Tea of St. Germain.
Take of  senna  leaves  4
  ounces.
Digest in proof spirits for
  24 hours.  After the di-
  gestion, dry without heat.
  Add
Flowers of elder 2£ ounces.
Fennel seed,
Anis seed, each 1 ounce.
Cream of tartar 6 drachms.
Mix. 
RECEIPTS.
603
                       No. 196
B Manne electe,
  Fructus tamarindorum,
  Magnesie sulphatis, aa gi.
  Coque cum   aqua font.
     gxij. ad viij. sub finem
     coctionis, adde
  Foliorum senne 3ij.
  Liquori colato. adde
  Extracti  hyoscyami  gr.
     viij.
  Syrupi papaveris gi. M.
Take of best manna,
Tamarinds,
Epsom salt, each 1 ounce.
Boil in 12 ounces  of water
  to 8.   At the end of the
  boiling add
Senna leaves 2 drachms.
To the strained liquor add
Extract of henbane 8 grains.

Poppy syrup 1 ounce.
Two tablespoonfuls every hour.
           No. 197.
Olei amygdalarum,
Magnesie sulphatis, aa gi.
Extr. aloes aquosi gr. x.
    "  hyoscyami gr. xx.
  Aque fontane gviij. M.
  Two tablespoonfuls every two hours
each time.
                       No. 198.
B Nicotiane 3iij.
  Coque cum aqua gix. ad
    vij-
  Colentur
Take of almond oil,
Epsom salt, each 1 ounce.
Aqueous extract of aloes 10
  grains.
Henbane 20 grains.
Water 8 ounces.
         Shake the mixture
Haifa cup full every hour.
         No. 199
Take of tobacco 3 drachms.
Boil in 9 ounces of water to
  7.
Let it be strained.
                      m
Succi spissati juniperi gi.

Aque petroselini giv.

                    3ij.
Take of inspissated juice of
  juniper 1 ounce.
Water  of  petroselinum 4
  ounces.
Dilute muriatic acid 2 drs.
Acidi muriatici diluti
  M.
         A tablespoonful every two hours
                     No. 200.
Pulv. cantharidum gr.
Camphore gr. vi.
Mucilaginis  g. acacie
  s. ut.
F. pilule No. iv
Take of cantharides 1 gr.
Camphor 6 grains.
Mucilage as much as neces-
  sary.
Make 4 pills.
One, morning, noon, and night with gruel 
604
RECEIPTS.
No. 201.
Pulvis Antidyscrasi-
 cus S. Purincans.
B Resine guaiaci gr. xx. ad
    XXX.
  Sulphureti antim. (aur),
Purifying: or Anti-
dyscrasic Powder.
Take  of resin of guaiacum
  20 to 30 grains.
Golden  sulphuret  of  anti-
  mony,
Calomel, each 2 grains.
  Hydrargyrii submuriatis,
     aa gr. ij.
  Magnesie carbonatis,
  Eleosacchari feniculi, aa
     gr. xx. M.
  For infants and delicate persons, let black sulphuret of
mercury or antimony be substituted for the calomel, in the
proportion of one grain for each year of age, and of a scru-
ple for adults.  Make a powder, half night and morning.
Magnesia,
Fennel candy, each 20 grs.
  M.
No. 202.
B Radicis sarsaparille,
    "    bardane,
    "    saponarie,
  Ligni guaiaci,
  Rad. glycyrrhize,
  Stipitum dulcamare
    pp. eq.
  CM.
Take of sarsaparilla,
Burdock,
Soapwort,
Guaiacum,
Liquorice roots,
Tops of bittersweet,  equal
  parts.
An ounce or an ounce and a half every day, in decoction.
No. 203.
 Decoctum Pollini.

r Rad. sarsaparille gi.
  Stipit. dulcamare gss.
  Pulver. antimonii crud. 3i.

  C. coque  cum aqua font.
    tbij. ad ftiss.  Adde
  Foliorum senne  3ss.—i.
  Colature adde
  Syrupi fumarie gi. M.
All to be taken in one day.
Decoction   of  Pol-
          lini.
Take of sarsaparilla 1 ounce.
Twigs of bittersweet f oz.
Crude antimony in powder
  1 drachm.
Boil in 2 pints of water to
  li pint.  Add
Senna £ to  1 drachm.
To the strained liquor add
Syrup of fumitory 1 ounce. 
RECEIPTS.
605
                  No. 204, (1.)
Decoctum   Zitt-     Zittmann's   Strong
 manni Fortius.          Decoction.
B Rad. sarsaparilla gxij.
    Infunde
  Aque communis mensuras
    xxiv.
  Et digere per horas xxiv.
    Turn additis
  Sacchari aluminati giss.
  Hydrarg. submuriatis gss.
  Cinnabaris 3i.
  Sacculolinteo inclusis, co-
    que  ad   remanentiam
    mensurarum octo,  sub
    finem coctionisaddendo

  Seminum anisi,
      "     feniculi singu-
    lorum contusorum  gss.
  Foliorum senne  giij.
  Radicis glycyrrhize giss.
  Cola et exprime.  Liquor-
    em obtentum decantha.
Take of sarsaparilla 12 oz.
  Pour over it
Common water 24 pints,

And digest for 24 hours.
Then add
Alumniated sugar 1| ounce.
Calomel £ ounce.
Vermilion 1 drachm.
Enclosed in a linen bag, and
  boil down to  8 pints; to-
  wards the last of" the boil-
  ing there being added of
  separately bruised
Anis seed,
Fennel seed, each \ ounce.

Senna 3 ounces.
Liquorice root 1^- ounce.
Strain and press the  liquor
  out.
                    No. 205, (2.)
 Decoct.  Zittman.    Weaker
        lUitius.
R Rad. sarsaparille gvi.
  Cum speciebus a decocto
    fortiori   mensurarum,
    octo  residuis   mixtas
    coque cum aqua  com.
    mensuris xxiv.  ad re-
    manentiam    mensura-
    rum octo, sub finem coc-
    tionis addendo
  Corticis citri,
  Cassie cinnamomi,
  Cardamomi minoris,
  Rad. glycyrrhize singulo-
    rumteontusorum et con-
    cisorum 3iij.
  Cola et exprime liquorem,
    obtentum decantha.
                      •  51
           Decoct,  of
      Zittmann.
Take of sarsaparilla 6 oz.
Boil with the residue of the
  preceding decoction,  and
  reduce to 8 pints, adding
  towards the end
Citron peel,
Cassia cinnamon
Lesser cardamoms
Liquorice root, each bruised
  and cut up.

Strain and express. 
606
RECEIPTS.
  Take a gill of the strong decoction (1.) while yet in bed,
quite early in the morning. Remain there until the perspi-
ration be over,  change linen, after this take two cups  of
coffee.  In the  course of the forenoon take a cup of broth ;
at noon a dish of soup, roast meat (fowl is preferable), and
vegetables, abstaining  from fruit,  wine, beer and pastry ;
from all kinds of ices; acids,  salted or fat  meats.   After
dinner, take again coffee, and half a pint of  the strong de-
coction, cold.   In the evening gruel.  Before going to bed
take half a  pint of the weak decoction (2).
  The medicine ought to be  kept  in the cellar j keeping
only two bottles for immediate use, which must  be well
shaken before using.

                       No. 205.
B Limat. ferri gr. x.          Take of iron filings 10 grs.
  Radicis rhei,              Rhubarb,
  Cinnamomi aa gr. ij.       Cinnamon, each 2 grains.
  Sacchari albi gr. xx.        White sugar 20 grains.
  Misce.  F. pulvis.         Mix. Let a powder be made.
           To be taken morning and evening.

                       No. 206.
B Florum ammoniacal. mar-  Take of martial flowers of
    tial. vel ferri tartaris 3i.    sal ammoniac or tartrate
                              of iron 1 drachm.
  Extracti gentiane 3ij.      Extract of gentian 2 dr.
  Corticis  aurantii 3i.        Orange peel 1 drachm.
  Aque melisse giij.         Melissa water 3 oz.
     "   cinnamomi gij.      Cinnamon water 2 oz.
  Syrupi cort. aurantii  gi. M.  Syrup of orange peel  1 oz.
                              Mix.
            A tablespoonful four times a day.

                       No. 207.
B Extracti taraxici           Take of extract of dandelion,
     "     chelidonii aa 3 iij-           "    chelidonium,
                              each  3 drachms.
  Acidi tartaris gss.         Tartaric acid,  f oz.
  Tincture rhei aquose gi.   Watery tincture of  rhubarb
                              1 oz.
  Aque menthe pip. gij.     Peppermint water„2 oz.
     "   distillate giv.        Distilled water 4 oz.
  Syrupi menthe gi.  M.    Syrup of mint  1 oz.
              A spoonful every two hours. 
                       RECEIPTS.                   607

                       No. 208.
B Pulveris rad. rhei,          Take of rhubarb,
  Extracti taraxici,          Extract  of dandelion,
    "     chelidonii,            "    chelidonium,
  Saponis,                  Soap,
  Gummii ammoniaci aa 3i.   Gum ammoniac, each 1 dr.
  Aloes gr. xx.              Aloes 20 gr.
  Misce.  Fiant pilule gr. ii.   Mix.  Let 2 grain pills be
    consperge seminibus ly-     made, sprinkled  with ly-
    copodii.                   copodium.
           Twelve morning, noon and night.

                       No. 209.
B Radicis belladonne gr. i.    Take of nightshade rooU 1
                              grain.
          rhei gr. v.          Rhubarb 5 gr.
  Sacchari albi g. xx.        White sugar 20 gr.
M.  F. pulvis.               Mix.  Make a powder.
          To be taken  morning and evening.

                       No. 210.
B ^Ethiopis mineralis gr. i.   Take of iEthiops mineral 1
    ad iij.                    to 3 grains.
  Pulveris puerorum gr. xx.   Pulvis puerorum  20 to 30
    ad xxx.                   grains.
  Misce.  F. pulvis.          Mix. Let a powder be made.
      Half in the morning and the rest at bed-time.

                       No. 211.
B Antimonii sulphuret. (aur.)   Take of golden sulphuret of
                              antimony,
  Hydrargyrii submuriatis,   Calomel, each 1 gr.
    aagr. i.
  Pulveris puerorum 3ss.     Pulvis puerorum •£ drachm.
  M.  F. pulvis.             Mix. Let a powder be made.
  Half in the morning  and  the  rest in the  evening (for
children of five years and upwards.)

                       No. 212.
B Antimonii sulphur, (aur.)   Take of golden sulphuret of
                              antimony,
  Hydrargyrii submuriatis,   Calomel,
  Ext. cicute aa gr. i.        Extract  of cicute, each 1 gr.
  Resine guaiaci gr. x.       Resin of guaiacum 10 gr. 
608                    RECEIPTS.

  Eleosacchari feniculi gr.  Fennel candy 20 gr.
    xx.
  Misce. Fiat pulvis.        Mix. Let a powder be made.
      Half in the morning the rest in the evening.
                       No. 213.
B Baryte muriatis 3ss.       Take of muriate of barytes
                              £ drachm.
  Aque distillate  gi.        Distilled water 1 oz.
         Ten to thirty drops, three times a day.

                       No. 214.
B Ligni sassafrage giv.       Take of sassafras 4 oz.
  Radicis rubie tincturi      Madder,
    "   glycyrrhize  aa gi.    Liquorice root, each 1 oz.
  TJ. M.
        A tablespoonful in infusion, as a tea, daily.

                       No. 215.
B Resine guaiaci             Take of resin of guaiacum,
  Extracti dulcamare aa 3ij.  Extract of bittersweet, each
                              2 drachms.
    "     cicute gr. xx.      Extract of cicute 20 gr.
  Florum sulphuris          Flowers of sulphur,
  Hydrargyrii submuriat. aa  Calomel, each 10 gr.
    gr. x.
  Misce.  Fiant pilule gr. ij.  Mix.  Let  2 grain pills be
                              made.
                   Ten, twice a day.

                       No. 216.
B Radicis saponarie          Take of root of saponaria
    "     taraxici                    "   dandelion
    "     bardane                    "    bardana
    "     sassafrage aa, gij.           "    sassafras, each
                                           2 oz.
    "     rubie tinctori giij.           "   madder 3 oz.
    "     glycyrrhize gi.M.           "   liquorice 1 oz.
  C. M.  Boil one ounce in a quart of wafer,  and reduce
to two-thirds.  The  whole to be taken in one day.

                      No. 217.

B Calcii chloridi gss.         Take of chloride of lime,
                              i oz.
  Solve  in  aqua  distillata  Distilled water 1 pint.
    B»i.               Externally. 
                       RECEIPTS.                  609

                       No. 218.
 B Potasse hydriodatis 3ss.    Take of hydriodate of po-
                              tassa ■%■ drachm.
  Adeps suille gi. M.        Hog's lard 1 oz.

                       No. 219.
  Ungucntum  Oph-    Ophthalmic  Oint-
      thalmicum.                ment.
 B Hydrargyrii oxidi rubri  Take of red precipitate 2 gr.
     gr- ii-
  Tutte gr. vi               Tutty 6 gr.
  Unguenti simplicis 3i.      Simple ointment 1 drachm.
  Extracti opiiaquos.gr. ss.  Aqueous extract of opium,
     M.                       i gr.

                      No. 220.
 B Boracis sode 3iss.         Take of borax 1£ drachm.
  Solve in aqua giv.         Dissolve  in water 4 oz.
  Aque laurocerasi 3iij. M.  Laurel water 3 drachms.

                    '  No. 221.
 B Spongie toste 3ss.         Take of burnt sponge % dr.
  Crete preparate           Prepared chalk,
  Eleosacchari citri aag. xx.  Citron candy, each 20 gr.
  iEthiopis mineralis gr. x.   jEthiops  mineral 10 gr.
  Misce.  F. pulvis.         Mix.  Let a powder be made.
         Half in the morning the rest  at night.

                      No. 222.
 B Spongie toste gss.        Take of burnt sponge £ oz.
  Coque cum aqua gxij. ad v.  Boil in 12 oz. of water to 5.
  Colature  adde             To the strained liquor  add
  Aque cinnamomi,         Cinnamon water,
  Syrupi corticis aurantii aa  Syrup of orange  peel, each
     gi.                       1 oz.
           A tablespoonful four times  a day.

                      No. 223.
B Potasse bi-carbonatis 3i.   Take of bi-carbonate of soda
                             1 drachm.
  Aque cinnamomi          Cinnamon water
  Syrupi althee aa gi.       Syrup of mallows, each 1 oz.
  Aqua fontana gvi.  M.     Spring water 6 oz.
          Two tablespoonfuls four times  a day. 
610
RECEIPTS.
No. 224.
B Sacchari albi gr. xx.
  Crete preparate gr. x.
  Ferri alcoholisati gr. i-
  Cinnamomi gr. i. M.
  M. pulvis.
Take of white sugar 20 gr.
Prepared chalk 10 gr.
Iron filings 1 to 2 gr.
Cinnamon 1 gr.
Mix.   Make a powder.
Take morning and evening.
B Resine guaiaci,
  Gummi acacie aa 3ij.
  Aque distillate gvi.
  Fiat emulsio; adde

  Potasse nitratis 3i.
  Syrupi gi.
  Vini antimonii 3i.  M
No. 225, a.
      Take of guaiacum
      Gum arable, each 2 dr.
      Distilled water 6 oz.
      Let  an emulsion be made ;
        add
      Nitre 1 drachm.
      Syrup 1 oz.
      Antimonial wine 1 drachm.
A tablespoonful every two hours.
B Tincture guaiaci volatil.
    gi.
  Mucilaginis  gum. acacie
    3ij.
  Syrupi amygdalarum,
    "     cort. aurantii,  aa
    giss.  M.
           Half a spoonful three times a day.

                       No. 226.
No. 225, b.
      Take of volatile tincture  of
        guaiacum 1 oz.
      Mucilage of gum arabic 2
        drachms.
      Syrup of almonds,
        "   orange peel 1£ oz.
B Soda carbonatis 3i.
Take  of  carbonate of soda
  1 drachm.
Extract of absinth 2dr.
Peppermint  water 4 ounces.
Syrup of orange peel 1 oz.
Tincture of  "   " 1£ dr.
  Extracti absynthii 3ij.
  Aque menthii pip. giv.
  Syrupi corticis aurant. gi.
  Tincture   "    " 3iss.
    M.
           A tablespoonful four times a day.
                      No. 227.
B Calcis  antimonii  sulphu-
    rati 3 ij-
  Coque  cum aqua fontana
    ibv. ad  iv.
         Half, or a whole cup, every two hours.
Take of calx  of antimony 2
  drachms.
Boil in 5 pints of water to 4. 
                       RECEIPTS.                    611

                       No. 228.
B Olei sabine guttas ij.      Take of oil of savin 2 drops.
  Extracti aconiti gr. i.      Extract of aconite  1 grain.
  Sacchari albi gr. xx.       White sugar 20 grains.
  Misce, f. pulvis.            Mix, make a powder.
          To be  taken morning and evening.

                       No. 229.
B Olei sabine guttas iv.      Take of oil of savin 4 drops.
  Calcis sulphureti gr. vi.    Sulphuret of lime 6 grains.
  Extracti aconiti  gr. ii.      Extract of aconite 2 grains.
  Sacchari albi 3i.           White sugar 1 drachm.
  M. f. pulvis.               Mix, make a powder.
       To be taken in three times during the day.

                       No. 230.
B Resine guaiaci 3ss.       Take of guaicum £ drachm.
  Lactis sulphuris gr. x.      Milk of sulphur 10 grains.
  Antimonii    sulphureti    Golden sulphuret  of antim.
    (aur.) gr. ij.               2 grains.
  Eleosacchari citri 3ss.     Citron candy £ drachm.
  Misce. Fiat pulvis.       Mix.  Let a powder be made.
               To be taken in three times.
                       No. 231.
B Hydrargyrii   bi-chloridi   Take of corrosive sublimate
gr- y-
2 sr.
  Solve in aqua distillata q.s.  Dissolve in distilled water
  Opii gr. ij.                Opium 2 gr.
  Mellis gr. xx.             Honey 20 gr.
  Mice panis, q. s. ut fiant  Crumb of bread as much as
    pilule No. xl.             will do.  Make 40 pills.
       Six,  ten, even twelve morning and evening.

                       No. 232.
B Hydrargyrii  oxidi  rubri  Take of red precipitate 1 gr.
    gr. i.
  Antimonii crud. gr. xl.     Crude antimony 40 gr.
  Extracti glycyrrhize q. s.  Extract of liquorice enough.
    ut fiant  pilule No. lxxx.  Let 80 pills be made.
  Ten at bed-time, and in the course of time that number
twice in  obstinate cases.
                       No. 233.
B Potasse hydriodatis 3 i.    Take of hydriodate of potass
                               1 drachm. 
 612                    RECEIPTS.

   Iodini gr. i.                Iodine 1 drachm.
   Aque distillate gv.         Distilled water 5 ounces.
   Syrupi papaveris gi. M.     Syrup of poppies  1 ounces.
              A spoonful three times a day.
                        No. 234.
 ft Hydrargyrii vivi fci.        Take of quicksilver 1 pound.
   Coque in vase terreo sepe   Water 4 pints.
     agitando   cum  spatula   Boil  in  an  earthen vessel,
     lignea cum  aqua fonta-     stirring often with a wood-
     na Ibiv. per  aliquot  ho-     en spatula for a few hours.
     ras.
                    Used as a drink.
                       *No. 235.
 B Extracti tanaceli,          Take of extract of tansy,
      "    quassie, aa 3ii.    Quassia, each 2 drachms.
   Olei tanaceti guttas x.      Oil of tansy 10 drops.
   Misce,  fiant  pilule pon-   Mix.   Make pills of 2 grs.
     dere gr. ij.
               Ten morning and evening.
                        No. 236.
 B Pulvis seminum santonici  Take of santonicum seed 1£
     gss.                      oz.
   Rad. valeriane 3iss:        Powder of valerian 1% dr. ^
   "   jalapa 3i.             Jalap 1 drachm.
   Acid tartari 3ij.           Tartaric acid 2 drachms.
   Oxymel scille 3 iij.         Oxymel of squills 3 drachms.
   Syrupi rubi idei q. s. ut  Raspherry syrup, as much as
    fiat electuaria.            will make an electuary.
           Three or four teaspoonfuls a day.

                        No. 237.
ft Seminum santonici 3i.     Take of santonicum seed 1
                              drachm.
  Radicis jalapa gr. x.        Powdered jalap 10 grains.
  Hydrargyrii submur. gr. ij.  Calomel 2 grains.
  Misce, f. pulvis.           Mix, make a powder.
  Half morning and night (for a child 6 years old, conti-
 nued for three days).
                       No. 238.
B  Fuci  helmintochortonis   Take of Corsican worm seed
    3iij.                     3  drachms.
  Coque cum aqua gviij.  ad  Boil in 8 ounces down to 4.
    iv.
  Colentur.                 Let  it be strained.
           A tablespoonful every two hours. 
RECEIPTS.
613
                       No. 239.
B Radicis spigelie 3 ij.       Take of pink root 2 drachms.
  Ebullitor cum aqua fonta-  Let  it be boiled in 1 pint of
    na fci.  Colentur.          water, and strained.
             Half a cupful every two hours.

                       No. 240.
B Ferri sulphatis gr. ij.      Take of green vitriol 2 grs.
  Pulv.jalape,              Jalap,
  Semin. santonici aagr. xx.  Santonicum, each 20 grains.
  Misce, fiat pulvis.         Mix, make a powder.
               One morning and evening.
                       No. 241.
B Pulv. corticis granati giss.  Take of pomegranate l\ oz.
  Coque cum aque  gxij. ad  Boil in 12  ounces of water
    viij.                      to 8.
  Colentur.                 Let  it  be strained.
  Two  tablespoonfuls every half  hour,  in  the morning,
fasting.
                       No. 242.
B Saponis gss.              Take of soap half an ounce.
 • Gummi ammoniaci,        Gum ammoniac,
  Extracti absinthii, aa gij.  Extract of absinth, each 2 oz.
  Misce, f. pil. gr. ij.        Mix, make pills of two grs.
                 Ten, three times a day.
                       No. 243.
B Sode carbonatis 3ss.      Take of carbonate of soda J-
                               drachm.
  Acidi tartari,             Tartaric acid,
  Sacchari albi, aa gr. xx.   White sugar, each 20 grains.
  M. f. pulvis.              Mix, make a powder.
                   Three times a day.
                       No. 244.
B Olei  terebinthine gss.     Take of spirit of turpentine
                               half an ounce.
  jEtheris sulphurici 3ii-     Sulphuric ether 2 drachms.
         Thirty to sixty drops three times a day.
                       No. 245, a.
B Potasse tartarisati 3iss-iij.  Take of tartrate of potassa
                               1*- to 3 drachms,
     (according to the age).     (according to the age).
  Aque distillate gij.        Distilled water 2 ounces.
  Syrupi  mannse gi.          Syrup of manna  1 ounce.
  Vini  antimonii gut. xx. M.  Antimonial wine 20 drops.
             A teaspoonful every  two hours.
                           52 
614
RECEIPTS.
                       No. 245, b.
 B  Vini antimonii guttas xxx.   Take of antimonial wine 30
                                drops.
   Potasse tartarisati 3iss.     Tartrate of potassa  H dr.
   Aque flor. sambuci gij.     Elder-flower water 2 oz.
   Syrupi althee gi.  M.       Syrup of mallows 1 ounce.
   A teaspoonful every two hours (for a child  of 3 years
 of age).
                         No.  216.
 B Olei amygdalarum 3i.       Take of olive oil  1  drachm.
   Aque fontane gij.          Spring water 2 ounces.
   Mucilaginis g. arabici q. s.   Mucilage  of gum  arabic,
     ut. f. emulsio, adde        enough to make  an emul-
                               sion, add
   Extracti hyoscyami gr. ij.  Extract of henbane 2 grs.
   Syrupi amygdal. gi.        Syrup 1 ounce.
    A teaspoonful, frequently repeated  in violent coughs.
                       No. 247, a.
 B Acidi sulphurici  diluti gt.   Take of dilute sulphuric acid
     x.                         10 drops.
   Syrupi mororum  gij.        Syrup of black berries 2 oz.
           Swallow a spoonful slowly and often.            •
                       No. 247, b.
 B  Radicis levistici,           Take of levisticum,
  Baccar. juniperi,  aa. gi.     Juniper berries, each 1 oz.
  Specieri pectoralis gij.     Pectoral ingredients 2 oz.
  C. M.                     Cut up and mix.
                       No. 248.
                             Take equal parts of
 B Evtracti  dulcamare,        Extract  of dulcamara, and
  Pulvis antimonii  crud. aa   Crude antimony.
     pp. eq.
  Misce, f. pil. gr. ij.         Mix.  Make 2 grain pills.
              Five to ten three times a day.
                       No. 249.
B Furfurisamygdalarum 3ij.   Take of bran  of almonds, 2
                              drachms.
  Aque rosarum,           Rose water,
   "  florum naphe aa gvij.  Orange water, eac-h 7 oz.
  Ut fiat e:nulsio, adde      Let an emulsion be made ;
                                adde
  Tincture Benzoes,        Tincture  of Benjamin,
  Boracis sode aa 3i.       Borax, each 1 drachm.
  As a lotion at bed time.  When the skin is irritable the
 orax must be omitted. 
RECEIPTS.
615
                       No. 250.
R Aque fontane flbiss.        Take of spring water 1\ pt.
  Lactis sulphuris 3v.        Milk of  sulphur 5 drachms.
  Camphore  3ij.             Camphor 2 drachms.
  To moisten the  exanthemas every night, and to  wash
them in the morning.
                       No. 251.
B Sode boracis 3i.          Take of borax 1 drachm:
  Syrupi mororum gij. M.    Syrup of blackberries  2 oz.
               A teaspoonful frequently.
                       No. 252.
B Hydrargyrii  submuriatis  Xake of calomel 1 drachm.
     3i.
  Adipis suille gi. M.        Hog's lard 1 ounce.
                       No. 253.
B Florum chamomille,       Take of chamomile flowers,
     "    lavendule,         Lavender,
  Herbe rosmarini,          Rosemary,
     "   serpylli,            Serpyle,
     "   thymi,             Thyme,
     "   marjorane, aa gij.  Marjorum, each 2 ounces.
  Conciss. M.
                    Boil for a bath.
                       No. 254.
B  Hydrargyrii bichloridi,     Take of corrosive sublimate,
  Ammoniemuriatici, aa 3i.  Muriate of  ammonie, each
                              1 drachm.
  Axungie porcine  gi.       Hog's lard  1 ounce.
  Tere exactissime perhor.  Triturate them well together.
   A teaspoonful to be rubbed into the soles of the feet, at
night.
  5                    No. 255-
B  Olei ricini gi.             Take of castor oil 1 ounce.
   Tincture  colocynthidis   Tincture of colocynth half
     gss.  M.                  an ounce.
                 To be used in frictions.
                       No. 256.
B  Magnesie carbonatis gi.   Take of carbonate of mag-
                              nesia 1 ounce.
   Radicis rhei 3ij.           Rhubarb 2 drachms.
     "   valeriane  3ss.     Valerian *-  drachm.
  Eleosacchari feniculi gss.   Fennel candy i ounce.
   Misce.  Fiat pulvis.        Mix. Let a powder be made.
   Once or twice as much as can be taken upon the point of
a knife. 
616                   RECEIPTS.
B Magnesie carbonatis,
  Crete ppt.,
  Cornu cervi rasuri,
  Visci quircini,
  Radix  valeriane, aa
    equales.
  Misce.  Fiat pulvis.
No. 257.
     Take of magnesia,
     Prepared chalk,
     Rasped hartshorn,
     Misletoe,
     Valerian, of each equal parts
PP
Mix.  Make a powder.
                  Like the preceding.
                       No. 258.
B Antimonii tartarisati gr. i.  Take of emetic tartar  1 gr.
  Solve in aqua  gi.          Dissolve in water 1 ounce.
  Oxymellis scille,          Oxymel of squills,
  Syrupi simplicis, aa  gss.   Simple syrup, each £ ounce.
  Pulv. rad. ipecacuanhe gr.  Powdered  ipecacuanha 20
    xx.                       grains.
  Misce.  Fiat pulvis.        Mix.  Make a powder.
  A teaspoonful every quarter of an hour  until vomiting
occur.
                       No. 259.
B  Syrupi de cichorico cum  Take equal parts of syrup of
    rheo,                     chicory,
  Aque feniculi, aa  gss.     Fennel water, each •*• ounce.
        A teaspoonful three or four times a day.
                       No. 260.
                            Take of syrup of blackber-
                              ries 1 ounce.
                            Honey of roses ■£ ounce.
                      M.    Borax 20 grains.
                       No. 2*1.
                            Take of flowers of zinc 8 gr.
B Syrupi mororum gi.

  Mellis rosarum gss.
  Sode boracis gr. xx.
B Oxidi zinci gr. viij.
  Moschi orientalis gr. iv.
  Laudani  liquidi Sydenh.
    guttas vi.
  Sacchari albi 3ij.
  Misce, f. pulvis in viij. pp.
    eq.
                            Oriental musk 4 grains.
                            Liquid laudanum  of Syden-
                              ham 6 drops.
                            White sug'ar 2 drachms.
                            Mix. Let a powder be made
                              and  divided into 8 equal
                              parts.
                   One  every hour.
                       No. 262.
B Spiritus cornue cervi sue-  Take of succinated spirit of
    cin. gutt. xl.               hartshorn 40 drops.
  Aque feniculi,             Fennel water,
  Syrupi rhei, aa  gi.         Syrup of rhubarb,  each 1 oz.
  Crete ppt. gr. xx.          Prepared chalk 20 grains. 
RECEIPTS.
617
  Extracti hyosCyami gr. ij.  Extract of henbane 2 grains.
  Moschi orientalis gr. iv.   Oriental musk 4 grains.
  Cum saccharo triturat.    Triturated with sugar.
  Croci orientalis gr. iij. M.  Saffron 3 grains.
            A teaspoonful every two hours.
                       No. 263.
B Olei hyoscyami,          Take of oil of henbane,
    "   camphore, aa gss.   Camphor, each £ ounce.
  Tincture thebaici 3i.  M.  Tincture of opium 1 dr.  M.
          Applied in frictions every two hours.
                       No. 264.
B Crete ppt.  3ss.           Take of prepared chalky dr.
  Aque feniculi,           Fennel water,
  Syrupi rhei, aa gi.        Syrup of rhubarb, each 1 oz.
  A teaspoonful every hour ;—shake up the medicine first.

                       No. 265.
B Magnesie carbonatis 3iij.  Take of magnesia 3 dr.
  Semenum feniculi,        Fennel seed,
  Corticis aurantii,          Orange  peel,
  Sacchari albi, aa 3ss.      White sugar, each £ drachm.
  M. f. pulvis.              Mix.  Let a powder be made.
          A teaspoonful morning and evening.
                       No. 266.
B Crete ppt.,                Take prepared chalk,
  Eleosacchari feniculi,    Fennel candy,
  Radicis althee, aa gr. xx.  Mallow root, each 20 grains.
  Laudani liquidi Sydenh.   Liquid laudanum 1 drop.
    gutt.  i.
  M.  f.  pulvis. Divid.  in   Mix.   Divide into four equal
    quature partes.            powders.
                        No. 267.
B Unguenti de althee,       Take of mallow  ointment,
  Balsami nuciste aa gss.    Balsam of nutmeg, each £ oz.
  Olei menthe crisp, gut. vi.  Oil of mint 6 drops.
  Laudani liquidi Sydenh.   Liquid laudanum of Syd. 20
    gutt. xx. M.               drops.
                        No. 268.
B Extract icascarille gr. xv.   Take of extract of cascarilla
                              15 grains.
  Aque feniculi gij.         Fennel water 2 ounces.
  Mucilaginis rad. salep,     Mucilage  of salep,
  Syrupi althee, aa gss. M.   Syrup of mallows, each half
                              an ounce.
              A spoonful every two hours.
                         52* 
618
RECEIPTS.
                       No. 269.
 B Potasse tartarisati 3ss.    Take of tartrate  of potassa
                              half a drachm.
   Aque feniculi giss.       Fennel water 1.] ounce.
   Syrupi manne & rhei, aa  Syrup of manna and rhubarb
     gss. M.                   each half an  ounce.
             A teaspoonful every two hours.

                       No. 270.
 B Potasse tartarisati 3ss.    Take of tartrate  of potassa
                              i drachm.
   Vini antimonii guttas xx.   Antimonial  wine 20 drops.
   Aque flor. sambuci giss.   Elder-flower water  1£ oz.
   Syrupi manne,            Syrup of manna,
     "   althee, aa gss.     Mallows, each ■%■ ounce.
   A teaspoonful every two hours. Strong and robust chil-
dren will require the addition of 20  grains of  nitre.

                       No. 271.
B  Ligni sassafrage gij.       Take  of sassafras 2  ounces.
   Rad. glycyrrhize gss.      Liquorice root ± ounce.
   C. M.
                A teaspoonful every day.

                       No. 272.
B  Asa fetide 3 ij.           Take  of asa fetida 2 drs.
   Spiritus Mindereri 3iij.     Spirit of Mindererus 3 drs.
   Mucilaginis g. acacie q.  s.   Mucilage  of g. arabic  as
     ut f. cum aqua melissa     much  as will  make  an
     giij. emulsio.             emulsion with 3 ounces of
                              melissa water.
               A teaspoonful every hour.

                       No. 273.
B  Extracti cinchone  gr. xx.   Take  of extract of Peruvian
                              bark 20 grains.
     "    taraxici 3i.       Dandelion 1  drachm.
  Potasse acetatis 3ss.       Acetate of potassa ^ drachm.
  Aque feniculi,            Fennel water and rhubarb
  Syrupi rhei, aa gi. M.       each 1 ounce.
            A teaspoonful four times a day. 
INDEX.
A.
Abdominal cough, 230.
Abdominal dropsy, 312.
Abortus, how to be prevented,
  514.
Abscessus lumbaris, 167,181,300
    "     renalis, 165.
Achores, 425.
Acidity of ihe stomach, 188.
Acrimony of the  stomach, 188.
Acrimonia hemorrhoidalis, 335.
Acrimony, cutaneous, 550.
Acute fevers, see Febres acute.
Adiposis, 480.
Affections  of  the   mind and
  nerves, 61.
Age, 27.
Agrypnia, 62,  218.
Ague-cakes, 123.
Agustia, 278.
Air, accumulations of, 318.
 "  and water, 310.
Alopecia, 433.
Amaurosis, 276.
Amblyopia, 276.
Amentia, 195.
Amnesia of language, 272.
Anesthesia, 278.
Anaphrodi.^ia, 279.
Anasarca, 317.
Angina, 143.
        biliosa, 144.
         catarrhalis, 144.
        chronica, 146.
        gangrenosa, 145.
         gastrica, 144.
         habitualis, 146.
        laryngea, 143.
        membranacea, 551.
        parotidea 145.
         pectoris, 146, 225.
        pharyngea, 143.
         polyposa, 551.
        putrida,  145.
         rheumatica, 144.
         serosa, 144.
Angina tonsillaris, 144.
        uvularis, 144.
Anxiety, 65.
Anidrosis, 378.
Anomalies of motion and sensa-
  tion, 210.
Anorexia, 279.
Anosmia, 278.
Anthrax, 111, 115.
Anuria, 375.
Apepsia, 273.
Aphonia, 51, 250, 271.
        completa, 271.
        paralytica, 272.
Aphthe, 296, 415.
        infantum, 417, 539.
Apoplexia, 67, 253.
        adynamica, 255.
         biliosa, 257.
         completa, 253.
         metastatica, 258.
         nervosa, 257.
         pulmonum, 259.
         sanguinea, 255.
         serosa, 255.
         spastica, 255.
 Appetite, excessive (bulimia)
          or (polyphagia) 250.
         for unusual food (pica)
           274.
         want of (apepsia) 273.
 Apyrexia, 117.
 Arachnoitis, 138.
 Architectura apoplectica,  255.
             phthisica. 285.
 Arthritis, 453.
          acuta, 453.
          anomala, 454.
          atonica, 455, 461.
          chronica, 454, 459.
          disorganisans, 454.
          destructoria, 454.
          fixa, 454.
          interna, 454.
          irregularis, 454. 
620                      INDEX.
Arthritis larvata, 454.
         manifesta, 453.
         nodosa, 454, 459.
         occulta, 454.
         regularis, 453.
         retrograda, 455.
         spuria, 457.
         vaga, 454.
Ascarides, 489.
         lumbricoides, 486,
          489.
         vermiculares, 486.
Ascites, 312.
         urinosus, 375.
Asphyxia, 259, 261.
         neonatorum, 537.
Asthma, 222.
         abdominale, 223, 224.
         acutum infantile, 222,
           227, 553.
         adynamicum, 223.224
         aereum, 223, 227.
         arsenicale, 223, 225.
         arthriticum, 223.
         atonicum, 223.
         calculosum,  223, 225.
         cardiacum, 223.
         consensuale, 222.
         continuum, 222.
         convulsivum, 222.
         emphysematicum,
            223,227.
         flatulentum,  223, 319.
         gibbosum, 223. 225.
         humidum,222,223,226
         hydropicum, 223.
         hypochondriacum,
            222.
         hystericum,  222, 224.
         idiopathicum; 222,
            223, 225.
         mechanicum, 223,
            2-25.
         mercuriale, 223, 225.
         metallicum, 222, 223.
         meta.?taticum,222,224
         millari, 227, 553.
         mucosum, 222, 226.
         nervosum, 222, 224.
         nocturnum, 224.
         organicum, 223.
         pannificum, 223, 225.
         periodicum, 222, 224.
Asthma, pneumaticum, 227.
          psoricum,  223.
          pulmonale, 223, 225.
          pulverulentum, 223,
             225.
          rheumaticum, 223.
          saburrale, 223.
          sanguineum, 222,224,
             225.
          saturninum, 223, 225.
          scrophulosum, 223.
          scorbuticum, 224.
          senile, 223, 227.
          serosum, 223.
          siccum, 222.
          spasticum, 222, 224.
          strumosum, 223, 225.
          syncopticum, 223,225.
          thy mi cum, 227, 541.
          tuberculosum, 225.
          urinosum, 223.
          venereum,  223.
Atony of the lungs, 282.
Atrophia, 280, 306.
          abdominalis, 306.
          hepatica, 306.
          lienalis, 306.
          localis externa, 307.
          mesenterica  infan-
             tum, 306, 557.
          pancreatica 307.
          pulmonalis, 307.
          stomachica, 307.
          verminosa, 306.

             B.
Balbuties, 272.
Bald head, 433.
Barrenness of women, 526.
Bile or boil, 427.
    in infants, 550.
Bilious accumulation, 187, 251.
Bladder,inflammationofthe,165
Bleeder families,  345.
Blennorrhoea, 346, 470.
Blennorrhea intestini recti. 358.
             pulmonum, 183,
               301, 347.
             syphilitica, 470.
             vaginas uteri, 347.
Blepharophthalmia  neonato-
  rum, 539.
Blindness, nervous, 276. 
INDEX.
621
Blood,  52,  evacuations—spit-
              ting of, 61.
           micturation of, 343.
           vomiting of, 331.
Brain, droosy of the, 317.
      fever of ihe, 138. 547.
      inflammation, 138.
      fever of children, 547.
Bronchitis, 148
Bronchocele, 452.
Bubones, pestilential. 111.
         venereal, 473.
Bulimia, see polyphagia,   (ex-
  cessive appetite), 250.

             C.
Calculus btfiary, 496.
         cyst.icus, 493.
         urinarius, 493.
Callositas cutis. 430.
         intestinorum, 160.
Calor ad sensum, 64.
      ad thermometrum, 64.
      chemicus, 65.
      mordax, 65.
      vivus, 65.
Cancer  scrophulosus, 445.
Carbunculus contagiosus, 115.
            malignus, 427.
Cardialgia, 244.
Carditis, 157.
Caries 434.
Carriage, 67.
Catalepsy, 215.
Catamenia, 499.
Catarrhosis, 184.
Catarrhal feVer of children, 547.
Catarrhus, 181,—aurium, 1S2.
          intestinorum, 182.
          intestini crassi, 182.
          malignus, 93.
          oc'ulorum, 182.
          pulmonum, 182.
          suffocativus.  259.
          vagine et uteri, 182.
          vesice, 182, 352.
Cause occasionales, 32, 71.
Causes  of disease exciting, 71.
       predisposing, 71.
       remote, 71.
       proximate, 71.
Cephalalgia, 241.
Cephalea, 241.
Cephalea gastrica, 242.
          hypochondriaca, 242.
          hysterica, 242.
          metastatica, 242.
          nervosa, 242.
          organica, 242.
          sanguinea, 242.
          vomitoria  hysterica,
            237.
Cessation of the menses, 508.
Chancres, 465, 472.
Chest, dropsy of the, 315.
     pressure, straining, sounds
       in the, 49.
Childbed, 516.
Children, diseases of, 529.
Chills, 64.
Chiragra, 454.
Chlorosis, 438.
Cholera, 367.
         biliosa, 368.
         orientalis, 112.
         sicca, 368.
Chordee, 471.
Chorea, 214.
Chronic fevers, 116.
Clap, 353, 465.
Claudicatio spontanea,  180,453,
  558.
Clavus, 241, 430.
Climate, 30, 31.
Cognition of the object of cure,
                          [24.
                disease, 30.
                patient, 25.
Colic, inflammatory, 159.
      varieties  of, 245,  etc.
Collapsus vasorum, 88.
Coma somnolentum, 62.
       vigil, 62.
Comedones, 429.
Complexion, 67. 68.
Condylomata, 473.
Congestions, sanguineous, 125,
  135, etc.
Constipation, 371.
Consumption, see Phthisis, 280.
Contagium, 108.
Contagious fevers,  see Febrea
  contag. 107.
Constitution of the patient, 25.
              diseases, 31.
Convulsions of infants, 545. 
622
INDEX.
              pregnant women,
                515.
 Cophosis, 277.
 Corium, 52.
 Coryza, 105.
 Costiveness, 371.
 Cough 49, 228, 230. See Tussis.
 Cow pox, 396.
 Coxagra, 180,460.
 Coxalgia, 214, 558.
 Crisis. 21, 30.
 Croup, 551.
 Crusta lactea, 423, 550.
 Crusta pleuritica, 52.
 Crusta serpiginosa, 423.
 Cure causal, 72.
      radical,  72.
      palliative, 72.
 Cutaneous diseases, 380.
 Cyanosis, 439.
 Cystitis, 165.
 Cystorrhea, 182, 352.

              D.
 Deafness, 277.
 Debility of the nerves, 204.
 Decay of children, 557.
 Dentitio dirhYilis, 548.
 Delirium actfvum s.  furibund.
           61.
         blandum, 62.
         somnolentum, 62.
         tremens,  140.  141, 199.
         typhosum, 62.
 Diabetes, 60, 350.
          insipidus, 350.
          mellitus, 350.
          spurius, 350.
          verus, 350.
 Diagnostics, 24.
              for children, 531.
 Diaphragmitis, 163.
 Digestion, 53.
 Diarrhea,  182, 359, 542.
         adynamic. 362.
         chronic, 361.
         colliqualive, 363.
         infantilis, 363, 542.
         purulenta. 363.
         putrida, 363.
         rheumatica, 361.
         tormir.osa, 359.
Diplopia, 63, 250, 319.
 Disorganizations, 481.
 Disposition, 32.
 Dropsy, vide Hydrops.
 Dumbness, 271.
 Dyscrasies,  434.
 Dyscropia. 371.
 Dysenleria.  182, 363, 367.
 Dyslogia, 271.
 Dyspepsia, 250, 273.
 Dysphagia,  270.
 Dysphonia. 271.
 Dysuria, 375.

              E.
 Ears, inflammation of the, 168.
 Ear-ache, 244.
 Ecchymoses, 413.
 Eclampsia. 545.
 Elephantiasis, 423.
 Emaciations, 280.
 Emphysema, 322.
             pulmonale, 223.
 Emprosihotonus, 219.
 Eneorema, 59.
 Encephalitis, 138.
             adynamica, 141.
             biliosa, 141.
             exsudaioriainfan-
               tum, 554.
             gastrica,  141.
            inflammatoria, 140.
             nervosa,  141.
             verminosa, 141.
 Endurcissement du tissu cellu-
  laire, 430.
 Enteritis, 159.
 Enuresis, 348.
 Ephelis, 429.
 Ephemera, 84.
 Ephialtes, 217.
 Epidrosis, 347.
          localis, 348.
Epilepsy, 210.
Epistaxis, 326.
Erethisinus nervosusj 128, 190.
Erotomia, 251.
Eruptions, see Zona,
Erysipelas, 169.
          bullosum, 169, 170.
          chronic or habitual,
             171.
          neonatorum, 540.
          phlegmonodes, 169. 
INDEX.
623
 Erysipelas pustulosum, 170.
 Erysipelas of children, 540.
 Erythema, 424.
 Essera, 409.
 Evacuations of blood, 61.
         from the intestines, 55.
 Exacerbation. 80.
 Exanthemata, 380.
              accidentalia, 381.
              acuta, 381.
              chronica, 382.
              essentialia, 381.
 Exanthemata primaria, 381.
              secundaria, 331.
 Exanthematic fevers, 548.
 Excoriationes neonatorum, 533.
 Excresceniiae, 430.
 Excreiions, 56.
 Expectoration, 60.
 Extftivasata, 324.
 Eyes, 63,  inflammation of the,
   168.

              F.
 Fainting, 67, 259.
 Falling sickness, 210.
 Fatuitas, 195.
 Favus, 425.
 Febres acriticse, 91.
        acute,79.
              contagiose, 107.
        atacte, 91.
 Febris biliosa, 100.
        bullosa, 414.
       catarrhalis, 105, 547.
                  maligna,  107.
Febres chronice,  116, 123.
Febris continens,  80.
Febres continuae, 79.
Febris duplicata,  117.
       gastrica, 100, 546.
               saburralis, 101.
       hectica, 124.
       inflammatoria, 85, 547.
Febres intermiitentes, 116.
       intermittens maligna s.
         perniciosa, 122.
       intestinales. 100.
       lenta, 116,  123. 302.
             nervosa, 124,302.
             symptomatica, 125
       mesenterica, 100.
       mucosa, 100.
 Febris nervosa, 90.
                gravis, 95.
                mitis, 94.
        nullius generis, 84.
        peiechialis, 413.
        phthisica, 124.
        puerperalis. 519.
        putrida. 99.
        remittens, 80.
        rheumatic.a, 105.
        simplex, 84.
        from teethings, 547.
        verminosa,  101.
 Feeling, activity of the, 61.
 Fevers, see Febres and Typhus.
 Flatulence, 55.
 Flatulency, 319.
 Fluxus coeliacus, 358.
        hepaticus, 358.
 Flux of milk, 522.
 Fluor albus. 182, 465, 524.
 Freckles, 429.
 Furor uterinus, 251.
 Furunculus, 427.

              G.
 Galactorrhoea, 522.
 Gall stone, 496.
 Gangraena critica, 91.
 Gastric disease, 184.
 Gastric fever, 100.
             in children, 546.
 Gastritis, 158.
 Gastroses, 184.
 Gastrosis chronica, 185.
 Gastrodynia, 244.
 Genius loci, 31.
 Giddiness, 62, 263.
 Glands, inflammations of, 145.
        scrofulous, 444.
 Gleet, 471.
 Glossitis,  147.
 Goiire, 452.
 Gonagra, 454.
Gonorrhea, 353.
          chronica, 462.
          secundaria, 353, 462.
          syphiliiica, 4~0.
Gout, 453, see Arthritis, 453.
      atonic, 461.
       chronic,  459.
      retroceded, 460.
Gravedo,  181. 
624
INDEX.
 Groaning, 51.
 Gutta rosacea, 426.

              H.
 Habit, 29.
 Habitual crises and diseases, 30.
 Hematemesis, 331.
 Hematosis, 345.
            hereditaria, 345.
 Hematuria, 340.
            renalis,  343.
            vesicalis, 343.
 Hemoptysis, 327.
 Hemorrhagie, 324.
               pulmonum, 327.
 Hemorrhoids, 332.
             ani cece, 338.
             anomale, 340.
             dolentes, 338.
             external, 338.
             flnentes,  339.
             furentes, 338.
             incongrue, 333.
             internae, 338.
             mucose, 341.
             pulmonum, 340.
             retrogresse, 333.
             saccate, 339.
             scirrhose, 338.
             urethre, 344.
             ventriculi, 340.
             vesice, 340.
 Hair plaited, 430.
 Head, dropsy of the, 317.
 Headache, 65, 241.
           of pregnant women,
             513.
 Hearing, 63.
 Heart, inflammation  of the 157.
      palpitation of the. 43,319
Heat, 64.
Hectic fevers, 123.
Hectica,  280, 309.
Helminthiasis, 486.
Hemicrania, 240.
Hemiphlegia, 253.
Hemitritaeus, 121.
Hemorrhages, 324.
Hepatitis, 161.
Hereditariness. 26.
Herpes,  172, 420.
Heuristic, 73.
Hiccough, 53,239.
 Hips, 180.
 Hoarseness, 50, 272.
 Hooping cough, 232.
 Horripilatio, 64.
 Hunger, 54.
 Hydrencephalon,  317.
 Hydrocephalus, 317.
                acutus, 554.
                chronic, infant.
                   556.
                externus,  317,
                   556.
                internus, 317.
 Hydropes, 310.
 Hydrops ascites, 312.
         cerebri  acutus infan-
           tum, 554.
         pericardii, 316.
         saccatus, 312.
 Hydrophobia, 113, 249.
 Hydrorrhachitis, 557.
 Hydrothorax, 315.
 Hypochondria, 203.
 Hysteria, 203.
 Hysterismus  of the stomach,
   186, 236.

              I.
 Iatrognomic, 24.
 Jaundice, 441.
 Icterus, 441.
       neonatorum, 538.
       niger, 443.
 Idiosyncrasy, 29.
 Ileus, 372.
       chronicus, 374.
       inflammatorius, 159.
 Impotency, 274.
 Impotentia imperfecta, 275.
          perfecta, 275.
 Incontinentia urinae, 348.
 Incubus, 217.
 Indigestion, 187.
 Induralio telae cellulosae  neo-
  natorum, 540.
 Infancy, characteristics of,  529.
Infarctus, 184, 189.
Infection, venereal,  465.
         primary, 465, 468.
          secondary, 465, 473.
         ulcerous^eo, 472.
Inflammationes, 125.
               activa,  130. 
INDEX,
625
Inflammat.   antagonistica.l 29.
             atonica, 130 131.
             catarrhalis. 133.
             chronica, 130, 134.
             consensualis, 129,
               136, 133.
             erethica, 129.'
             erysipelatosa, 134.
             exsudatoria,  127,
               133.
             gangraenosa, 130,
               133.
             idiopathica, 129,
               138.
             maligna, 130.
             metastatica, 134.
             nervosa, 129.
             occulta, 125.
             passiva, 130.
             periodical, 130,134
             phlegmonous, 133.
             phlogistic, 133.
             putrida, 130, 133.
             rheumatic,  133.
             specific, 134.
             sicca, 129.
             sympathica, 129.
             topicae,  125.
Inflammation, of abdomen, 158.
           brain, 133.
           bladder. 165.
           bronchitis, 148.
           caul, 164.
           chest and lungs, 147.
           dorsal vcrtebre, 142.
           ears, 163.
           eyes, 163.
           heart, 157.
           intestines, 159.
           kidneys, 164.
           liver, 161.
           mesentery, 163.
           midriff, 163.
           mouth, 146.
           ovaria. 166.
           pancreas, 164.
           peritoneum, 164.
           psoas muscle, 167.
           spinal  marrow, 142.
           spleen, 163
           stomach, 153.
           throat, 143. see Ang.
           womb, 166.
53
Insania, or Insanity, 195.
Inunction, mercurial, 476.
Intermittent lever, 116.
Interpretatio Naturae,  32.
Intertrigo, 429.
Intestines, evacuations from the,
            55
         accumulations of, 189.
Intonatio intestinalis, 319.
Irascibility, 198.
Irritatio cerebralis inflammato-
          ria. 139.
Ischias 180, 240, 460.
       nervosa cotunni, 180,
Ischidrosis. 378.
Ischuria, 375.
Itch, 417.
Itching of the genitals, 241.

             K,
Kidneys, inflammation of the,
           164.
          stone in the, 493.
Lactation, 521.
Land-scurvy, 440,
Laryngitis, 143.
           exsudatoria, 551.
Laughing, 51.
Lentigo, 429.
Leprosy, 423.
Lethargy, 263.
Leucorrhea, 352, 524.
Lientery, 3i7.
Limping, 558.
Lipothymia, 67, 259.
Lithiasis, 492.
Liver, inflammation of the, 161.
Lues venerea, 462.
             inveterata, 476.
             universalis, 473.
Lumbago, 131,240.
Lumbrici, 4-J6, 439.
Lungs, consumption of the, see
  Phthisis. 230, 303.
Lupus, 420.

             M.
Malacia, 274.
Madness, or Mania, 195.
Marasmus senilis, 300, 305.
Materia rheumatica, 177. 
626
INDEX.
Measles, 400.
Melaena 341.
Melancholia, 195.
Meningitis,  138.
Menostasia, 379, 503.
Menstruation, 345, 499.
             difficult. 507.
             obstructed, 500.
             profuse, 505.
             suppressed, 503.
             cessation of, 508.
             regimen during,
                503.
Mental diseases, 195.
Mesenteritis, 163.
Meteorismus, 55.
Metritis, 166.
Metrorrhagia, 345, 505.
Miasma, 108.
Mictus cruentus, 343.
Midriff, inflammation of the, 163.
Miliaria alba et rubra, 410.
       chronica, 412.
Mind, action of the, 61.
Miscarriage, how to prevent,514
Miserere, 372.
Mode of living, 29.
Mole, 432.
Molimina hemorrhoidalia, 333.
         menstrua, 501.
Morbilli, 400.
Morbus hemorrhag. mac. Werl-
        hofii, 345.
Morbus niger, 341.
Morbus verrucosus universalis,
         431.
Moria, 195.
Motion, musculosis, 66.
Mouth, inflammation of, 146.
Mucosity of the stomach, 188.
Murmuratio intestinalis, 319.
Muscular motion, 66.
Myelitis, 142, 305.
        chronica, 305.

             N.
Nevus, 432.
Nature and  Art, 19.
Nausea, 54.
Nephritis, 164.
Nephritic stone, 493.
Neuralgia, 240.
Neuroses, 190.
Nervous fever, 90.
         blindness,  276, 526.
         consumption, 302.
         diseases, 190, 545.
Nightmare, 217.
Noma, 434.
Nostalgia, 303.
Notalgia. 240.
Nubecula (in the urine) 59.
Nymphomania,  251.

              O.
Obstructio alvi,  371.
Occupation, 29.
Odontalgia, 243.
Oedema, capitis, 317.
         pulmonum, 223
Omentitis.  164.
Onania, 354.
Onanismus, 251.
Oophoritis, 166.
Ophthalmia humida, 182.
           scrophulosa, 451.
           neonatorum, 539.
Ophthalmitis, 168.
Opisthotonus, 219.
Orchitis, 473.
Order of rational mode of treat-
        ment, 73.
Otalgia, 169, 244.
Otitis, 168.
Otorrhea, 169, 182, 356.

             P.
Pedarthrocace,  445.
Pain, 65.
Palpitation of the heart, 43, 227.
Pancreatitis,  164.
Paracusis, 250.
Paralysis, 66, 481,  atrabilaria,
             269.
         of the brain, 253.
         dorsalis. 269.
         localis. 264.
         medullaris, 269.
         metastatica, 267.
         of the lungs, 259.
         rheumatica,  173.
         sanguinea, 265.
         syphilitica, 267.
Paralytic diseases, 252, 272.
Paraphimosis. 471.
Paraplegia, 253. 
INDEX.
627
Parasites, 481.
Parotitis,  145.
Paroxysmus, 117.
Parturition, 516.
Pathogenesis, 31.
Pellagra.  424.
Pemphigus, 414.
Period of life, 27.
Peripneumonia, 147.
Peritonitis, 164.
            puerperalis, 519.
Perspiration, 56.
Perspirabile retentum, 172.
Pestis bubonica, 111.
Petechie, 413.
Petechianosis, 345.
Pharyngitis, 143.
Phenomena of disease, 30.
Phimosis, 471.
Phlebitis universalis, 85.
Phlegmasia exsudatoria abdo-
           minalis. 519.
           alba dolens puerpe-
             ralis, 523.
Phlyctaene.  424.
Phrenitis, 138, 141.
Phtlvsiosis,  288.
Phthisis, 280, 303.
          abdominalis, 300.
          accidentalis, 288.
          constitutionalis, 288.
          consumata, 284.
          Sens, 282.
          florida, 288, 293.
          formata, 290.
          hectica,  309.
          hepatica, 299.
          incipiens, 282.
          intestinalis, 300.
          laryngea, 298.
          manifesta, 284, 290.
          mesenterica,  299, 300.
          pituitosa, 281,  301.
          pulmonalis, 281.
                    purulenta,
                       281, 291.
          purulenta, 297.
          renalis, 299.
          scrophulosa 307.
          sicca, 307.
          tabes pulmonalis, 301.
          trachealis, 298.
          tuberculosa, 281, 307.
Phthisis uterina, 300.
        vesicalis, 299, 300.
        vomica clausa, 297,300
Physiatric, 19.
Physometra, 323.
Pica, 250, 274.
Piles, see Haemorrhoids, 332.
Plague, Levantine, 111.
        cold, 112.
Plaited hair, 431.
Pleuritis, 147.
         chronica, 154.
         rheumatica, 153.
Pleuro-peripneumonia, 147.
Plica polonica, 431.
Pneumatoses, 310.
Pneumonia, 147.
            gangrenosa, 154.
            notha, 154.
            putrida, 154.
            rheumatica, 153.
 Pneumonites, 147.
 Podagra, 454.
          retropulsa, 455.
 Pollutio, 305, 354.
 Polydipsia, 249.
 Polyphagia, 250.
 Polysarca, 480.
 Porcupine skin, 431.
 Priapismus, 219, 251.
 Profluvia, 323.
 Pregnancy, 510.
 Prophylaxis phthisica, 289.
 Prosopalgia, 242.
 Pruritus, 240.
          vulvae, 241.
 Pseudacusis, 250.
 Pseudfesthesie, 210.
 Pseudo-erysipelas, 169.
 Pseudopia, 250.
 Pseudo-organisations, 481.
 Psoitis, 167.
 Psychical treatment of insane,
    201.
 Ptyalismus. 347.
 Puberty, 500.
 Pulse, 33.
        art of feeling the, 44.
        varieties of it,  39.
 Pulsatio abdominalis, 227.
 Purpura, 410.
 Pustula nigra, 427.
 Pyrosis, 245. 
628
INDEX.
              a.
Quartan fever, 117, 121.
Quinsy, 143.
Quotidian fever, 117.

              R.
Rabies, 113.
Rachitis, 452.
Raphania, 218.
Rational method of curing, 72.
Raucitas vocis, 272.
Recidives, 121.
Regimen menstruale, 503.
         for infants, 535.
Remissio, 80.
Respiration, 45.
            varieties of anoma-
             lous, 46.
Restlessness, 62, 218.
Rhagades, 428.
          ani, perinei, genital.
             339.
Rheumatalgia. 173.
Rheumatic affection of the mu-
          cous membrane, 181.
          fever, 105.
Rheumatismus, 173.
             acutus, 174.
             arthriticus, 174.
             chronicus, 174,177
             fixus, 174.
             frigidus, 173.
             intestinorum, 366.
             intestini crassi,364
             vagus, 174.
             verus. 174.
             universalis, 106.
Rheumatoses, 172, 179.
Rickets, 452.
Rigor, 64.
Risus sardonicus, 52.
Rubeole, 409,
Ructuositas, 319.
Ruminatio humana, 238, 270.

             S.
Saburra, 185.
Saburral accumulation, 187,189
Salivation, 347.
Satyriasis, 251.
Scabies, 417.
Scald-head,  425.
Scald-head of infants, 550.
 Scarlet fever, 405, 548.
 Sciatica,  ISO.
 Scorbutus. 440.
 Scotomia, 250.
 Scrofula, 444.
 Scurvy, 440.
 Sediment in the urine, 59.
 Secretions, 56.
          of urine, 57.
          salivary, 60.
 Sea-sickness, 239.
 Sea-scurvy, 440.
 Selection of remedies, 73.
 Seminal weakness, 354.
 Senses, action of the, 61.
 Serpigo, 339.
 Sex, 27.
 Sexual diseases of females, 498.
 Sexual instinct,disorders of,251.
 Sight, 63, 250.
 Singultus, 66, 239.
 Skin, dropsy in  the, 317.
 Sleep, 62.
 Sleeplessness, 62, 218.
 Small pox, 386.
 Smelling, 63.
 Sneezing, 51.
 Soda, see Pyrosis,
 Sopor, 62.
 Somnambulism, 195, 216.
 Sordes primarum viarum, 184.
 Softening of the brain,  556.
                stomach, 544.
 Specific method, 72.
 Specifics.  73.
 Speech, 50
       faults of, 271.
       loss of, 51.
 Spasmodic diseases, 210.
 Spasms, 66.
        of children, 545.
        of the stomach, 244.
        menstrual, 507.
        clonici,  210.
        tonici. 210.
Spina bifida 554.
           ventosa, 434, 445.
Splenitis, 163.
Spondilitis, 142.
Spuia, 61.
      cocta, 61.
Sputa subacta, 61.
Sputum cruentum, 327, 330. 
INDEX.
629
 Sputum sanguineum, 61.
 Squinting, 63.
 St. Anthony's fire, 169.
 St. Vitus' dance, 214.
 Stammering, 272.
 Steatoma. 480.
 Stenocardia. 223.
 Sterilitas, 276, 526.
 Stillicidium  uteri,
 Stomach, acidity of the, 188.
          ache, 244.
          acrimony of the, 188.
          inflammation  of the,
           153, 188.
 Stomacace,  J,,fi
 Stomaitis,   $
 Stone of the bladder, 493.
             kidneys, 493.
 Strabismus,  63.
 Stranguria, 375.
 Strangulatio hysterica, 224.
 Structure, 67.
          apoplectic, 26, 255.
          phthisical, 26, 2s5.
 Struma, 452.
 Stuttering, 272.
 Stymatosis, 344.
 Suckling, 521.
 Sudor anglicus, 343.
       ani, perinei et  genita-
         lium, 339.
 Suffocatio hysterica, 224.
 Suffocative catarrh, 259.
 Suggilationes. 324.
 Suppressiones, 369.
 Suppression of the itch, 419,
               piles,  340. 379.
               menses, 503.
               syphilis, 467.
Susurrus aurium, 250.
Sweat, 56, 347.
Sycosis menti. 422.
Symptomatology, 32.
Symptomata, 71.
Symptomatic method, 72.
             fevers, 123.
Synocha, 85.
Syncope, 67,  259.
Syphilis, 462.
        localis s. primaria,462.
        secundaria s. universa-
        lis, 463, 473.
         inveterata, 476.
 Syphilis larva ta, 478.
         of infants, 541.

             T.
 Tabes, 280, 300.
       dorsalis, 304.
       medullars, 304.
       nervosa, 302.
       pulmonalis, 301.
 Tenia, 486, 490.
 Tapeworm, 490.
 Taste, 63.
 Teething, difficult, 548.
          fever from, 547.
 Temperaments, 28.
 Tenesmus, 56.
 Tenuitas serosa sanguinis, 52.
 Tertian fever, 117.
 Tetanus, 219.
         of children,  540.
         linguee, 219.
         localis, 219.
         neonatorum, 220.
         penis, 219.
         traumaticus, 221.
         universalis,  219.
 Therapeutics, 70.
             for children, 532.
 Thirst, 54, 249.
 Throat, 143, see Angina.
 Thrush,  415, 539.
 Tic douloureux, 242.
 Tinea capitis, 425.
 Tongue, inflammation ofthe,147
 Toothache, 243.
           of pregnant women,
             513.
 Tracheitis, 143.
 Transpiratio  insensibilis, 56.
 Trembling, 66, 219.
 Tremor, 66, 219.
 Trichocephalus, 486.
 Trichoma, 431.
 Trichuris, 4^6.
 Trismus, 219, 221.
        of children, 540.
Tussis, 228.
      varieties  of, 229-234.
Tympanites,  321.
             abdominalis, 321.
             intestinalis, 321.
             thoracis, 223.
             of the uterus, 323. 
630
INDEX.
Typhus, 81, 90, 95.
Typhus abdominalis, 98.
         contagiosus, 110.
         enteriticus, 98.
         erethicus, 96.
         gastricus, 98.
         gravior, 90.
         icterodes, 112.
         irritativus, 96.
         mitior, 94.
        nervosus,  90.
         putridus, 99
         versatilis, 96.

              U.
Ulcers, 434.
Ulcus syphiliticum, 472.
Uterus crepitans, 323.
Urethritis exsudatoria, 462.
Urine, 57.
       varieties of,  58-60.
Urinary calculus,  493.
Urticaria, 410.

              V.
Vaccination, 396.
Vaccinella,  396,
Vari, 426.
Varicella, 395.
Variole, 386.
         varieties of, 388.
Variola spuria, 395.
Varioloides, 398.
Venereal disease, 462-479.
Vermes, 486.
        intestinales 486.
         superficiales, 486, 492.
Verruce, 430.
Vertigo, 62, 263.
         caduca, 263.
         tenebricosa, 263.
Vesania, varieties of, 199.
Vibices, 413.
Vision, double, 250, 319.
Vitiligo, 423.
Voice, 50.
Vomica, 296.
         closed, 297, 300.
Vomit, black, 112.
Vomiting, 54.
          chronic, 235.
          varieties, 236.
          of'blood. 331.
          of children, 544.
Vomiting, of pregnant women,
             513.
Vox balbutiens, 51.
     rauca, 50.

              W.
Warts, 430.
Weak part, 29.
Weeping, 51.
Whites. 524.
Whooping cough, 232.
Womb, inflammation of the,166.
Worms, 486.
Worm-fever, 547, in children.
Yawning, 51.
Yellows, 441.
Yellow fever, 112.

              Z.
Zona, zoster, 172.
/;-
                           ERRATA.

 Besides a few bad spellings of Latin words and a few errors of punctuation, the fol-
lowing corrections are to be mentioned.
 Wherever " sublimate" is used in  the translation, mercurius sublimatus cor-
rosivus is meant by this term.
 In the article " Diabetes  mellitus" not 50-100 pounds (as in the original) of urine,
but as many fluid ounces are understood to be discharged.
 Instead of vagina crepitans (page 323) read uterus crepitans. 
THE
THREE  CARDINAL MEANS
ART OF HEALING.
          C. W. HUFELAND.
ONE OF THE PHYSICIANS IN ORDINARY TO THE LATE KING OF PRUSSIA,
 AND PROFESSOR TO THE UNIVERSITY OF BERLIN, KNIGHT OF THK
         RED EAGLE ORDER, ETC., ETC.
/oGfffO.
      NEW-YORK:
WILLIAM RADDE, 322 BROADWAY. 
 
THE  THREE   CARDINAL  MEANS  OF
          THE  ART  OF HEALING.
  The art of medicine possesses three great means, which
are pre-eminent over all others : they are bleeding, emetics,
and opium.
  They represent, as it  were, the three fundamental me-
thods  of the healing art: the antiphlogistic,  the gastric,
and the exciting; and at the same time the three funda-
mental systems of the human economy:—that is  to say,
venesection for the  irritable ; emetics  for  the  nutritive ;
and opium for the sensitive systems.   They have a direct
influence  over  life, and are the most  decisive and prompt
remedial  agents known,  true heroes,  capable  of giving
either life or death;  they decide the  struggle at the criti-
cal moment; on their judicious use  particularly depends
the success and reputation of the practitioner.   They are
unique, each  is one by itself, and cannot be  replaced by
any thing else.
   He  who knows how to use them rightly, is a master in
our art, and may be recognized as such by the ability with
which he  wields them.   But often,  like a virtuoso, it is
only  to one instrument he is attached.   Many a physician
has paid  particular  attention to the emetic, and performs
admirably on  this instrument; but does not understand
bloodletting, and is ignorant of its appropriate application.
Another is skilled in bleeding, but is incompetent in the
use of emetics and opium.
   Even whole  periods have occurred in which this was the
case   and where  one or the other of these remedies has
prevailed.  Strictly speaking, one or  the other of them has
always had supremacy in medicine ;  one alone has always
reigned, and we can in the annals of medicine as in politi-
cal history, clearly  see  the successions of these monar-
chies alternately ruling the profession.*
   * In this remark I do not mean to accuse the physician of a fond-
 ness of fashion.  The reason for these changes is undoubtedly found-
 ed on the changes which take place in nature in  the change of the
 prevailing constitution.  But there is also joined to this a predilection 
4                      VENESECTION.
  Fifty years ago venesection governed almost absolutely.
It was succeeded by  the reign of emetics for a long space
of time; then opium took its turn as sovereign. Now vene-
section begins again to predominate.
  These three remedies, however, differ totally in nature.
Each is fitted to its own peculiar cases.  One cannot be
substituted for another, without endangering the life of the
patient.
  It seems to me,  therefore, worthy of the labor, to sub-
mit these heroes of our art to an accurate examination, to
define their power  as well as their limits, and to assign to
each its place,   but  particularly to point out  the cases
wherein they are  likely  to be  misapplied, abused,  or ne-
glected ; and the cases wherein their use is not yet so ge-
nerally acknowledged.
                           I.

                     Venesection.

               " The life of man is in his blood."
                                         Moses.

  Venesection undoubtedly ranks first among all remedies,
being the only one,  by which we abstract a part of life it-
self, and  may diminish the amount of vitality in its very
source.  For, nobody now doubts the  truth of what I pro-
nounced 25 years ago, and what so many then contradict-
ed : that blood itself imparts life to the body, not only as a
stimulant,  but a constituent part of life itself, a vital fluid
organ.
  Yes, I believe what the holy writ says : " The life of man
is in his blood."   Blood is the mother, from which every
living thing proceeds—the seat of the ever active creative
power.   Without fluid there is no life ; every living thino-
proceeds from fluid, is maintained by fluid. Life is nothing
else  than a ceaseless repetition  of the act of  creation.
for certain remedies, amounting to an abuse, which arises  from want
of observation and reflection, and from want of an independentexer-
c*ise of the practitioner's own judgment.   I may here refer to what I
have already said in my work on "Military Plague;" and to the ex-
cellent treatise of Sydenham,  "De novas febris ingressu ;" in which
this great man  describes how he himself was compelled  by nature,
and by the altered character of disease,  to abandon the method of
treatment he had hitherto followed,  and to adopt a new one. 
VENESECTION.
5
Without blood the nerves and the brain are lifeless; but
the heart and the blood live without nerves.
   Weakening of life is, consequently, the primary and prin-
cipal effect of the abstraction of blood.  On that account
venesection is the greatest remedy in all disorders marked
by an abundant development of life in the blood; such are
the inflammatory diseases.  This disposition may, in the
commencement  of'a febrile  malady, be completely van-
quished by a venesection made in season;  and general or
local  inflammation already existing, may  be removed by
one or repeated  venesections, and life saved.
   Venesection produces a no less important secondary ef-
fect:  relaxation  of the fibre ; and resolution of spasm and
contractility.  By this property it is also a great remedy in
those diseases  which are not properly inflammations, but
in which there exists only an inflammatory disposition: in
nervous diseases, spasms and convulsions, nervous fevers,
in cases of suppressed evacuations of spasmodic reaction ;
it is useful even for promoting the crisis, as the eruption in
cutaneous diseases.—The depression of life, and relaxation
of fibre is altogether dependent on the proper quantity dis-
charged, and the velocity with which it is effected.
   The  third effect of bleeding is,  the diminution of the
quantity of blood. This must be considered separately from
the former.  As plethora is not an imaginary but a really
morbid state, and as a mere abundance of blood may be the
cause of numerous diseases, the  mere diminution of the
quantity may prove a great curative, even when no inflam-
mation is present. In this case neither the part of the body
whence the  evacuation  is made, nor the time of doing so
is so much to be considered as the proper quantity.
   Finally, there is a fourth effect, it is derivation.  This is
 most important in local congestions and affections.  Here
 the place of abstraction deserves particular attention.  This
 opinion, it is known, has recently been doubted. But the in-
 credulous need  only to be reminded of the  effect of vene-
 section in pleuritis. Why is a venesection on the foot
 without avail, why one on the opposite arm of little bene-
 fit or even of detriment, and why does a discharge from the
 arm  of the  affected side only give immediate  relief?—
Farther, it is an observation which I have found repeatedly
 confirmed,  that a venesection on the arm may remove the
 menstrual flux and disposition to abortion, whereas a vene-
 section on the foot may increase and promote both.
   Every one will again comprehend  that  bleeding is the
 principal remedy in inflammations and other diseases of an 
6                     VENESECTION.
inflammatory tendency, and there is no need to dwell fur-
ther on the subject.   But that which is less understood is,
that where no inflammation exists, in plethora and in chro-
nic diseases, that it acts as a derivative and particularly as
a great preventive  of some diseases.   To demonstrate and
lead the attention  to this is the chief object  of this paper.
   We  have omitted  bleeding  in a great many  cases, in
which our predecessors used it regularly, and  with signal
benefit, founded on experience ;—we now omit it, certainly
to the prejudice of mankind.
   If only as an assertion, I may be permitted to hazard an
hypothesis.  It strikes  me as  very probable  that the dis-
eases of the  heart, which have become so very frequent
within these last 20 years, are chiefly due, exclusive of po-
litical events affecting  the heart, to the omission  of vene-
section, the result of a false system predominant in these
times.  All the other physical and moral causes also existed
formerly, and with equal violence and continuance, as dur-
ing the thirty years and the seven years war ; nevertheless,
diseases  of the  heart did not  prevail to  an equal extent
then.   The cause  adduced by me is novel, and  is well cal-
culated to  produce the effects assigned.  Formerly it was
a fashion and a rule, to perform a prophylactic venesection
after  every violent commotion of the body as well as of
the mind ;  such  as violent passions, overheating, plethora,
general and local,  in  short whenever an excitement of the
blood and  a  rush  to the heart happened, in  order to avert
the evil consequences likely to follow, and to derivate the
blood from the  heart.  In the last twenty years this has
been  neglected.   Seduced by a false theory, physicians
did not bleed in all these cases; they in general rejected
preservative bleeding, and, led by a false notion of debility,
they substituted wine, rum, and stimulant medicines,  after
violent mental and corporeal emotions. Must it not follow
as a consequence of this sin of omission, that  the rush of
blood being neither diminished in its quantity nor in  its
force,  but suffered  for  a length  of  time,  that  it would
finally produce  distention and enlargement  and other dis-
organizations of the heart 1
   I will  especially advert  to the following cases in which
many years' experience have taught me. how beneficial and
indispensable it is  to make a venesection;  and on the con-
trary how dangerous it is to omit it, many sad  instances of
which I have learned, and of which practitioners do not yet
seem to be convinced. 
VENESECTION.
7
                   1.  Pregnancy.

  It was an inviolable rule  with our predecessors,  when
pregnant women suffered accidents during the first months,
to open a vein in the arm, and during the last months pre-
vious to confinement in the foot; and by this practice fe-
males  were  benefitted.   The  nervous,  and  after it  the
asthenic period of science  appeared, obedient to which
physicians dared not bleed; the good old habit ceased to
be in fashion and at last was forgotten ; even this principle
was  brought forth: every pregnant woman was to be re-
garded as inclined to astheny, under this state abstraction
of blood was hazardous, both for her and the foetus.  I, on
the contrary, sustain the very opposite  principle.  It has
always guided me, and afforded me success in my practice :
Every  pregnant woman must be regarded as a bivivid being,
with increased sanguification and nutrition, and her habitual
discharge of blood suppressed; therefore, she is rather more
inclined  to a plethoric and sthenitic state than to one of de-
bility.
   There are two periods of pregnancy, when venesection
is the only means, and is indispensable for preventing great
danger.
   The first, is in the second, third, and fourth month, when
violent accidents  set in ; such as  violent toothache and
headache,  vomiting, vertigo, fitsbf fainting, cough, oppres-
sion of the chest,  precursors of abortion,  bellyache,  pain
in the  back,  weakness of the lower extremities,  pressure
on the uterus and vesical region.  Here  the habitual men-
strual  discharge is impeded, while  the consumption of the
foetus  is still trifling ;  these causes always produce a cer-
tain degree of plethora.   In all these cases, unless a signal
and decided  weakness and exhaustion is present, I always
bleed  in  the arm,  for a venesection on  the foot might be
promotive of abortion. All those complaints are surest re-
moved and abortion  prevented by  it.   How often have I
not removed by this means alone the most violent vomit-
ing—vomitings  which had resisted  all other remedies.
   The  second  period for bleeding is in the last month,
shortly before confinement; at  which time every pregnant
woman shows a plethoric constitution ; or abetter rule is:
when there are no evident proofs of weakness and want of
blood.  A double advantage is obtained by this venesec-
tion, which must be made on the foot previous to delivery.
In the  first place it will  be  rendered easier.  How often, 
8
VENESECTION.
 even during labor, when the throes had vainly tortured the
 laboring woman for a  length of time, have I not effected
 an abatement of the cramplike pains and an easy delivery .
 In the  second  place a multitude of bad consequences and
 dangerous accidents  after delivery are thus avoided.  I
 particularly allude to the, sudden apoplectic death during
 or immediately  after labor; to  immoderate hajmorrhages ;
 and  to puerperal fever.  Nobody will deny that parturition
 has a great resemblance to a violent  lesion.  Pain, separa-
 tion of organic parts, loss of blood, mental emotion,  occur
 united here as there;  also the result is  the same—fever.
 Now it  is a rule with all good surgeons, to institute a vene-
 section  previous to every  operation, when the  condition of
 the  individual  will admit of  it, since it  guards  greatly
 against  violent  inflammation and other bad consequences.
 Even in the operation of amaurosis this  truth has been
 recently strikingly confirmed.—Why should we not  apply
 the same principle to labor—a perfectly analogous state 1
   It is one of the  most fearful and affecting events,  when
 healthy and  blooming parturient women, suddenly die by
 an apoplectic fit with  or without convulsions,  sometimes
 without any  haemorrhage, at  other  times with and after
 haemorrhage, in  the very act of delivery or shortly after it
 terminated.  I have observed this accident much more  in
 young plethoric, than in aged and feeble persons; also in
 cases wherein venesection had been omitted  previous  to
 confinement.   All thisiten'ds to prove that such an apoplec-
 tic fit is produced not by a deficiency of strength, but by
 the sanguineous congestion to the brain, brought on in the
 full vessels by the forced  exertions of labor.   I consider
 venesection,  shortly before  delivery, as  the only  preser-
 vative against such an emergency, and  never have I obser-
 ved these accidents to happen, when it had been previously
 performed.


          2. Cessation of tJie  Catamenia.

   This is another period in which great evils may be pre-
vented by venesection, but in'which  it is frequently neg-
lected.  This cessation  is by no  means, as  some believe
always a consequence of weakness brought on by advanced
 age and a decrease of sanguification ; it is simply due to a
cessation of sexual life and the functions of the genital or-
gans ; while the rest of the organism  and sanguification
may  remain active and vigorous;  so much so, that at this 
VENESECTION.
9
 time  the  body increases in size and strength by the very
 cessation  of the monthly flux ; and many women are seen
 to become strong, full, and blooming at this period.   How-
 ever, this  very vigor which  follows the monthly suppression
 frequently produces the worst accidents, and the time which
 intervenes between the restoration of the balance is rightly
 styled the critical period of female life.  This equilibrium
 does not  consist  in the mere restoration of  a proper pro-
 portion between nutrition  and secretion, nor in a new dis-
 tribution  of humors ; but also in a new distribution of the
 powers even of productivity, which, being now deprived of
 its normal formative organ, is thrown into a false—a patho-
 logical direction.   Hence  arise  the many accidents which
 endanger life,  and which  can be traced to  two sources.
 They are either  sanguineous congestions to the head, the
 chest, the stomach, and other abdominal viscera, extrava-
 sations of blood, metrorrhagia, hajmatemesis, haemoptysis,
 haemorrhoidal  complaints  and nervous attacks ; or  they
 are disorders of secretion  and consequences of a degener-
 ating productivity, as  the formation  of scirrhi, or their
 transition  into cancer, cutaneous diseases,  ulcers, gout,
 dropsy.
   The treatment solely applicable to this period, and which
 may prevent all these accidents,  consists in a restoration of
 the balance, in diminishing plethora, derivating  the blood
 from noble parts, and supplying new secretions for those
 which have ceased to exist.
   The  safest means to fulfil these indications, unless for-
 bid by great debility, is a moderate venesection performed
 every six months, even every three  months in the case of
 plethoric  women, and  such as  were  subject to copious
 menstruation.
   When there are local congestions and affections, let ten
 to sixteen cups be applied every two months, a kind of de-
 rivation which  I  have  found very useful in this period, in
 order to  free the capillary system, which is so frequently
 the seat of disease.  The  diet must not be too nutritive ;
 daily exercise and a  cooling  cathartic must be taken for
four or  six days every  month.  The  best kind of laxative
is  a glass of six or ten ounces of Seidlitz water every morn-
ing.   When important and obstinate affections and conges-
tions, as vertigo, an apoplectic disposition,  oppression  of
the chest,  cutaneous  diseases, arthritic affections set in,
fontanels are required.
   These abstractions of blood are to be performed more
and more  seldom, as the period of cessation advances and 
10
VENESECTION.
plenitude decreases, so that no more be made after one, in
others after two or three years.   There are persons, how-
ever, of so plethoric  a constitution, that one abstraction
yearly must be  persevered in from this period onward to
advanced age.
   I do  not hesitate to assert,  that following  these pre-
cepts, and especially the occasional venesection, will often
prevent the worst accidents of this period, even cancer, at
least scirrhus from passing into cancer, which is then so
frequent.


             3. Phthisical Disposition.

   There are two modifications of the phthisical disposition,
the atonic and the florid or inflammatory.  In the first, re-
laxation of the lungs and atony of the whole system is per-
ceived ; it is distinguished by cough and a mucous expec-
toration becoming more frequent and copious. To  prevent
it from  passing into real consumption, strengthening is re-
quired,  which may be effected by a continuous use of Ice-
land moss, Peruvian bark, and similar tonics.  Abstraction
of blood would be injurious in such a case, and accelerate
that transition which  we desire  to prevent.  In the florid
phthisical disposition, on the contrary, a phlogistic  state of
the lungs  inclined to inflammation, irritated, frequently
tuberculous, exists, with an augmented irritability of the
whole vascular system. The cheeks are red, as if painted ;
they and the hands are  often  hot,  a constantly irritated
pulse, frequent stitches or pains in the chest, with short dry
cough and oppression, disposition to haemoptysis and febrile
motions, are characteristic of it.  Here  the only means to
save life and to prevent the transition into real consump-
tion, consist in an antiphlogistic diet and small venesec-
tions repeated from time to time.  I have enabled persons
so constituted to pass safely through that perilous period,
the age from the sixteenth to the twenty-fifth year, by the
following  treatment:   a  moderate venesection  of  six  or
eight  ounces every two, three, or four months,  fontanels
or, still  better, mezereum  on the arms,  internally nothino-
but whey and milk diet, the expressed juices of mellagines
of tussilage, carvil, borrage, grass-root,  cucumber-juice
small doses of digitalis.  The best proof of the importance
of abstractions of blood in these cases is exhibited by Na-
ture herself in  the female sex;  for every one knows that
the continuance of menstruation is  the  surest remedy to 
VENESECTION.
11
 prevent phthisis for a long time, even where there is a great
 disposition to it. It is only when the menstrual flux ceases
 that phthisis manifests itself to its full extent, and  then the
 patient is lost.


            4. The  Apoplectic Disposition.

   In men, who have a short stout body, short thick neck,
 and unusually large head (which is therefore called archi-
 tectura apoplectica) a natural disposition to apoplexy exists,
 and when such individuals get farther advanced in age, up
 to forty or fifty years, the precursors of it, vertigo, feeling
 of fulness in the head, tingling and buzzing at the ears, un-
 usual  sleepiness and forgetfulness set in.  In the  absence
 of such a structure this disposition is produced at a certain
 age by other diseases, especially by gout and haemorrhoidal
 complaints.  Even old age alone may generate it in pletho-
 ric persons, by straitening or even  ossification of the ex-
 ternal vessels, by which a stronger rush of blood inwardly
 and to the brain (plethora ad spatium) is brought on.  In all
 these cases,  when the above-mentioned forerunners  set in,
 and indications of plethora associate with it, I know of no
 greater remedy to prevent apoplexy and preserve life, than
 a  frequent use of cooling cathartics,*  fontanels,  and oc-
 casionally a venesection alternately on  the  arm  or foot.
 The most appropriate seasons, indicated by Nature, for
 such  prophylactic venesections are the  time of the  first
 snow in November, when the contraction of the peripheric
 vessels, combined with the  pressure of the atmosphere, is
 likely  to  produce congestions to the head, and the time  of
 the first summer heat, in May or June (the season of bloom-
 ing, as the ancients called  it),  when  the first influence  of

  * I cannot too strongly recommend a remedy against vertigo," first
 brought into notice by  Kaempf, which innumerable cases'have con-
 firmed to me.  It is the following:
                      R. Gum guniac,
                        Cretnor tartar,
                          of each half a drachm,
                               M. F. P.
   S. To be taken, for several days, in the evening, before retiring.
  I have found this remedy of excellent use, not only against vertigo,
but in general as a preservative against apoplectic fits in persons of
advanced age,  when atonic gout is likely to be mixed with it.
  It may be repeated every month, for several days.  When haemor-
rhoidal congestions are  connected with it, I add ten to fifteen grains
of lac sulphuris. 
12
VENESECTION.
 warmth creates an unusual distention of the blood (plethora
 ad volumen), and thereby congestion to the brain.
   I know a number of persons, who have  prolonged their
 life up to eighty years by such annual venesections.  That
 very old age is often the sole indication for bleeding, even
 in individuals who were not in need of it formerly; and I
 cannot omit to recommend this point to particular atten-
 tion.  Old age ought  not to lead us to suppose weakness
 alone, as many practitioners do, and suggest  the use  of
 tonics.   In  persons of a  sanguine constitution and good
 digestion, very active  sanguification persists up to  great
 age, and the plenitude  of blood now becomes  dangerous,
 since its equal distribution is impeded by the straitening of
 the vessels and the decreased motive power in the smaller
 and capillary ones, and local congestion of blood, especially
 to the brain, is caused.  Therefore, there are persons who
 attain their fiftieth or  sixtieth year of age without need  of
 bleeding, but who, from this period onward require annual
 venesection.  Be careful  in this, as in the fit of apoplexy
 itself, not to be  deceived by  the  external appearance  of
 weakness and deficiency of blood, pale countenance and
 leanness.   Such individuals  are often internally most rich
 in blood; of which a full,  strong, and  hard pulse is a sure
 indication.  I have abstracted from a man of seventy-two
 years of  age, of pale, meagre constitution, who had had a
 fit of apoplexy, and laid speechless and consciousless, with
 pale face, but with a  full, hard pulse, first one pound  of
 blood, and this being of no use, and  the vein yielding  no
 more, immediately fourteen ounces of blood from a second
 vein of  the  other arm, and  it  was not until he had lost
 twenty-six ounces of blood, that speech, consciousness, and
 ability to  swallow returned, and the  attack  of apoplexy
 passed by happily.


                  5. Haemorrhages.

  Here also venesection has been too much forgotten and
neglected, owing  to the erroneous idea that haemorrhage
is always caused by debility, and is  a substitute for abstrac-
tion of blood.  Practitioners seem to have forgotten that
haemorrhages might arise from plethora and from increased
 vascular  action ;  that  loss of blood by venesection has a
quite different effect from that by haemorrhage ; and finally,
that  it is better that  a superabundance  of blood be dis-
 charged from a vein of the arm, than from the lungs. 
VENESECTION. .                   13
  Bleeding from  the  lungs deserves particular attention.
This most plethoric organ of our body, one so apt to lesions
which are so irremediable, requires venesection, according
to my opinion, at every eruption of  blood, though it  be
trifling, except  the  single case, where a putrid dissolution
or an ulcer in the lungs is evidently the  cause.  In  all
other cases it will be  prudent to.commence  by a moderate
venesection, which often is alone sufficient to stop bleed-
ing, at least prepares the system for the application of other
remedies ; and which  is essential for preventing dangerous
consequences,—inflammation of the bleeding part.
   It is likewise often the only remedy, or, at least, an indis-
pensable accessory in  metrorrhagia, particularly those cases
which happen in plethoric subjects, and at the period of the
menstrual cessation, when a venesection in the arm occa-
sionally repeated is often the only means of relief.
   Bleeding is less necessary in hsemorrhoidal haemorrhages,
haematuria, and haematemesis..  But  even  in these cases it
may be salutary when plethora exists, or a previous haemor-
rhage has been suppressed.

                   6. Commotion.

   I must now mention  the important case  of a  violent
mechanical concussion, a fall or a blow.  The consequence
is always a local  debilitation of one or several internal vis-
cera, distention of the vessels injured, and a congestion or
a real extravasation of blood, either into the cellular tissue
or poured out externally (haemoptysis, haematuria, metror-
rhagia).  Thus violent concussions are  apt to give rise to
inflammation of the brain, of the lungs, of the kidneys, &c,
which have  the further peculiarity of being  of a compound
character, active and passive; that is to say, consisting in
a considerable accumulation and stagnation of blood in a
debilitated vascular system, in  which irritation, develop-
ment of warmth and inflammation is increased by the exist-
ing local plethora.   This  state is liable to be mistaken in
its intrinsic character, and has indeed been  frequently mis-
taken.   When  the asthenic  theory reigned, the conse-
quences of all  commotion, even  inflammatory phenomena
were regarded as mere weaknesses, treated with stimulants,
and  abstraction  of blood  was  abstained  from ;  in conse-
quence of which, if the patient did not immediately die, he
fell into a chronic disease of the viscera, frequently ter-
minating in consumption.
   The only correct treatment of such inflammations (a com-
                           B 
14
. VENESECTION.
motione) is to  unite both methods, for both states of dis-
ease are united here,—that is to say, the evacuant and tonic
method.
  The first thing to be done is a venesection, in order to
promptly  remove  the local accumulation  of  blood.  As
soon  as this has been sufficiently done, have recourse to
the topical application of .cold, and internally to antiphlo-
gistics, as long as inflammability is evident; if these means
be not at  hand,  an infusion of arnica  montana (leopard's
bane) is the specific, to effect a prompt absorption of the
stagnations and  extravasations which follow commotions;
a property which is implied in the (German) popular name
of this plant, which is Fall-Kraut, falling herb.
  The commotion may not be followed by inflammation,
but by a chronic affection  of the part  injured.  In such a
case,  a stagnation of the humors within or without the ca-
pillary vessels (an extravasation into  the cellular tissue,
parenchyma of the part) must be suspected.  The doctrine
of extravasations and stagnations of blood in the substance
of the viscera merits attention, and needs farther investi-
gation.    We see externally,   after  violent  contusions,
ecchymoses, which last for weeks, months, even for a long-
er time, spreading from one part to another, as from the
shoulder to the  ends of the fingers, and which are often
followed by disorganizations, indurations, suppurations:
the same also happens to the internal viscera. A protracted
pressing or pains in  single viscera, as in  the  lungs, liver,
spleen have often been observed, have lasted many months
without yielding to  any remedy, and  finally  have disap-
peared by spontaneous  discharges of blood from the lungs,
stomach, or intestinal canal.  But it more frequently hap-
pens, that  such  local accumulations and stagnations gra-
dually form into incurable obstructions, indurations, sup-
purations, or other pathological metamorphoses.
  All these evils, acute as well as chronic, are  most surely
prevented by a venesection made in season; that is, imme-
diately after the  accident.


7. Plethora  at Spatium, by faults of structure or
                    proportion.

  By this, I understand a state of the body, in which,  while
sanguification  continues perfect, there exist  mechanical
obstructions, which impede and deprive the blood of room
to circulate. 
OPIUM.                       15
  This  is  the case.in all humpbacked persons;  for  the
spinal distortion diminishes the space between the pelvis
and the chest, and gives a new  curvature to the  aorta, by
which the circulation of the blood will be necessarily ob-
structed, and forced to  accumulate in the large vessels
near the heart.   When these deformities are great, we al-
ways find the subject of them troubled with haemorrhoidal
congestions, or congestions in the chest and head; for which
there is no other cause than this.  The only means of alle-
viating the  complaints of such deformed persons,  and to
prevent the dangers of congestion, is to practise moderate
venesections occasionally.
   We meet with something of the same kind also in those
cases where there is considerable congenital disproportion
between the limbs and the body. A person who has very
short legs  will always be more subject to sanguineous con-
gestions to the  head and chest, than a long legged one.
In general  the apoplectic disposition is owing to the short-
ness of the neck, the large size of the head, and the com-
pressed form of the  rest of the body.  In little children
it is likewise the proportional  size of the head which ren-
ders them particularly so liable to sanguineous congestions.
There may be a disproportion even in the vessels ;  the con-
stant disposition to internal sanguineous accumulations is
often due to disproportional smallness of the  external ve-
nous vessels.
   We must  also mention those cases, where a great part
of the room designed for the motion of the blood has been
taken away by amputations of large limbs, or the tying and
adhesion of large blood vessels (in aneurisms).  In all these
cases the faulty structure is an indication for the abstrac-
tion of blood when cases require it;  venesections in these
cases are important preservatives.
                          II.

                      Opium.

  Sacra vitae anchora, circumspecte agentibus, est opium ;  cymba
Charontis in manu imperiti.                         Wedei..

  We  will now speak  of the second  heroic remedy—■
opium.  A great, a mysterious, an  extraordinary remedy,
still incomprehensible in its effects ; and on which Nature
has appropriately placed a crown at  the completion of  its 
16                      OPIUM.
vegetative life (in the capsules).  We are perfectly right
to style it a hero ; for it unites all the virtues of one.  It
is a remedy whose power affects the very source of hie,
whose effect is decisive of life or death ; and used in the
critical moment  may save, as surely as it will  destroy if
wrongly applied; which is unique in its operations, and
canno't be replaced by any other one ; finally, it has often
reigned king, even despot over the whole medical world,
and spread benefits as well as ruin over  humanity.
  What  Wolfgang Wedel has said of it in his Opiologia,
will remain for ever true :  " Sacra vite  anchora, circum-
specte agentibus, est opium ;  cymba vero  Charontis in  manu
imperiti.'"—It is a double edged  sword,  a divine gift from
heaven in the hand of the master; the most deadly poison
in the hand of the ignoramus.  O that it were possible  to
commit it only into the  hands of a master, and to withdraw
it from the profane hands of the demi-physician.
  The history of opium is the history of medicine. It has in-
separably accompanied the art of healing through all its va-
rious phases; alternately been raised up to the skies, and,
as it were, revered ; again dreaded and banished ; but always
again  sought for as indispensable.  The greatest masters
of the art,—Galen, Sydenham, Hoffmann, Werlhof, paid re-
spect and veneration to  it, and believed  that one could not
be a physician without it.  And how far back is the date
when  every  disease was thought to be curable by opium,
and that  almost every physician  carried  the opium-vial  in
his pocket 1  Did it  not defeat  all other medicines, and
maintain the  battle-field alone 1   Can we deny that at that
time, opium really controlled medicine, even that it had
the most decisive influence  on  the theory  of medicine 1
It was its frequent use  and  its extraordinary effect  that
most contributed to start the opinion, which considered the
original character of all  diseases to be astheny.
  But as it is in  general the lot of  men to pass from one
extreme  to the other, so has it also happened  with opium.
To a predilection for this remedy, and its abuse,  which
only a few lustres ago perpetrated so much  mischief, and
to an ignorance of its real merit, succeeded an exaggerated
horror of its use among  physicians, and  thereby was medi-
cine deprived of one of  its most excellent remedies,  and
many  a patient  of the  relief which it alone could  afford.
  It is time to  seek a reasonable medium, and to instate
this venerable drug in its true rights.  This is the object of
the present  treatise:  to appreciate the  virtues of opium
to reduce them to fixed principles, and to give a proper 
OPIUM.
17
rule  to physicians,  especially to  young practitioners;
whereby to avoid abuse, and to apply it in  its proper place.
All—even life and death—depends on a correct knowledge
of its primitive effects, on a right  appreciation of the indi-
cations, and an accurate  discrimination of the case.  The
first  and most important thing is undoubtedly a knowledge
of the primitive effect, the essential character of a remedy.
As every disease has its peculiar character developed in
the organism, so is the effect of every remedy nothing less
than a disease created by art, and possessed of a character
of its own.   In order to understand  the primary effect of
a remedy, we must  have a  knowledge of the alteration
which it produces in general in the  living economy, what
are the alterations it produces in the various systems, what
is the system it attacks in preference,  carefully  discrimi-
nating the proximate from  the remote effects.  For this
purpose it is not  sufficient  to know the names of the dis-
eases in which opium has proved  beneficial.  This can at
most impart an empirical knowledge.  Nor is a chemical
analysis sufficient, however accurate it be ; it will always
remain subordinate  to autonomy and  autocrasy of hfe.
But  least of all are we to respect a deductio a priori, which
will  ever change obedient  to the wind of every system.
The primitive effect can only be determined on by observ-
ing the effects of its  operation on the living organism, as far
as they strike the senses.  It is only the proximate, essen-
tial, constant effects that  come  into consideration,—not
every phenomenon which follows its use,  as Homoeopathy
pretends to; for  a multitude of accidental causes, depend-
ent  on individuality, and on temporary external and  inter-
nal conditions, co-operate and modify those effects.  The
task therefore is to  inquire  from  experience, and to sepa-
rate the proximate, essential, and constant effects of opium
from the secondary  and accidental ones.
   Large is  the field and difficult the task.  One might feel
 inclined to believe, from the immense crowd of observa-
tions and trials, which have been accumulated, and are before
us since more than ten centuries, it might be easily done.
But this is not so.   For now we have to distinguish which
of its effects belong to the individual's constitution, to  the
 idiosyncrasy of the  person ;  what is to be attributed to the
 reaction which is altered by disease, what must be ascribed
 to the various  epidemical  and endemical  constitutions
 which so greatly modify all living  beings; how much is
 owing to habit, as in the east; finally, how much is attri-
 butable to the observer, and the spectacles through  which
                           B* 
18
OPIUM.
he sees the subject, and by which even facts may present
quite a different appearance, and by which so  many false
and  single-eyed observations have been brought before the
public.  I  shall endeavor, according to these considera-
tions, to lay  down and  fix the most essential  out  of this
vast mass of observations  and trials,  and my own  longse-
val experience.  In this respect Brownianism was particu-
larly prolific.  It may very properly be  considered the
greatest and most  universal experiment, which  has ever
been instituted on mankind.

               Constant Phenomena.

  When we bring opium in conflict with the living organ-
ism, be it by  the internal or external surface, the following
symptoms appear as constant:
  1. The pulse is  raised,  becomes full and vigorous.   This
effect is immediate and constant.   Acceleration is only re-
lative, and depends on the variability of the vital state.  In
a healthy state, a moderate acceleration is  observed, even
when the vital power is increased.  If,  on  the contrary, a
frequency of pulse  exists, excited  by weakness,  opium
moderates it and makes the pulse slower and more regular.
Large doses also render the pulse slow and like that of an
apoplectic person.
  2.  Turgor (expansion) of blood.   It is manifest in the ful-
ness of the pulse,  in the swelling of all the vessels,  in the
sanguineous congestions that happen.   It tends  first to the
head, the lungs, or to any other predisposed organ, and is
apt to create  haemorrhages, even inflammations.
  This vital  turgescence, exhibited in the expansion of
blood, must be considered as a peculiar effect of opium,
and  deserves particular attention.  It was known under
the name of rarefactio sanguinis by gray antiquity, and re-
garded as the primitive effect of opium.  And it is indeed
one of the most constant phenomena, and is perceptible at
all times.  The pulse becomes full and large even  in debil-
itated persons, and such as are poor in blood ; an  artificial
plenitude, a true plethora ad volumen is the consequence.
Therein particularly, resides  the danger of sano-uineous
congestion to the head  after the use of opium ;° and on
this circumstance depends the dissolution of the blood the
decomposition of the living mixture which sometimes hap-
pens.                                               v
  3.  Increase of vital warmth.  It is an inseparable com-
panion, a co-effect  of the augmented  vital turgescence, 
OPIUM.
19
and of the increased circulation,  and is one  of the  most
constant effects of opium.
  4. The  nervous system,  especially the sensorium, is di-
rectly and  mightily affected;  sensibility is diminished, for
it produces stupefaction,  sleepiness, coma; when  applied
locally, numbness, insensibility of the part,  cessation of
pains and spasms.  Sometimes, it is true, Us internal use
produces increased gaiety, exaltation of the sensorium, of
psychical life, even delirium, which may  reach unto  fury.
But these are excitements which very soon pass away, and
are followed by a contrary state.   They  are  relative, and
 depend partly on  the dose, partly on individual varieties.
 They belong in part to the affection of the nervous system,
 which,  before  yielding  to  the  narcotic  power  of the
 remedy,  resists the attacking agent for a while ; partly also
 to an afflux of blood to the brain, on which opium acts as
 a powerful stimulant, and exalts its action, as is seen  in any
 other sanguineous or inflammatory state  of the brain.
   The immediate operation of an agent on the  human eco-
 nomy is  most accurately and  best ascertained  by  its local
 effect, and  this in opium is always a  diminution of sensi-
 bility.  When applied  to the intestinal canal, the action ot
 the latter ceases;  applied on an  external part, it removes
 pain and spasm, provided that the epidermis  is whole ; tor
 otherwise the soreness of the part would of course  render
 that, as every other application of a foreign  substance, es-
 pecially of a resinous one, painful.
    5. Constipation of the bowels, and  dryness of the throat,
  owintr to a local paralysis of the intestinal canal and itsab-
  sorbe°nt vessels, created by its internal  application.  This
  is a stupor, a sleep of the intestines.
    6. Increased secretion.of the skin, sweat.  The product ol
  the exciting power, of the  augmented arterial action, the

    * The  pure effect of opium can be known only in persons unaccus-
  tomed to its use.  Therefore, the effect of it amongst the  Turks  and
  other oriental nations, as well as amongst us in  persons accustomed to
  °t, does not prove any  thing to the contrary.  Habit producesaper-
 • fectly new relation between the opium and an orgamsm alieady ac-
  customed to its excess, blunted and pathologically altered.   I he mad
  courage  of the Turks, created by opium, is a double product, created
  by the double, positive and negative effect of opium  ; on one part >is
  negative • disregard, forgetfulness of danger and of themselves, by the
  delotentiati ,c  P°wer of opium ; on  the other part exaltatmn of en-
  Sy aTco  fagl by the increased tendency of blood  to the  bra.n and
  heart -We also" see persons in our ownclimate, by long and  abundant
  use of this remedy in large doses, suffer no other percepfble effect than
  rforgetfulnes of themselves, of their pains,  of their whole morbid
  condition, whence results their mirth and contentment. 
20
OPIUM.
 motus periphericus, combined with the sedative, the  solu-
 tion of the cutaneous spasm, the relaxation of the orifices
 of the vessels.  Hence it promotes suppuration, and is apt
 to create pimples, petechia; and aphthae in fever.
   7. Besides these,  the  effect on the genitals and urinary
 organs may be adduced as  almost a constant effect; it ex-
 cites their action.   The  first are most excited ; amorous
 dreams, erections and  emissions generally follow its use.
 As to the urinary apparatus, the discharge  of urine is in-
 creased  in quantity and in frequency; ,but this depends on
 circumstances, and is yet a question  to be settled, whether
 it be a real increase  of the urinary  secretion, or only in-
 creased  urgency to make water.
   8. Too abundant  anrJ too long continued use brings on
 dissolution of the blood, decomposition of the  vital combina-
 tion and mixture, putrescency, gangrene, rapid transition into
 complete putrescency after  death.  Although thisis a  secon-
 dary, it is still one of the most  constant effects  of opium,
 after a concentrated use of it (opium poisoning), or after
 a protracted use.  All acute fevers may be changed by the
 abuse of opium into putrid typhus ; all inflammations  into
 gangrene.   Also in chronic diseases this inclination tp dis*
 solution  and haemorrhages is manifest after its long con-
tinued use.   Even among the Turks its abundant use brings
on a gradual mortification,  and the most profuse haemor-
rhages.   Equally constant is the rapid transition of such
dead bodies into putrescency, and the effect of opium is
 perfectly similar to the effect of lightning.
                  Primitive Enectr

  We see thus in opium a most wonderful and unique com-
bination of excitement with stupefaction ;  of an animating
with a destructive power ; and it is these effects which are
distinctive of the remedy, and which give to it so high and
exclusive  a value for practice.  Depression,  even complete
annihilation of sensibility, of nervous  life, and  awakening
and raising  of the irritability of the heart and the whole vas-
cular system ; that is to say, of the organic, vegetative, prim-
itive life,  along with augmentation and acceleration of the
vital process unto fatal hyperanimalization, destruction of all
plasticity  and  incipient chemical  dissolution,—this  is the
essential character, the primitive effect  of this extraordi-
nary remedy.   Hence the instantaneous excitement and
filling of the pulse, which was reduced by weakness j mo- 
OPIUM.
21
deration of the pulse accelerated by weakness ; the conver-
sion of violent, sanguineous congestions into inflammation ;
hence  the rapid transition into gangrene,  colliquation,
hypercarbonization, putrescency and putrefaction."
  Opium  is therefore  a great, even the greatest excitant
and  cardiacum, in the  strictest sense, which we possess.
And this  is, indeed, a  positive primary effect, not a medi-
ated one,  the effect of  secondary or antagonistic reaction.
The best evidence of this is furnished by trials  on persons
who are almost in an exhausted state. I must remark here,
as a general observation,  that  in  order  to  ascertain its
effects on the living body, it is  most necessary to consult
pathology, and  its pathological effects ; not only the trials
on healthy persons.  One ought to have seen himself the
wonderful momentaneous effects which a dose of opium
produces in  the most prostrated and exhausted state of the
vital power, as in typhus fevers and in malignant small-
pox ; how the scarcely  perceptible, quick, trembling, inter-
mittent pulse changes into a full, equal, vigorous one, how
the skin acquires an uniform  warmth, an universal, vital
turgescence spreads a  new sensation of life; vigor, cour-
age, and  comfort pervade the  patient, and the internal
curative process, the crisis, which  hitherto could not be
effected, all of a sudden receives the most  vigorous  im-
pulse, and from  that moment all the salutary productions
and secretions of Nature go into operation.
  In this Brown was perfectly right, though it was known
and in usage a long time before.   He only forgot the other
side ;—that  this  remedy acted  also as a sedative  on the
nervous system,  and that even  its  exciting  impulse is so
powerful, and  affects  life  so deeply, that the  excitement
passes rapidly into the greatest  prostration and paralysis ;
hence, we cannot  attribute to  it  a really and lastingly
roborative virtue.
  But  the idea of irritation and excitement does by no
means exhaust the effect of opium, no more  than the idea
of over-irritation does that of its  secondary effect.  For its
operation extends deeper; the excitation attacks the primi-
tive  process of life, the chemico-vital mixture, and  the
over-irritation becomes  an over-living, a vital  process in-
creased above the normal measure.   This is made evident
by the rapid transition  of the bodies of those who have suf-
fered from it, into putrefaction, gangrene and dissolution.
Therefore, the  sedative  effect ought no less than the ex- 
22                      opium.
citement  to  be considered  a fundamental operation ot
opium.                                              ,
  Nor is  this sedative  effect, as is generally supposed, a
secondary one, created by over-irritation ; but, like excite-
ment, it is a primitive action, exerted immediately on the
nerves,  and which  strikingly shows the power of opium,
locally applied, in arresting  pain, spasm, and even every
species of activity.                       ....
  It is, therefore, with a full conviction that  I maintain:
There is no remedy, in our whole stock of medicines, which
operates so directly and powerfully, and at the same time so
variously  on life, on the fundamental principle of vitality, as
opium.  He who  uses it, has life  and death in his hands,
bordering very near on  each other.  So true is what the
great Sydenham says: " Without opium all medicine would
be imperfect and insufficient."

                Rlode of Operation.

  Every inquirer will naturally ask: How are we to explain
the surprising  and, to a certain  degree, contrary effects,
and  such  as  no other remedy produces %   This task has
occupied and exercised the sagacity of the physicians since
thousands of years.   It is one of  the most difficult riddles
put by Nature to the inquiring mind ; and nothing is more
instructive, and at the same time more discouraging, than
an  exposition of the various opinions put forward on this
account.  It is, so to say, a history of the human mind and
the variable states of science; and as this  mysterious re-
medy affects the innermost  relations of organic life, its
history furnishes an  exhibition  of the fundamental ideas
which prevailed from time to time of Nature, and of the
actions  of life.  The first we meet with is  the theory of
vital  spirits, which, according to the  opinions of the an-
cient physicians, are fascinated and enchanted by opium in
some wonderful way.*  After this came the  Galenian view
of temperature, according to which opium was of a cold
nature, and therefore  required the assistance of aromatics.
Afterwards  the opinion  of Sylvius, who endeavored  to
explain all in a chemical way ; supposed that opium was
possessed  of a  peculiar  principium sulphureo-volatile
which was productive of all its effects.   Helmont asserted'
that opium  operates  on  his  " archaeus," and by  this he

  * The great Bacon thought that  the effect of opium was to drive the
spirits from the surface, and to concentrate them at  the centre.  Hist.
Vitse et Mortis.  Art. xii. 
opium.                       23
accounted  for  the phenomena.   The  more mechanical
school supposed the effect of opium to be due to an  ob-
struction of the finest  vessels.   Then the  opinion, that
opium operated merely by expanding the  blood, spread
universally and prevailed  for a  long time; an opinion to
which even the great F. Hoffmann assented to a great ex-
tent.—Then appeared the more accurate knowledge of the
nervous system, and its influence on  the organic functions,
the great discovery of Haller, that of the difference between
sensibility and irritability, which altered the views in physi-
ology and pathology, and thereby also the view heretofore
entertained of  the operation of opium.   It was now par-
ticularly referred to the nerves, exclusively so by Cullen.
In more recent times, two other remarkable explanations
were  given.   The one most ingeniously excogitated by
the subtle Lewis Hoffmann.*  He founds it on the prin-
ciple, that the small vessels and  their terminations, having
a weaker degree of irritability than the large  ones, and the
heart,  consequently lose it before the latter under the irri-
tating operation of opium.  Hence results a state  of rela-
tive weakness, a want of action and obstructed circulation
of the humors in the smaller vessels, and by this resistance,
by this disturbed equilibrium, an increased and strengthen-
ed reaction of the heart.—The second explanation comes
from the famous Brown.  According to him, opium  is the
strongest and most diffusible stimulant for the whole system.
It consequently arouses a violent  reaction  in the whole
economy, but by the very same  cause is  consequently fol-
lowed by the greatest exhaustion ; which is indirect debi-
lity.  The most recent opinion  is that appertaining to the
system of polarity  prevailing  in natural philosophy,  and
which approaches to the chemical view.
  The plurality of physicians hold now to the opinion, that
opium operates  by irritating  the whole  system ; and that
the narcotic effect is a consequence of  over-irritation, of
indirect debility.   I oppose to this two questions:  In the
first place,—why do not other equally volatile remedies,
which excessively irritate  the vascular  system, such  as
musk, ammonia,  castoreum, likewise create narcotic ef-

  * Who lived half a century later than Frederick Hoffmann,  for
whom young physicians often mistake him.
  t  Even such was the opinion of Brachet in his Traite sur TO-pium ;
Paris, 182S. 
24                       opium.
 fects 1   And in the second place,—do we not see narcotics
 which  produce most violent narcotic effects without the
 least irritation of the vascular system,  without alteration
 of the pulse and warmth, even by retardation of the pulse,
 and consequently diminished action of the heart!   Hence,
 I deem it clearly evident, that the narcotic matter is some-
 thing peculiar, which, independently of the irritative power
 of the  heart  and  vascular  system, operates directly and
 specifically to the brain and  nervous  system, and is capa-
 ble of depressing and affecting it directly, and without the
 medium of an over-irritation.   This narcotic principle is
 manifestly present in opium.  The proofs are as follows:
 the peculiar smell of opium, which is very similar  to that
 which we perceive in hyoscyamus, stramonium, and other
 narcotic plants, and which always betrays the existence of
 narcotic matter.   Farther,  the  local  sedative effect of
 opium; it operates also when externally applied, relieving
 spasm,  and  soothing, without any affection or excitation of
 the vascular system ; it may even  (as I have experienced
 myself, when on a hot day I held a  large piece of opium in
 my hand for a length of time)  by  a strong and long con-
 tinued external application, affect the sensorium and create
 narcotic accidents* without  any excitement of  the  blood,
 merely  through a nervous consensus.  The mere applica-
 tion to  the temples causes sleep.f  The topical application
 to the stomach, when taking it as a medicine, immediately
 stops the local sensibility and nervous action of this organ
 (appetite, digestive power, and peristaltic motion);  its ap-
 plication to  the  intestinal canal by injections arrests the
 peristaltic action of  the intestinal canal.  Farther, we see
 that the mere vapor,  which  is the purest element of  narco-
 tic matter,  produces  stupor.  The  aqua opiatica,  which
does not contain any thing chemically recognizable, conse-
 quently only the exhalation^ the most volatile part, has also
 a  sedative  effect  in  ophthalmias.    Finally, experience
teaches that the watery extract operates antispasmodically
and soothingly, without exciting the vascular system  (simi-
lar to other pure narcotics, as hyoscyamus, stramonium),

  # Has the strongest alcohol ever done so ?  I ask of those who con-
sider the  effect of opium identical to that of wine.
  t It is one of my usual remedies in sleepless>iess of nervous patients
this so frequently tedious complaint, to apply on both temples every
evening the following plaster :
            R. Einpl. de hyoscyamo half an ounce.
               (>pii 20 grains.
               Malax. 
opium.                      25
but which the resinous preparation would produce,—evi-
dently proving the existence of narcotine, which is active,
without any excitement of blood and vessels intervening.
We may, by the admixture of nitre and other antiphlogis-
tics, deprive opium of its heating property, and still the
sedative remains.
  We must, therefore, distinguish the sedative from the
exciting operation of opium.  The only true and satisfac-
tory explanation of its mode of operation is, according to
my opinion, the following: a peculiar and  intricate union
of a narcotic with an excitant principle ; the first tending to
the nervous system, the other to the vascular.  The mere
aspect of one  of the important narcotics  shows that this
difference exists, and that the narcotic effect is by no means
in equal proportion to the exciting, which, however, would
be the case if both were one and the  same, or the effect of
one and  the same stimulus.  Stramonium is perhaps the
strongest narcotic we are acquainted with after opium ;  it
does not in the least excite the pulse nor the vascular sys-
tem, according to experiments made on animals ; digitalis,
on the contrary, operates depressingly, belladonna, on the
other  hand,  excitingly.  Prussic acid is capable of totally
annihilating sensibility, without producing the least excite-
ment  of the heart and vascular system.  These remarkable
varieties in the effects of narcotic remedies, seem to me to
furnish the  strongest proofs  of difference between sensi-
bility  and irritability as primitive organic powers.
  Let us now resort to chemistry, that art which resolves
all things, and ask :  To what principles can opium be redu-
ced 1  Perhaps it will throw some light on  the various
powers which this drug possesses, and it may give to us the
key  of the mystery.
  Ancient chemistry was contented with dissolving it  in
water, wine and alcohol,  to separate the parts which were
soluble in water from those not soluble, and it was found,
that  the watery solution (extractum  aquosurri s. gummo-
sum) possessed the narcotic virtues, though in a lower de-
gree, but  not  the hot properties,  and that the latter  per-
tained, consequently, to the resinous part; wherefore this
was  prescribed by the physicians,  when  sanguineous ex-
citement and phlogosis rendered the use of opium hazard-
ous.
  Modern chemistry, which has made such great discove-
ries, and has discovered entirely new modes of penetrating
                           c 
26
OPIUM.
into the interior of nature, has directed her attention  also
touhis important object, and  submitted opium to the most
accurate and manifold examinations.  It has discovered as
primitive  substances, oxygen, carbon and hydrogen.   The
result is, that opium may be divided into four ingredients,
morphium, meconium, and narcotine, to which the extrac-
tive matter* must be added.  But opinions differ very much
regarding the properties and effects.  Thus much is cer-
tain, that  morphium alone is of little efficacy.  It must  be
combined with an acid in order to operate, and then it has ef-
fects pretty much resembling those of opium unto fatal poi-
soning. But narcotine (Derosne's principle) remains, which
is very  efficacious according to some, indifferent according
to others.  Equally wanting of confirmation is the opinion,
that the latter produces the exciting, the first  the sedative
effects.  Besides, we have yet to  consider the extractive
matter, which the Swedish chemist Lindbergson maintains
is the most efficacious one in opium.
   What results from all these investigations for the physi-
cian 1  Neither morphium alone is opium, nor meconium,
nor the narcotine, nor the extractive matter ; but, what
even the great chemist  Orfilaowns: the effect of opium pro-
ceeds from the combination of all these ingredients, and I add,
from the peculiar mode of combination and existence, which,
however, is destroyed by chemical  analysis.  The lesson  for
practice is : he who wants to use opium, let opium be the article.
In this he is  sure  to have all  the ingredients that it con-
tains, and in that very peculiar organic combination, which
probably in all bodies  is the principle  and foundation  of
their essence.
   Of far greater importance to the  physician  is a know-
ledge of the spirituous and the watery solution of opium,
tinctura opii, and extractum opii aquosum.  The first produ-
ces narcosis, with  sanguineous  congestion and increased
action of the heart; the latter narcosis with less, or at least
with much less heating power.  This is confirmed by ex-
perience, and is  of  great practical  importance  for  the
various cases of its application when we wish to have the
sedative united  with the  exciting power, or the  sedative
alone.
   * But that very extractive matter seems to me by no means unim-
portant, and chemistry may allow me the question, whether it did
not treat the same too much as a trifle in general as well as in partic-
ular. For what is it but an ingredient, which we do not yet  know ?
 And would it not be better to call it, instead of using the non-signifi-
cant word extractive, rather problematic matter, as un incentive for
future investigations ? 
opium.                       27
  But this distinction is also important in a chemical point
of view, for it  shows in its  most simple form that the in-
gredients of opium  which  are soluble in water possess a
more purely narcotic power than those soluble in spirit, the
resinous; it also shows that the narcotic and exciting pro-
perties are also  contained in the alcoholic extract, which
must be distinguished from the former.  The first are  the
meconic-acid,  morphium  and the extractive matter;  the
latter the pure opium and the narcotine.
   I may here be permitted to subjoin my own opinion on
 the examination.
   Irritability is different from sensibility not only in name
 but in reality; it is independent, and  its action resides in
 itself, is not secondarily dependent on the nerves, though
 influenced and modified by them.   In this respect  Haller
 was perfectly right; and it needs nothing but a look to the
 heart and its nerves, so insignificant when compared to its
power, and to the first " punctum saliens," which distends
 and contracts without nerves, in order to become convin-
 ced of this truth.*   Now to conceive the idea of irritability
 and an irritable  system, the  subject  must  be  taken in  its
 totality ;  I therefore prefer to call  it the sanguineous life,
 the sanguineous system.   For the blood is its element, and
 the heart and  circulation  exists for the blood's  sake, not
 the blood for the heart's sake (one  of the usual views), in
 order to put it  in motion.  The blood,  not the  nerve, is
 the source and supporter of life;  the nerve needs the blood.
 Fluids exist before the solids; all life  springs from fluid,
 not alone in its origin and formation, but continually during
 its whole existence.   The  blood and the vascular system
 are consequently the base  of the proper organic, the vege-
tative  plastic life ; the  blood is the factor, the nerve the
 regulator of life.
   Susceptibility  to external impressions, therefore, by no
means relates solely to the nervous system,  nor is it de- *

  * I will recall to mind only two additional  proofs of the peculiarity
and independence of irritability, as a peculiar original organic power.
In the first place, the contraction and oscillation of the muscular fibre,
even after the  nerves have been cut; when  not only chemical, but
even mechanical irritation is applied.  In the second  place, the ab-
sence of fatigue in incessant labor and contraction, as we perceive in
 the heart ; whereas all action dependent  on the nerves is subject to
the law of fatigue.  This shows, 1 believe, absolutely, a  self-acting
power, innate in the organ, not  replaceable by any thing, in short, a
peculiar power. 
28                      opium.
pendent and solely due to it and only secondarily to  san-
guineous life, but external  influences  operate  as well im-
mediately and directly on the blood (its mixture and life)
as  on the nerves.   I will only call in mind the  effect of
venesection.  It evidently operates directly on  the mixture
of the blood.  The same is  true in regard  to warmth  (the
life); it directly creates  an increased turgescence of the
blood, and increases sanguineous life without a previous
assistance of the nervous system.
  In  like manner opium  operates simultaneously and di-
rectly on the nerves and blood, and produces in the latter
a momentary increase  of its vitality, which  is clear and
manifest  by the temporary and apparent distention (tur-
gescence), by the augmented action of the heart, and by the
increased vitality of the  products directly dependent on
the blood, as suppuration ; and finally by the acceleration
of the whole vital process, and the aptness  to  decomposi-
tion and  putrescency which follows.   We  must  attribute
to the idea of vitality a higher  and more extended sense
than is generally admitted.   Do we  not perceive in the
plants, which are  likewise  living organic beings, clear
proofs of vitality, and even  a certain degree of irritability,
though they are destitute  of nerves 1  Do we not see some
substances increase, others  lower, even destroy their vital-
ity, though they have no nerves,  as  frequently repeated
experiments sufficiently prove 1  And can  we deny that
the internal animal life has such a vegetative life for its
foundation 1
  In order to say all in one word, opium  is one  of  those
remedies, whose mode of acting cannot be confined, like
that of others, to the ideas of stimulus,  irritation, excite-
ment,  but which,  like the superior  agents  of  Nature,
warmth, light,  electricity, operates directly on vitality it-
self, and on all points causes modifications and phenomena,
penetrates and fills this vitality, with this peculiarity, that
it increases the organic vegetative sphere of life, the fun-
damental, plastic, vital  process, but on the contrary, de-
presses the sensitive sphere.
                     Indication.

  The principal indication for the use of opium may right-
ly be derived from  its primitive effect, as before stated.
It is as follows.
  Spasm, nervousness, i. e. anomalous or increased sensibili- 
opium.                      29
ty, but (which is well worthy of notice) in depressed vital
energy of the vascular system and the whole sanguineous life.
This applies to the whole system as  well as  to parts, and
to the acute as well as to the chronic state of disease.
  The more  the  erethismus of the nervous system in-
creases,  the more  the energy of the heart  and vascular
system, consequently that  of the  fundamental system is
prostrated;  that is to say, the more that real vital debility
is present: the more  proper and greater is the indication
for opium ; and this is, indeed, its highest merit, when the
most imminent danger of life is brought about by this dis-
proportion, as is the case in malignant small pox, gangrene
and typhus.
   On that account opium is the more beneficial, the more
the economy is debilitated by previous losses of  humours
or artificial abstractions  of blood and gastric evacuations.
   Therefore, soothing the excited nervous system, norma-
lization of its anomalous actjon (where also  the disorders
of  secretion are to be classed), resolution of the spasm,
especially of the painful spasms, and increasing the energy
of the heart and the whole organic life—must be the prin-
cipal ideas,  which  determine its use and guide us in its
application.
   It  is especially and particularly indicated in pain, in a
#ecessity to create perspiration generally, when it is requi-
 site to produce  a strong impulse  from the  centre to the
 periphery, in debilitating stools.
   Hence naturally result the counter-indications.   The
 first is plethora and an inflammatory diathesis.  As long as
 an abstraction of blood  is indicated, opium will be a most
 dreadful  poison,  since  it  forcibly augments sanguineous
 congestions,  especially  to  the  brain, and increases local
 irritation.  This observation applies also to every incipient
 fever, which is known  to  be  always inflammatory in its
 onset (genesis).   By such an unseasonable  use of opium,
 every fever  may be  converted  into a typhus, as we have
 often enough had occasion to see at the  time of the Browno-
 nian  period, as I have shown in my treatise  on  artificially
 made nervous fevers.
   The second contra-indications are, gastric accumulations
 in the stomach, in which opium never does good, but even
 proves injurious by retaining them.
   The third is, a state of blood inclined to dissolution and
 putrescency, which is likewise increased by opium.
c* 
30
opium.
                    Application.

  It is  beyond my task, to show the use  of this  great
remedy in all special cases and diseases.  To accomplish
this end, I would have to go  through the whole of patho-
logy.  For there is indeed no disease, in which opium has
not been used, and with good reason, under certain condi-
tions.  I shall only here state the cases in which it is most
valuable, in which no other can replace it; and such where
its use is doubtful, and needs  accurate discrimination, and
those, in which it is yet too little known and used.

               Local Inflammations.

  I commence with its virtue in local inflammations.  This
will make many a phlegmonist of now-a-days shake his
head.  But so it is, and I consider the proper use of opium
in inflammation as a superiority of modern practice and the
master stroke of a practitioner.  The case is this : it hap-
pens sometimes, and not unfrequently, that the symptoms
of local inflammation, after  a proper application of general
and topical bleeding, do not entirely cease ; or, after they
have abated, return with increased violence;  as in pleuritic
affection,  pain in  the side, cough, short respiration, tlffe
pulse is quick and feverish, but so small, that we dare not
venture on another venesection.  In such a case, antiphlo-
gistics have,  it is true, removed the share which the blood
and vascular  system had in the  inflammation : but the irri-
tation of the  nervous system of the inflamed part, the in-
creased sensibility, or spasm, as it is called, in the inflamed
part is left, is even increased by the debility which follows
too copious venesections ; if more blood be now abstracted,
the more will pain and the  local  symptoms increase, and
must increase.  Here  opium  is the only, a most  divine
remedy; it can, as by a charm, remove  the remainder of
the inflammation within 24 hours ; for it unites both powers
which are needed  here, in  a degree nowhere else to be
found ; partly to remove the abundance of increased sensi-
bility, the spasmodic state from the inflamed part, partly to
arouse the too much debilitated and inactive vessels, and
to give them  that degree of activity which is requisite for
the absorption of the stagnant  or effused blood, and for
completing the necessary local as well  as general  crisis
both of which must be aggravated by continuing the anti'
phlogistics. 
opium.                      31
      This applies particularly to pleurisies or painful pneu-
   monies.   The judicious use  of  opium may in such cases
   save much blood, even the life of the patient.  Here, how-
   ever, the glance  of a master is  needed.   For, alas! used
   unseasonably, it may cause •the  greatest injury ; we have
   seen too much of this during  the Brownonian period, when
   the practitioner administered opium immediately from  the
   commencement,  and without having previously made an
   abstraction of blood.  The pain abated, but oppression re-
   mained, the inflammation was not discussed, and the conse-
m quence was a transition into gangrene, and a fatal issue, or
   induration and suppuration ;  the patient had his life saved,
   and apparently recovered; the salutary power of opium
   was praised,  but he had the germ of future death lingering
   in him, which sooner or later  would be  developed, and
   manifested in  phthisis.  This  is the dangerous  side of
   opium ;—it is capable of temporarily assuaging pains and
   morbid sensation, and bring  the physician as well as  the
   patient into the most hazardous  illusion ; by which  the fa-
   vorable days for using effectual  curatives are neglected.
      Opium has its place only when the lancinating pains in
   the chest do  not yield to bleeding and antiphlogistics ; or
   when  having ceased they return, even with more force,
   and that even a vesicatory proves unavailing, the pulse con-
   tinuing small and tender, and does not admit of any fur-
   ther abstraction of blood, then—usually the 5th or 6th day
   —is the seasonable time for the  use of opium ; one grain,
   in the form of Dover's powder, taken in the evening, works
   wonders, takes away, as it were by charm, the remains of
   inflammation within one night, and  completes the general
   as well as local crisjs.  But use the combination with mer-
   cury,* which I have used in numerous such qualified cases
   with the best success, for mercury operates simultaneously
   on the lymphatic  portion of the inflammation, dissolving
   and absorbing the lymphatic coagulum or extravasation
   which perchance may have remained.
      Frequently, nothing more will be needed for completing
   the cure  but this remedy continued for  24 or  48 hours,
   with warm expectorative beverage.  The pain disappears,
   perspiration  becomes free, expectoration comes on, a criti-
   cal sweat appears, and the feverish pulse is soothed.

                     • R Calomel gr.vj.
                        Opii gr.ij.
                        Sacchari albi dr.ii.
              M. f. P. Divide it in six equal parts.
                 D. S. One powder every 2 or three hours. 
32                      opium.
   At the commencement of inflammatory rheumatic pleu-
 risies it is often sufficient for  the whole cure, to make  a
 copious venesection in the arm, and  to give immediately
 after a Dover's powder.
   I know even of a case of carditis, where, after bleeding
 as copiously  as could be, the most fearful palpitation with
 the most violent anguish of death persisted ;  it was in vain
 to give aqua  laurocerasi.   Opium removed these  remains
 promptly  and perfectly.
   In all inflammatory maladies, careful attention  must be
 paid to the pulse, which is th*e chief criterion, by which we ^
 judge whether this remedy is proper  or  not.  The use of
 opium is not only inadmissible while  the  pulse is strong
 and hard; but even during its use we must accurately ob-
 serve its effect; for  if the pulse becomes again hard and
 accelerated, it is  a proof, that  a remnant of  inflammation
 is still in the  blood, and which  the opium has roused, that
 it is still too  early to resort to  it. Set it aside and have re-
 course to other narcotics, as hyoscyamus, aqua laurocerasi,
 digitalis.
   The same thing happens in all other local inflammations,
 we must therefore proceed according to  the  same princi-
 ples.  It applies to inflammations of all the abdominal visce-
 ra, of the  spleen,  the stomach ; especially to that of the
 stomach, which, on  account  of the  great sensibility and
 nervous sympathy of this part, may be  so intense that  the
 patient may be said to die not by the inflammation, but of the
 nervous spasm which it has created : in such  a case opium
 is the only salvative.
   The same  holds good in regard to  cholera acutissima,
 the  true treatment of which  ought in general to be  the
 same as for the most intense gastritis, which  is after due
 abstraction of blood, to  give opium with  calomel and mu-
 cilaginous beverages as the only curative  means.  In en-
 teritis, in  ileus innammatorius, when  the spasmodic con-
striction of the intestines, the constipation persists, as an ef-
fect  of the nervous state  which follows the inflammation
which venesection has not been able to cure, there is nothing
 so capable of affording alvine evacuations as  calomel and
 opium combined, and warm baths.
   This  applies even  to purgatives, to which we are  often
 obliged to recur.   They operate only when combined with
 opium.  Lately in an obstinate case of ileus even the strong-
 est drastic, oleum crotonis, was inefficacious, until opium
 was added.   The same is true  in respect to ischuria in-
 flammatoria.   When abstractions of blood have been made 
OPIUM.
33
in vain, when  the  catheter and diuretics refuse their ser-
vice, opium enables the urine to flow.
  Particular regard is due to inflammation of the throat,
and especially to croup.  It is one of the most important
rules of practice in all these diseases, especially in the lat-
ter that  a period  may arrive when, by a proper antiphlo-
 gistic  treatment the  irritation has  been removed, a  ner-
 vous inflammation, i.  e. a spasmodic state in the organs of
 deglutition or  respiration  still  remains,  keeping  up the
 difficulty of  swallowing in the first case, and in the latter
 that of breathing ; as strong as if inflammation still existed,
 and which may even terminate in death.   Here the  anti-
 phlogistic method is of no farther use, for the case is now
 one of spasm left by inflammation ; opium or a similar active
 antispasmodic remedy, a vesicatory to the neck and anti-
 spasmodic emollient cataplasms are  alone able to bring
 relief.                                     ,  .    •  .  •
   I consider myself  obliged to  insist  upon this point, in
 the case of croup, for I  have observed, that practitioners
 often  have only the idea of the  presence of inflammation
 and antiphlogosis ; so that on this account the patient is
 not cured, whereas the use of opium or musk at this period
 takes  away the complaint  as it were by charm, and proves
  a salvative of life in  the strictest sense.  In this way  we
 can explain the contradiction among  physicians,  some ot
 whom look upon  the disease as inflammatory, others as
 spasmodic ; both supported in their views by the  eriect ot
 their  remedies.  Both are right to a certain  extent.   *or
  although the disease is naturally and  originally inflamma-
 torv  and often may  be cured by antiphlogistics alone,  yet
  the inflammatory stage may rapidly pass into a spasmodic
  a nervous one, in which  change spasmodics alone are ot
avai
  Cerebral inflammation must be treated according to the
same principles.  Opium here finds its place as a specific
sensorial remedy, in a double point of view as soon as, af-
ter  due bleeding,  application of  cold and antiphlogistic
purgatives, stupefaction  and delirium will not  yield, and
the pulse no more admits of abstraction* of blood.  In this
case inflammation  has passed into a  nervous state of the
brain, or a serous  effusion is already present;  opium will
often suffice  alone  to  take away the  v)|hole remainder  of
the disease, to which, however, on account of the extrav-
asation, calomel may be  added.  I saw the good effects of
opium against delirium tremens with pleasure ; it brought
back many physicians to the use of this remedy which 
34
OPIUM.
I
had been entirely laid aside, obedient to notions of antiphlo-
gosis : but  my surprise  was not slight when I  saw these
effects looked upon  as a new  phenomenon ;  for the best
practitioners since a long time  have appreciated opium in
cerebral affections, or in such as put on a nervous charac-
ter at the end of inflammation.

              Nervous Fever and Typhus.

   This leads me to speak of  the use of opium in nervous
 fever or typhus.
   I am far from believing that these fevers are always due
to cerebral  inflammation; but thus  much is certain, there
always exists a morbid affection of  the brain and nervous
system ; and the brain is here the centre  of action, as the
heart is in inflammatory fevers.—A sanguineous congestion
is very apt to associate with it, as with every local irrita-
tion ; but there  is  a  vast difference between congestion
and  inflammation, and the share  performed by the vascu-
lar system is always accessory, not  essential.   This  state
however makes  a great,  a decisive difference  regarding
the use of opium.   However much opium may seem  indi-
cated for  the nervous affection of the brain and nervous
system, it will nevertheless operate very injuriously when
sanguineous congestion  or inflammation of the brain  is
connected with  it.  Here opium will surely serve to accel-
 erate the transition into stupor and  apoplexy.'  This sub-
ject needs no farther  discussion, since the sad experience
of opium afforded by the Brownonians.
  But it is therefore the more necessary to look again on the
other side, which had  been lost sight of, and to do justice
to opium also in  this respect.
  There are four cases, in which  the use of opium  in ner-
vous fevers is exceedingly beneficial, even  indispensable.
   1. When  the nervous fever is from its very onset  purely
nervous, that  is a fever of debility,  created by  excessive
exertion, excesses in venery and masturbation, liquor and
the like ;  or  has attacked a nervous  individual;  when no
sign of inflammation  is  perceptible. Here,  after  a  few
evacuants, we may at once proceed to the use of opium :
and often, nothing else is wanted  to  accomplish  the cure.
—Here also must fee mentioned, the lately  so much praised
use  of opium in the delirium potatorum.  Besides  these
there is a  kind of nervous fever, which  chiefly occurs in
delicate, nervous, and young persons.  The pulse is irrita-
ted, there  is great prostration, on local symptoms,  but only a 
opium.                      35
slight  delirium, the  pulse exhibits  no signs of inflamma-
tion ; or sanguineous congestion to the head ; antiphlogis-
tics alleviate,  but the fevers  and  delirium continue for 8
to 14 days.  In such cases, both the fever and  delirium
will cease by a small addition of  tinctura opii to the an-
tiphlogistic potion.
   2. When after the accessory abstractions of blood and
the application of cold and cathartics, though the signs of
congestion  cease, yet the delirium persists, even  passes
into fury.  In this case  the fever is of a purely nervous
nature, and opium, to which it is better to add calomel, ac-
cording to the mixture before  mentioned, is  all that need
be employed.
   I shall never forget the joy which opium gave me in the
treatment of one of  my  most  worthy colleagues.  He lay
in the  seventh day of a very  intense typhus; with small,
scarcely perceptible  pulse, sopor, delirium, subsultus ten-
dinum ; abstractions of blood,  cold, cathartics and calomel
had  been profusely used.  The above mentioned  powders
(of calomel and opium) were administered to him, and after
6 doses the pulse became slow and  raised; the spasmodic
symptoms disappeared, the head became free and the cri-
sis was  effected ;  amelioration followed from that day,
and  was  completed.  How many  similar  cases  could I
not cite.
   3. When typhus is  accompanied from the commence-
ment with diarrhoea, dysentery or  cholera, a  derivation
from the brain is effected ; but great danger of exhaustion
ab exinanitione is brought on.  In such a case opium is the
only remedy that will arrest this profusion, soothe the over-
irritation of the intestinal canal, and  thereby save life.  We
must however be sure that the first  ways have been cleans-
ed.  Thus, opium was the only remedy in the years 180G
and 1807, at the time of the army plague in Prussia, when
diarrhoea was essentially  connected  with the typhus.
  4. When the period of complete  prostration, when the
indicatio vitalis appears,  and the  most vigorous nervines
and excitants are incapable of raising the small quick pulse.
Here I know of no greater  remedy than an addition of
laudanum to the  other excitants, given in frequently re-
peated small doses.
  To be able to give due praise  to this beneficent gift of
heaven, one must have witnessed in these cases how opium
is able to change in  one  night the small  quick pulse into
a quiet, full and vigorous one ; to appease the delirium, to
restore consciousness, to  stop the debilitating evacuations, 
36                      opium.
 and to produce a really wonderful transmutation.   But we
 must not forget the warning in nervous fevers, to resort to
 opium only, after purgatives and remedies derivative from
 the head  have been properly used ; and not to use it too
 early.

                   Intermittent Fever.

   The effect of opium is most apparent in fever and ague ;
 most so in pernicious intermittent fever. It is evidently the
 only remedy to save life in these cases, and it is only since
 we learned this virtue from L. Hofmann that we can boast
 of being masters of this disease.   Pernicious intermittent
 fever is  one  in which every paroxysm is combined  with  a
 symptom that  endangers life : as apoplexy,  sopor and  the
 like ; and in  general the  second or third paroxysm  proves
 fatal.  In such cases opium may save life in a double way.
 In the first place, during the attack of such  an apoplexy,
 he  who  believes that venesection will do good is  greatly
 mistaken ; for  the fit is nothing but spasm,  and it is only
 opium that can solve it and  remove the apoplectic state.
 The apoplectic state is a paroxysm  of intermittent  fever,
 and all depends on preventing or suppressing the paroxysm
 as  quickly as possible.  This cannot be done in  a surer
 way than by administering to the patient during the apy-
 rexia  one ounce  of fresh and finely alcoholized Peruvian
 bark, and adding to the  last dose  immediately previous to
 the paroxysm, 1 grain of opium.  In general  we may con-
 sider  this as the surest method of suppressing the  inter-
 mittent fevers.

                       Spasms.

  It is generally known that opium is the surest remedy in
 spasmodic  diseases.  Even  every quack is reminded by
 the word spasm of the word—but only of the word—opium;
 and this  very circumstance  is ominous; for what a vast
difference is there not between those spasms where opium
 is serviceable, and those  in  which it  is injurious, causes
even irreparable, fatal injury!  And how few know what
this difference is, and observe it!  I shall now endeavor to
 designate those cases.
  Three  points  are carefully to be distinguished before we
 resort to opium.   We must  find out, whether spasm  ia
combined with  plethora, congestion to the head, or even
with an  inflammatory diathesis, or engendered by one of
these;  or whether  it  is, exempt from that complication 
opium.                      37
  and  is  of a purely nervous  nature.  In  the  first case,
  especially in  youthful  persons and  in  infants  during
  dentition,  opium will augment the  spasm,  and likely in-
  crease it unto fatal apoplexy.  Here it is absolutely ne-
  cessary to previously remove the congestion by abstractions
  of blood,  antiphlogistics and  derivatives ; and  this often
  suffices to banish the spasms.   It is only when the spasms
  persist that opium is allowed and serviceable.   It will, how-
  ever, be  better  to   use  antispasmodics at first, such as
  hyoscyamus, aqua laurocerasi, zinc ; and if these fail, opium.
  In the second case likewise opium will be not only not use-
  ful, but obnoxious.  The stomach and intestinal canal must
  previously be cleansed  by emetics  and cathartics,  which
  alone often suffice for removing the spasms ; should spasms
  continue aYter their application, give opium.
    The third  is the  only  case  in which opium is proper
  and serviceable, and it  will be more  useful in proportion
  as the spasmodic state is  founded on real  debility ; or
  that the debility  has been caused by abstractions of blood
  and by purgatives ;  in short, as the pulse is smaller, softer
 and  emptier.   I must,  however, here  remark,  that hys-
 terical persons  commonly have a peculiar idiosyncracy
 against opium ; therefore it will always be advisable in the
 case of such  individuals, to combine  it with a corrector,
 as hyoscyamus,  castoreum.   Sydenham's composition is
 applicable to  such cases, as also are the various  combina-
 tions  of opium with aromatic and balsamic substances, in
 the form  of theriac and mithridate, as formerly found ne-
 cessary by medical  practitioners.  An important observa-
 tion, and one  which has been confirmed to me in many in-
 stances, is,  that opium used in injections is  by far more
 generally efficacious in violent spasms of a  nervous  cha-
 racter, especially those of the abdomen, and in such as are
 located in the spinal marrow and intercostal nerves, than
 when taken by the mouth.

              Traumatic  Nervous Affections.

  Traumatic irritation deserves particular notice.  When
after severe wounds  and great loss of blood the patient lies
spasmodic, stiff, half lifeless, or when in  such cases the
pains become  exceedingly violent, as generally happens on
the second or  third day, when the pulse and the whole as-
pect announce spasm, the inflammation has lost its lively
color, the suppuration becomes  more ichorous than puru-
lent, then  opium is the only remedy that can save the pa-
                          n 
38                      opium.
 tient,  and rapidly change the scene  into a more favorable
 aspect;  for it simultaneously appeases the pain, resolves
 the spasm, raises the vital power, and is capable of ameli-
 orating  the inflammatory and  suppurative process by its
 peculiar influence on the vascular system and the plasticity
 of the blood.
   It is only recently that I was again convinced of this, in
 a case of a Cesarean section.    The operation had been
 performed five days before by the master hand of Graefe
 thirty-six hours after rupture of the membranes, and was
 completed in five minutes.  She was a weakly woman  and
 had been bled twice previously and  once  after the opera-
 tion.  She had hitherto taken potio Riveri alternately with
 extract  of hyoscyamus and aqua laurocerasi, which miti-
 gated  the pains.  On the fifth  day the pains Became  ex-
 tremely  violent and resembled  labor pains, forcing the pa-
 tient to  cry out.  The pulse increased to 135 beats, was
 small ; the hands  grew cold, viscous sweat set in, and  the
 inflammation of the  wound was languid.  One drop of lau-
 danum and two drops of liquor anodyn. were given to her
 every  hour.  After a few hours the pains abated, the pulse
 rose, decreased 20 beats ;  the edges of the wounds became
 more vividly inflamed, the suppuration less  ichorous, and
 from this moment the curative process went on normally
 and terminated favorably.
   That opium-is the only salvative  remaining in trismus
 and tetanus traumaticus, I need scarcely mention.  The
 whole  medical world is persuaded of it.  Its  virtue as a
 resolvent of the nervous spasm  is here strikingly illustrat-
 ed.  In this disease the sensibility of the nerves  is so ob-
 structed  that even the narcotic  effect of opium is not felt.
 We may  give it unto the most enormous dose without de-
 triment.   But  as soon as it has  resolved the spasm, the
 normal perception and reaction of the system  ao-ainst  it
 takes place.   Given also by injections in large doses from
 half an ounce  to even an ounce of laudanum at a single
 dose is often of far  greater efficacy, even  frequently the
 only mode of application possible when  the  mouth is en-
 tirely shut up.

                       Insanity.

  The  effect of opium in mental diseases depends on many
 circumstances : it is  sometimes  extremely rapid and deci-
sively beneficial, in other and more  numerous cases it is
inefficacious, and not rarely is very pernicious. It is there- 
opium.                      39
fore most necessary to distinguish the cases with  the ut-
most care.  The principal rule is this : The more the men-
tal derangement is of a purely nervous nature, the more it
is combined with or derived  from real weakness, so will
opium prove more beneficial ; as this is seen in the insan-
ity owing to excesses in drinking and venery (delirium tre-
mens, nervosum), in the cases of hysterical persons, that
which  remains  after  inflammatory affections,  and those
cases which are purely psychical.  But where  a plethoric
state, or a disposition to an active phlogistic excitement of
the brain exists, or where the evil does not originate in the
brain or nervous system but in the abdomen; in accumula-
tions, obstructions in the precordial viscera, which is es-
pecially the case in the melancholic, opium will be injurious.
It may, however, be useful at the end of the disease after
the material cause has been removed ; when nothing but a
nervous state continues.   Here, also, it  is important to
remark  that opium  given by injections produces by far
more effect in delirium nervosum, than when taken by the
mouth.
          Cough and Complaints of the Chest.

  Cough and pectoral complaints are likewise important
objects for the  use of opium.  It cannot  be denied,  that
some kinds of cough, even of consumption, may be cured
by opium.  But it is  equally certain, that  by far a greater
number are  aggravated, even true inflammation  of  the
lungs and its transition into true phthisis  may be brought
on Thereby.   All depends upon the different nature of the
pectoral  complaints,  which  the  art of the physician must
discriminate. When  the cough is of an inflammatory char-
acter, the effect of an inflammation or sanguineous  con-
gestion of the lungs, or  at least complicated with it, opium
will always  injure.  The same applies  to the  catarrhal
cough  as long as it remains complicated with inflammatory
irritation; likewise to gastric cough, which nothing but an
emetic can remove,  but which will  be rendered worse by
opium.   When the cough is purely nervous or spasmodic,
then opium is superlative.  A single dose of Dover's pow-
der, taken in the evening, is capable of removing it entire-
ly.  Also in convulsive cough it is one of the principal
remedies in the second nervous sgige.   There is even a
kind of phthisis, which  is purely nervous in its origin, and
in its first stage is the product of the increased sensitive- 
40                       opium.
ness of the lungs and the whole nervous system.   Here it is
most important, to diminish the increased  nervous irrita-
bility of  the lungs as well as of the whole system ; and in
such a case, besides the use of asses milk, of jellies of Ice-
land moss and salep, of tepid baths, of woollen clothing, the
intermediate use of opium may be of excellent  service for
diminishing the cough and curing the morbid condition.*
                       Dysentery,

   The use of opium in dysentery merits our particular at-
tention.—Here also the cases  must be well  distinguished.
He, who would give opium in a  bilious or  inflammatory
dysentery, would kill  his patient.  On the contrary it is
the only salvative in a purely rheumatic dysentery.  That
dreadful rheumatic  dysentery engendered  by damp and
cold, which killed so many thousands of the Prussian army
in the campaign of 1792, as long as it was treated with rhu-
barb, at  that time  in usage, only became controllable,
and   was  annihilated,  when  opium   was  universally
used  against it.  But I  advise an emetic of  ipecac to be
given before resorting to the use of opium ;  and to use it
not in a full  dose at once, but in small frequently repeated
doses mixed with a mucilage or an emulsion ;  since a sup-
pression of  dysentery may be caused which is  always
injurious ; while  the intention must be only to gradually
diminish the increased  secretion of mucus,  the escape of
blood, and to resolve the spasm, which locks up the foecal
matter,  all which is best attained by the latter method.


                        Diabetes.

   A similar state takes place in diabetes.f  For the  prox-
imate cause lies in a morbid erethism of the kidneys, which
may increase to convulsiveness, and is complicated in the
diabetes "mellitus"  with a peculiar alienation of produc-
tivity (chemico-organic secretive process), so that,  instead
of the usual urinary  salts, saccharine matter is generated.
Against this proximate cause  opium  is  surely  the  chief
remedy, though the  multifarious,  even  entirely opposite

  * See my treatise on prevention and cure of pulmonary consumption
in the collection of my miffor writings, "Vol. IV., I. of the new series'.
  t An analogy implied by the very German name : Ham-Ruhr
(.Dysentery, Ruhr). 
opium.                      41
remote  causes may sometimes require very different pre-
vious remedies and methods which may be sufficient for a
cure.  But when we cannot discover any of these remote
causes, such as plethora, congestion, metastases, abdominal
obstructions, or when the disease continues after their re-
moval, and we have to do only with diabetes as diabetes,
with that  specific nephritic erethismus and  secretive dis-
order, then opium most completely fulfills the only remain-
ing  indications,  which are to  remove the local nervous
erethismus and to create a vigorous peripheric impulsion ;
to promote diaphoresis as a derivative and anti-stimulant;
and  opium in large doses and continued for a long time,
together with animal food, are the principal means to at-
tain  this end ; and of this I have been  convinced by  my
own experience, conformable to the statements of Warren
and Rollo, and lately to that [of the worthy Blane, who in
the Repository gives us  two  remarkable instances.  Also
Baron de  Stosch in his recent valuable essay on diabetes,
gives opium the praise it deserves.


                  Poisons.  Miasmata.

   The most remarkable effects of opium are its anti-mias-
matic and anti-venomous powers.
   It  was a  fact universally  admitted  in antiquity, that
opium resisted poisons and infection.  It is  known, that
the mithridate, a mixture of  opium  and spices similar to
theriaca,  received its name from Mithridates, king of Pon-
tus,  who  took it  daily, in  order to resist the influence  of
poisons.  The emperor Marcus Aurelius used theriaca for
a like purpose.
   It  is undeniable, that a certain  degree of  insensibility
and  blunting of the nerves may also diminish the operation
of poisons and miasmata on the organism, since this oper-
ation depends on the susceptibility derived from the nerves.
This is also confirmed by the curious fact, that hypochon-
driacal and hysterical  individuals, in whom the susceptibil-
ity of external impressions  is impaired by the peculiar
direction  and  concentration  of their sensibility  to  the
interior—to  their physical part,—are less liable  to conta-
gious and epidemical maladies.
   But we must here carefully distinguish the animate from
the inanimate miasmata.
   As regards the  first, opium may be useful in a  double
manner ;  in  the  first place by blunting the nerves against 
42                      opium.
the influence of  the poison and impairing the nervous re-
action ; in the  second place by its diaphoretic influence,
volatilizing and  expelling the power of the  poison.  But
the ancients did  not sufficiently regard the property which
opium has of increasing the circulation, heating and infla-
ming.; hence arose the sad abuse made of it in acute fevers ;
for physicians thought that there was  always a miasma at
the bottom which required to be  expelled ;  they transmit-
ted nearly all fevers into malignant putrid ones, complica-
ted with pimples and petechia?.
   In acute miasmata, therefore, its use will be always per-
nicious, except  in the first moment of infection, when  a
dose of Dover's powder, attended with subsequent sweat-
ing, has often removed within 24  hours the first vestiges of
the disease.
   It is of greater  importance in  chronic   miasmata,  in
which its  great power of exciting the blood, of volatilizing
and throwing to the periphery, can be highly beneficial and
make up what the organism is wanting of in reaction.
   Let us  first of all take the example of syphilitic infection.
It is confirmed by numerous facts that opium is the best
remedy against  some  remnants of  syphilis, which  are
beyond the reach of mercury.  There  was even a time (in
the years 1780-85) when in England  they  believed  they
were able to cure syphilis by opium alone, without the aid
of mercury, and a multitude of instances to prove this
were laid before the public.  Nor could it be denied, that
the symptoms  of syphilitic  infection  were  removed by
opium alone ; also Bennard's Arcanum anti-syphiliticum,
composed of opium and alkali possessed the same virtues.
My experience and that of others have convinced  me, that
the specific virtue which mercury has of annihilating the
syphilitic virus  cannot  be  replaced by opium,  but the dis-
ease  created by this virus in the organism—its reaction,
the critical  elaboration  and secretion of the  virus—may
be highly promoted and regulated by this  remedy.   In the
 second stage of infection, after the inflammatory state had
been passed away, I saw the  effect of mercury evidently
increased and accelerated by an addition of opium.   In in-
veterate syphilis, particularly when it  has degenerated by
an improper use of mercury, opium combined with corro-
 sive sublimate has done  better than when I gave corrosive
 sublimate alone. I consider it as indispensable to the use
 of corrosive sublimate.   It  is not alone a " corrio-ens," as
 it is  commonly supposed, but a mighty "  adjuvans"  of
 mercury.  Not  only the troublesome,  often dangerous ac- 
opium.                       43
cessory  effects  of this corrosive metal, as burning in the
stomach, spasm  of the stomach, nausea, colicky pains and
diarrhoea are prevented, but even the mercurial power and
effect  on the virus, its volatilization and evacuation, are
exceedingly augmented ;  and the  reproductiveness of the
virus, which is the principal object of cure, is thereby anni-
hilated.  We cannot too much prize an impulsion towards
the  skin and whole periphery, which  opium imparts and
mercury is  destitute of.  It may produce salutary sweats
and critical secretions, especially in weak torpid subjects.
   In order to give an explanation and a correct knowledge
of the effect and application of opium, I am obliged to say
one word on the innermost peculiarity of this obscure and
complicated morbid state,  which  is comprised  under the
name  of inveterate, modified, degenerated or larved syphi-
lis, also called "morbus secundarius syphiliticus," or "se-
quela" now, alas ! of so frequent occurrence, and embittering
the life of  so many men.  It is however not always the
 same condition, but varies very much.
   In the first we have  to distinguish  the  virus, and the
 productiveness  of the  virus.  The  virus  may be des-
troyed,  buj not the reproductiveness  of it in the organ-
 ism.  This is the most common case in the imperfect and
 insufficiently long continued mercurial cures, when the
 physician or patient is content with the  disappearance of
 the symptoms.
    This reproductiveness is peculiar to the nerves, as is all
 that is specific, even in the normal, the secretive and  the
 individual  states.    It is evident, that the greatest nervine,
 opium, must be particularly efficacious, and the most proper
  adjuvant to quicksilver.
    Now, the virus may be in a latent, dormant state ;  expe-
 rience has  sufficiently shown that its action may be suspend-
 ed though not  cease to exist ;  and the analogy afforded by
 other agents, as caloric, which may lie concealed in a body
 in its free as well  as in its latent condition, even the analogy
 of other miasmata as the hydrophobic, which may exist for
 months even for  years in a latent state, is confirmatory of
 the latent possibifity of syphilis.   What remedy could be
 more apt than  opium, to  revive  and arouse the dormant
  germ, by its volatile, all  penetrative,  irritative  power, and
  to make it an object of critical elaboration ; or when it is
  fixed by a chronic spasmodic incarceration, as sometimes
  really appears, to dissipate the spasm and set the poison at
  liberty.                                              ,
    Farther, the virus by length of time may have penetrated 
44                      opium.
 deeply  into the economy, and become assimilated  with it.
 What remedy is more capable of penetrating deep into the
 system, and of exciting a new and general reaction in the
 most remote and subtile folds of the system than opium 1
   And  finally, the case, now of frequent occurrence, in
 which the virus ceases to be venereal, but by its long con-
 tinuance in the system, and the frequent but imperfect use
 of mercury, which has divested it of its specificity, but has
 not  destroyed it,  a new pathological product,  an entirely
 peculiar dyscrasy,  for which  we have no name—it might
 perhaps be  called deutero-syphilitic—has been generated,
 not  extinguishable by mercury alone, or when the patient
 is really infected  with a mercurial poisoning by excessive
 or irregular use of mercury.   In all these cases opium, by
 its excitative, penetrative power, creating critical motions,
 especially cutaneous crises perfectly answers the indication.
   I  avow that it is often difficult,  even  impossible, to dis-
 tinguish these different states from  one another;  hence
 they are  usually  confounded under the general name of
 " sequela luis venerea?" or " lues degenerata."   But I can
 declare, that  I  have  seen  perfect cures effected by corro-
 sive sublimate combined with opium,  even after inunction
 and  salivation had failed.
  When it is a genuine mercurial disease, mercury of course
 will  not cure it, and it may be recognized by this very cir-
 cumstance.   Sulphur  is the  only  remedy in  this  state;
 opium however is  the best adjuvant.
   This  leads  me to the second  point of this subject, the
 antidotal power of opium in physical poisoning, especially
 the metallic,  such as  the mercurial, saturnine,  and  arseni-
 cal.   Opium acts a principal part in the cure of all secon-
 dary poiso'ning,  that is  to  say, when the virus  has passed
 into the second  ways, or penetrated the whole system.  It
 is  a known fact, that in poisoning with lead, after the first
 ways have been properly evacuated, opium is the principal
 remedy.  The same is true of chronic mercurial and arse-
 nical poisonings, when  it is to be combined with sulphur,
 the great chemical neutralizer of metallic  poisons.  It is
 undoubtedly in a great measure on this that the remarkable
antisialagogic virtue of opium depends, and which renders
 it one of the most efficacious remedies  against salivation
 during the use of mercury,  even to cure salivation ; though
this  effect of opium may partly be attributed to its periphe-
ric and diaphoretic virtue, which is  consequently a deriva-
tive  and sedative  effect, of which we are now going to
 speak. 
OPIUM.
45
  In the bite of the viper and similar animal poisonings,
the virtue  of opium is chiefly owing to its salutary and
prompt excitation of perspirative crisis.

             Crisis,  Vivification of the Skin.

   I am now o-oing to treat of the extraordinary and pecu-
liar  power which opium has of operating on and vivifying
the  cutaneous system,  and altering its pathological secre-
tions.   This is strikingly manifested in two cases.
   The first is that of small pox.   When in malignant small
pox the suppuration ceases about the 5th or 6th day after
the  eruption, and degenerates  into  an  ichory secretion
when  the pustules do not fill, or  when they assume a livid.
appearance, approaching gangrene, with great prostration
and violent typhus fever, then I know of  no remedy, which
so vigorously promotes the suppuration  of the pox, brings
 abouf the  perfect crisis,  and thereby salvation to the pa-
 tient,  as opium.  This I have often had  occasion to see in
 my early practice, especially in  the malignant variolous
 epidemy* al Weimar,  in 1786.  Here its double virtue, af-
 fords relief;  the soothing virtue removes the horribly pain-
 ful  cutaneous irritation, to which the patient  is subject;
 and its exciting property arouses a vigorous critical impul-
 sion in the half dead surface.                      .
   The  second  case is gangrene,  especially that  kind  ot
 mortification, which  appears in old people locally on ex-
 ternal parts, without previous inflammation,  ihe  cause ot
 this is a deficiency of plastic vitality ; for which opium  is,
 according to all experience, the  only remedy.
    Opium" has a particular power  to promote the suppurative
 process, and to make good  pus, of which an advantageous
 use may be made in all cases, where th.s is of importance.
    It is known that  opium has not only the power to excite
 perspiration, but also frequently to  produce eruptions ot
 no determined  character, more like miliaria than any other.
 I have seen these  eruptions, especially in persons tainted
 with  arthritis—and in many cases it has a critical effect.
 This  is of o-reat importance and value, in a multitude ot
 chronic diseases, especially in nervous maladies, which are
 more frequently material than is commonly believed ;  that
  is  that they are the product of a  morbid matter thrown on
  the nerves, and disturbing their normal action.   Une in-
  stance may serve for all.  A middle-aged  man labored for
  years under coxalgia, which caused him to go lame.   He
  had  an attack of dysentery,  which obliged  him to use 
46
OPIUM.
opium.   The consequence was a very profuse sweat and a
general cutaneous eruption ; after which his hip was cured,
and he has since had the full and free use of limbs.   Here
the hip complaint was  probably nothing but  a metastasis
of rheumatic matter to the part.  This was  made mobile
by the opium, and secreted  by the cutaneous crisis in the
shape of an exanthema.

                 Pseudo-organizations.

  Opium exerts a very remarkable and  salutary effect on
some external  morbid  productions,  especially on  some
kinds of polypus of the vagina, the nose, the meatus audi-
torius, etc., where  its  long continued use produced a gra-
dual wasting,  and finally a perfect cure.   This local sana-
tive virtue certainly deserves to be profited of more fre-
quently, and in more species of organic  disorders.

                      Palliation.

  I will  speak, in conclusion,  of the palliative virtue and
effect of opium, which is generally considered  insignificant,
but is often most  important and surpasses every other nar-
cotic. It consists  in alleviating  sufferings and pains, sooth-
ing,  raising the  mind  and easing the act of  dying.  Is it
not a great  deal in this  poor  terrestrial life, which is so
often filled with misery, and which it is  too frequently dif-
ficult to leave without more  suffering  before reposing in
death 1  And  what remedy is there able of imparting this
consolation to  life  in an equal  degree with opium 1  If it
had no other power, it  would on that  account  alone be con-
sidered,  like its brother sleep, the highest gift  of God.
  No other remedy can alleviate pain and  anxiety equally
with opium, even act like a charm, removing  it for a time.
Not  a hundred, but a thousand times I have seen my pa-
tients quite changed in physiognomy, speech, and  whole
external expression in  the morning, after taking opium the
preceding  evening.  The effect lasts usually  for 24 hours.
  I will only mention  the disconsolate situation of the in-
curable  consumptive, who gradually  fades away under an-
guish and  loss of breath ; of the cancrenous patient, who,
without  any  prospect  of cure  is tortured by most violent
pains ; and of the  protracted  agony of one, who  labors
under pectoral dropsy.—Who would be  physician without
opium 1  How  many sick has  it not saved from despair!
For  one of the great properties of this great  drug is, that 
OPIUM.
47
 it soothes not only corporeal pains and complaints, but af-
 fords  also to the mind a peculiar energy, elevation and
 tranquillity.
   This soothing virtue manifests itself in the most splendid
 manner,  in relieving  death in  severe cases,  to effect the
 "euthanasia,"  which is a sacred duty  and the  highest
 triumph of the phvsician, when it is not in his power to re-
 tain the ties of life.   Here, it is not only  capable of taking
 away  the pangs of death,  but it imparts even courage and
 energy for dying ;  it promotes in a physical way even that
 disposition of mind-, which elevates it to heavenly  regions.
   An instance, which I but lately witnessed, may find a place
 here instead of many others which I could relate.   A man,
 who had labored for a long time  under  complaints of the
 chest and vomicas, finally approached death.  The most
 dreadful anguish of death, with a constant danger  of suffo-
 cation, seized him ; he got in real despair, and his state was
 an insupportable torment even for  the persons around him.
 He now took i grain  of opium every hour ; after  3 hours,
 he became quiet, and after he had taken 2 grains, he fell
 asleep ;  slept quietly  for several hours, awoke quite cheer-
 ful,  free from pain and anxiety, and at  the same time  so
 much strengthened and appeased in his mind, that he bade
  farewell  with  the greatest composure and satisfaction to
. his relatives ; and after he had given to  them his  blessings
  and many a good admonition, fell again asleep and ceased
  to live while sleeping.

                  Detriments and Dangers.

    One word  more on the injuries and dangers,  to  which
  opium may give rise.   They are, alas!  very great, and it
  might be difficult to decide,  whether opiflm has not done
  as much injury as good.  The same, however,  applies to
  venesection, gun-powder,  and  all the  grand powers and
  agents  of nature,  not excepted fire.   The greater  the
  power of doing good, the greater also the power of doing
  mischief, and who would dispense with  such an instrument
  on account of its being able to do injury by abuse 1
    The first, and certainly the greatest danger lies not in its
  fatal but in its illusory effect.  It appeases, it soothes pams,
   inquietude, spasms, and other tormenting sensations, which
   are but the cries of  suffering  nature  calling for  relief; it
   influences even the mental  disposition and imagination,
   and is capable of inspiring so much courage and  hope, that
   the  patient as well as the physician may be deceived re- 
•
 48                       opium.

 garding the real condition of things; the concealed danger
 which  induced both to indulge in dreams of carelessness
 and hope, at a time when the most active assistance is re-
 quired and may possibly  be still attended with success.
   The second danger  is that of an apoplectic cerebral af-
 fection. It is greatest in infants in the first year, at a time
 I cannot too earnestly warn against the use of opium, and
 when one  single drop  of laudanum may be a large,  a too
 large  dose. Resort to it only  in imminent necessity and
 danger, as in an exhausting diarrhoea which endangers life,
 and in this case in  the form  of  injections  one drop  tritu-
 rated  with sugar,  divided into four parts (^  of a drop for •
 one dose) is to be given internally.
  The third, in active inflammations:  increasing inflamma-
 tion and  accelerating it to pass into  suppuration and gan-
 grene.
   The fourth:  incarceration of gastric impurities and ab-
 dominal obstructions, increase  of sanguineous congestion
 in the portal system.
  The fifth: increase of  colliquation and  putrescency  in
 the  blood,  of colliquative sweats, generation of pimples,
 petechias, aphtha?.  It is to be dreaded in all  fevers when
 given unseasonably or in copious doses or a too protracted
 use, most so in gastric  fevers.
  Finally, the last:  bad habit.  One  may get  into the ha- m
 bit of taking opium, so much so  that it becomes a daily
 want, even after the malady has  ceased.  The  patient now
 takes it to raise himself to that  point of comfort, vivacity
 of physical and mental usefulness, just  as the drinker of
 brandy gets accustomed to brandy,  and it becomes to him at
 last as indispensable as  an article of use.  The same result
follows, a need  of larger doses, analogous  to drunkenness
and  its effects,-which are to increase nervous  debility,
trembling, destruction of the digestive and reproductive
powers, finally delirium  tremens, blunting of the senses and
mind, haemorrhages, dissolution of the blood, tabes. 
VOMITS.
49
                          III.

                       Vomits.

                Si quid movendum est, move.
                                        Hippocrates.

  In speaking of vomits,  I speak  of  one of the curative
means  employed by nature herself.  Vomiting is  one of
the most common phenomena, by which nature announces
the existence of an  internal morbid state.   It is one of the
most important operations  of nature, an act by which she
often rids herself of disease at  its birth  or  in its course.
  Vomiting is, however, one of the most tumultuous acts
of the organism, even one  of the most contrary to nature,
a complete inversion of the order of things, an evacuation
by that passage whose office is the reverse, a sort of orga-
nic convulsion, comparable to  the volcanic explosions of
inorganic nature.
  In the  secret depths of the organism, at the centre of all
the sympathies,  at the focus  of nutrition, in the first and
most  important  organ through which foreign matter is in-
troduced into the economy, in that one where all that is to
form part of our future existence receives the first imprint
of our nature, a revolution bursts out, agitating the dia-
phragm  and  the respiratory organs with violent  convul-
sions,  shaking even  the heart—the centre of organic life,
penetrating through the nervous system to its extremities,
filling  the  soul  with a new sensation—unique and  painful
but more  oppressive than painful, that  feeling which is
comparable to hunger in an inverse order, and to which we
give the name of disgust or nausea; provoking in irritable
persons  intense  nervous symptoms—syncopy, cold sweats,
spasms,  convulsions; finally,  not only expelling the con-
tents of  the stomach and of matters seated farther in the
interior,  but also producing an activity in  all the secretions
—that of the liver, the skin, the intestinal canal, the bron-
chia, and the kidnies.
   It is no wonder that such an act has attracted the atten-
tion of  physicians  from the earliest times.  From the re-
motest ages vomiting, whether natural or provoked by art,
has been regarded  as  one of the most  important means
of art.                                     4
                           E 
50
VOMITS.
  The ancients were content to base the curative opera-
tion of vomits on the idea of humorism and mechanism.
Towards the middle of the last century, physicians (Cullen,
Tissot, Schaeffer,  Stoll)  began to see the utility of vomits
in a dynamic light, and  to employ them as a means of ap-
peasing spasm, of modifying sensibility, of arresting febrile
irritability, and of correcting the biliary secretion. These
views have unfortunately been carried too far—to an abuse
of emetics.  This was during the reign of gastricism.
  Brown and his disciples appeared next.   The use of vo-
mits was stamped with the seal of proscription ;  or at most,
was permitted in cases  of gastric accumulation of crudi-
ties.  Vomits they considered as pure debilitants.
  Is there not reason to deplore the unhappy blindness of
a theory, which robs art of one of its most precious instru-
ments ; of the spirit of sectarianism, and especially the con-
tempt  of experience !   Is it not wonderful that a school
which  declared war against the idea of material humorism,
was precisely that school which placed vomits in a class of
means,  which  belonged  to a purely humoral theory; that
is to say—among evacuants; so that, while attempting to
elevate its views it limited the extent of its  horizon 1
  Under the expression—gastricism,  the very idea  of an
emetic was considered as one of disgrace and unworthy of
a philosophical physician, regardless that Stoll did not con-
sider the  gastric method of treatment as one of mere eva-
cuation, and that all his  reasonable partisans thought  more
of the dynamic power of the  remedy than of the evacuation
it produced, and  certainly they gave  a wider and a better
interpretation  to nature than the disciples of excitability,
who, nevertheless, looked upon them with an eye of piti-
able contempt.
  Truth at last triumphed. Physicians returned to the use
of vomits and  bleeding.   But,  now  they fall into  another
extreme : it is  the dynamic virtue of the remedy,  and the
discharge of noxious matter that is seen; in one word, the
effects are looked upon as purely nervous,  and under this
impression a new abuse  springs up.
  To-day, we stand  between two schools;  thatofBrous-     /
sais, which  sees  inflammation everywhere and thirsts for
blood ; that of Hahnemann,  which is content with tempo-
rization and rejects all heroic means.   Both are hostile to
vomits, which  they  consider as  incapable  of  aught but
trouble and danger.
  The practice of medicine is at present in a strange posi-
tion.   Somejemploy  vomits only empirically and too  often 
VOMITS.
51
in excess ; others totally abstain from them, believing them
to be useless as a remedy and otherwise dangerous.*
  O, holy nature!  show us the true path;  with your own
hand unfold to us our art ; and preserve us against the er-
rors of schools!
  The fault was, as it yet is, to look upon the action of
vomits  in  a partial light.  Even  now, some see no other
effect from them than evacuation ; others nothing but  ex-
citement or irritation;  in one case nothing but a material
discharge, in another nothing but a dynamic power.  But
here, as elsewhere, if we would explain the nature of dis-
eases or  the  action of medicines, both theories must be
united*.  This  is  a law which I ever imposed upon myself
and proclaimed to others.  It is only by this union that a
complete and a satisfactory explanation can be had.
   We shall now declare what is the mode in which vomits
act, not according to  speculative notions,  but under  the
dictation of experience ; next  point out the indications for
their use,  again without the assistance of theory but obe-
dient to practice ; that is to say, relating the symptoms
which call for them; after this, pass in review those cases
in which they are useful, necessary, sometimes the only
thing which can save  the patient, and also those cases in
which  they are  hurtful and  are even  a mortal poison;
finally, we shall give rules whereby their complete effect
may be attained, and the art of exciting emesis, the import-
ance of which is great.


                   Mode of Action.

   Vomits  have two effects, general and local.

                    1.   Local Effects.

   These are generally  two, accordingly  as evacuation or
stimulation ensues, a modification of nervous activity.
   As recards evacuation,  vomits not only discharge  the
contents  of the stomach, but those  of contiguous viscera
—the  duodenum.  The evacuation  reaches even  to  the
  * Even not long ago an estimable writer said that  vomits should
never be given, except when poisons have been taken into the sto-
mach.  I cannot help  reproducing  here a passage that I wrote thirty-
five years ago, and which unfortunately is still applicable. " It is
painful to see young  and unexperienced practitioners expunge  with
a dajh of the pen, the best established results  of the experience of
past ages, and thus deprive mankind of a powerful remedy, at least 
52
VOMITS.
gall-bladder, the biliary ducts, the whole  liver,  whenever
the bile is driven into the stomach, both  by the irritation
excited and  by the  mechanical pressure exerted.  Here,
then, occurs a  phenomenon  which a purgative  can never
produce, and to which the great utility of vomits in bilious
fevers is specially due.  This evacuative  power acts even
on the lungs and air passages; and it cannot be denied that
the shock given to the  whole economy—the contraction
of the diaphragm and of the intercostal muscles which ac-
companies vomiting—is not capable of mechanically expel-
ling the mucus, pus,  concretions, and lymphatic accumu-
lations contained in the air  passages ; of freeing the lungs
from them,  giving  great relief to the patient, whose  life
often depends on clearing the bronchia from  engorgement
of  mucus,  as in the  cases  of children—pertussis  and
croup.  It is not only gross matters,  crudities, bile, muco-
sities that are thus expelled ; for vomiting appears to carry
along with it more subtile bodies; for example, contagious
principles, as is proved by the efficacy  of vomits in  the
commencement of infectious  diseases.
  The local nervous affection is as  important  as is  the
evacuation.   By this, vomits can totally change the ener-
vation of the stomach,  of the liver and neighboring parts,
in a word of the whole  solar plexus, of which we have  the
proof as  much by a cessation  of the spasmodic  state of
these organs, as by a modification in their secretion, which
recovers  its normal character.   It is this nervous effect
which,  at the same time that mucosities,  bile, and sabura
are  expelled, destroys  that morbid state,  whose presence
caused the production of the saburas,  and consequently it
drys up the source.


                  2.  General  Effects.

  These are due to  sympathies dependent on the gastric
nerves. The connexion of these nerves with all other parts
of the body gives great importance to  these general effects,
and is the medium through  which vomits affect every sys-
for a time, by their influence on some persons ; it is therefore the duty
of one who loves truth not to remain silent, but to proclaim with a
loud voice and regardless of theory, that which nature has taught us
during a long series of years. Though we may allow, in science as
in politics, that revolutions are sometimes necessary to  change the
current of ideas, even when a slow course seems more sure and con-
formable to reason, we ought no less to save from wreck those truths
which have become the legitimate property of mankind, that they be
not lost and require to be again discovered." 
VOMITS.
53
tern,  of the economy.   They are distinguished into those
which  excite or stimulate,  those which translate by  anta-
gonism (antispasmodics), and  those  which excite secre-
tion  and absorption.
  The excitant effect is made apparent, principally by in-
creased activity of the lungs and heart, organs which first
feel  the influence.   Hence  it is, that emetics are employed
with advantage to recall life to the asphyxiated, the  para-
lytic, the apoplectic, and in cases of hooping cough (cere-
bral  and pulmonary paralysis).
  Revulsive  and antispasmodic effects  are often called
forth,  and  play  a great part; for in this case the counter-
irritation acts on the most  essential part next to the brain,
that is, on the ganglionary system,  which sympathizes
with all parts of the economy.  Therefore, this effect may
reach  to the remotest points.  It is in this way that vomits
become a most  powerful means for calming all kinds of
spasms.   They have  even been  successfully employed
against epilepsy, intermittent fevers,  spasms, asthma, and
convulsive cough.  They  are particularly useful in moral
affections of the brain—in  mental alienation.  Even  when
employed  in small doses,  they produce great effects by
their counter-irritating and calming power.
   The secretive effects of vomits are seen most strongly
marked on the skin.  On this account they are salutary in
 rheumatism and in the exanthemata.  ' They also augment
 that by the kidnies,  the intestinal canal,  and  the  salivary
glands. They equally activate absorption by the lymphatic
 system, as is seen when administered in dropsies, even that
of  the joints and scrotum, and the resdlution of stagna-
tions  and local  tumefactions.
      Indications, and Counter-Indications.

  This is the principal indication :  Vomitus vomitu sanatur.
Hippocrates gives it thus :  Si quid movendum est, move.  In
other words,—when nature herself calls for the evacuation
of something noxious, tends to or has attempted vomiting,
it becomes an imperious duty to favor the discharge, which
injunction is never disobeyed with impunity.
  However, we must be sure that this effort of nature  is
due to a gastric accumulation,  that  is to  say, to gastric
turgescence.  Its existence is known  by symptoms of gas-
tric sabura.   And  it is from this that the  rule comes,  to
                           L* 
54
VOMITS.
give no vomit  unless there be signs of sabura in the sto-
mach.
  For vomiting may depend on a multitude of other causes.
It may  be due to inflammation of the stomach, which ex-
asperates the irritability  of this organ to  a  term which
causes its contraction.   It  may result from exalted sensi-
bility of the viscus.   And, what is more common, may be
due  simply to a sympathetic affection of the stomach,  de-
pendent  on some  distant irritation;  such is the vomiting
proceeding from  the  liver, frcm the spleen, pancreas, kid-
nies (especially in calculary cases), from the brain (in hy-
drocephalus, and concussion of the brain).
  In all  these  cases, a vomit would be useless,  injurious,
sometimes even fatal; for example, in gastritis.
  But independently of this general indication, vomits may
be prescribed on account  of  their energetic influence on
the nerves ; to  excite, translate, and activate secretion and
absorption. This is what happens in mania, spasms, rheu-
matisms, etc., when not counter-indicated.
  The counter-indications for vomits are :
  1. Inflammation, and that  of  the stomach before  all
others;  for in  such  a case an emetic might act as a real
poison,  and  cause immediate death.   They  are  equally
counter-indicated in  all other internal  inflammations,  for
they would exasperate the phlegmasia and render it more
dangerous.  But, I wish it to be particularly observed that
I mean a real inflammation ; for an irritation resembling an
inflammation, is not  subject to  the  same interdiction.   I
must, here, raise  my voice against a modern error, and
take the part of vomits,  of which this error has pronounced
the exclusion. Every  spasm has been called inflammation ;
while I assert that a host of spasms,  even the most painful
ones, have instantly  yielded  to a vomit in my practice,
when they depended  on the presence of a gastric matter.
Nor should erysipelatous inflammations be considered as
counter-indications;  far from it, for vomits are the best
means to combat them.
  The empirical rule is then : to abstain  from vomits when-
ever there is violent fever, red  and dry tongue,  intense
thirst, violent burning pain in the stomach, and impossibi-
lity to retain in it any thing, for these are the symptoms of
inflammation of this viscus.
  2. Vomits are also forbid in constipation ; for they not
only act more violently at such a  time, excite spasms, and
may determine dangerous congestions to  the brain  and
chest; but they may also  render the constipation itself 
VOMITS.                      55
more obstinate, give rise to a permanent antiperistaltic mo-
tion, and  produce ileus.   In such cases, the bowels ought
first to be emptied before the administration of a vomit.
  It is also customary to consider hernias, pragnancy, and
the presence  of the catamenia  as  counter-indications to
vomits.  I admit that in these cases it is preferable to ab-
stain  from vomits, and to  seek the same relief by purga-
tives;  but when  life is at stake, the imminence of danger
silences the lesser fears,  and removes every hesitation.
Persons affected with hernia may guard against the proce-
dentia of  the intestines by a proper bandage,  and by sup-
porting the tumor at each rejection.
   Finally, I must add, that emetics ought never to be given
 immediately after a fit of passion  (colere), whatever be
 their efficacy to  provoke a biliary discharge ;  for  they
 might cause dangerous accidents.   In such case, let ano-
 dynes be  first administered, and when the lively nervous
 excitement is appeased, a vomit may be given.
          The Art of Exciting Vomiting.

  No remedy requires so much art as an emetic to produce
the desired effect.  It is from not knowing this, that eme-
tics  are accused of inefficacy, of too great violence, and
that they have lost credit with a great many practitioners.
  One of the principal  causes of the unfavorable operation
of vomits,  formerly was, and is still, the usage of giving
them at a single dose.  No physician is capable of deciding
beforehand, what is  the extent of the gastric  irritability
and  of its turgescence, on which the effect of the remedy
depends ; so that the same dose, which is enormously great
under one circumstance, will be inefficacious in another.
  The first rule then is : never to give a vomit at a single
dose, but always in divided doses.   This method affords
two advantages : first,  the first doses act as digestives, and
dispose the contents of the stomach to be more easily dis-
charged ;  by the next, we are capable of exactly calculat-
ing  the effect, that  it may be neither too strong nor too
weak.  Therefore, let  a fourth of the whole dose be given
every fifteen minutes until  vomiting occurs; and then wait
half an hour, during which period  should the patient not
have vomited  three times, we  give half as much as the
whole quantity of the medicine  already taken.  Nor are
the  liquids which the patient takes without importance.
Too much drinking may dilute the remedy and weaken its 
56
VOMITS.
action ; or by distending the stomach render the evacua-
tion difficult and increase the distress.   It is better then,
not to drink after the first doses, and not until nausea has
commenced ; now a cup full of chamomile tea may be taken,
and repeated after each discharge from the stomach. When
vomiting  becomes  painful,  we  may  employ warm water
containing a little butter with success.
   Vomiting ought  to be  repeated at least three times, in
order to clear the stomach effectually; in a word, it ought
to be continued  until bile comes up ; the  only sign that the
stomach is completely cleansed.
   There are only three cases in which we ought to prefer
administering the vomit in a single dose : in extreme in-
sensibility of the stomach (as in certain typhus fevers); in
mental  alienation, mucous  sabura;  in cases of poisoning
which require prompt action ; and finally in  diarrhoea, for
here, small doses might pass the pylorus and aggravate the
intestinal irritation.
   After settling what is the dose,  the next thing is the se-
lection  of the kind  of vomit, each  substance  being  pos-
sessed  of accessory properties which  deserve respect.
Emetic tartar enjoys very energetic  powers, and like all
other vomits  it  shakes the whole frame, and acts on the
bowels. It consequently is applicable in  sluggish patients,
when there are tenacious  mucosities  in the stomach, and
a tendency to costiveness.   But it ought to be avoided in
the case  of delicate and  irritable persons, or  when diar-
rhoea is present.  Ipecacuanha is more antispasmodic, less
acrid, and more  constipative ; hence it is fitter for irritable
persons, inclined to spasms, and  affected  with diarrhoea.
Oxymel of squills is excellent in mucosities, it acts gently,
and is particularly indicated in cases of mucous accumula-
tions in the primee via?.  I have, therefore, found that it is
best to unite all  these three substances, when an antispas-
modic and an incisive effect  are needed, in this way cor-
recting one by the other.  I  generally make use of the for-
mula No.  258.
  One more  point  remains to be examined,  which is the
preparation of the patient, and the precautions which con-
comitant circumstances  call for.  This is  the most import-
ant of all,  for by its neglect  the  remedy  may not act, or
acting,  produce  injurious even  dangerous effects.   The
following  cases must be distinguished:
  1. Immobility of sabura.   It may  be too viscous, too
fixed, too  enveloped in adhesive mucosities.   Such a state
of things  is known by a foul tongue, the  coating of which 
VOMITS.
57
is dry and  firm, by the absence of nausea while there is a
desire to vomit.  If we hurry a vomit in such a case we
fatigue the patient uselessly, produce violent retching with-
out°effect, for the vitiated matter remains behind.  Diges-
tives, then, must first be given, either sal ammoniac  (when
there is a tendency to diarrhoea, or one already exists), or
tartrate of potassa (when there is a tendency to costive-
ness).   The result will be that the gastric symptoms will
disappear spontaneously  along with mild alvine evacua-
tions, dispensing with the vomit;  or, when symptoms of
gastric turo-escency appear more and more,  and the accu-
mulation becomes  more  mobile,  we give a gentle vomit
which will now operate with ease and efficacity.
   2 Mobility  of sabura.   In  this case there is strong tur-
cescency,  made  evident  by a thick fur, humid and soft
tongue,  tendency to  vomit,  or  vomiting  already com-
 menced. In such a case an emetic ought to be given forth-
 with, but with care lest it act excessively.   Consequently
 emetic tartar  is  to be avoided, and ipecacuanha given, ot
 which 5 grains with oxymel of squills  repeated every ID
 minutes, until  a sufficient effect be produced.
   3  Plethora—known by a full strong pulse, acute lever,
 inflammatory disposition.  An emetic given in such a case
 without preparation, might occasion much mischief, pro-
 duce  violent congestion to the  head and chest, bring on
 rupture of vessels and hemorrhages.  We ought then first
 to combat the plethora by moderate venesections, which
 will prevent the anticipated accidents.           ....
   4 A spasmodic state.  The patient  is excessively irri-
 table,  and is  subject to spasms, syncope, feels much pain
 at the precordia and anxiety. In this case, a vomit m.ght
 provoke violent spasms, even undue vomiting, if the ano-
 malous state  of the nervous system is not previously or
 simultaneously  removed.  To  do this we  commence  by
 making antispasmodic  frictions, and  applying narcotic
 cataplasms on the epigastric region ; and internally admi-
 nister anodynes, and to  the emetic we add a few grains of
 hyoscyamus or castoreum.
    5  The patient has diarrhcea, and at the same time all the
  symptoms of  gastric turgescence are present.  In this case
  it  is to be feared that a vomit,  especially emetic tartar,
  may escape downward, and augment the diarrhcea. There
  fore, we first give sal ammoniac in mucilage, after  which
  a full dose of ipecacuanha.             .     ,   o-ravior
    This occurrence is common enough in  typhus gravior,
  complicated with inertness of the stomach ; life is in great 
58                      VOMITS.
danger ; and this is one of the most difficult problems in
practice.  The patient, overcome with weakness; in  the
eighth or ninth day of fever,  is affected with stupor and
other nervous  symptoms;  his  tongue is  highly charged
(evacuations have most likely been  neglected) ;  there is
retching and attempts to vomit, anxiety, a continual aqueous
diarrhoea,  which is often colliquative.  Here, a vomit is in-
dispensable ; it is even the only remedy to save life ;  but
we have to fear that it may pass the pylorus, increase  the
colliquative diarrhoea, which  would place the  life of the
patient in great danger.  It is important first to  arrest  the
diarrhaa,  and  to rouse the natural excitability of the  sto-
mach.  This  is attained by giving  first  a dose of opium
with  ipecacuanha, applying vinous and aromatic fomenta-
tions on the epigastrium, giving enemas of starch contain-
ing  opium,  after which a  scruple of ipecacuanha at  one
dose.  More than once by this means 1 have attained  the
object I sought, and  brought  about the commencement of
convalescence.  A  vesicatory on the epigastrium will also
contribute to rouse the languishing excitability of the  sto-
mach.  1  saw  a  patient who  had taken a vomit, and four
hours had elapsed without effect, spontaneously vomit after
a vesicatory had commenced to draw.
   I have here one more remark to add.  Many imagine that
nothing more is needed after the emetic.  But it is not so;
in  order  that  the effect of the vomit be complete, the pa-
lien^ ought to have  several stools;  for the vomit always
drives a part of the sabura into the duodenum, or the liver
pours out a larger quantity of bile,  and  these substances
must be evacuated  downwards; without this the relief and
use of a vomit is incomplete.   Therefore, if  dejections do
not spontaneously  take place, we  must  never  neglect to
prescribe a gentle laxative after every vomit.
   I shall  terminate by making a few remarks on excessive
vomiting. It is generally due to a neglect of properly  pre-
paring  the  patient,  or to too strong a dose of the emetic.
The vomiting  continues,  either  because  inflammation or
haematemesis has been produced,  or because the forces
have been excessively reduced.  Happily, we possess  cer-
tain means for the relief of such a case.  The first is to give
abundantly  of mucilaginous drinks, after which the potio
Riveri (but  not effervescing, which almost always adds to
the existing irritation), under the following form :
         ft. Carbonatis potassa? 3ij.
            Syrupi citri q.  s.
            Aqua? melissa?  §iij. 
VOMITS.
59
           Syrupi florum aurantii gi.
      A tablespoonful to be taken every half hour.
At the same time we apply a vesicatory to  the epigas-
trium, and mint boiled in wine.
       Use of Vomits in Particular Cases.

  Let us now examine, in conformity with the principles
which we have just established, those diseases in which
vomits are particularly appropriate; also those in which
they are too often neglected, or not justly appreciated, and
let us add to this review such remarks as are afforded by
our own experience.

                     Acute Fevers.

  In all fevers, the pra?cordial ganglia and the great sym-
pathetic appear to be the point first irritated, as it were the
focus whence proceeds the febrile irritation. Proof is fur-
nished by the  sensations,  which the first appearance of a
fever produces, the loss of appetite and digestive powers,
which take place  at once, the chills which emanate from
this region.  This particular nervous affection has not yet  N
met with an explanation.   There  is no means so powerful
as emetics to combat it, and to act on that part of the ner-
vous system in which  it is seated. Hence it is, that vomits
 are  looked upon as the most general antifebr.les, as well as
 the  best means for conquering  fever itself, to destroy fe-
 brile irritation in the bud, even when given in such small
 doses as  are  insufficient  to  excite vomiting;  and expe-
 rience has established  the efficacy  of James s powder,
 which, as is well known,  is an oxide of antimony.
   But there are cases of fever in which this affection of the
 stomach and intestinal canal attain a high degree, not only
 of morbid irritation, but also of alteration  in the secretions
 and humors,  and continues to be the  source of the disease
 while it lasts.  It imparts its own character to the disease,
 hence the latter are called gastric.   The  fact is that there
 are fevers in  which gastric symptoms; and a pervers  n ol
 the humors are the salient points; and in which there are
 no  other means  of relief, or when very intense, of saving
 life, than the use of vomits and purgatives.
   The fundamental  indication in such cases is to l»*ten to
 the voice  of  nature, and to favor the tendency  she mam-
  ests   Vomitus vomitu curatur.  Called to a patient labor- 
60                      VOMITS.
ing under fever, from the commencement of which nausea
and vomiting, bad taste, foul tongue with a yellow or brown
crust exist, the physician who hesitates to prescribe a vomit
commits a grave fault, and the patient will cruelly expiate
the error; for it is important to seize the  moment in which
nature calls for  an evacuation, or is disposed for one, and
it  is particularly here that Hippocrates had reason to say :
Quid movendum est, move.  It is even often impossible to
repair  the evils  following the omission of a vomit.  Given
in time, it  may  stifle the disease at its birth ; as its omis-
sion may leave it of long duration, hard to cure, incurable.
With this truth young practitioners cannot be too deeply
imbued.  Let it not be thought that a purgative can supply
the place of a vomit.  A purgative can never expel what a
vomit draws forth.   I have seen the remains of indigested
food remain in  the stomach fifteen days in spite of conti-
nual purgation, and finally come away by  force of a vomit.
It  must also be borne in mind, that the shortest road of dis-
charge  is the best  one, through which putrid sabura can
be discharged in cases of fever; for, by following the whole
course of the intestinal canal, and consequently  making a
longer sojourn in the body,  the offensive matter would in-
jure the body more by  irritation, debility,  and absorption.
But, what is still more important, purgatives never provoke
that salutary revolution in the whole nervous and secretory
systems, the stomach and liver;  that which overcomes the
faulty action, and dries up the source of sabura.
  A single vomiting is  often insufficient.  It needs to be
repeated two or three times.   In a word, it must be admi-
nistered as  often as nature calls  for it by a gastric tur-
gescence.
  The  various  forms and complications of gastric fevers
are to  be respected.  As regards matter, fevers are distin-
guished into sabural, bilious, mucous, verminous ; and as re-
gards form,  into inflammatory, nervous, and putrid-gastric.
  Local  as  well  as general inflammation  may accompany
every kind  of gastric fever, and requires to be taken into
consideration before any thing else.  It must be checked by
adequate  sanguineous  evacuations  before proceeding to
the vomit.
  In the nervous or putrid complication,  the vital forces
must be supported  by  a simultaneous  administration of
nervines, excitants,  tonics and antiseptics.
  Simple sabural fever, that which is caused by indigestible
matter,  requires, in  general, nothing but vomits and pur-
gatives. 
VOMITS.
61
  Bilious fever requires prudence, on account of the in-
flammation which often complicates it,  especially  in the
hepatic  system; and  on account  of the acrimony  which
the bile sometimes acquires ;  on this last account we must
abstain  from violent  emetics,  especially  full doses, and
nTder abundance of dilution.
  Mucose  fever is always accompanied with great slug-
gishness of the digestive organs.   It is, therefore, the spe-
fes of fever  in &ich  vomits  are particularly ind.cated;
but requires at the same times energetic  incisive, and

6°Vomfts may also be useful  in worm fevers, as much to
dislodge worms that sometimes nestle in  the stomach  as
to get rid of certain sympathetic symptoms.  Thus, a vomit
will in  antly relieve the violent pain in the side, apparently
men "tic which is so commonly met with in this fever
P G nerklTy all those sympathies which are seated above
 the d"aph a.m (chest, neck, and head) in cases of  gastric
 fever! announce a turgescence upward,  and indicate the
 use of vomits.

                   Intermittent Eever.

   1 feel persuaded by all the essential symptoms of the dis-
  ease  thai  its seat is in the precordial ganglia and great
      .VhTtiP nerve •  and my conviction is fortified by  the
  SeXnt  effect's Vf vomits"   Often have we.seen  a vomit
  taken  before the access prevent it. Ordinary intermit ents,
  especially those of the spring, are frequently curable by
  vomits alone  in  the intervals of which sal ammoniac is
  liven    n  hose which are more severe, which even re-
  Ebark, we must commence by a vomit; it will render
  the action of cinchona more  supportable and the  fever of
  more  easy cure.   I have often seen cinchona, or  quinine,
  which sUs easier, ineffectual, even augment  the  disease,
  and even disturbing the period  of apyrexia: if it be  sus-
  pended? and an emetic given, the case suddenly changes,
  £ will  operate well,  the fever cease, and cure  speedily

  f°I°have acrain lately had occasion to be convinced of the
  ex raordina'ry powers of vomits.  A  man  of a certain age
  who  was attacked the preceding year with jaundice, again
  7  1  TS • the chief symptoms were sleeplessness, lo.s of
  took  .U , n1^. C™eo_S„?ed respiration, intermittent pulse,
  aPPeUt:r stool  "frequent febrile"flushes, but without regu-
  Z%t  «d i'Jeliow tint of the eyes.   This state lasted 
62
VOMITS.
three weeks, followed by alarming  emaciation  and great
prostration.  Until now  the  patient had  taken solvents,
sal ammoniac. As the fever grew more marked every night,
growing more regular, and as intermittent fever then pre-
vailed epidemically, he  took quinine,  at first in 6 grain,
then in 8 grain doses every day.  But as the fever increas-
ed in intensity with each dose of this  medicine, it  could
no longer be used.  This circumstance  suggested the pro-
priety of a vomit.  Two grains of emetic tartar afforded
four evacuations and several  stools, which brought away a
great quantity of bile and mucosities.   From this moment
every  trace of fever disappeared, the  anxiety ceased, as
well as the dyspnoea and  cough; appetite and sleep return-
ed, and the complexion brightened ;  in  a word the patient
became convalescent,  and this regularly progressed to a
cure. It is evident that the mere, discharge of the bile was
sufficient, with the regulation of the  hepatic action.
  I must mention a fact regarding emetics of which I have
often profited.   It is not uncommon for intermittent fever
to be irregular, without decided intermissions, destitute of
type, and resembling a  continued fever.  Let a vomit be
given now, and the disease will become  a regular intermit-
tent  fever with  well  marked  apyrexia, which  bark will
quickly cure.

                   Contagious  Fevers.

  The  precordial and great sympathetic nerves are no
doubt the point on which the action of febrile miasms first
settle ; often the road through which they enter the eco-
nomy.  Vomiting and  other gastric symptoms are ordina-
rily the first  symptoms.  This is seen in  small pox,  in
measles, and particularly in contagious  typhus.  We have
no  other indications for the use of vomits in this stage. By
this means we may expect to expel a part of the contagious
principle, to destroy its action, and prevent its regenera-
tion.  I have, indeed,  often seen these  remedies when ad-
ministered in the commencement of fever  diminish its vio-
lence.  They  are capable  of preventing  the influence  of
contagious typhus.
   On the contrary, later in the disease, when the contagious
principle has  penetrated into the  system and commenced
to act, when nature already makes critical efforts to throw
it off'by the skin, in a word,  it is an  exanthematic fever, I
advise  great circumspection.  If  the eruptive period has
commenced, if the exanthema  appears,  the revolution and 
VOMITS.
63
counter-irritation  producible by a vomit  is not only in-
jurious but dangerous  to the cutaneous crisis,  as 1 have
sometimes seen. It is, therefore, only in a pressing neces-
sity, and wiien the gastric symptoms render its use indis-
pensable, that a vomit may be employed.
  But in the diseases which follow these contagious erup-
tive fevers, an epoch arrives when vomits can be employed
with  advantage.  This is a point to which I am bound to
call attention, because  it is precisely that  one which is the
least  thought of.   Measles  in  particular, and the  cough
 which it  so  commonly leaves behind,-a cough which is
 only  the  sign of a remnant of a psoric  irritation  in the
 lungs, and which, as we know, is so apt to degenerate into
  ubeVcles, are particularly benefited by an emetic. Of this
 I had a sinking example in the following case.  A little
 girl  twelve  years  of age, went well through the measles;
 £d reached  the fourteenth day of the disease her state was
 satisfactory ; since several days the fever had ceased and
 even appetite commenced to return : but of a sudden this
 JS  ceased, the cough became violent respiration embar-
  assed deb  lity  increased,  sleep was disturbed, she had
 headache  and constipation, and purgatives had only little
 effect: I gave a vomit; it operated six times, and brought
  away mufb.  mucosity  and bile ; from  this momenta.pon;
  £neous diarrhcea  came on, a true crisis, affording five or
  six stools a  day ; the cough disappeared, appetite returned,
  and health was soon re-established.

                     Angina, Croup.

    In every inflammation of the throat, according to my ex-
  perience, emetics are one  of the most active and generally
  useful means.  The  irritation which they excite  on  the
  nerves of the mucous membrane of the pharynx appears to
  have a salutary influence,  often a decisive one, over the
  inflammatory stasis,  and  are productive of prompt relief.
  DifficuUy of swallowing is no objection to their use, for the
  patient vomits easier than he swallows.   The only excep-
  tion "s pure  inflammatory angina of a high degree,  that
  ct*tA which calls  for sanguineous evacuations.
  S Vomits are particularly useful in the following cases, m
  which we cannot too strongly recommend them.
     1 In true gastric  angina; that is to  say, when symp-
  toms of a gasfric state accompany  the inflammation from
       nLpncement; they are: loaded  tongue bad taste,

  z::z*^"  *•»»■in thia case angma is onlya 
64                      VOMITS.
 sympathy  of gastrosis, with turgescency upward, for the
 cure of which a vomit will suffice, often banishing at once
 all symptoms of inflammation in the throat.
   2. In croup.   Vomits have a  powerful action over this
 disease, and particularly at two epochs.
   They are proper at the commencement.   If there be a
 means to arrest the development of croup, to arrest it when
 developed, it is surely an  emetic.  Of this I have had proof
 in numerous instances ; among which I shall cite only one.
   A child three  years of age, vigorous,  plethoric, and in
 health, was chilled by a north-east wind ;  felt feverish for
 three days, and had cough ; every night about 3 o'clock a
 spasmodic cough supervened with such violent symptoms
 of suffocation, and barking cough, that it was taken for the
 asthma of Millar, and for which musk was prescribed with
 calomel in  the intervals.  I saw  this patient for the first
 time on the fourth day: the pulse  was full and frequent; a
 constant cough;  respiration alternately  oppressed ;  the
 head was free from trouble, in other respects the child was
 gay and had some appetite, but the tongue was charged.
 Here I saw the commencement of croup, which, as is some-
 times seen, was accompanied with periodical spasms in the
 respiratory organs; forthwith  I  prescribed the following
 emetic :  1  grain of emetic tartar,  20 of ipecacuanha, oxy-
 mel of squills, and raspberry syrup each half an ounce, and
 one ounce  of water:  to  be  taken by teaspoonfuls every
 quarter hour until vomiting occur.  When the patient had
 vomited three times a great quantity of rmicosity, the cough
 ceased, and the child slept for fourteen hours calmly in an
 abundant perspiration. The next morning, both cough and
 dyspnoea having  completely  disappeared, the crisis was
 finished, and the birth of croup aborted.
   Vomits are  also useful at  the last of the disease, when
 the false membranes detach but cannot escape, whence is
 heard a rattling respiration and  augmentation of suffoca-
 tion.   A vomit  aids  the  expulsion of the gluey mass of
 membrane and clears the trachea.  Here is an example :
   A child  two  years of age, of good health, with  the ex-
 ception of frequent  coryzas, was  attacked with  violent
 croup.  Called in on the evening of the second day,  I found
 it  laboring under  attacks  of imminent  suffocation, with
barking cough and wheezing respiration ; a continual ten-
 dency  to raise  the head and stretch forth the neck, pulse
 120. Eight leeches were applied to the neck, calomel every
 hour, and injections of vinegar.  After the operation of the
leeches, and the  taking of eight grains of calomel, which 
VOMITS.
65
procured several stools,  it was evidently relieved.  M 12
o'clock the pulse was reduced to 90:  but the voice was
rough and the respiration still rattling. I applied two more
leeches, and prescribed  every quarter hour the emetic al-
ready  mentioned.  It was followed by  immediate amelio-
ration.  The treatment  was  terminated by a potion, con-
taining 1 scruple of carbonate of potassa, 1  ounce of water,
£ ounce of syrup of manna,  and 20 drops of  antimonial
wine, of which  the  patient took a teaspoonful every two
 hours.                                             .
   3. In parotitis, a disease which is generally epidemical.
At first it is seated in the  parotid and sublingual glands ; but
as it increases  it also  attacks the internal glands of the
 mucous membrane of the  throat ; hence it may cause im-
 minent suffocation, and  even  cause complete trismus.  In
 such a case, and at the last extremity, the principal remedy
 is a  vomit, it is even the only  one that can save life. When
 the  disease is light and without danger, and belongs more
 particularly to the class  of inflammations, which attack the
 mucous membranes, it requires nothing more than diapho-
 retic and antiphlogistic remedies.  But this is no more the
 case when the disease has acquired intensity ; even emis-
• sions  of blood,  calomel and vesicatories fail, and nothing
 but  emetics can place  the  patient out of danger.  This
 may be judged  of by the following fact:
   A woman,  26 vears of age, was attacked with  parotitis
 of a most severe'character,  affecting not  only the parotid
 glands, but also the submaxillary  and sublingual glands ;
 the  tonsils were so swollen that the patient could swallow
 only with great difficulty, and was scarcely able to breathe ;
 the  jaws were so fixed as almost to close the teeth; real
 trismus  existed ; the case  had reached  the ninth  day.
 Venesections, leeches, vesicatories, mercurials, cataplasms,
 and frictions had all failed.  A vomit was the only remain-
 ing  resource,  but there was hesitation on account of the
 closure of the  pharynx and  jaws through which the  con-
 tents of the stomach might be arrested, and cause suffoca-
 tion.  However, no alternative was left, and the effect was
 surprising  Those  organs which  refused passage to the
 entry of "substances, readily  permitted their exit; imme-
 diately after the trismus ceased, the glandular  swelling di-
 minished, deglutition became possible, and in a few days re-
 covery was complete.                     .      ,.
   I cannot too  strongly recommend vomits m this disease.
 At a time when it prevailed epidemically, and did not spare
 even  children at the breast, a vomit  given at the onset, 
66                      VOMITS.
proftrptly  arrested the disease and brought about a rapid
cure.
  4. In angina gangra?nosa.   In this dangerous disease,
but fortunately a rare one, being met with in this country
only as an accompaniment to scarlatina maligna, in which
a gangrenous  disposition is seen from the commencement
of the inflammatory symptoms, vomits are the means most
to be relied upon, especially at the outset.
  5.  In the stomatitis.  I regard vomits as a great specific
against this affection, and as one which acts with the great-
est promptitude.  In cases where  every means had been
exhausted, I have seen a single vomit cure this painful and
disgusting malady.
   In a word, I repeat it—a vomit is the only hope in all in-
flammations of the throat, in  which antiphlogistics and
antispasmodics have failed, and in which there is a threat-
ening suffocation.

                      Pneumonia.

   There is a species of pneumonia in which venesections,
nitre, opium,  and vesicatories, indeed, in  whieh every
means fail  excepting a vomit.  This is one  of the great-
triumphs  of this remedy.   I remember the time when the
only treatment in pneumonias was bleeding; again when
we had recourse only to opium and stimulants ; lastly when
nothing but leeches and calomel were in vogue ; but at all
these periods  I have repeatedly seen this great truth made
evident—that  there are cases wherein every treatment fails
except  that by vomits.   What  is  even the  method of
Peschier,  of late celebrity, if  it is not the same as that
which Schroeder, Tissot, Stoll, and Richter recommended
forty years ago, and which consisted in the employment of
tartar emetic  in pneumonia,  to produce at first vomiting,
after which gentle purgation 1
   These pneumonias are  called gastric, or  false.  They
depend immediately on the gastric  system,  and are pure
consensual irritations, or pulmonary inflammations provok-
ed by such an  irritation, and are consequently analogous to
erysipelas of the surface, which have the same origin, and
which vomits cure.
  They are distinguished from purely inflammatory pneu-
monias  by the absence of hardness in the pulse, that it is
not so strong, nor so difficult  to compress, and is some-
times even soft and small; by gastric  symptoms from the
beginning,  such as furred  tongue, yellow or brown, bad 
VOMITS.                      67
taste, particularly a bitter one, repugnance for food, naifsea,
and  even vomiting, weight in the region of the stomach,
cephalalgia in the forehead, sometimes even delirium, yellow
tint  about the mouth,  in  the wrinkles of the face and the
white of the  eyes ; finally, by extraordinary  prostration
and  curving up oflne  body at the very onset.  The stitch
in the side  which is a chief symptom in these  miladies is
often so  painful as to  cause a short breathing,  as happens
in the most inflammatory and intense pleurisies.
   When, on approaching the patient, we find him laboring
under such a violent state of the chest,  with all the signs
of gastrfc turgescence, there is no other course than to ad-
minister an emetic forthwith ; for the violence of the affec-
tion  in  the thorax is due to  the extreme mobility of the
gastric  sabura.  A bilious  or  sabural vomiting will soon
follow,  and we  shall be surprised to find the pain in the
side, the oppression and anxiety disappear suddenly, as if
by enchantment.
   But sometimes  this  gastric character is associated with
true  inflammation ;  that is to  say,  there is a gastric pneu-
monia.   The  pulse is full and hard; great thirst, high co-
lored urine, considerable heat.  In  such a case, the inflam-
matory character is to be first subdued by bleeding and an
antiphlogistic regimen; after  which we have recourse to
the antigastric method.
   Thus, when we  meet with a hard and full  pulse, with
signs of gastric turgescence; that the  patient is young,
and of a plethoric constitution, we  ought  to bleed from the
arm, after this give a vomit. Sometimes the real character
of the  disease does not present the usual appearance; in
this case the vomit must be given first.
   As an example  I shall now cite a case taken from my
practice.  A  woman,  35 years of  age, attacked with vio-
lent  fever and  painful  stitches in the side.   Besides she
 had  a short  dry cough, short and oppressed respiration,
 violent headache, gastric symptoms, hard and full pulse.  I
 ordered a large bleeding from the right arm ; and as she
 was costive,  a mixture of Glauber's salt, antimonial wine
 and electuary of senna.  The pain lessened for  a few hours
 after the bleeding, but again reappeared with increased
 violence;  the next day the pulse  was fuller and more fre-
 quent, but had lost its hardness; the headache  was violent,
 the dry cough had  augmented; the seat of the pain, about
 the edge of the ribs and the hepatic region was tumid and
 painful  to touch, proving that the liver participated in the
 inflammation ; besides  there was  nausea, and the tongue 
68
VOMITS.
was'covered with a moist brown coat. On account of these
manifest signs of inflammation as well as of the gastric af-
fection, I again ordered the patient to lose blood to the ex-
tent of 16 oujices ; which, on coagulating presented no buff.
The pains did not diminish much and the^ nausea increased.
I now gave emetic tartar and ipecacuanha in divided doses.
The patient vomited three times a great deal of bile and
mucosities; followed by an immediate  diminution of  the
pain and fever; the pulse fell from  110 to 90 pulsations.
From  this moment convalescence progressed  each day
under the  use of  purgatives,  which  were persisted  in for
some time.
   However, the signs of a gastric character are not always
so  strongly  marked;  and there  are latent  pneumonies
which require great  attention on the  part of the practi-
tioner; for, though the state of the patient is the same, the
symptoms  are not so clearly marked.  The  diagnosis is
doubtful, and in the beginning we are guided by negative
indications.  There is  violent pain  in  the side  and great
oppression,  but the pulse is not inflammatory, and the other
signs  of synochus are absent.  Bearing now in mind the
antecedents of the case, such as grief, contradictions, dis-
turbed digestion, and taking into consideration'the feeling
of weight and tension in the precordial region, the aspect
of the  tongue, or even the yellow tint of the face,  there is
no longer cause for hesitation. I particularly name anxiety
as a symptom of a hidden gastric state.  In this case it may
attain great  height, and we must be careful not  to confound
it with inflammation-   It is  a pressing indication for a
vomit, which is the  only remedy capable of  removing it.
Finally, in  very doubtful cases, we may try a small bleed-
ing ; and if the case is really  an inflammatory one, a few
ounces of  blood lost will give some relief; if the case is
purely a gastric one,  the  pains will increase rather than
diminish, and now we will close the vein at once, for we
have  to  deal with  a gastric not with an inflammatory dis-
ease.  It  sometimes happens during the bleeding, or imme-
diately after, that a gastric turgescence becomes apparent,
and  a  spontaneous vomiting  occurs.  If  a  vomit be now
given  it will produce the best  effects.  We  must here no-
tice the circumstances under which the true nature of the
case has been mistaken from the commencement, where
we have  already had recourse to bleeding several times,
always without benefit, without diminishing the pain in the
side ; finally, where the patient still has fever, pains in the
chest,  difficult respiration, a gastric state, the  pulse inter- 
VOMITS.                      69
diets further bleeding;  here a vomit may,  even late in the
disease, procure complete relief, and is the only means to
banish danger.
  These cases in which emetics have been neglected, and
are required at a later period in pneumonies,  are very re-
markable, and prove how powerful even indispensable they
are.   They  have often occurred  in my practice, and are
again  becoming frequent now that an exaggerated view of
inflammation exists, and  that bleeding method leads to a
negligence of the gastric character.—Out of a vast number
of cases, I shall relate only one for instruction.
  A woman of  30 years was seized with all  symptoms  of
pneumonia.  Her physician used venesection, leeches, pur-
gatives, and the whole internal antiphlogistic method; the
most violent symptoms were diminished, it is true, but the
chief  affection  continued.  I  found her in the 8th day of
disease,  in  a violent  fever, having  a constant  irritative
coucrh,  difficult breathing, and particularly a constant tor-
menting anxiety, alternating with fits of fainting, the utmost
weakness, dizziness, delirium, quick pulse, small and soft,
urine jumentous, tongue covered with a yellow-brown coat-
ino-, and suffering at the same time from an extremely pros-
trating watery  diarrhoea.   Resolution  and decisive action
were  here necessary, no time  was to be lost, life was at
stake.'  That anxiety, cough, and difficulties of respiration
did not arise from  genuine pneumony, was  made evident
by the  pulse, the  jumentous urine,  and especially by the
possibility of inspiration without coughing.  The most ur-
gent symptoms to be attended were the prostration of the
vital powers (menstruation had moreover set in), and the
profuse  exhausting  diarrhoea.   Therefore small  doses  of
Dover's powder and mucilaginous injections were ordered.
A repose of 6 hours ensued, after  which appeared anxiety,
stitches in the side,  nausea, pulse extremely small,  quick
and intermittent, fits of fainting, vertigo,  unconscious dis-
charge  from the intestines.   The unavailing use of seda-
tives,  the  continuing even increasing difficulties of the
chest,  above all the  anxiety and nausea, showed that a ma-
terial irritative was still present in  the  prsecordia, and
ought  to be considered as the principal cause of the per-
sistence of the pectoral and nervous affections and of the
fever;  and  that an emetic was  here indicated,  and this
alone could procure relief and salvation in this state really
endangering life.   It was,  however,  very hazardous and
uncertain in this extreme prostration and the continuance
of the diarrhoea.  Should the  emetic act  on the bowels it 
70
VOMITS.
might carry the debility to a fatal extent.  A small dose of
Dover's powder was therefore given a few hours before,
in order to guard against this downward tendency, and
then 6 grains of ipecacuanha administered every  10 mi-
nutes; after 4  doses three copious discharges of bilious
phlegm ensued.  After this  the. patient enjoyed  a quiet
sleep of a few hours, and when she awoke her respiration
was natural, and the anxiety and stitches had disappeared.
The following day the fever was but trifling, the chest and
head entirely free, and there remained only weakness and
a disposition to diarrhcea.   In  short,  she was cured, her
dangerous state was  removed within a few  hours  by a
single emetic, and convalescency followed in a short  time
and without any further difficulty.
  I shall yet mention two  cases of this kind, if only to di-
rect the  attention of young practitioners to  this  subject
and to  the value  of emetics;  for, in either case a single
emetic not only saved the life of the patient—the principal
object  of course—but also laid the foundation of the physi-
cian's future reputation and his subsequent prosperity.
  One of my academical friends left the university for the
great capital of a foreign country, in order to make his for-
tune.  Not long after his arrival, he was sent for by one  of
the principal men of the city, who had already labored for
10  days  under an acute  pectoral fever.  He was attended
by the first physicians of the place,  and was despaired  of
by them.  Another trial yet remained  to be made, and that
by  the recently arrived foreign physician.   Venesections,
vesicatories, antiphlogistics, pectoral remedies, all had  been
tried in vain.  The patient lay in a soporous state, rattling
in the throat  with  great  oppression of the chest,  violent
fever, in short he seemed to be  in agony. The young  phy-
sician came from Goettingen, out  of Richter's  school, and
had there been made acquainted with  gastric pneumonias.
Finding amid all  the  bad  symptoms that there were also
frequent eructations and nausea, that the tongue was cover-
ed with a thick loose brown coat, the praecordia distended,
and the  patient carrying his hands often to this part: all
signs of the existence  of a gastric accumulation.   Deter-
mined by this, he prescribed an  emetic. The patient threw
up  an  enormous quantity  of bilious  impurities and  was
saved.  The natural consequence was to give  him the repu-
tation of a great adept; his fame resounded through the
city, and he became within a short time the most popular
and most noted practitioner.
  The  second case was that of a distinguished universally 
VOMITS.
71
venerated princess.  She lay  in the 11th day of a pulmo-
nary inflammation, accompanied  with a miliary eruption.
Her physicians had used all the remedies that were proper
to the case, without success. Danger  had reached the
highest pitch,  and her recovery was  doubted.  A foreign
physician, who had been sent for, ventured, in spite of the
apparently fatal weakness, to order an emetic. She vomit-
ed, and this was  the signal of her recovery.  This single
emetic made him her physician in ordinary.
   But I go farther, maintaining, as I have been convinced
by many  facts, that  in  all pneumonies, with or  without
pains in the chest, when the degree of inflammation is not
so violent as to require  a venesection, there is no more se-
cure, prompt, and more effectual remedy than tartar emetic
__(for  bere the virtue of antimony seems to be essential),
 f a grain given every hour.   The first doses produce vo-
 miting, the following gentle purging, sweat and expectora-
 tion—all  do what is necessary—and perform in this way a
 cure*
   This applies not alone to the gastric, but also to that
 which is  not less frequent—catarrhal and rheumatic pneu-
 mony ; in which  it is  not the matter discharged, but the
 antistimulus at the precordia, which  here has specific ten-
 dency to the pectoral organs and creates the good effect.
    How much  is gained  for the integrity and safety of the
 organic fabric if the use of calomel, now too much in vogue,
 be superseded.
                  Erysipelas  of the Face.

    In all kinds of erysipelas emetics and cathartics are  the
 principal means of cure ; but especially in erysipelas faciei,
  in which they really deserve the name of a  specific.   It is
 known to what an alarming height, even endangering life,
 this disease may  attain in the third  stage.   Violent  fever,
  anxiety, delirium, even furor torment the patient;  every
  thing  announces a translation to the brain.  Even in this
  case an  emetic is the only salvative.   I have several times
  seen, when abstractions of blood, as usual, had been made
  to no purpose, the promptest and most decisive relief pro-
  cured by an emetic.  Do not hesitate to give it,  and be not
  deterred even by  apparent  congestion; and if one is not
  sufficient, give boldly a second.

                          Aphthe.
    Thrush  is  particularly one of those diseases  in  which
  emetics are  indicated.  It  is an anomalous production of 
72                      VOMITS.
 the mucous membrane, always connected with an abnormal
 secretion of the stomach, and therefore likely to be propa-
 gated to this organ.   In infants gentle gastric remedies are
 generally sufficient, but, as soon as the  malady becomes
 obstinate, the  best and  promptest remedy is an emetic.
 The same is  true of the aphthous affections of adults.

                         Cough.

   There is a species of cough, which we rightly call gastric
 cough, distinguished by  signs of a gastric disorder and ac-
 cumulation,  a furred tongue, loss of appetite, nausea, etc.
 In such cases gastric remedies, dissolvents, purgatives, but
 chiefly emetics are most curative of the cough.  Such a
 cough  may  have been treated  for months with the usual
 catarrhal remedies without success;  a single emetic re-
 moves it.

                   Tussis Convulsiva.

   Hooping cough is not an inflammatory nor therefore  a
 gastric disease ; but as I have already proved 40 years ago,*
 that a contagious convulsive nervous disease of the pre-
 cordial and  pulmonary nerves existed, which,  it is true,
 may in  the beginning be  combined with a febrile inflamma-
 tory affection, but then it always passes into its true cha-
 racter, the spasmodic  nervous, and  which is  always con-
 nected  with  a  peculiar influence over  secretion of these
 organs, which  it increases and thickens.  Here  an emetic
 is still the principal remedy on two accounts; in the  first
 place, as  the most active contrastimulus, capable of sooth-
 ing a spasmodic state ; in  the second place, as a most be-
 neficial evacuation of the accumulated viscous phlegm and
 alterative of  the mucous secretion.   This is fully confirm-
 ed by experience.  An emetic always procures alleviation
 and  amelioration of the attacks for a  few days.  And  I
 have always  found it exceedingly easy in its operation and
 accelerative of the cure of the disease.  Besides, along with
 the use of proper anti-spasmodics and anti-irritatives of the
 skin, an emetic ought to be administered intermediately.

                Pulmonary  Consumption.

   Emetics are  in general not curatives of pulmonary con-
 sumption, though the  Englishman Reid extols their use.
  * Hufeland's remarks on small pox and diseases of children, Jena
1797.                                          I 
VOMITS.
.  73
fn the inflammatory kind and stage of consumption, where
there is a disposition to hemoptysis, they can become very
injurious.  But they may be of use in two cases.  The first
is the purulent; when,  whilst inflammatory signs are ab-
sent, expectoration is  difficult, and fever and anxiety is
thereby  increased; here  an emetic occasionally adminis-
tered, "can  procure great relief.  The second is the pitui-
tous, which originates in the abdomen, m disorders and
accumulations of the digestive system;  as well as the gas-
tric cough, mentioned before, which may even change into
a pituitous consumption.  In  such cases I have seen the
 most-striking curative effects produced by  emetics fre-
 quently repeated; and I refer to my treatise* on this sub-
 ject.

                Dyspnea, Choking Rheum.

    Asthma is known to  belong to the  most difficult and
  often most dangerous diseases.   Also  here emetics main-
  tain a hicrh rank  among  palliatives.  In the moist or pitui-
  tons (asthma humidum) the same, occasionally given, bring
  if not  a perfect  cure, at least  a great relief. In the dry
  spasmodic (asthma spasmodicum, asthma convulsivum) it is
  the greatest of all known alleviating means  : even in that
  kind which sets in  periodically, as a real paroxysm, and
  puts the patient  in danger of life, it is often the only means
  of salvation.  Here  experience has taught, that an emetic
  has effected a perfect resolution of the spasm and restora-
  tion, after musk and opium had been used in vain.
     The same applies to choking rheum (catarrhus suffocati-
  vus) or paralysis of the  lungs, that fit which is so like apo-
  plexy,  with only this difference, that in the  first  case  the
  cerebral nerves, in the latter the pulmonary nerves are in
  a paralytic state.   When the patient is i^r.lVhJSn
  nent danger of suffocation, has a rattling breath  the brain
  and consciousness being generally free.   Also here, after
  a venesection has been previously made, the emetic is the
  greatest,  even the only salvative left.

                   Dysentery  and Cholera.

     In dysentery an emetic of ipecacuanha given in **« onset
   is a chief means of cure. In  numerous cases I did not wan
   any thing  else to cure this disease but an emetic given at
     * Prevention  and cure  of consumption,  founded on  experience.
    Hufeland's miscellaneous writings, vol. 4. 
74                      VOMITS.
the commencement, and then emulsions of gum arabic with
small doses of opium.  I have  always observed, that  the
emetic first administered had a most favorable influence on
the whole cure, and shortened it; for when it had been ne-
glected, the best remedies had by far a less sure and prompt
effect.  Ipecacuanha is always preferable to  tartar emetic
in this disease; for, the first, by its very nature operates
more permanently, even in small doses.
  In cholera morbus, cases may occur, where an emetic is
indispensable.  The  immoderate discharges  are, as it is
known, generally acted on by soothing remedies, but then
sometimes a state of nausea,  dyspepsy, and bilious-gastric
indication remains,  a proof, that there  is left  a remnant of
bilious accumulation which acts anew, and  here I have
several times observed, that nothing removed this state so
quickly and perfectly as a moderate emetic.

                    ■Rheumatisms.

  I have myself had but little experience regarding the ef-
fect  of emetics  in rheumatisms, because other remedies
proved sufficient in my hands, so that  I have spared this
exertion and debilitation to the stomach and digestive func-
tion.   But I  have been persuaded by the experience of
others, that an emetic is indeed  a very efficacious remedy
in rheumatism, though I still hold to the opinion, that it is
preferable to  try first other remedies, and only when they
prove abortive,  to have recourse  to this method of treat-
ment, which,  at  any rate,  affects the  important digestive
system.

                       Insanity.

  Among all physical means against  insanity  I consider,
besides the cold affusions,  emetics the  most efficacious.
An emetic is a most  powerful  antistimulant against  the
morbid action  of the brain;  and the more  decided this is,
that extreme inactivity and insensibility of the precordial
and abdominal  nerves  (connected  with all these psychical
cerebral affections,  especially the melancholic),  the  more
certain it is  that this  disturbed equilibrium  is one of  the
most important  causes in these  diseases; therefore^ a for-
cible  excitation and arousing of these organs  is here  more
proper and of greater  efficacy, to restore the balance and
to regulate the cerebral action.   To this one circumstance
may be added, one to which too little attention seems to 
VOMITS.
75
be paid, the importance of the stomachical sense, the pecu-
liar property of the stomach, exhibited in hunger, still more
in appetite,  most in nausea.   This feeling of hunger is one
of the strongest and most forcible,  pervading the whole
organism, affecting  even the mind unto insanity and des-
pair,  as the effect of hunger sufficiently proves, and so it
must  be, since the preservation of mankind, all life and the
working of the world, depends on this sense and the sexual
instinct.  For that very reason it is one of the most effica-
cious means,  to bring man, when he is lost in insanity, to
consciousness, and  to set him  again in a normal relation
with himself and with the world.  It is undoubtedly in this
that resides the great benefit of fasting  cures. Nausea and
inclination to  vomit operates on the same sense,  only in a
reverse way;  and  how many  unfortunate  persons have
there not been restored in this way since Mutzel's time 1
   My experience has fully confirmed it.  Emetics proved
exceedingly efficacious not only in melancholies, but even
in cases of most violent rage, and in the delirium potato-
rum.  I hatfe still particularly to notice  melancholia suicida,
in which I have several times observed, that the thought of
self-destruction  disappeared after the administration of an
emetic, and the cure perfectly succeeded after gratiola and
neutral salts had been used intermediately.

                  Apoplexy,  Paralysis.

   As much as emetics must be avoided in an apoplectic
 state, while a full pulse, red face, in short, while indication
 of venesection is present, they are equally recommendable,
 where this is not the case, and now they are certainly  the
 most vigorous irritatives and  excitants; and frequently
 they are the only ones, which procure  relief.
   But  as  the unseasonable use of them  will produce the
 greatest injury and accelerate death, I  shall point out those
 cases of apoplexy, in which they are proper.
    1  When apoplexy is of a purely gastric origin, as after
 a meal, overloading of the stomach,  or is  attended with
 nausea, spontaneous vomiting, furred tongue; an emetic is
 the real radical and causal  remedy ; in plethoric persons,
 however, and where the pulse is full, a venesection is to be
 made previously to its administration.
   2  In sanguine apoplexy,  when after proper abstraction
 of blood and  diminished pulse, the sopor and an apoplectic
  state will not cease.                                .  .
    3. In nervous or serous  apoplexy, when the pulse is in 
76
VOMITS.
the beginning small and weak, the face not red and bloated,
but pale and shrivelled, the treatment must commence with
an emetic.
  What has just been said of apoplexy, is true of all  kinds
of paralysis.   Emetics have often been the most vigorous
animatives.

                       Asphyxia,

             Especially  of Newborn Ijjfants.

  The emetic is, in my opinion and experience, one of the
most  important remedies to arouse the  life of a newborn
child, or to bring the weak and suppressed life into opera-
tion.  Here it is a most momentous means to move for the
first time the action  of the respiratory  function and the
smaller circulation.   Which irritative tends so directly,
even  mechanically to arouse  the  midriff, the  pectoral
muscles, the heart and lungs, as the stimulus and action of
vomiting 1  Besides,  in many cases, the inactivity of these
organs and of the suffocation resulting therefrom  is prin-
cipally owing to overfilling with phlegm, which the  weak
newborn child is not  able to throw off.   The so called as-
phyxia is often nothing else than a true  suffocation.  And
here, indeed, no other means is left to us, but the removal
and expulsion of the phlegm, which fills the air-passages
possibly  effectuated by vomiting.  I am really astonished,
to see this great auxiliary disregarded among the resusci-
tatives; and  I take this occasion  to recommend  it  most
earnestly to general attention.
  In confirmation  of it, I will communicate a case, which
has strikingly convinced me  of it.  A lady had the mis-
fortune, twice to give birth to children, which in other re-
spects were strong and well built, but came to light almost
lifeless.  They did not utter a sound, at best a very hoarse
tone, and no respiration could be perceived ; after a  Bhort
time they  died away.  The  skilful practitioner had». used
all imaginable animatives; baths, inhalation of air, frictions,
aspersions, injections, etc., without success.  At the  third
confinement  my assistance  was called for.  I here recog-
nized that the case proceeded from a stoppage of respira-
tion,  and  resolved  to administer an emetic, which I kept
ready for the purpose.   The child was easily and  happily
delivered, but the former phenomena presented themselves.
No crying, no respiration, only a weak, hoarse sound at its
first appearance.   I ordered the child to be placed imme-
diately in a warm bath, and made it swallow a teaspoonful 
VOMITS.
of oxymel  scilliticum with 1 grain of ipecacuanha and a
little chamomile tea; after 6 minutes a second  dose, and
then an active vomiting ensued and  much evacuation of
phlegm, immediately afterwards it cried lustily; respira-
tion °vent into operation, and the child was saved. All went
on excellently, and this  child is now a healthy, robust man.
  Also  in the asphyxia  of adults, this great remedy ought
to be more used,  than  is done at the present time.  Led
by  the  reasons just adduced, in order to arouse the heart
and the respiratory organs by a mighty stimulus in their
neighborhood, and  to rid the lungs of material  accumula-
tions, an emetic  of emetic tartar ought to be infused, as
soon asHhere is a possibility of swallowing, or when swal-
lowing  is not practicable, be injected into the veins.

                 Diseases of Children.

   Emetics, according to my opinion,  take the  lead of all
 other remedies in the treatment of children.  The morbid
 matter  in infants is most frequently located  in the precor-
 dia.  In children the system of the precordial nerves is of
 particular  pathogenetic and  sympathetic and therefore of
 therapeutic influence ;  and every operation on it has a by
 far more general and decisive effect on the whole economy.
 Finally, in children  the  operation of vomiting  proceeds
 much easier  than in adults.   All this has been proved to
 me by  experience  in numerous cases, so that I could fill
 whole  volumes on this subject.   I have removed in innu-
 merable cases immediately and perfectly the most  violent
 fevers  of  children by  an emetic,  given at the onset of the
 disease; so I have  done "away with pectoral and tracheal
 affections, appeased  the most violent cough, which would
 not yield to any remedy, cured vomiting, diarrheas, dysen-
 teric attacks, even  spasms,  when they  originated in  the
 precordial nerves.   The result of my experience at  the
 end of my long practical career is this :  "When a  child—
 especially in the first  years  of life—is attacked by fever,
 attended' with want of appetite  and furred tongue,  still
 more,  when  it vomits  spontaneously, or has  eructations
 and an inclination to vomit, never neglect to administer an
 emetic." It is of indefinable use, frequently alone performs
 a  curn, and  its omission is  hardly compensated subse-
 quently by other remedies,  even by emetics.   Nor ougrht
 we to  avoid using emetics, when the cough and difficulty
 of respiration are  present at the same time ; it often per-
 fectly  removes them. 
78                      VOMITS.

  I except only one case : when a child is attacked by a
fever with soporous symptoms.  Here  congestion  in the  -!
brain,  even perhaps incipient inflammatory hydrocephalus
is always to be presumed, and an emetic might do mischief.
  We need not fear the violence of the exertions in vorn.it-
ing, or the congestion to the head likely to appear—which
may perchance be a contra-indication in adults, but  cannot
deter us from prescribing emetics to children.  Children
vomit much easier than adults, the younger they are the
easier they throw up.
   Vomiting, however, must not be excited more than tlrree
 or four times; and an easy, simultaneously phlegm-dissol-
vent, rather antispasmodic emetic ought to be selected.^ A
 great deal depends on the selection of the substances which
 are used.  In infants, and where there is a spontaneous dis-
 position to vomit, oxymel  of squills, 1 teaspoonful every
 quarter  of an hour, along with chamomile tea is perfectly
 sufficient; in more grown persons a mixture of oxymel
 scille (which is a dissolvent of phlegm and always ex-
 ceedingly facilitates  vomiting) and ipecacuanha;  in still
 more advanced in age, a small addition of tartar emetic
 solely to  sharpen the irritation a little, except in those
 cases, where  there is a great disposition to diarrhcea, which
 the emetic tartar  would likely increase.  I would advise
 the following formula for children :
          R. Pulv. rad. ipecac. 3i.
            Oxymel. scille
            Syrup, rubi idei
             Aque fontane aa  gss.
 One teaspoonfull to be taken every | hour, until vomiting
 commences,  and then wait for the effect which may be re-
 peated in half an hour, if no further vomiting occur.  This
 mixture is the best in children in their first year; for older
 ones | of a grain of emetic tartar may be added.
                                                     4 ■
                         Poisons.

    The  most natural thought, which strikes us first, is to
  discharge the poison from the stomach, by the same road
  it was introduced, as the shortest, even  in imitation  of" na-
  ture.  It is  a rule without exception  to excite vomiting
  when we are called for in time. We do so, presuming that
  the poison is still in the stomach.  We  must, however, be
  careful to distinguish these two ca^es.   Sometimes after
  taking  acrid and  caustic poisons, they cause such violent
  and forced vomiting, that we need do nothing more, but to 
fc
VOMITS.
79
Ir
promote and sustain  it by copious drinks of milk and oil.
But sometimes vomiting does not take place; or it is only
an imperfect vomiturition ; this is particularly the case after
narcotic poisons having been swallowed.   Here an emetic,
the best is tartar emetic, is  to be given.   Sometimes the
insensibility  of the stomach caused by the narcotic is so
great, that this does not take effect,  and recourse must be
had  to  stronger  emetics,  as  sulphate of zinc.—How far
the stomach  pump may be able to replace the emetic, time
and  continued use will teach. It seems to me, that poisons,
which  stick  to the membranes and folds of the stomach,
are more perfectly evacuated by the self-active contraction
of the stomach, than by mere mechanical pumping.
/
/
    University Press,
JOHN F. TROW, PRINTER,
  114 Nassau-stre et,
      New-York. 

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