'M\ $$m* &>; '^ m&ffifc?* i.-» •<•, '■ ; • jy *«r>« *■■■ •-;•#&;* 'Jr? ***■' « 3# I 1 ;^ fe4^#'---- •.■.••-- yv,"."v r.. JJ ■£?Uitf> :> • .• ,• .-if 1' ' ' A*1 * ... Tl ""V (XrY ;*\ NL" 0010^7*} SURGEON GENERAL'S OFFICE LIBRARY. Section. No. 113, W.D.S.Q.O. -f^ Afe_2J9_i£i6 ;i«f. *j'^.*-... yt ROBB & CO.'S ' FAMILY PHYSICIAN. -A WORK ON- DOMESTIC MEDICINES. -DESIGNED TO SHOW- How to have Health, which is Equivalent to Time and Money, -BY- R. L. ROBB, M. D., J. V. BEAN, M. D., Jimuwopathic, Allopathic. S. LUCRETIA ROBB, M. D., Diseases of Women and Children. COMPLETE AND COMPREHENSIVE TREATISE ON DISEASES, WITH THEIR BEST MANNER OF TREATMENT. SOLID BIT SITBSCRIPTIOIT OaSTXyST. - \ "' PUBLISHED BY ft .IV 0 %f_.HZJC.\) ROBB & CO., BOOK PUBLISHERS, V ^ .f\ ^/J BURLINGTON, IOWA. VMB4 1873 Entered according to act of Congrpss in the year 1879, By R. L. & S. L. ROBB, In the office of the Librarian of Congress at Washington. All rights reserved. CHAS. I. BARKER, Steam Book and Job Printer, Burlington, Iowa. °K/cV \i;;^0tD TO THE THINKING MASSES, And to all classes of our fellow men who love the light of plain truth, rather than the darkness and bigotry tbat results from one class holding all the most vital knowledge pertaining to our bodies, keeping it covered by a cloud of words from the dead languages, and thereby aiding in mak- ing it a cloak under which ignorant men can hide their wickedness, this work is most cheerfully dedicated by THE AUTHORS. TABLE OF REMEDIES. ABBREVIATION LATIN. 1 Ac Aconitum napellus 2 Agar Agricus muscarius 3 Agnus Agnus castus 4 Alum Alumina 5 Ambra Ambra grisea 6 Amm c A mrnonium carbonicum 7 Amm mur Ammonium Muriaticum 8 Anac Anacardium 9 Ant c Antimonium crudum 10 Apis inell Apis mellifica 11 Arg fol Argentum foliatum 12 Arg nit Argentum nitricum 13 Arn Arnica montana 14 Ars alb Arsenicum album 15 Aris virg Arislolochia Virginia 16 Asa Asafcetida 17 Asarum Asarum europseum 18 Aurum f Aurum foliatum 19 Aur mer Aurum muriaticum 20 Baryta Baryta carbonica 21 Bell Belladonna 22 Borax Borax 23 Bov Bovista 24 Brom Bromium 25 Bry Bryonia alba 26 Cahin Cahinca 27 Cal car Galearea carbonica 28 Cal caus Calcarea caustica 29 Cal phos Calcarea phosphorica 30 Calen Calendula officinalis 31 Cac gran Cactus grandiflorus 32 Camph Camphora 33 Cann Cannabis sativa 34 Canth Cantharides 35 Cap Capsicum annuum 36 Carbo a Carbo animals 37 Carbo v Carbo vegetaoilis 38 Caus Causticum 39 Cepa Cepa 40 Cham Chamomilla vulgaris 41 Chi China 42 Cic Cicuta virosa 43 Cim Cimicifuga racemosa 44 Cin Cina 45 Cist c Cis:us canadensis 46 Clem Clematis erecta 47 Cocc Cocculus indicus 18 Coc cac Coccus cacti 49 Coff CofFea cruda 50 Colchic Colcbicum autumnale 51 Col Colocynthis 52 Con Conium maculatuin 53 Cro Crocus ENGLISH NAME. Monk's.hood, wolf-bane Bug agaric Amanita Chaste-tree Argilla, Clay, Ox. of Alumen Ambergris Carbonate of Ammonia Muriate of Ammonia Malacca-bean Crude Antimony Honey-bee Silver-foil Nitrate of Silver. Leopard's bane Arsenic Virginia Snake-root Asafcetida Common Asarabacca Gold Muriate of Gold Carbonate of Baryta Deadly Nightshade Biborate of Soda Puff-ball Bromine White Bryony Chinca-ioot Carbonate of Lime Caustic Lime Phosphate of Lime Marsh Marigold Nightblooming Cerus Camphor Hemp Spanish Fly Cayenne Pepper Animal Charcoal Vegetable Charcoal Caustic Tincture Common Onion Common Chamomile Peruvian Bark Water Hemlock Black Snakeroot Worm-seed Rock Rose Virgin's Bower Seeds of Cocculus Cochineal Ra.v Coffee Meadow Saffron Bitter Cucumber Spotted Hemlock SafEron TABLE OF REMEDIES GERMAN NAJIK. 1 Sturmhut. Eisenhut. 2 Fliegenpilz. 3 Keuschbaum. 4 Thonerde. 5 Amber. 6 Kohlensaures Ammonia. 7 Salzsaures Ammonium. 8 Malaecanuss. 9 Schwefelspiesglanz. 10 Honigbiene. 11 Blattsilber. 12 Salpetersaures Silber. 13 Wohlverlei. 14 Arsenik. 15 Virginische Osterluze. 16 Stinkender Asand. 17 Haselwurz. IS Blattgold. 11) Salzsaures Gold. 20 Kohlensaure Schwererde. 21 Tollkirsche. 22 Borax. 23 Bovist. 24 Brom. 25 Zaunruebe. 26 Cachincawurzel. 27 Kohlensaure Kalkerde. 28 Aetzkalk. 29 Pbosphorsaure Kalkerde. 30 Goldblume. 31 32 Kampfer. 33 Hanf. 34 Spanische Fliege. 35 Spanische Pfeffer. 36 Thierkohle. 37 Holzkohle. 38 Aetzstoff. 39 Fwiebel. 40 Feldkamille. 41 Peruvianiscbe Rmde. 42 Wasserschierling. 43 Schlangenwurzel. 44 Cinasamen. 45 Steinrose. 46 Brennwaldrebe. 47 Kockelsamen. 48 Cochenille. 49 Kaffee. j 50 Herbstzeitlose. 51 Holoquinthen. 52 Fleckenschierling. 53 Saffran. ANTIDOTES. Vinegar, Coffee. Wine, Coffee. Camphor. Ipecacuanha. Camphor. Camphor. Oils Camphor, Coffee. Camphor, Coffee. Pulsatilla. Vinegar, Arnica. Puis. Merc. Kitchen Salt, Camphor, Vinegar. Sesquioxide of Iron. Camphor. Camphor. Camphor, Vinegar. Mercurius. Wine, Camphor, Mercury. Sulphate of Soda. Coffee, Camphor. Coffee. Camphor. Ammonia, Coffee. Aconite. Nitric Acid. Bryonia. Arnica. Opium, Vinegar. Lemonade. Camphor. Camphor. Camphor, Arsenic. Camphor, Arsenic. Coffee. Ammonia. Aconite, Cocculus. Arsenic, Veratrum. Tobdcco. Coffee. Ipecac. Zinc. Bryonia. Camphor. Tea, Wine. Aconite. Vinegar, Honey. Camphor. Coffee. Aconite. 6 TABLE OF REMEDIES. ABBREVIATION LATIN. 54 Crotal Crotalus horridus 55 Crot ole Crotonius oleum 56 Cup met Cuprurmmetallicum 57 Cupr ac Cuprum aceticum 58 Cupr sul Cuprum sulph 59 Daph Daphne indica 60 Digi Digitalis purpurea 61 Dros Drosera 62 Dulc Dulcamara 63 Eup Eupatorium 64 Eupho Euphorbium 65 Euphra Euphrasia 66 Ferr Ferrum metalicum 67 Ferr ace" 1 Ferrum aceticum 68 Ferr mur Ferrum muriaticum 69 Fil m Filix mas 70 Graph Graphites 71 Glo Glonoine 72 Hama Hamamelis Virgin iana 73 Helleb Helleborus niger 74 Hep sul Hepar sulphuris 75 Hy acid Hydrocyani acidum 76 Hyos Hyoscyamus niger 77 Hyp perf Hypericum perforatum 78 Ign Ignatia amara 79 Indigo Indigo 80 Iod Iodium 81 Ip Ipecacuanha 82 Jalap Jalapa 83 Kali bi Kali bichromicum 84 Kali car Kali carbon icum 85 Kali hi Kali hidiodicum 86 Kreaso Kreasotum 87 Kousso Kousso 88 Lach Lachesis 89 Laur Laurocerasus 90 Led pal Ledum palustre 91 Lye Lycopodium clavatum 92 Lob Lobelia 93 Mag car Magnesia carbonica 94 Mag mur Magnesia muriatica 95 Mangan Mahganum 96 Mery Meryanthes trifoliata 97 Meph Mephitis putorius 98 Mer viv Mercurius vivus 99 Mer sol Mercurius solubilis 100 Mer dul Mercurius dulcis 101 Mer iod Mercurius iodide 102 Mer corr Me-curius corrosivus 103 Mez Mezereum 104 Morph Movphium 105 Mosch Moschus 106 Mur ac Muriatis acidum 107 Nat car Natrum carbonicum 106 Nat inur Natrum muriaticum 109 Nit acd Nitri acidum 110 Nux jug Nux juglous ill Nit Nitrum 112 Nux moschNux moschata 113 Nux vom Nux vomica 114 Olean Oleander 115 01 jec Oleum jecoris ENGLISH. Rattlesnake Poison Croton Oil Copper Acetate of Copper Sulphate of Copper Indian Daphne Fox-glove Sun-dew Bittersweet Boneset, Ague weed Spurge Eye-bright Iron Acetate of Iron Muriate of Iron Male Fern Black-lead Nitro-Glycerine Witch-Hazel Christmas Rose Sulphuret of Lime Prussic Acid Black Henbane St. John's Wort St. Ignatius' Bean Indigo Iodine Ipecac Jalap Bichromate of Potash Carbonate of Potash Iodide of Potassium Creasote Kousso Lachesis Cherry Laurel Marsh-tea Club-moss Indian Tobacco Carbonate of Magnesia Muriate of Magnesia Manganese Buck Bean Skunk Mercury, Quicksilver Soluble Mercury Calomel Iodide of Mercury Corrosive Sublimate Mezereon Morphia Musk Muriatic Acid Carbonate of Soda Kitchen Salt Nitric Acid Walnut Shell Nitre, Saltpetre Nutmeg Vomic Nut Oleander Cod Liver Oil TABLE OF REMEDIES. 7 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 79 80 81 82 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 GERMAN. Klapperschlangengift. Crostonoel. Kupfer. Essigsaures Kupfer. Kupfervitriol. Indischer Seidelbast. Fingerhut. Sonnenthau. Bittersuess. Durchwachsener. Wolfsmilcb. Auiientrost. Eisen. Essigsaures Eisen. Salzsaures Eisen. Mai'iinliehes Farrenkraut. Reissblei. Schwarze Niesswurz. Schwefelleber. Blausseure. Bilseukraut. Hexenkraut. Ignazbohne. Indigo. Iod. Brechwurzel. Trichterwinde. Kromsaures Kali. Kohlensaures Kali. Hydriosaures. Kreasot. Lachesis. Kirschlorbeer. Porst. Baerlapp. Aufgeblasene Lobelia. Bittersalzerde. Kochsalzsaure Bittererde. Braunstein. Bitterklee. Stinkthier. Quecksilber. Aufloessliches Quecksilber. Versuesstes Quecksilber. AetzsublimatQuecksilberchlo' Gemeiner Kellerhals, Morphine. Moschus. Kochsalzsseure. Lungensalz. Kochsalz Salpetersaeure. Nussbaum. Salpeter. Muskatnuss. Brechnuss. Oleander. Stockfish Leberthran. ANTIDOTES. Arsenic, Ammonia. Demulcents, Opium. White of Eggs. Mercury, Cocculus, Nux. Hepar Sul. Ipic. Bryonia, Rhus. Acids, Camphor. Camphor. Camphor. Quinine, Ipic. Camphor. Camphor. Arsenic, China. Kreosote. Pulsatilla, Arsenicum. Arsenic. Arnica, China. Camphor. Vinegar. Ammonia, cold affusion. Vinegar. Camphor, Vinegar. Boiled starch water and Sugar. Tincture of Galls. Ipic. Lobelia. Camphor. Acids. Milk, Mucilage. Lemon-juice, Acids. Arsenic, Ammonia. Ammonia, Coffee. Camphor. Camphor. Camphor, Ipic. Pulsatilla. Arsenic. Coffee. Camphor. Camphor. Gold Iodine. Hepar Sul., Gold. Iodine, Nitric Acid. Nitric Acid. de White of Eggs. Vinegar. Quick emetics. Camphor. Magnesia. Arsenic. Nitric Ether. Soap. Aconite. Camphor. Wine, Coffee. Camphor. 8 TABLE OK REMEDIES. ABBREVIATION 116 Olric 117 Op 118 Petro 119 Phos ac 120 Phos 121 Phy 122 Plat 123 Plumb 124 Plumb act 125 Pod pel I2ti Puis 127 Ran b 128 Ran s 129 Rhod 130 Rhus tox 131 Ruta g 132 Sabad 133 Sabin 134 Samb 135 Sang 136 Sec 137 Sen 138 Sep 139 Sil 140 Spig 141 Spong 142 Squi 143 Stan 144 Staph 145 Strain 146 Sul 147 Sul ac 148 Symp 149 Tabac 150 Tarax 151 Tar em 152 Tereb 01 153 Teu m v 154 Thu 155 Urt u 156 Xanthoxl 157 Val off 158 Vari 159 Verba 160 Veralb 161 Ver vir 162 Vine 163 Vio tri 164 Zin Sul 165 Zin LATIN. Oleum ricini Opium Petroleum Phosphori acidum Phosphorus Phytolacca decandra Platina Plumbum Plumbum aceticum Podophyllum pelltaum Pulsatilla Ranunculus bulbosus Ranunculus scelaratus Rhododendron chrysanth Rhus toxicodendron Ruta graveolens Sabadilla Sabina Sambucus nigra Sanguinaria canadensis Secale cornutum Senega Sepia Silicea Spigelia Spongia tosta Squilla martima Stannum Staphysagria Stramonium Sulphur Sulphuris acidum Symphituin officinale Tabacum Taraxicum Tartarus emeticus Terebinthina Teucrium marum verum Thuya occidentalis Urtica mens Xanthoxylum fraxincum Valeriana officinalis Variolin Verbascum thapsus Veratrum album Veratrum vivide Vinca minor Viola tricolor Zincum Sulphas Zincum ENGLISH. Castor Oil Opium Rock Oil Phosphoric Acid Phosphorus Poke Root, Poke Berry Platina Lead Acetate of Lead May Apple Wind Flower Crowfoot Malignant Crawfoot mLiberian Rose Poison Sumach Rue Mexican Barley Savin Elder Blood Root Ergot Rattlesnake Root Cuttle-Fish Juice Silica Pink Root Burnt Sponge Squills Tin Stave's-acre Thorn Apple Sulphur Sulphuric Acid Common Comfrey Tobacco Dandelion Tartar Emetic Spirits of Turpentine Wall Germander Tree of Life, Arbor Vitea Nettle Prickly Ash Valerian Cowpox Virus Mullein tVhite Hellebore American Hellebore Winter Green Pansy Sulphate of Zinc Zinc TABLE OF REMEDIES. 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 132 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 GERMAN. Opium. Mohnsaft, Stein eel. Phosphorsaeure. Phosphorus. Platina. Blei. Essigsaures Blei. Schildblsetteriger Entenfuss. Kueclienschelle. Hahnenfuss. Giftiger Hahnenfuss. Siberische Schnecrose. Giftsumach. Raute. Sabadillasamen. Sodebaum. Flieder. Blutwurzel. Mutterkorn. Senegawurzel. Sepiensaft. Kieselerde. Spigelie. Rcestschwamm. Meerzwiebel. Zinn. Stephanskcerner. Stechapfel. Schwefel. Schwefelsaeure. Wallwurz. Tabak. Lcewenzahn. Brechweinstein. Terpentinoel. Katzenkraut. Lebensbaum. Brennessel. Baldrian. Kuhpockengift. Kcenigserze. Weisse Niesswurz. Niesswurz. Wintergruen. Stiefmutterchen. Schwefelsaures Zink. Zink. ANTIDOTES. Motion. Coffee, Camphor. Aconite. Camphor, Coffee. Milk of Magnesia. Colchicum. Opium, Alum, Sulphuric Opium, Alum. Nux., Sul. Coffee. Coffee, Camphor. Camphor. Camphor. Bryonia, Coffee, Lobelia. Camphor. Camphor. Camphor. Camphor. Lobelia. Camphor. Arnica, Camphor. Aconite. Camphor. Camphor. Camphor. Camphor. Pulsatilla. Camphor. Vegetable Acids. Aeon., Camph. Magnesia. Ipic. Nux. Camphor. Tincture of Galls. Camphor. Camphor. Cocculus. Vegetable Acids. Aeon., Coffee. Camphor. Camphor, Coffee. Aconite, Coffee. Camphor. Hepar Sul. Ignatia. Hepar., Ignat. CONTENTS. Table of Remedies...............................................Page 4 Publisher's Preface..............................................Page 17 Author's Preface......................................... .....Page 19 Introduction to Allopathic Treatment..........................Page 22 J?ar*t First. THE METHOD OF INVESTIGATING THE CONDITION OF THE PATIENT, OF DISTINGUISHING BETWEEN A STATE OF HEALTH AND DISEASE, AND OF DETER- MINING THE PECULIAR NATURE OF THE DISEASE. CHAPTER I....................Page 27 THE GENERAL INVESTIGATION OF THE PATIENT. The Constitution and its Varieties : Plethoric, or Sanguine, Fee- ble, Bilious, Apoplectic, Nervous, Dry, Wirey, Lax, Lymphatic, or Mucous, Catarrhal, or Rheumatic, Scrofulous and Consumptive. The Temperaments and their Varieties: The Sanguine, The Bil- ious, The Melancholic and The Phlegmatic. The Antecedents of the Patient's Family. The Sexes and their Distinction. The Age and the Conditions which Qualify It: The earliest pe- riod of childhood ; The second period of childhood; The third period of childhood; The first period of maturity; Full maturity ; The first period of decline; The second period of decline, or old age. Individual Characteristics. Manner of Living, General Habits, Occupation. CHAPTER II....................Page 34 THE INVESTIGATION OF DISEASE— By Consideration of the Cause, General Character and Partictdar Symptoms. The Causes of Diseases: First, Individual exposure, excesses, etc. Second, Endemic, or those peculiar to a certain locality. Third, Ep- idemic causes, or those for the time being prevailing over a large ex- tent of country. The Pulse,its Varieties and Indications: The art of feeling the pulse, in order to determine its character accurately. When and how contents. 11 not to feel the pulse. What to do before you feel the pulse. How to place the fingers to get the most information, and what you learn from the fingers correctly placed. The average of health. General in- ferences deducible from the pulse. Various names for alterations of the pulse, as frequent, slow, quick, sluggish or tardy, soft, strong, feeble, large, small, full, empty, unequal and intermittent pulse. Indica- tions attributable to these varieties, respectively and jointly. The Condition of the Blood, its characteristics. Spontaneous dis- charges of blood generally. The Urine, its Varieties and Indications : The variations apparent in the urine, and their indications. The Function of Breathing : its Varieties and their Indica- tions: The breath in health. The variations to which breathing is subject, and their indications. The Digestive Functions, and the indications which they afford. The evacuations and their indications. Nausea and vomiting, and their meaning. Information derived from the appetite, and its variations. Absence of appetite. Natural appetite. Excess of appetite. Thirst and the indications it affords. The Tongue, and its indications and differences of appearance. The Nerves, Brain, Sensations and senses, and the information de- rived from their study. Loss of consciousness. Delirium. Fainting, etc. Motion, or muscular action, and rest or sleep, including spasms, convulsions and paralysis. The Organs of Sense, eyes, ears, nose, taste, etc., and the knowledge derived from them. CHAPTER III.................page 42 GENERALITIES. Coughs, and their indications. The condition of the skin, hot, natural or sweaty, and the lessons it teaches. The complexion, its changes and varities Sounds given out by the chest, and the method of ex- amining and interpreting them. The voice and speech. Tearfulness and laughter, as signs of health or disease. Loss of, or unhealthy in- crease of, flesh. Sneezing, yawning, groaning, etc. The saliva, defi- ciency and increase. The expectoration, and its valuable indications. Verification of death. CHAPTER IV..................Page 79 DIET. CLOTHING AND HABITS. CHAPTER V....................Page81 ADMINISTRATION AND REPETITION OF THE HOMOEOPATHIC MEDICINES. External applications. THE BATH. Cold Salt Water Bath. Cold Fresh Water Bath. Hot Fresh Water Bath. Tepid, Shower, Vapor and Medicated Baths. Instructions, When and How to Use the Different Baths. Acclamation. Apparent death. Verification of Death. 12 contents. Part Second. CHAPTER VI...................PagenG DISEASES OF THE BRAIN, THE CORD, AND THE NERVOUS SYSTEM, GENERALLY. Spotted Fever Cerebro-Spinal Meiiengitis. Hyperemia of the Brain, or Excess of Blood to the Brain. Anaemia, or Lack of Blood to the Brain. Apoplexy. Inflammatory Diseases of the Brain and its Membranes. Paralysis. Brain Fever. Acute Inflammation. The Spinal Cord, and its Membranes—Myelitis. Dropsy of the Brain, or Water on the Brain. Lock-Jaw—Tetanus. Trismus. Delirium Tremens. Epilepsy —Spasms. Spasms of Infants—Eclampsia infantum. Chorea. St. Vi- tus's Dance. Catalepsy. Hysteria—Hysterics. Part Third- CHAPTER VII..................PageiG6 DISEASES OF THE HEAD. Headache—Cephalalgia Hemicrania. Nerve Pain. Face Ache. Face- Ague. Neuralgia of the Face. CHAPTER VIII............... Page i79 DISEASES OF THE EYE. Inflammation of the Eye—Opthalmia—Acute and Chronic. Cataract- Specks on the Eye. Strabismus—Cross-Eye. Weeping, or Watery Eye. Stye. Blindness—Conjunctivitis. CHAPTER IX..................Page 192 DISEASES OF THE EAR. Inflammation of the Ear and Earache—Otitis Otalgia. Discharge from the Ears—Otorrhcea. Deafness. Humming or buzzing in the ear. CHAPTER X ..................Page 200 DISEASES OF THE NOSE. Catarrh—Cold in the Head—Coryza—Acute and Chronic. Inflammation of the Nose. Bleeding at the—Epistaxis. I?»r*t Fourth. CHAPTER XI..................Pao-e 214 DISEASES OF THE MOUTH, FAUCES AND THROAT. Canker of the mouth—Stomititis. Quinsy—Apthous sore throat. Ca- tarrhal sore throat. Diphtheria. Mumps—Parotitis. Scurvy of the Gums—Scorbutus. Toothache—Odontalgia. contents. 13 Part Fifth. DISEASES OF THE STOMACH AND INTESTINES. CH A PTER XII.................Pa"-e 23.9 DISEASES OF THE STOMACH. Dyspepsia—Acute and Chronic. Bleeding from the Stomach—Hozmate- me*is. Spasm or cramp of the Stomach—Cardialgia. Heartburn. Waterbrash—Pyrosis. CHAPTER XIII.................rage 276 DISEASES OF THE INTESTINES. Diarrhoea—Intestinal Catarrh. Simple Diarrhoea. Chronic Diarrlnea. Cholera Morbus. Fevers. Bilious Fever. Gastric Fever. Inflammation the Bowels—Enteritis Catarrhal Dysentery. Epidemic Dysentery Flux. Colic—Enteragia. Flatulent, Bilious, Hysteric, Rheumatic, Neuralgic, Printers, and Copper Colic. Constipation—Stenosis. Piles * Hemorrhoids. V^oriua—Helminthiasis. Prolapsus ani. Jr*art Ss*ixth. CHAPTER XIV................page 331 DISEASES OF THE LIVER AND SPLEEN. DISEASES OF THE LIVER. Congestion of the Liver. Inflammation of the Liver—Acute and Chronic. Jaundice. Gravel in the (bill-bladder. CHAPTER XV...............Page 339 DISEASES OF SPLEEN. Inflammation of the Spleen. J?ai*t Seventh.. CHAPTER XVI................page 342 DISEASES OF THE KIDNEYS AND BLADDER. DISEASES OF THE KIDNEYS. Inflammation of the Kidneys—Nephritis. Bright's Disease of the Kid- neys. Gravel. CHAPTER XVII..............Page 352 DISEASES OF THE BLADDER. Inflammation of the Bladder Qistitis. B.oody Urine—Hematuria. Wet- ting the Bed—Enuresis Nocturna. Spasm of the Bladder. Paralysis of the Bladder, II contents.. I»ai-t Eiglith. CHAPTER XVIII...............Page 361 DISEASES OF THE MALE SEXUAL ORGANS. Inflammation of the Testicles. Nightly Emissions—Spermatorrhoea. CHAPTER XIX.................page 367 DISEASES OF THE FEMALE SEXUAL ORGANS. Leucorrhcea—Whites—Vagnitis. The Menses. Derangements attendant upon their first Appearance. Suppression or Delay of Menses— Amenorrhoea. Profuse Menstruation. Cancer of the Womb. Inflam- mation of the Breasts—Mastitis. Cancer of the breasts. I*ai*t INinth. CHAPTER XX.................Page 391 DISEASES OF THE RESPIRATORY ORGAN. DISEASES OF THE LARYNX AND TRACHEA. Catarrh or Common Cold. Catarrhal Fever. Cough. Croup. Mem- branous Croup. Hoarseness. CHAPTER XXI.................Page 411 DISEASES OF THE LUNGS. Congestion of the Lung.s. Hemorrhage of the Lungs Bronchitis—Acute and Chronic. Influenza. AVhooping Cough—Pertussis. Pneumo- nia—Inflammation of the Lungs. Asthma. Hiccup—Singultus. CHAPTER XXII................Page 456 DISEASES OF THE PLEURA. Pleurisy—Inflammation of the Pleura. Part Tenth. CHAPTER XXIII................page 465 DISEASES OF THE ORGANS OF CIRCULATION. DISEASES OF THE HEART. Inflammation of the Heart—Carditis. Palpitation of the Heart. An- gina Pectoris. CHAPTER XXIV...............Page 476 DISEASES OF THE ARTERIES AND VEINS. Diseases of the Arteries. Inflammations of the Veins—Phlebitis. Vari- cose Veins or Dilation of the Veins. contents. lo Part Eleventh. CHAPTER XXV.................page 48i DERANGEMENTS OF SINGLE SYSTEMS. DISEASES OF THE BONES, MUSCLES AND JOINTS. Inflammation of the Bones and the Membranes covering them. Rickets —Rachitis. Lumbago. Inflammation of the Joints. Hip Joint —Coxalqia. Knee Joint—White Swelling—Gonitis. Joints of the Foot. CHAPTER XXVI................Page 499 DISEASES OF THE LYMPHATIC VESSELS AND GLANDS. Acute Inflammation. Chronic Inflammation. CHAPTER XXVII...............page 502 DISEASES OF THE SKIN. Erythema—Erysipelas. Hives— Uriticaria. Dandruff— Pityriasis. Scaly Tetter. Barbers' Itch. Bottle Nose. Ring Worm. Tetter. Salt Rheum—Eczema. Shingles. Boils and Carbuncles. Scald Head— Favus. Itch—Scabies. Ulcers. Abscess. Whitlow—Felon. Chil- blains. Corns. Part Twelfth. CONSTITUTIONAL DISEASES. CHAPTER XXVIII...............page 526 ACUTE CONTAGIOUS DISEASES. Measles. Scarlet Fever. Small Pox—Variola—Varioloid. Chicken Pox. CHAPTER XXIX...............Page 549 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Fever and Ague—Intermittent Fever. Typhoid Fever—Enteric Fever. Yellow Fever. Cholera. CHAPTER XXX...............page 602 CONSTITUTIONAL DISEASES WITHOUT DEFINITE INFEC- TION. Rheumatism of joints and muscles. Rheumatism of Sciatic Nerve. Green Sickness—Chlorosis. Gout—Arthritis. Consumption—Tuberculosis. Part Thirteenth. DISEASES PECULIAR TO WOMEN. CHAPTER XXXI................page eis PREGNANCY: General Observations, Air and Exercise, Clothing, Diet, Employment of the Mind, and habits during. Morning Sickness. Constipation. Diarrhoea. Toothache. Urinary Diffi- culties. Swelling of the lower limbs. 16 CONTENTS. MISCARRIAGE. General Symptoms. Exciting Causes. TREATMENT BEFORE CONFINEMENT. Preparation of the Breasts. Preparations for Labor. The Bowels. Diet. False Pains. Treatment after Delivery. General Management. Af- ter Pains. Flooding. Duration of Confinement. CHAPTER XXXII ..............Page 642 DISEASES FOLLOWING CONFINEMENT. Secretion of Milk. Milk Fever. Childbed Fever. The Lochial Discharge. Abdominal Deformities. Weakness after Labor. Sore Nipples. In- flammation of the breasts. Part Fourteenth. TREATMENT OF INFANTS AM) CHILDREN. CHAPTER XXXIII...............Page 653 TREATMENT AFTER BIRTH. Stillborn children. Suspended animation—Treatment—Mechanical mea- sures, etc. Swelling of the Head. Navel rupture in infants—Mechan- ical Treatment. Rupture in the Groin. Expulsion of the Meconium. Suckling of the Infant. The choice of the Nurse. Diet during Nur- sing. Additional Diet of Infants. Sleep—Sleeplessness. Exercise. Weaning. CHAPTER XXXIV...............Page oui DISEASES OF INFANCY. Inflammation of the Eyes. Hiccup. Cold in the Head. Itegurgitatioii of Milk. Acidity.' Flatulence, etc Milk-crust. Milk-scab. Milk Blotches. Thrush—Aphthm. Part Fifteenth. THE REPERTORY. CHAPTER XXXV...............Page (m Containing a complete list of all pains, conditions, symptoms, etc., as developed by any form of disease and pointing out a complete list of remedies known to cure that particular symptom, pain, or condition. The Index. PREFACE. In presenting this work, the publishers take a special pride, believing that it is a book that will be the means of saving many valuable lives and a vast amount of needless suffering from disease. There has never been published any work on domestic medicine, which aimed to put in the hands of the people the vast amount of information, as to disease, its causes, the circumstances modifying it, its course, its careful and systematic treatment, and ale the signs of Uivpulse, tongue, breathing, digestive organs, evacuations, appetite, thirst, position, mental state, eyes, ears, nose, etc., and the indications of those signs, as used by physicians, in deter- < mining the nature of the disease and its probable termination ; all this has been kept back from the masses by physicians as their individual stock in trade; here it is all shown in plain language. While the authors do not claim this as a purely original work with them, we claim that they have brought together in this compact form, the gems of useful information, gleaned from the whole field of medical art and literature, and adapted in language to the comprehension of the common reader, who is entirely unversed in the technical language of medical science. While it has been necessary to use a very fete of those medical words, whenever they do appear, there and then appears their meaning, enclosed in parenthesis. Efforts have been heretofore made to produce a book giving the treatment of a few diseases with their Allopathic and Homoeo- pathic treatment, but both treatments written up by the same author; and in the nature of the human mind there would be some bias in favor of one or the other of the leading schools of medicine; and the treatment of the school of their choice would be fair, while that of the opposite would be more or less incomplete or unfair. Here we offer a work complete; covering the whole field of the art of medicine. The treatment includes only those remedies which have been proven by personal observations to be truly reliable: and are accompanied by practically verified curative indications in every case. The Allopathic Treatment, by Dr. J. V. Bean, must satisfy the friends of that school of medicine. As a staunch, rock-rooted, educated and experienced physician of that school, he stands in the front rank of his profession. While his education gives him command of the whole field of his art, his experience enables him to select his remedies from the 2 18 OCR FAMILY PHYSICIAN. very best, and present them to bis readers in the manner they can most safely use, and receive the most benefit from them. His language is plain, forcible, to the point, and very hard to misunderstand. The Homoeopathic Treatment, following each separate disease, is clear, concise, careful, full and entirely reliable. The "Repertory" is one of the many valuable features of this work. By its help the remedy may be surely and quickly selected that will most certainly remove any disease, or symptom of disease, that can lie cured at all. The Hydropathic is jointly treated by the authors in connection, with their treatment, whenever it may accomplish or aid in accomplish- ing the desired end. Dr. S. Lucretia Robb has added many very valuable hints on the treatment of the diseases of women and children, suggested by, and pro- ven to begood during, years of experience. The Home Remedies.—A great many times, in cases of extreme emergency, there is some simple remedy in the house, which, if knoAvn, could be used, and thereby cure, or at least relieve, until something more could be done in the way of selecting a better remedy, or procuring the aid of a physician. These home remedies are pointed out and are always safe and at hand. The Index is very complete. If you have any name for your disease you will find that in the index, and from the index will be guided to the description and treatment you are in search of. While we do not expect or desire this work to entirely do away with the good, faithful physician, we do expect to make a very great reduction in the number of his professional visits and office prescriptions to every one of our subscribers. And we do hope and desire to assist in educating the masses of the people in the art of medicine, until it will be altogether impossible for any of those ignorant pretenders, now living off the ignorance of the people on this subject, to live at all. We aim to encour- age every competent and educated physician, and by helping our subscri- bers to know the true and good from the false, we know Ave ar^ surely gaining that end; and while greatly reducing the amount of bis bill to any one family where our work enters, we increase greatly the number of families he will be called upon to treat; so you will see the jjood man prosper while the quack must tramp, bare footed, with elbows out, seek- ing for a victim, but no victim for him shall be found where this book enters. With the strong conviction that we are offering a work of no ordin- ary merit, we present this to a deserving and appreciative public, believing they will, on examination, fully confirm our convictions. THE PUBLISHERS. AUTHOR'S PREFACE, In undertaking a work of this character, it is but natural to feel the great weight of the responsibility assumed, taking the holding of the health and life of thousands upon thousands of fellow human beings, with all that life and health contains of usefulness, happiness, love and power, to individuals, families, communities, states and nations upon ourselves, we cannot avoid a feeling of terrible responsibility. A desire and deliberate determination takes possession of our minds to write nothing without careful consideration—to hold nothing back from the people, that can give them a better understanding of themselves and their diseases. In this work, we have endeavored to bring together in a compact form, all the information necessary to give the reader (without any need of other books) all the information needed to fully understand the cause, ■nature, course and treatment of any disease they may feel called upon to treat, or may in any way come in contact with. Following the descrip- tion of the peculiarities of each disease, we have arranged a carefully pre- pared treatment. Those who believe in the Allopathic treatment, will find that full and complete, without any reference to any other treatment. Those who prefer the Homceopathic treatment, will find that ample. Those who prefer to employ the Hydropathic, or water treatment, will find a chapter giving full directions for the preparing and using the dif- ferent baths; and in the treatment of separate diseases, you will find full and frequent directions for their use. Home Remedies receive special attention, and we believe that our readers will be surprised and highly pleased with this portion of our work. We have omitted all treatment and reference to diseases of the sexual organs of a venereal nature. It is felt that their introduction into any work, save one of a strictly professional character, is highly improper. They are of so grave a character, and so long-lasting, and often terrible, in their effects upon the organism, as to demand the highest professional skill in their treatment. We have included articles on the treatment of numerous complaints not heretofore included in any work on domestic medicine;—especially of those which are peculiarly prevalent in certain climates—such as 20 OUR. FAMILY PHVsrciAN. Tropical Diseases, etc.; directions for the discrimination between what if really a symptom of disease, and what is not, etc. The public is entitled to an explanation of the more cogent reasons we have for such a course and for so enlarging the work over others heretofore offered to the public. First of all, the common sense of every reader will admit that we should write for the many, and not for individual cases—that we should attempt to embrace all contingencies as much as possible, and not confine ourselves to merely local circumstances ; and that it does not, therefore, follow that persons whose situation and the like render any of these details unnecessary to them, should be compelled to adopt our suggestions simply because we have published them ; whereas, it does necessarily fol- low, that those who are beyond the reach of any other resource—either by reason of distance or icant of means—must wholly depend, either upon their own unaided judgment, or upon the directions afforded in works of this kind. Suppose, for instance, a family resident in the center of a highly cul- tivated country, like this; that family is not, therefore, within easy and immediate reach of the best jtrofessiouai advice, in which case, it is best that a Avork like this should be in the hotae to represent the physician, in so far as that is possible. But suppose another, and a very common case, as of the emigrant to distant states and territories; to sparsely inhabited or desolate re- gions; from Avbence, we would ask, are these to obtain the professional advice which would be so essential to them, unless it be from such direc- tions as Ave are able to afford them in a Avork of this kind? In this case, it must be admitted on all bands, that the work does good in comparison to its extent, amplitude, enlargement and coniprehensiAeness. Where- fore, then, should these essential conditions be AvithheldV Again, these are not all the questions involved; there are yet more vital points relating to the variations which may become necessary in the actual treatment of disease when once undertaken. In these eases, it is sufficiently ob\rious that those who prefer to exclude professional advice should be so far removed from Hie chance of error as possible, which can- not be done without ample detail, because disease has scarcely ever in two distinct cases, the same positive and exact characteristics. It is fortius reason, also, that we have entered so largely into the consideration of the " Investigation of the Patient and of Disease." We are convinced that the great fault of domestic works in general is, that they do not give inmigh information, and, consequently, that they often mislead instead of enlightening the reader. It is obvious, that the presence of inherent constitutional defects may occasion external appearances of disease, Avhich are especially susceptible of erroneous inferences, and therefore without this very important clue, the directions for the treatment of any particular disease may become a mere " Avill-o'-the-wisp " to lead the unprofessional reader into entangle- ments, and there leave him in utter darkness. We desire the reader, invariably, to consider the important reference alluded to, and, in fact, the Avhole of the introductory part. author's preface. lil It is, also, for these reasons, as well as for those already given, that we object to the extreme condensation of a domestic work, or to the lim- itation of its sphere to a particular class of diseases, and that we consider works founded upon this affected idea practically useless. We noumere enjoin the layman, who has means and immediate access to educated'and reliable professional advice, to undertake the treatment of dangerous diseases irithout it. We only endeavor to provide for those who do not possess those ad\rantagcs. Upon such grounds as these, we beg to intrust this Avork to the ver- dict of a liberal and discriminating people, and to state that we anticipate a hearty welcome to our evident endea\ror, even if the product of our labor should fall short of its earnest purpose. R. L. R. INTRODUCTION. It is my purpose in writing a description of the treatment of disease for popular use, to represent as fairly and plainly as I can the principles and practice of the regular profession or school of medicine, in a manner which can be comprehended by all. It is not my intention to present an exhaustive treatise upon the practice of medicine in all its de- partments. That has been ably and thoroughly done in many recent works on the practice of medicine by Flint, Bristowe, Bartholomew and others. It is a matter of great importance how far it is proper to interfere in the management of diseases. ObA'ious is the fact, that in the great ma- jority of cases, diseases will, Avithout special treatment, end in recovery. It is not to be supposed, therefore, that every instance of recoArery is a cure. The prevalence of quackery depends largely upon the popular error, that the faA-orable termination of disease is always owing to the means employed. The greater the enlightenment of the public upon this subject the less frequent will be imposition in medicine. The fact is, that disease, as a rule, tends to recovery and not to death, by the powers of nature alone. In all such diseases, the true course of treatment is indi- cated by a study of the way in Avhich nature effects her cure and in follow- ing that course. Much harm is often done by the unnecessary employment of medicines. It is therefore a rule which should never be violated, that active treatment should not be employed, except in cases where it is cer- tain to do good. It should not be inferred that proper treatment is useless. On the contrary, even in cases which would end favorably if trusted to nature alone, much good may be done by shortening the duration of the disease, relieving the sufferings of the sick, and in preventing unpleasant and even dangerous consequences. In other instances, proper treatment is the means of saving life. The successful application of remedies and the power of choosing between those of less or greater energy depend upon experience and observation (or knoAvledgej not only, but a logical mind, judgment, common sense, and tact. The General Rules for Treatment of the sick may be summar- ized as follows; 1. The removal of the cause upon Avhich the disease depends, is among the most important. In many instances this suffices. For exam- INTKOIU'CTIOW 23 |>le, nervous headaches may depend upon the continual use of coffee; dys- pepsia upon improper food and insufficient exercise in the open air; colic upon irritating matters in the bowels, etc., etc. Causes are also sure to interfere with a cure, as choler. It may be stated, as a general hiAV, that diseases are rarely station- ary. They tend to get better or to get Avorse. This fact affords valuable indications for treatment. It should be determined whether the disease intermits or not—i.e., whether the pain, fever, or other disordered sensation or action returns at regular intervals of time, and going off again after a longer or shorter period of duration; or whether the disease remits—i.e., becomes less vio- lent at regular intervals. Such diseases will yield to the treatment known as anti-periodic, Avhich will be given in the article on the treatment of in- termittent fe\rer. Some diseases run a definite course and cannot be safely interrupted, such as the irruptive fevers. In such cases, when fully formed, proper management consists in preventing or removing injurious influences, mitigating their A'iolence, correcting, as far as possible, any tendency to a fatal issue, and conducting them to a favorable termination. There are diseases which are indefinite in their course, and have a tendency, Avhen not unusually severe, to get well sometime, and are often arrested or shortened by treatment. The apparent danger should be then kept in view and energetic measures never used, if moderate means will accomplish the end. Again, there are diseases which have a tendency to a fatal result un- less interrupted. These must be checked with mild means, if you can, but with the most energetic, if necessary. 24 our family physician. Then again, we And there are diseases Avhich are necessarily fatal in their character, or at least are so in the present state of our knowledge. Here our endeaA'ors should be to support the powers of life and so prolong it, and to relieA'e the suffering of the patient and render him more com- fortable. In the diseases invohing great danger to life, the way in which the affection will cause death, affords an important guide in treatment, by means of Avhich a fatal termination may be a\rerted. In many cases, the whole aim of treatment Avill be to obviate the tendency to death. For our purpose here, we can reduce all modes of death to two, viz.: by interrup- tion of respiration (called apnea), and by failure of the circulation or exhaustion (called asthenia). These two modes of dying may be com- bined. The best illustration of the first mode named, (apnea), is furn- ished by gases of strangling. Other instances are in diseases invoking obstruction to the passage of air to the lungs, or which make them incompe- tent to receiAre air, as croup and other inflammations of the air passages, catarrhal feArer in children, extensiAe inflammation affecting both lungs, dropsy of the lung or pleural sac and acute consumption. In all these cases the obvious indication is to supply oxygen to the blood. Obstruc- tion to the circulation may be caused by paralysis of the heart, by over- distention, by pressure upon the great Aessels by tumor, by dropsy of the sack covering the heart (pericardium), or coagulation. In these cases the indication is to prevent or overcome, if possible, these obstructions. But in all diseases which proA'e fatal by exhaustion, the mode of dying is by asthenia, as in the continued fevers fatal of themselA-es. The indica- tion is then to obviate this tendency by tonics, nourishment and, per- haps, also by stimulants. 4. The use of remedies is also governed by the stage of the disease. In the commencement of a disease, experience shows that a measure may be effectual in arresting its progress which would be harmful or useless at any later period in its course. A beginning cold is frequently cut short by a full dose of opium or DoA^er's powder, but so favorable a result would not follow later in the case. Depletion is frequently useful in the commencement of diseases, but is harmful when advanced ; on the other hand, stimulation is frequently of great importance in the latter stages of acute prostrating diseases, where, if employed at the commencement, would have worked an injury. When one disease folioavs or appears in the course of another, or an accompanying symptom develops an undue importance, great watchfulness and frequently new measures of treat- ment are demanded. 5. The condition of the system at the time of the attack has the most important bearing upon the treatment. Measures which would be prop- er in a robust, hearty person with an abundance of healthy blood, would be wholly unsuited in a feeble constitution, and those in Avhom the blood is impoverished or vitiated. The latter Avould necessarily require tonic and supporting treatment from the very first, Avhile depletion might be beneficial in the former. The circumstances under which the patient is constantly placed, or those to which he was exposed previous to the oc- currence of the disease, must be taken into account. INTRODUCTION. 25 The age of the patient has an important bearing upon treatment. In- fancy is well known to be more than proportionately susceptible to many medicines, and while the restorative processes are rapid, the system is also easily depressed below the point of recovery. Supporting treatment is early called for in prolonged diseases of infants. In advanced life, though less susceptible than middle life to the action of medicines, ex- cesses, of any kind whatever, are not well borne, caution is demanded and large doses should never be given. Supporting measures are demanded earlier in the course of disease in the old than in middle life, though excessive stimulation is not safe. Women are more susceptible than men, and should be treated more delicately. Particular care is required during menstruation, and unless treatment is demanded, it should be suspended during menstruation. In pregnancy, all purturbating treatment, such as emetics and cathartics, should be aA^oided. Individual peculiarities should be considered; any special susceptibil- ity or peculiar action of a remedy dictates its avoidance in those persons. Hereditary influences must be considered ; the known constitutional habits of the parents should be weighed and govern the treatment of the child. For example, the child of scrofulous parents should, under some cir- cumstances, be treated differently from one in whom there is no heredi- tary morbid predisposition. The habits of the patient have an important bearing upon the treat- ment, and should be thoroughly investigated and knoAvn. Exhaustion from immoral excesses; debility and impoverishment of the blood from insufficient food in quality, or variety, if not absolute starvation and bad air; gluttonous indulgence of the appetite; intemperance in the use of alcoholic drinks and the effects of one's occupation or business, all have an important bearing upon the treatment. All these conditions call for supporting treatment at once and often for stimulants. Previous disease often leaves a debility which calls promptly for sup- porting treatment. Peculiar tendencies to different diseases (diatheses) such as rheumatism, gout, consumption, etc., modify greatly different diseases, and may impress upon them more or less of their own character. The patient cannot be properly treated without giving these facts their proper bearing. 6. Co-existing influences often modify greatly the disease results of particular causes. The most prominent of these, are the epidemic (a widely prevailing disease), or endemic (a locally prevalent disease) influ- ences and the miasmatic, especially marsh miasma, which causes ague and other periodical diseases. Without attending to these influences which modify disease, the treatment Avill be liable to be attended with fatal blunders. In all miasmatic districts, it is Avell known that all diseases assume a character resembling more or less closely the periodical fevers with which these districts are invested. In all these localities, especially in autumn and winter, when other fevers, from whatever cause, and also inflammatory diseases, exhibit the remittent character of the proper miasmatic (or marsh) fever, we also see the best results follow the admin- istration of quinine. Epidemics, (wide-spread prevalent diseases) it is 2('i UlUt FAMIEY PHYSICIAN. well known, impart more or less of their own character to all coincident diseases. Sometimes, notAvithstanding the epidemic influence, there is maintained a vigorous state of the system; Avhen this is the case, the type of disease is said to be ethenic. At other times, the tendency is to a feeble and weak, or typhoid, condition; this is said to be asthenic. The latter condition calls at once for supporting and nutritious measures, and in the former, these measures are not as early called for, and eA'en deplet- ing remedies may be useful. 7. The pointing of nature, as shown by the expression of wants by the patient, should not be disregarded, but should be Avatched for and cautiously gratified, eAren though they are opposed by the dictates of our own reason, or even to the whole course of our experience. It is some- times noticed that the patient, during the progress of a severe disease, expresses a wish for some drink or article of food, or some change in other respects, Avhich would seem to be highly improper. As such Avants are expressed, often as the mere result of restlessness, or whim of the patient, it should, of course, be properly denied. But if the same wish is repeated from time to time, against the authority of physician, attendant and the judgment of the patient himself, it may be looked upon as a real want of the system, and indication by nature Avhich ought to be com- plied Avith. At first it should be gratified cautiously, and in a manner that little harm could result, if it should happen to be a mistake. If good should result from careful trial, a greater indulgence may be per- mitted. On this point, Prof. Geo. B. Wood forcibly says: "The prac- titioner Avill often be gratified at witnessing a rapid recovery, dating from the moment of his judicious surrender of his own judgment to the im- perious call of the system." If error is committed on this point, let it be on the side of caution. S. In the treatment of any disease, it is a good general rule to attend to the state of the functions (secretions and excretions) and to correct any disorder there, even though they are not directly connected with the dis- ease. Especially should the bowels be kept regular, and constipation (fecal accumulations) carefully guarded against. The secretions of the skin and kidneys should be maintained, as nearly as possible, in a healthy stalte, and to this end, frequent examination of the urine is to be made. An irregular circulation, the temperature and nervous action should also receive attention. By these means alone, we occasionally cut off* one of the chief sources of disease, and give great aid to recovery, for it is not always easy to determine how far diseases are mutually de- pendent. J. V. B. t OUR FAMILY PHYSICIAN. JPar*t First. CHAPTER I. THE METHOD OF INVESTIGATING THE CONDITION OF THE PATIENT, OF DISTINGUISHING BETWEEN A STATE OF HEALTH AND DISEASE, AND OF DETER- MINING THE PECULIAR NATURE OF THE DISEASE. The investigation of the condition of the Patient, and the discrim- ination of the particular nature'of the Disease, are evidently essential to appropriate treatment. It is, therefore, imperative that a work of this kind should contain such simple regulations on this head as may lead un- professional persons easily and simply to a clear and positive resolution. Such an investigation may properly be divided into two distinct sections, tiamely: first, the general inArestigation of the patient, and secondly, the particular inA^estigation of the disease. 1.—THE GENERAL INVESTIGATION OF THE PATIENT. The general investigation of the patient should comprise a scrutinizing inquiry into the particular constitution of the individual—the tempera- ment—the antecedents of the patient's family, as of the general health, habits, etc., of the parents, and of each of their families respectively—the sex and the relative state of the secretions especially, consistent with the state of health in such sex—the age of the patient, and the circum- stances which qualify this condition—conditions, impressions, or habits, etc., which are individually peculiar to the patient—the weak or particu- larly susceptible part, and what, if any, be the particular affections to which the patient has been subject—the general habits, occupation, me- thod of living, diet, etc.,—the relations between the climate and the indi- vidual, or any transitions of climate to which the patient may haATe been exposed. 1. the constitution and its varieties. A plethoric (sanguine constitution), or full habit of body, characterized by redundancy of animation and vital energy in health, and a prevailing and predominant activity in the circulative system; the complexion being florid and glowing, the frame full and stalwart, the limbs generally active the spirits and muscular apparatus buoyant and elastic, the generation of natural warmth abundant, and the pulse full and strong; but, consequently, 2S OUR FAMILY PHYSICIAN. with susceptibility to inflammatory influences, and a predisposition to local, organic, or general congestions or suffusions or emissions of blood. A feeble constitution, as opposed to the foregoing—in Avhich fatigue is naturally a ready consequence of exertion ; when the breath will easily be exhausted by sudden or rapid motion ; when the generation of heat will be naturally deficient, and the operation of the functions generally slow and easily impeded, or vexed by being the least overtaxed, the mus- cles being readily wearied and incapacitated—the secretions varying from excess to deficiency or suspension—and the organs being either too readily proA'oked and stimulated, or very dull and insusceptible of external cir- cumstances—and the pulse being naturally feeble, soft ami yielding. The patient is consequently subject to diseases characterized by torpidity and utter inaction of the functions, or by excessive relaxation. A bilious constitution—characterized by dark and somewhat turgid skin, or even by superabundant yellowness of the skin, (an imperceptible proportion of yellow in the skin, observed on close examination, being in- dispensible to a really healthy complexion), and by the readiness Avitb which the liver sympathizes in and becomes affected by (very external or internal contingency with predisposition to derangements affecting the digestive functions and the stomach generally, and to irregularity of such functions ; as also to dark colored urine, costiveness (\vith dark motions), and piles;—the pulse is apt to be wiry. An aplop/etic constitution (a subdivision which is important here), characterized by the short, thick-set, or close full frame, Avith large head, apparently buried between the shoulders, the neck being very short and thick, and the pulse being more or less of the character of the plethoric habit, and the patient being predisposed to sudden rushes of blood to the brain. A nervous constitution (a A'ariety which is often found in combination with the bilious), especially characterized by predominant excitability of body, of mind; absence of fixity (or changeableness) of ideas, habits, in- clinations, etc.; irritability, and extreme sensitiA'eness and inequalities of temper—the puis*, being accordingly also variable, easily subject to exceed- ing acceleration, but often subsiding, in sedate moments to a movement slower than is customary. The patient is subject to the Aarious affections so difficult of distinction and classification, which come under the head of nervous diseases ; such as spasmodic affections, fits, apparently traceable to no distinct- cause, fugitive and inexplicable pains, particularly such as are aggravated by very slight touch or by apj/roxim/ it ion, but which are re- lie tied by pressure. A dry, wiry, constitution (not uncommonly combined with the bilious or nervous), characterized by swarthy complexion, sharp, deep-set fea- tures, searching glance, persistently dry condition of the skin; firm, hard, Aviry condition of the muscular and tendinous fibre; deficiency of flesh and angular frame ; generally, also, rapid motion and quick percep- tion; the urine is dark, the motions are habitually hard and scanty, the secretions and transpirations are usually deficient, and the pulse is gener- ally distinct and wiry, but commonly, also, quicker than that of the ner vous habit i Avhen unexcited). The patient is subject to inflammatory INVESTIGATION OF THE PATIENT. 29 affections—to which the intestines are especially predisposed—as also to diseases generally, which occur (as it were) with superabundant animal power. A la.r, lympliatic, or mucous constitution.—These three varieties, Avhich are, indeed, susceptible of very nice distinctions, are, however, sufficiently analogous to be united in a Avork of this kind, they are opposed to the foregoing. The complexion is generally fair, the flesh apparently full, but soft, flaccid, and puffy ; the skin pallid, the frame rounded, the muscular and tendinous fibre unstrung, yielding, and re- laxed ; sensations of chilliness prevail, and the indiATidual is usually more sensitiA-e of cold than of heat, but is also aliATe to immoderate elevation of the latter ; the natural generation of heat is deficient, the circulation sluggish, the pulse being slow, (sometimes rather full, but always soft, easily compressed, yielding). The patient is subject to the transmutation of every disease into a sluggish, persistent, or chronic form, (the crises and resolution being in general imperfect), to superabundant secretions or ac- cumulations of phlegm, to catarrhal affections, to abscesses, to excessive discharges of phlegm, etc., etc., to the accumulation of Avater (by decompo- sition or imperfect composition of the blood) about particular organs, or throughout the body (generally as the immediate consequence of inflam- mation), and sometimes to the sudden suppression of discharges. Tlie catarrhal or rheumatic constitution (nearly analogous to the last, but having one A-ery distinctiA^e feature in the susceptibility of the exter- nal surface), characterized especially by Avant of sufficient activity and nervous tension and vitality in the skin; Avhich therefore remains easily affected by eAery external circumstance, effects transpiration A'ery defec- tiA-ely and inadequately, and is apt by being susceptible to the sudden suppression or repercussion of such transpiration to recom-ey the morbid humors which haAre been expelled by internal organs upon those organs themselves, and thereby to generate diseases of the character indicated by the nomenclature which Ave haA^e selected. A Aery decided feature of this habit of body consists of extreme susceptibility to derangement of diges- tion, which, if inherited, maybe considered as the predisposing cause to such tendencies. A constitution in which tlte skin is especially liable to become diseased (psoric) (more distinctly capable of individual classification than the scro- fulous lmbit, but yet a mere modification of the latter),—distinguishable by the predominance, recurrence, or continuance of irregular and unheal- thy secretions from the skin, and irregular action of the glands associated with it: eruptions of various characters—ulcerati\Te sores, general foulness —which seem to appear as the result of CATery affection of whateAer kind, and either to accompany or to follow every derangement. The consumptive constitution (in the majority of instances again, a modification of the scrofulous habit, but more subject to appropriate classi- fication in a Avork of this nature)—identified in general by very clear, transparent skin, bright flush-spot on the cheeks, especially on the left cheek; flatness of the chest, and holloAvness on the breast-bone; slender, attenuated, lengthened, fragile frame; elongation and spareness of the neck; prominent profusion of the shoulder-blades ; sudden and rapid 30 OUR FAMILY PHYSICIAN. growth ; prevalence of heat of the hands after eating; irritability of the circulative system ; and consequently a pulse characterized by smallness and quickness. The patient is particularly susceptible to complications affecting the lungs, resulting from eA*ery inflammatory or irritative pro- cess (which is also very frequent and readily provoked); to want of breath and complete exhaustion after every unusual degree of exertion, especially after rapid motion, and often in consequence of mere mental excitement or momentary irritability ; to inflammatory affections of the lungs and adjacent membranes (and expectoration of blood), which Avill ever be liable to result in decay of those organs. 2. THE TEMPERAMENTS AND THEIR VARIETIES. The temperaments are subject to an infinity of individual peculiari- ties Avhich might constitute separate divisions, but which, in our estima- tion, Avill be more readily comprehended by the reader in his investigation into individual characteristics. We shall, therefore, confine the division of temperaments to the following distinctions, which even are often com- pounded, and which should be held to modify the relations of morbid manifestations. A sanguine temperament (usually associated Avith a.plethoric constitution) —which is characterized by habitual animation and buoyancy of spirits, gayety, good humor, etc.; the mind and body are alike quickly stimulated into excessive action, but eAery affection or disturbance is usually of as rapid a course, and brief a duration, as it is severe while it lasts. The bodily health is usually good and strong,—and slow or lasting diseases are of rare occurrence ; but the majority of affections, (Avhich haA^e a predispo- sition to assume a violent and inflammatory type) are exceedingly seA^ere when they do occur, and run a very rapid course. A choleric temperament (usually associated with the bilious constitution) characterized by the violence of the reaction occasioned by any irritation, or stimulus, or impulse, and particularly by its severe implication of the biliary apparatus, which, with increased and altered secre- tion of bile reacts upon the moral and mental faculties, and has a tendency to engender a liability to the proAocation of ill-humor, and even vengefullness and malignity, or to rancor and acrimony of temper, upon the revival of causes of excitement, The complexion is usually swarthy, with a yelloAvish tinge; the muscular and tendinous fibre hard, wiry, and tightly strung; the hair dark, and the features acute or deep- set. The patient is subject to bilious derangements,—and to bilious com- plications with every derangment, not uncommonly provoked by the violent fits of excitement to Avhich he is constitutionally subject. The melancholic temperament is identified by the slow, meditative dis position; the gloomy, retiring, solitary, and hypochondriacal temper; the tacit, latent, and unobsei-Aable progress of affections produced by external impressions but silently harbored. Every impression is deep and lasting, and broods upon the mind and body ; but the patient is not subject to violent impulses, nor very susceptible to sudden impressions the organs being none the less alive to such impressions; the sensibility is apparently blunted or subjected to the reflective powers. The body is INVESTIGATION OF THE PATIENT. 31 alike slowly but progressively affected by external circumstances. The patient is subject to diseases affecting the intestinal apparatus, especially, Avhich assume a chronic and continuous character. A Phlegmatic temperament (which is usually associated with the feeble and lax, or lympliatic constitution),—is distinguishable by the tardy opera- tion of all functions, mental as Avell as bodily; by the sloAvness Avith which irritation or stimulation is produced, and by the no less remark- able slowness, as Avell as by the inadequacy of the reactionary power. The predispositions are to be gathered from the remarks on the " feeble," and on the " lax," or " lymphatic constitutions." 3. THE ANTECEDENTS OF THE PATIENT'S FAMILY. We should pay especial attention to the general health, habits, or particular diseases (if they be known) of the parents of the patient, and of the paternal and maternal relations, AA'hich may serATe to elucidate the origin of a bad habit of body, especially if such diseases as scrofula (in any of its multiplied forms), cutaneous disorders, consumption, gout, piles, etc., be distinguishable as habitual Avith any member of the family, wlwse constitution could have been inherited by tlie patient. This is a most essential consideration; for it will very frequently be found that when a remedy is distinctly indicated in the case, it fails to operate without previous preparatory treatment; and Ave are puzzled by the failure; wliereas, after the previous administration of an apposite preparatory remedy, the medicine already distinguislied as appwpriate, but administered without effect, frequently becomes signally successful. This is generally OAving to heredi- tary defects of constitution. For remedies, see Repertory. 4. THE SEXES AND THEIR DISTINCTIONS. In the male Ave anticipate redundancy of animal strength, ATigor, energy, and circulative power, and Ave must consider disease in a modified or aggravated aspect, according to the ascendency or deficiency of these characteristics. In the female Ave may anticipate more acute sensibility, greater ten- derness and excitability, and a less Adgorous and persistent reactionary power. We must not, moreover, omit to consider the conditions depend* ent peculiarly upon the organs of parturition, etc., and upon the func- tions associated with them ; the progress of pregnancy, and the genera- tion of milk; or, on the other hand, the presence of periodical derange- ments should be duly considered in relation to every simultaneous de- rangement. Relaxation of fibre and lymphatic accumulations are also (to a great- er or less degree) inseparably associated with the peculiarities of the sex; and the greater intensity and additional sphere of nervous sensibility should lead us to consider, Avith great caution, such nerAOus spasmodic or hysterical indispositions as occur associated with natural, predisposing causes. 5. THE AGE AND THE CONDITIONS AVHICH QUALIFY IT. Age is not to be considered without regard to conditions of previous health, or disease—of habits, manner of living, climate, avocations, etc., etc., especially in relation to persons Avho haAre attained maturity. It 32 OUR FAMILA* PHYSICIAN. may, however, (subject to such modifications) be considered under seven distinct sections, ATiz.—childhood constituting three, maturity two, and decline two. 1. In the earliest period of childhood (the first of infancy) extend- ing to the period of the earliest teeth, the human being is extraordinarily susceptible to external influences; sensitiA^e to a higher degree, and con- sequently alive to any sudden irritation from apparently slight causes ; the brain in particular is liable to precipitation of blood, and the acute sensitiveness of the wmole nervous structure renders spasmodic affections predominant, 2. Ln the second period of childhood—extending to the seventh year in our climate—we have to consider the natural irritability of the system, the want of firmness of fibre, the susceptibility to fatigue, readily obvi- ated by the proA-ision of nature,—a preponderance of tendency to rest; and Ave haA-e to anticipate the occurrence of organic inflammations, par- ticularly as connected Avith the respiratory or cerebral apparatus, and irregularities in the accumulation of flesh. 3. In the third period of childhood—extending to the beginning of manhood or Avomanhood—the equilibrium between the functions, facul- ties, etc., being better established, and the tissues having become inured to external influences, we should consider the occurrence of such affec- tions as already described more minutely Avith reference to particular habit of body, circumstances, indiAridual habits, advocations, etc., situation and other local and general external causes. 4. In the period of approaching and progressive maturity—extend- ing to the twenty-fifth year in our climate—the vigor of the circulative system should be developed ;—it is then, also, that Ave may anticipate the serious deATelopment of latent or declared bad habits of body, traceable to parentage, and particular care should then be taken,—especially if in infancy or childhood a course of constitutional treatment has been neg- lected,—to neutralize or modify such constitutional defects—affecting the Lungs and the Brain especially—as in Epileptic or Consumptive affec- tions; both being considered in due relation Avith the progress of sexual powers. 5. The period of maturity—extending generally from the twenty- fifth to forty-fifth year in our climate—must especially be considered in relation Avith habits, mode of life, avocations, locality inhabited, trans- itions of climate, (if any) etc., etc., because any of these circumstances may tend ATery materially to lengthen or abbreviate the stage of vigorous matu- rity. In some cases we may extend it to the fifty-fifth year; in others it may as reasonably be limited to the thirty-fifth year. In general, the period of maturity projierly so called, (Avhether of long or short duration) is characterized by continual, even, regular, and vigorous operation of all the functions and faculties. 6. The first period of decline—which may at present be said to ex- tend, in our climate, generally, from the forty-fifth to the fifty-fifth year —may be distinguished by diminished activity of mind and body, super- vening irregularity of the functions, decreased powers of endurance and INVESTIGATION OF THE DISEASE. 33 strength, returning susceptibility to external influences, and debilitation of the attributive poAvers of either sex. This period, whether deferred or premature, is almost infallibly distinguishable by such characteristics. 7. The second period of decline, or old age, which may set in from the fiftieth to the sixtieth year, in our climate,—or sooner or later, accord- ing to antecedent circumstances, is indellibly characterized by the de- crease of aeuteness in the perceptive faculties, and in the organs which convey sensations—as of light, sound, smell, taste, and sensitiveness of touch,—by growing obtuseness of moral and mental sensibilities; by de- creasing retentive mental power;—by general attenuation of frame, di- minution of physical power, stiffness of joints, muscles, etc., aridity and puckering of the skin, the development of latent defects of circulation, and the like 6. INDIVIDUAL CHARACTERISTICS. The peculiarities of individual patients, and the particular efleet of particular external influences, etc., upon them, both as to mind and body, should be very carefully considered ; and it is absolutely necessary, for the thorough appreciation of the distinctive points relating to the case of a patient, Avith Avhose habits, constitution, and susceptibilities, etc., Ave are not perfectly coiiATersant, that Ave should most carefully gather the history of the particular and characteristic mannerism (if it may so be termed) which identifies him. Every person, whatsoever, must in some point or other be considered to constitute an exceptional case, and be so studied for successful treatment. 7. AFFECTIONS, ETC., TO AVHICH (IF ANY) THE PATIENT IS ESPECIALLY LIABLE. It can hardly occur that a patient is not more subject to one class of disorders than to any other; and although this, to a certain extent, falls within the pale of the considerations suggested above (see 6.), yet there is one essential point to be considered here, namely, the issue or final crisis, in Avhich such disorders termiate,—which is ever characteristic. 8. METHOD OF LIVING, AND GENERAL HABITS. It is a most important comparison to institute, in the study of any case,—to consider the relation between the habit of body or disease, and the method of living, occupation, etc. The habits may be especially considered in respect of the following distinctions:—(1) whether seden- tary or active; (2j whether the chief exertion be of mind or body; (3) whether the locality generally inhabited be of a close, artificial (town) or of a free natural atmosphere; (4) whether the clothing, food, and other comforts, or even necessaries of life have been sufficient, but moderate, or excessive, (both as to quantity, in proportion to actual requirement, or richness,) or deficient in quantity simply, or, not only insufficient, but also unwholesome; (o) whether the domicile and person, or either, luwe been habitually cleanly, carefully attended to, or foul and neglected, (as to domicile, particularly as to cleanliness, drainage and ventilation; order and regularity are, however, also essential); (6) whether the habits as re- 3 34 OUR FAMILY PHYSICIAN. Sards feeding and fasting, labor and rest, etc., occupation or want of occu- pation, haA-e been regular or irregular, desultory or uncertain. With excessive confinement, close atmosphere, deficiency of exercise, etc., we may associate affections of the stomach and liver (especially.), of the digestive functions generally, and depression of spirits, as also (if the place of occupation be of a foul atmosphere), affections of the lungs With excess of mental labor, we may associate nervous complaints, and habitual irritative fevers. With insufficiency or unhealthy kind of food, deficient ventilation, drainage, and cleanliness, we associate low fevers, eruptive fevers, typhoid and putrid, or even intermittent complaints, and skin diseases. With excess of nutrition and indulgence (in comparison to physical exercise), we may associate inflammatory complaints, and rush- es of blood to particular organs. And in all cases analogically Ave may ally the nature of the complaint Avith the nature of the habits, occupa- tion, food, etc. !>. THE PART OR ORGAN ESPECIALLY SUSCEPTIBLE. By investigation into the most frequent result of casual, accidental, external or internal causes, we may readily ascertain Avhat part of the system is particularly liable to irregular or unhealthy action. And this research is ever requisite, because every individual Avill be found to have one organ especially susceptible, and liable to become deranged by causes, in some cases even, such as would seem to involve any other complication, rather than that Avhich actually occurs. 1U. ATMOSPHERIC AND OTHER LOCAL INFLUENCES. The atmosphere, soil, etc , of particular localities, is known to be prone to engender particular derangements. It is also known that the water of particular springs and riATers, Avhether owing to the presence of mineral substances, to excessive hardness, or to other causes, has a ten- dency to generate particular diseases. It is, therefore, very important that these and the like particulars should be submitted to close investi- gation. 2.—INVESTIGATION OF DISEASE. BY CONSIDERATION OF THE CAUSE, GENERAL CHARACTER, EXAMPLES, AND PARTICULAR SYMPTOMS. The investigation of disease, may properly be confined to the consid- eration (1) of the various general, particular and local causes; (2) of the general character of the disease; (3) of the general characteristics of the disease, as compared Avith existing or recorded examples; (4) of the Symptoms:—which last must again be divided into the consider- ation of the pulse, its \-arieties and indications; the discharges generally; the nature of the blood, if any be discharged, the state of the digestive functions ; the mouth and tongue; the eyes, the respiration, and its pecu- liarities; the peculiarities of complexion, motion, action, or inactivity, ap- pearance, etc.; the symptoms exhibited by the nervous system generally, and especially by the brain, etc. INVESTIGATION OF THE PATIENT 35 1. THE CAUSES OF DISEASE. These are either what may be termed constitutional causes, which consist in any unhealthy condition of the system, and for the distinc- tion of which the reader should consult the part on "Constitution," or they are more immediate, as those hereafter subjoined : This latter class of causes consists -.—First. Of such as may be traced to individual exposures, excesses, etc., or to particular conditions, either of locality, dwellings, atmosphere, circumstances, habits, particular suscep- tibility, constitutional predisposition, foregoing diseases, and consequent deterioration of constitutional strength, etc., all of which belong more especially to the "investigation of the patient," and have already been recited. Second. Causes which are peculiar to a district, country, climate, or particular spot, and Avliich are then designated as endemic. Almost every district, especially such as are remarkable for rapid evaporation, excessive and sultry heat, stagnant waters and rapid decomposition of vegetable matter, or marshes Avith little or no drainage, or bleak exposed situations, where dry, cold, and searching Avinds prevail, and the waters are hard, and generally impregnated Avith mineral substances; for sudden and fre- quent changes of temperature; for general flatness of country, or for elevated and irregular surface; for Avinds of a particular character, and from a particular quarter; whether inland, insular or coasting; whether the prevalent occupation be that of factories or fields; and whether the habitations of the people are isolated, Avell ventilated, Avell drained, gener- ally clean, or closely packed, squalid, small, dark, loathsome, ill-drained, and ill-veutilated. These, and many local distinctions of a similar char- acter, will tend to render the generation and prevalence of particular diseases, properly speaking indigenous, or endemic, and should therefore be duly considered. Third. Causes Avhich are of a general, indeterminate character, such as heat, cold, damp, draught, and particular electric relations, but Avhich are prone to become associated Avith sudden transitions of atmospheric condition, and which Avill be the more surely developed by the presence, or precedence, of certain other diseases arising from similarly indetermin- ate causes, by the superabundance of particular natural products (vege- table or fruit), or by the deficiency of food, as in cases of famine, or by calamities of various kinds. These are generally classed as Epidemic causes, and are properly divided into three sections, viz.: those which occur regularly at certain seasons; those which are of continuous dura- tion, and are apparently of incessant development, such as small-pox, measles, scarlet fever, etc.; and those more properly and exactly epidemic, that is, which, appear under particular electric, and other conditions, from time to time, scouring Avhole regions, and whole continents, etc., wherever the like circumstances tend to engender them, but which then unaccountably subside. It is worthy of especial notice, that all three general ciasses of these causes engendering disease, are to be removed, modified, extenuated, or 3fi OUR FA Ml LA' PHYSICIAN. pven eradicated, by judicious management, by the removil of the direct ernwjt (if any be apparent), or by the preparation of the system by means of specific remedies. 2. THE GENERAL CHARACTER OF THE DISEASE. This is determinable by considering the various manifestations in conjunction with the state of the circulation or action of the heart as dis- tinguishable in the condition and peculiarities of the pulse, which alone can serve distinctly to characterize disease.—Pain is very generally no criterion, except as qualified by the pulse;—the muscular and nervous action is usually no criterion, except as qualified by the pulse; the diges- tive functions, secretions, discharges, etc., etc., will often leave the degree of progress, danger, or curability in disease undetermined, without re- ference to the pulse; to the consideration of which we Avill therefore proceed. THE PULSE: ITS VARIATIONS AND INDICATIONS. 1. THE ART OF FEELING THE PULSE IN ORDER TO DETERMINE ITS CHARACTER ACCURATELY. First. Avoid feeling the pulse abruptly, and until the patient has been beguiled (if possible) by irrelevant conversation. Second. Make such an in\restigation of the history of the case as to as- sure yourself that there may not be some immediate casual circumstance calculated to have fluttered, or otherwise affected the patient, and thereby to have disturbed the pulse more immediately. Third. Place three of the fingers upon the artery on the inner side of the left wrist of the patient, having the thumb so applied to the back of the wrist that the pressure which you apply to the artery can be modified, increased, etc, in any and eAery degree; and that thereby, and by so varying the degrees of pressure (having a considerable length of the artery under the three fingers) you may be able, not only to distinguish the number of beats Avhich occur in the minute, but also the particular nature of such beats; as, for instance, Avhether by pressure you can apparently suppress the gush of blood through the vessels ; or Avhether, Avhen strong- ly pressed, the current seems to worm through beneath the fingers like a wire; or whether the bound is so strong as apparently to force the fingers aAvay in its impetuous passage; or Avhether the pulsations are A-ery sudden, distinct, abrupt, and as it were, convulsive; or Avhether, on the other hand, the pulsation appears to linger and to pass languidly; or, whether, again, there is no distinct pulsation, but a rapid thrill, rather to be denominated a vibration than a pulsation. In order thoroughly to distinguish these Arariations, it is imperative that the attention should be absolutely centered in this one object, and not distracted by any other circumstance. 2. THE AArERAGE STANDARD OF HEALTH. The healthy pulse of an adult (in the stage of maturity) male person of large and expansive frame, should (Avith the modifications before men- tioned under the head of " Constitutions ") be firm, not compressible, but INVESTIGATION OF THE DISEASE. 37 sensibly urged through the artery, notwithstanding pressure, yet neither hard (corn-eying a shock to the touch), sudden and twitching, nor like a thread worming its Avay beneath the fingers; but moderately full, eATen, regular, and numbering from 70 to 7V- beats in the minute. The healthy pulse of an adult (in the stage of maturityj male person, of smaller frame and proportions, should, in general, number from 72 to 7S beats, subject to the same general characteristics in other respects. The healthy pulse of an adult female should, Avith the same general reservations, number from SO to 8~> beats in the minute; but we should not anticipate as strong or full a pulse in a woman as in a man ; nor, indeed, should we always attach much importance to the casual precipita- tion of the pulse, especially of highly-nervous females. The healthy pulse of a young person in the second stage of childhood, viz. from seATen to fourteen years of age, should number from 80 to 8(i beats in the minute. The healthy pulse of a child under seven years old, from the period of teething, may be stated at from 80 to 96 beats in the minute. The healthy pulse of an infant, before teething, may be stated at from 100 to 120 beats in the minute according as the child is robust or weakly ; the robust infant generally exhibiting a less frequent but stronger pulsation. The healthy pulse of the first stage of declining life may be generally stated, for the male, at 70 beats; and for the female at 75 beats in the minute. The healthy pulse of the second stage of declining life (that is, old age), may be stated for the male, at from 55 to 65 beats; and for the female, at from 65 to 70 beats in the minute. 3. GENERAL INFERENCES DEDUCIBLE FROM THE PULSE, ETC. 1. Palpitation of the heart.—The palpitation or pulsation of the heart, when felt distinctly, and predominantly, or when even heard, or so severe as to reverberate, as it were, through the frame, and to shake the side, etc., may be considered as characteristic either of— Nervous irritation, the result of sympathetic disturbance originating in the stomach, especially if worms be present ; of hysterical and other spasmodic affections ; of severe bodily suffering,or of violent emotion, etc., and when the result of hysterical disposition, should occasion no apprehen- sion ; or of— Excessive debilitation, resulting from loss of blood, or other severe, excessive and protracted discbarges, in which case it generally termin- ates in a swoon, which, if casual, does not indicate organic disease of the heart; or of— * If, however, the pulse be habitually slower or quicker, we should assume this as an individual standard, because instances are upon record of the pulse of healthy adult males varying from 30 to 50 beats. A'oung infants are known to have a pulse numbeiing from 140 to 150 beats. If the skin be moist at a natural heat, and not flushed, this would be no sigu of disease. The pulse also varies before and after meals. ::s OUR FAMTLY PHYSICIAN, Sudden determination of blood to the heart, or other organs, which, in females, should apprize us of an approaching menstrual crisis (if in due season i; or of— Organic disease of the heart, when it will be characterized by con- tinuance, or very frequent recurrence, constantly terminating in loss of consciousness. 2. The pulst—will serve to determine the most essential questions respecting disease, such as (1) the degree of vital power possessed by the patient; (2) the nature of the disease, tbat is, Avhether or not inflammato- ry action be present; (3) specific characteristics of the disease, that is, whether it be the result of superabundant strength of the blood and sys- tem, or Avhether it be occasioned by, or attended with, a depressed con- dition of A'ital energy ; (4) the degree of progress made by disease upon the vital poAver, and consequently the greater or less degree of urgency; (5) especially in highly critical cases, when no other distinct index is afford- ed, the selection of the ajipropriate reactionary remedy ; (0) according to the greater or less degree of impression made upon the pulse by such admin- istration, Avhether or not Ave haAe properly selected, and how far Ave should be justified in changing the medicine. 4. VARIOUS NAMES OF ALTERATIONS OF THE PULSE. 1. Frequent pulse—A term applied to the succession of the beats. By this Ave understand simply an increased rapidity of repetition. 2. Slow pulse—The designation of a pulse less rapid than in health. 3. Quick pulse—A term which designates the rapidity with, which the current passes through the artery at each beat, qualifying the charac- ter of the beat; Avhereas frequency (as above) is a term denoting the rapid- ity with which one beat folloAV.s another. 4. Sluggish or Tardy pulse—ExpresssiA-e of the languid, extended na- ture of the beats. 5. Hard pulse—Expressive of the sensation or firmness and posi- tiA'eness which it conveys to the touch. 6. Soft pulse—expressiA'e of the smooth Aoav" (so to speak) of the blood beneath the pressure of the fingers. 7. Strong pulse—The denomination of a pulse, which seems to bound beneath the touch, and repel compression. 8. Feeble pulse—That which yields to compression, apparently defi- cient of vigor to force its Avay in spite of pressure. 9. Large pulse—Expressive of the dilation and expansion of the artery, as eA'inced to the touch. 10. Small pulse—ExpressiA'e of the apparent retraction of the artery, and the minute channel through which the blood passes, as evinced to the touch. 11. Full pulse—A denomination applied to a pulsation which seems thoroughly to fill the artery at each beat; whereas the large pulse is only understood of a dilating current, without conveying the idea of solidity, us of a Avell-filled vessel. lNVESTlCATloN OF THE DISEASE. 39 12. Empty pulse—When the beats do not seem to convey a very dis- tinct elevation to the artery, and Avhich appears as a combination of the characteristics of the soft and small pulse. 13. Unequal pnlsi.—That which, without being suspended, does not beat at regular intervals of time, or in which the quality of the current as hard, soft, feeble, full, etc.,) differs Avith different beats. 14. Intermittent pulse—Ov that Avhich is characterized by the occasion- al suspension of beats. 5. INDICATIONS ATTR1BU TABLE TO TIIKE A'ARIETI Es, RESPECTIVELV AND JOINTLA'. 1. A A'ery important distinction to be determined, namely: whether the disease is characterized or engendered by excess or deficiency of vital power ; that is, by over-luxuriance, or poorness of blood, is to be e\inced by the strong, hard, (incompressible) pulse on the one hand, and by the soft feeble (compressible) pulse on the other hand; the first being indicative of excess, and the second of deficiency of strength. 2. Another distinction in determining the nature of the disease con- sists in the explicit indications afforded by an unequal', or changeable pulse, which, in acute cases, identifies the malady as nervous, not inflammatory, and, in chronic cases, as irrespective of the circulation, and associated with the nervous system only. Thus Ave should be most cautious not to mistake cutting, stitching, pricking, or shooting pains in the chest, or violent fixed pains (even Avith violent throbbing), or pains in the chest, (as just des- cribed), with suffocative oppression of breath, accompanied with such a state of pulse, for inflammation; for the pulse would herein distinctly iden- tify purely spasmodic or neuralgic- suffering. 3. A healthy pulse, or a pulse of a purely nervous character, as just described, attending affections of the chest, and especially of the air-pas- sages, is precisely, in some cases, the unmistakeable index of Asthma, in contnvdistinction to Consumptive affections, which are ever characterized by a feverish, feeble, irritative, accelerated pulse. 4. The accelerated pulse, if unqualified by any other feature, exhibits irritation, or fever (properly so called), or increased susceptibility to irrita- tion, Avhich may result from mechanical causes, tending to lessen the scope of the heart as (tight-lacing, etc,,); or from cold in particular, which has caused an irregular retrocession or congestion of blood; or again, from an increase in the richness or quantity of the blood, which destroys the equili- brium between the motive action and the current of blood. Increasing acceleration is indicative of increasing inflammatory action; subsiding ra- pidity is indicative of the removal of the irritation and analogously of its cause. If the frequency of the pulse continues or returns after a crisis (re- sulting in perspiration, sleep, etc.), we may judge that the effort of nature was incomplete, and that therefore a continued effort remains. Frequency of pulse may be associated with the over-strong or over-feeble state of the circulation, and will be more continuous and difficult to subdue when qualified by feebleness than by strength; it will also in many cases be more excessive. Thus, in cases in which the pulse is very frequent, (as, 40 OUR FAMILY PHYSICIAN. for instance, 120 to 180, or even 200 beats in the minute,) it is also small and then points out the lowest state of debility, or Avhat is called a pu- trid condition. This is, indeed, an imperfect pulse, and sometimes pro- ceeds to a mere thrill of vibration, when it is totally indistinct. An anal- ogous sensation may, however, be conveyed in very severe cases of " inflammation of the substance of the lungs," as an inflammatory pulse; but then the artery will be dilated and full, if a long breath be drawn and held; whereas the pulse of debility is qualified by a small, retracted, artery- Again, if the pulse be accelerated, and also strong, or full, and hard, we may distinguish a decidedly inflammatory condition—inflammatory fever. 5. The small pulse, unqualified by any other condition, is indicative either of weakness or of spasmodic condition, which may be easily deter- mined by the accompanying or antecedent circumstances, and by the follow- ing distinctions:— If associated with hardness (small and hard) it is especially indicative of a convulsive state. If associated Avith softness (small and soft), it is especially characteris- tic of debility. Further avc may study the folloAving distinctions, either singly or in association :- The slow pulse (if not habitual—some adult subjects, especially males, having habitually a pulse varying from thirty to fifty beats in the minute, without disease), is indicative of insufficient quantity of blood—as after severe depletion—of advancing age, of the subsidence of fever (which fre- quently leaves a reactionary pulse below the standard of health), or of pres- sure on the brain, as in cases of congestion, water in the head, etc. Asso- ciated Avith the following variety, especially after concussion of the brainj etc., it is of a serious charactt r. The sluggish or tardy pulse particularly distinguishes a torpid condition and a low typhoid character assumed by the disease, and pressure on the brain, when it is of more serious import than the slow pulse, and of still more serious consequence when associated with the last. The hard pulse (simply) indicates especially inflammation, (as in fever, etc.; or a convulsive condition (when qualified by evidences resulting from the investigation of the nervous symptoms distinguishing this condition. In old age again, the hard pulse (especially if large) is of very frequent oc- currence, as caused by the drying, contraction, or even ossification of the arteries, which convey this sensation to the touch, owing to a decrease of suppleness or elasticity. The soft pulse (simply) proves the absence both of inflammation and convulsive condition. The strong pulse, which indicates superfluity of blood, a full habit. The feeble pulse, indicating deficiency of blood, an attenuated habit. The large pulse (simply) indicates an unimpeded elasticity of action, and is the truest index of the absence of Cramp, irritation, or excessive irri- tability; it is the distinctive feature, especially after acute inflammations, of a vigorous operation of the heart, and proves that there is an ample sufficiency of blood in active circulation (consequently no local or organic determination); the large pulse (when unqualified by other features) is INArESTIGATION OF THE DISEASE. 41 therefore to be considered h* a proof of the effectual resolution of an irrita- tive effort, (such as fever), when it sets in at the crisis. The large pulse may, howe.ver, be associated with fullness (only) when it points out the insufficient liquefaction of blood (or thickness) in which case it is easily compressed, as often occurs in typhoid fevers, (with debil- ity), and Avhen it is a spurious fullness; or, again, the large pulse may be associated with fullness and hardness, when it clearly indicates irritation of a peculiar kind. The full pulse distinguishes a plethoric or full condition or habit of body. The empty pulse offers indications analogous to the " small and soft," (as above stated). The unequal 01* changeable pulse generally characterizes a universal ner- vous condition, and is one of the distinctive features of nervous tevers, or of fevers resulting from, or accompanying deficient vital energy. It also indicates spasm at the heart, or even a deeper and organic derangement of the heart, or deficiency of elasticity or energy in the action of the heart; and it may also, in cases of inflammation of the substance of the lungs, be held to indicate such a state of congestive or other obstruction as impedes the progress of the current through those organs, when, consequently, it is a most serious symptom. The intermittent pulse. In this we may especially distinguish a spas- modic condition of the heart, (sometimes organic disease), particularly sym- pathetic, as resulting from intestinal affections, such as congestive deter- mination of blood, or such as excessive relaxation of the bowels, or predis- position to relaxation. THE CONDITION OF THE BLOOD. By this division of investigation it must not be suspected that the inspection of blood abstracted by venesection is indicated, for the use of the lancet is the great and grievous error which has been effectually super- seded. The artificial abstraction of blood is, therefore, as an all but invari- able rule, out of the question. But it will often occur, when the condition of the blood affords very distinctive indications of the nature of the disease or of the system generally, that spontaneous or casual discharges take place. which we may have an opportunity of investigating. We should princi- pally notice a tendency to coagulate very quickly, or too firmly, or in too great a relative proportion to the fluid residue; or, on the other hand, an excessive predominance of the fluid proportion or absence of coagulation. 1. Coagulation which is too rapid, firm, or too great in proportion to the fluid residue, especially if further qualified by the superficial float- ing of very little of the watery humor, (which is one of its constituents), that, again, being coated over the surface with a verv firm white skim, is positively indicative of inflammation, tendency of the disease to develop inflammation, or predisposition of the patient (if in health) to attacks of inflammatory disease. Coagulation, in general aspect as just stated, but which throws up a superficial skim, of detached, unconnected, woolly, or yellowish, or sometimes greenish appearance, distinguishes an irritation of a nervous rather than of a specifically inflammatory character. 42 OUR FAMILY PHYSICIAN. 2. Insufficiency of the watery constituent, that is, when all or al- most all of the blood is dark and thick, indicates a highly bilious habit of body. 3. Superabundance of the watery humor as a constituent of the blood, thatis, Avheu the tendency to coagulate is slow, and affects only a small portion land that often of a paler color than is usual), and Avheu the greater part resolves itself into a Avatery superfluid, indicates a deficiency of power to appropriate and distribute the nourishing portion of the food for the sustenance and uses of the system ; and (if of menstrual blood) a constitutional disposition to debile disorders, such as " green sickness." 4. Absence of healthy coagulation, the blood being dark, but remain- ing entirely commingled in all its component parts, not separating the watery humor, ami remaining in a thick inadhesive condition, (not jelly-likei, indicates what is termed a putrid condition, or that stage of dissolution in which the vital energy sinks from deficiency of poAver to ex- pel what is mischievous las in putrid typhus); and, in general, a scorbutic habit of body, which iiiA-olves a predisposition in every disease to assume a putrescent character. '>. A dark, yet clear, red blood, indicates strength, and a sufficiency of reactionary power. (!. Black, or \Tery dark purple blood :—Avhich is associated with such diseases as result in predominance of A'enous OA-er arterial blood, and which may indicate organic defect of the structure of the heart, particu- larly if the complexion have a bluish or purplish hue; and Avhich may also indicate a highly bilious complication of intestinal derangement in scorbutic subjects (particularly), more especially if the blood be muddy, thick, and black. 7. Pale blood, from superabundance of watery fluid, also characterized by excessiA'c liquidity, indicates constitutional Aveakness in the predomi- nance of the watery humor as a constituent. Pale blood (from light redness of the coagulating portion) indicates a pernicious constitutional habit, such as the constitution heretofore de- scribed as " Rheumatic.,1 8. The Avatery humor (as a constituent of the blood) thoroughly and distinctly separated from the coagulating portion, which is deposited in a firm jelly (and without any of the unhealthy manifestations described under 1) above, may be assumed as an index of a healthy process of circula- tion. 9. The Avatery humor (as a constituent of the blood) appearing whit- ish and thick, indicates deficiency of constitutional A'igor, especially in the distribution of nutriment. 10. The watery humor (as a constituent of the blood) appearing of a distinctly yelloAvisb hue, indicates an admixture of bile with the blood. 2. SPONTANEOUS DISCHARGES OF BLOOD GENERALLY. If the discharge be from the nose, in cases of inflammation of the brain, severe determination of the blood to the brain, or of inflammatory THE INVESTIGATION OF THE DISEASE. 43 fever of any kind, the symptom is to be considered as a wholesome crisis. In general, discharges of blood may appear as the crisis of a disease, particularly of severe fever; but they may occur as the result of local de- terminations of blood or inflammations, of over-due fullness and disten- sion of the vessels, of precipitation of blood upon a weak part, (or, gener- ally, of comparative deficiency of firmness and strength in such part, as when a blood-vessel is broken); or again (as a most critical symptom) of a putrid condition. THE 1 RIXE, ITS VARIETIES AXD THEIR INDICATIONS. From the consideration of the blood and its appearances, we cannot transfer our attention more appropriately than to the like variations in the urine, as the discharge, the processes attending the secretion of Avhich are most intimately connected Avith the blood. 1. THE HEALTHY APPEARANCE OF THE URINE. Unaffected by any of the subjoined or other particular circumstances of age, sex, method of living, active, or sedentary, particular articles of food or drink, the season of the year, and as a most important excep- tional condition, the constitution of the patient—the urine should be of a pale, brightish yelloAV or straAv-colored, remaining clear after standing, precipitating no sediment, and of the peculiar annnoniacal smell, but de- void of all loathsome odor. Exception 1. However, in old age, it is consistent with health that the urine should be offensive, lessened in quantity, and deepened in color. Exceptirm 2. Amongst females a degree of sediment is not ahvays an unhealthy sign, and the urine is habitually of a paler hue. Exception 3. With respect to the habits of life, it may be reserved that a person leading a Aery active life, with especial predominance of physical exertion, should emit darker and more scanty urine than the stated standard—and, that in an indi\ridual of very sedentary habits, it should be characterized by more copious but paler discharge. Exceptwu 4. As to eating and drinking, it may be stated as an excep- tion to the general rule, above, that certain vegetables (especially those of a diuretic nature), such as asparagus, Avill usually cause the discharge to be offensive; other substances will give it a bright, gold yelloAV; excess of stimulating liquor Avill render the discharge pale and copious, etc.; whereas, also, within about six hours after eating, it Avill commonly be cloudy. Exception, 5. The increase of constitutional vigor, or perhaps more immediately the greater enjoyment of open-air exercise which the sum- mer affords, tends to render the urine darker and more scanty, whereas, in winter (that is, under contrarj7 circumstances,) it is usually less highly colored and more abundant. 44 OUR FAMILY PHYSTCTAN. 2. THE PROPER TIME AND METHOD OE INVESTIGATION. The urine should not be examined, or at least no reliance should be placed upon its manifestations, Avithin less than six hours after a meal; and such of the urine as is reserved for investigation should then be set aside in a place where the temperature is even and moderate for at least tAvo hours, not being at all exposed to sudden transitions of temperature in the interval, after which we may examine Avhether any of the sub- joined evidences be present. 3. THE VARIATIONS APPARENT IN THE URINE, AND THEIR INDICATIONS. 1. With respect to the progress of fevers, the urine affords the most Araluable characteristics, varying Avith each stage, as the result of the febrile course is developed ; as, for instance : Before the fever has taken any turn towards issue, that is, so long as it continues to rage without any tendency to a crisis, the urine, of what- ever color, is emitted (and remains after standing! perfectly transparent and clear; or, in other cases, (especially nervous fevers, and fevers in which the digestive functions are predominantly implicated,) the urine Avill be emitted (and will continue the same, and without deposit after standing,) thick and cloudy. 2. As the determination of the feArer approaches, the urine, which was previously clear, Avill become thick, and Avill begin to form a small half-floating cloud, or sometimes even a similar cloud completely buoy- ant, or which, should it sink for a time, will rise again completely to the surface. The two latter are, howeA'er, indicative of a somewhat unfavor- able issue in the imperfect completion of the crisis, whereas, if, on the other hand, the cloud formed in the urine sinks, Ave haA-e reason to an- ticipate a wholesome resolution. 3. The actual determination or crisis of the fever is distinguishable by the precipitation of a sediment ^ simply),—in cases in which the urine had previously been clear,—and by the like precipitation of a sediment, and the complete clearness and transparency (as if filtered) of the over- floating fluid, in cases in Avhich the urine had previously been muddy and thick. But for this precipitation of a sediment to constitute a wholesome indi- cation, it should, also, be smooth, undisturbed, light,—assuming an appa- rent, slight, rounded, eleA'ation towards the center,—white, or of a slightly gray color. It should not constitute more than one-fifth or one- fourth (at the most) of the whole volume discharged, and it should be deposited quickly after the emission. For, otherwise, it is a bad sign ; as, for instance: If black, or A^ery dark, it indicates a putrid condition. If of the color of bile, or red, it characterizes an intermittent type of disease, or sometimes of a rheumatic tendency. If white and gritty, or deposited from dark, turbid urine, there is de- praA'ed habit of body, or perhaps some concreting substance in the urinary canal. THE INVESTIGATION OF THE DISEASE. 4o Or, generally, if disturbed, irregular, of a purple hue, muddy, heavy and constituting from one-half to two-thirds of the whole volume dis- charged, it is a bad sign. 4. In general: If the urine be red when the pulse is accelerated, there is a de- cisive and positive indication Avbercby to distinguish constitutional fever, inflammatory action, and increased development of internal beat,—from a similar condition of pulse, Avhich might otherwise characterize a purely spasmodic affection. If of a deep saffron-color, it represents the admixture of bile in the blood, etc.; and if this hue be conveyed to Avhite absorbent surfaces moistened Avitb it, it decisively indicates jaundice. If it be thick and black, here is an indication of such a degree of inflammatory or putrid condition, as resolves itself into gangrene. If bloody, turbid, thick, and depositing an excessive proportion of sediment, Ave have an evidence of approaching decomposition of the blood. If, other things being equal, it be characterized by the floating of an apparently oily substance on its surface, Ave have an evidence of what may be termed adA^anced constitutional decay. If matter be mingled with it, there must be internal suppuration. If the urine (of children) appear, as it Avere, milky, Ave have rea- son to deduce the presence of Avorms in the intestines. If it be thick, but pale, or still more, if it be very changeable in appearance, during the course of a fever, Ave have reason to look upon the disease as of a nervous kind. If it be clear, transparent, and watery, and there be continual urging to discharge it, the nature of the affection is distinctly spasmodic. If it be bloody, there is probably a degree of inflammation about the bladder or kidneys. If slimy, Ave deduce a discbarge of the character of phlegm from the bladder, or obstruction of the neck of the bladder by some concreting substance. Or, again, as regards the manner or sensations which character- ize the discharge: If the discharge be involuntary, the affection is of a paralytic character; but it should, also, be noticed that in such cases of fever as evince this symptom, it is sometimes very difficult to ascertain whether it is really involuntary (in the true sense of the term). If really so, it is a serious manifestation. If, on the other hand, the discharge be either difficult, painful, or impeded, it variously represents disease of a locally, inflammatory, or spasmodic nature. 6. Or, further, as to the antecedent circumstances : It should be noticed that sudden check of perspiration will often occasion an exceedingly copious and watery discharge of urine. 4fi OUR FAMILY PHXSICIAN. Whereas excessive relaxation of the boAvels, the previous u^e of drastic purgatives, or profuse sweating, Avill frequently cause a darker and more scanty discharge. Chemical and Microscopic Distincitons, and the distinctive features of other varieties in respect of the urine, have been intentionally omitted, as calculated to lead unprofessional persons into erroneous ex- periments. THE FUNCTION OF BREATHING: ITS VARIETIES AND THEIR INDICATIONS. In many diseases, especially those Avhose seat is in the respiratory apparatus, the manner of breathing, the pains, etc., developed by the act of breathing, the sound emitted by the inward and outward passage of the breath, etc., are the only signs upon Avhich Ave can rely for a thor- ough and distinctive appreciation of the nature of the affection, Avith the reservation, hoAvever, that the relations between the pulse and respiration are never to be overlooked. In all diseases, especially in those of an in- flammatory or putrid character, there is much important insight into the direction, etc., of the malady, acquired by a careful consideration of the operation of this vital function. 1. THE BREATH IN HEALTH. The frequency, and even the manner, of breathing, in individual cases, is best determined by the habitual conditions of both. But, inas- much as there should be about four pulsations to every act of respiration, it may be deduced that, in health, supposing the medium standard of the adult pulse to be so beats in the minute, there Avould be 20 inspirations and 20 respirations in the same time: and in the like proportion. The breathing Avould also be easy, slow in repetition, and in inhaling and exhaling equal and fidl. It is not, however, to be inferred that the relative equality of proportion between the beating of the pulse and the expansion of the lungs is in itself a sign of health (as Avill presently trans- pire), although it may be assumed therefrom that the blood is not deteri- orated in quality, on the one hand, and that the operation of the lungs is not organically affected, on the other hand. 2. THE A'ARI.VTIONS TO WHICH BREATHING IS SUBJECT, AND THEIR INDICATIONS. Frequent respiration—by which is understood a rapid and contin- uous succession of inspirations and respirations—is an evidence either of accelerated circulation or fever, and consequently of organic inflamma- tory affections, or of inflammatory affections of any kind, im^olving con- stitutional .disturbance; and also of insufficient (elasticity) strength of the lungs. Frequency of respiration, Avheu associated with smallness or shortruss; that is, with inadequate expansion, is an evidence of some ob- struction which oppresses the operation of the lungs; as, for instance, '■reated by congested blood (as in inflammation of the lungs), by the presence of Avater in the cavity of the chest, (or even, in severe cases, in the cavity of the belly), by inflation with wind (the oppression being THE IN\TESTIGA1T0N OF THE DISEASE. 47 communicated by the contiguity of the lungs to the inflated parts of the r-tomach', or by the alteration of the substance of the lungs, etc. This variety is opposed to the habitual degree of sloAvness in the breathing of health. The slow (unfrequent) breathing, Avhen less frequent than in health, and further qualified, by deep breathing at remote intervals as if in a convulsive effort, is frequently associated Avith spasmodic affections, swooning, etc., and is an evidence of want of strength. The quick respiration—a term by Avhich is understood that the ui-spiration is incomplete, and is quickly succeeded by the /■e-spiralion —is occasioned by the presence of some oppression or obstruction, Avhich renders the expansion Of the chest so painful as to hurry the operation of decreasing the pressure by expelling the air; it is almost invariably the result of any severe inflammatory affection of the intestines, or apparatus of respiration, and commonly occasions a more sudden and spasmodic effort to expel the air, as manifested in cough. It is opposed to the healthy tardiness of respiration; that is, to the deep, slow, protracted inspiration, and respiration, Avith power to hdd the breath (full) for a length of time. Tardiness—-may, however, be excessive, as resulting from Aveak- ness. The deep or long breath—when even, protracted—as to the inhal- ing, and exhaling—noiseless, and evidently without effort, is one of the characteristic features of healthy respiration; but, when deep, long breath, is evidently the result of a severe effort, somewhat difficult, irreg- ular, sonorous, and sometimes abrupt, it becomes an evidence of spasmodic affection,—especially involving the anterior portion of the cavity of the chest and abdomen, or, sometimes, of great fullness of the vessels about those regions ; or, again, (as if there be a long pause between the explo- sion of one draught, and the re-inspiration of another) of a condition of stupor and delirium. The small or short breath '(simply)—may be considered an evi- dence either of Aveakness, or of spasm. We have already noticed this variety, as associated with frequency. Difficult breathing— implies several distinct varieties, either of Avhich may appropriately bear this name. In any degree, difficulty of breath- ing may be associated Avith coldness of the extremities (especially the feet), confusion and heat of the head, and empty, small and remittent pulse, owing to the obstructed and dilatory progress of the blood through the lungs. If casual, difficult respiration may be attributed to some acci- dental or even mechanical cause of oppression. As a symptom of disease, it would arise from the presence of any obstructing matter, blood or Avater, etc., impeding the action of the lungs and air-passages, etc.; or as a symptom, unattended with any evidence of inflammation, it would be occasioned by spasmodic affection of the respiratory apparatus. Moaning or sighing breath is a variety of difficult respiration, and seems rather to identify the enAreloping membranes of the lungs as the seat of the affection. 4s OUR IAMILY PHYSICIAN. Oppressed breath (simply) may arise either from impeded digestion, from particular conditions of atmosphere, or from affections of the air- passages. Feinting Breath rather identifies obstructions (such as thickening of the lining membrane) in the windpipe, and air-tubes. Suffocative breath.—that is, when the breath is totally arrested by re- cumbency—may result from extravasation (pouring out) of blood on the lungs, etc., from the accumulation of water, from alteration of the sub- stance of the lungs, or from Avhat is termed paralysis of those organs ; in any case it is a most urgent symptom. In all respects it is opposed to the easy breathing, or to the habitual degree of ease in breathing, which char- acterizes the healthy state of the patient. Warm breath (simply)—indicates a degree of fever; if very hot par- ticularly if the extremities be cold, it is a positive index of general, inter- nal inflammatory action, or qiore particularly of inflammation of the substance of the lung.s, or of some of the adjacent intestinal parts. Cold breath—indicates a deficiency of vigor (superfluity of Avatery humor) in the blood, and consequently sluggish, languid circulation. It may result, hoAvever, from obstruction which prevents the effectual pas- sage of the blood through the lungs. As a symptom appearing Avith the sudden suspension of pain, and with general dullness of sensation in severe organic inflammation, it indicates internal mortification; in any case, as attendant upon the last stage of a Arery critical disease, it is a fatal sign. Unequal breath—an expression Avhich conveys its meaning—may, in very severe cases, result from obstructions impeding the inhalation or exhalation of the air (chiefly in the windpipe and air-tubes), or it may be occasioned by purely casual circumstances ; as, for instance, spasmodic affection of the nerves connected Avitb the respiratory apparatus. It is opposed to the equal breathing of health. Noisy respiration—or that which is attended Avith unnatural sounds, is subject to several modifications—as,, for instance, whistling breath, Avhich, in the majority of cases, indicates the result of spasm, or of accu- mulation of phlegm, etc., in the windpipe. Battling breath, Avhich may nsult from the presence of matter, blood, or phlegm, partly obstructing the air-tubes; or, as a fatal sign, it is the result of paralysis of the lungs. Flapping breath, or that which is accompanied with an occasional sound, as of the sharp flapping to and fro of a dry valve, indicates the presence of very adhesiA-e matter or phlegm in delicate cells connected with the air- passages. Crackling or crepitating breath, Avhich, as associated with in- flammation of the lungs, would be qualified by^the other distinctive symp- toms of that disease, may (particularly in aged persons) indicate deficien- cy of moisture in the lining membrane of the air-passages. Oppressed breathing, or oppression of the chest, will be treated of under the head of anxiety, (see " Pain," etc). Offensive or fetid breath—-a symptom Avhich requires no further de- scription, but which must be considered in due relation to other circum- stances—as, for instance, going too long without food, will engender it. INVESTIGATION OF THE DIGESTIVE FUNCTIONS. 49 The menstrual periods are sometimes attended with it. Excessive use of mercury, under any treatment, is another ascertainable cause. A scorbutic Ivabit of body (or that in which every affection has a dispo- sition to resolve itself into a greater or less degree of putrescence) is unmistakeably discernible from this symptom, when continual and habit- ual. Excess of animal food may occasion it. Decay of the teeth and inat- tention to the proper cleansing of the mouth and teeth, Avill almost inevitably induce it. In typhus, it characterizes the putrid degeneracy of the disease. In affections of the chest it usually characterizes suppur- ative processes in the lungs, etc. As a general rule, especially in the absence of any particular conditions, such as have been stated—foulness of the stomach, or the presence of worms, or other impure substances in the intestines, may be distinguishable by offensive breath. THE DIGESTIVE FUNCTIONS, AND THE INDICATIONS WHICH THEY AFFORD. The digestiA'e functions, as is well known, afford some of the most pal- pable indications of derangement; and inasmuch as the nutritive or tri- butary process is entirely centered in this portion of the system, one very important deduction is dependent upon its condition ; namely, the suffici- ent or insufficient degree in which the subsistence of the whole constitu- tion is provided for by the processes acting upon the food, and, in the habitual state of the digestive process. Persons of habitually strong digestive poAvers are more likely to resist the injurious effects of external circumstances ; such as heat, cold, infec- tion, sorrow, etc., etc.; but once attacked Avith disease (especially inflam- mation), they are prone to be \rery seriously affected. At the same time disease will be more likely to run a rapid course Avith such subjects, and to terminate promptly, than to degenerate into chronic disease. If the digestiA^e process be habitually weak, Ave have a general indica- tion of precisely contrary conditions. 1. THE EVACUATIONS AND THEIR INDICATIONS. Costiveness.—Suspended or deficient evacuations may be the effect of inflammatory tendency; or of muscular debility; or of inaction of the loAver intestines; or, again, of deficient or altered discharge of bile from the liver into the intestines; or of general debility of the sys- tem and poverty of blood. Suspended evacuations may, hoAvever, be occa- sioned by mechanical obstruction of the bowels, as the lodgment of improper substances, etc.; Avhereas deficiency of discharge may result from excessiA'e discharges or transpirations of another kind. Very dark, evacuations may be either associated with costiveness or relaxation, and in both instances they usually, when not induced by the nature of the food, evince an exuberance of bile. Hard evacuations are of various kinds:—as hard and large, hard and small (detached), hard and knotty, etc.; in general they exhibit a deficient degree of natural irritability in the lining membranes, more or less excess of internal heat, and deficiency of moisture. Relaxation, as understood, not only of less consistent, but of more copious evacuations, is also subject to variations in the frequency, 4 50 OUR FAMILY PHYSICIAN. color, odor, etc., of the motion. In general, it may result from inflamma- tory or nervous irritability of the intestinal canal; or from the presence of obnoxious, irritating substances, impurities, etc.,—such as undigested food, Avorms, etc.,—therein; or from suppression of other discbarges; or emotions; or again, from a debilitated condition of the boAvels, or of the entire system. If the discharge be green (of an infant), acidity is commonly exhib- ited ; if dark, predominance of bile; if pale, deficiency of bile. Spantaneous discharge should be distinguished from involuntary di-s- charge,the former being of little importance, and being a common result of unconsciousness (when relaxation is present) and occurring, also, owing to the excremental matter being completely liquefied. Involuntary evac-uations, properly so called, and attendant upon the last stage of severe fevers, especially fevers of a typhoid character, are indicative of paralysis, and are to be looked upon with great appre- hension. Diminished evacuations are not necessarily opposed to the lessened consistency, and may occur either with highly consistent or very liquid motions; in the latter case, hoAvever, they generally exhibit an imperfect expulsion of the matter to be evacuted, and, in such instances, of the presence of some irritative substances in the canal. If unqualified by any other manifestation (such as hardness, or those already stated) and especially if there be a constriction of the passage, the decreased quantity of the evacuation may be attributed to spasm. Straining to evacuate, is sometimes of spasmodic character, espe- cially if the motion be only partial, very scanty, or totally suppressed. But without spasm, or especially nervous character, such straining may result from a greater or less degree of inflammation and its sequels, or from the peculiar susceptibility of the canal to irritations. Of painfid evacuation Ave shall have occasion to speak under the head of 'Pains.' 2. FLATULENCY—WIND IN THE STOMACH AND INTESTINES—AND ITS INDICATIONS. The generation of wind either in the stomach or in the bowels, arises from the production of the elements, in the form of gases of the normal phlegm which is secreted from the blood. If habitual and ex- cessive, it is clearly indicative of Aveakness or derangement iof nervous action or tone) in the stomach, if the wind be expelled upwards,—ox in the bowels, if the intestines become inflated, or the Avind be expelled dowiiAvards. Flatulent distension of the belly, occurring in children, often iden- tifies an additional morbid state, characterized by the presence of Avorms in the intestinal canal. Flatulent, drum-like distension of the belly during the course of fever, betrays Avant of vigor which may occasion serious results, [f, at the same time, the belly thus distended be very tender, and severe pain be caused by pressure, a tendency to local inflammation is clearly exhibited NAUSEA AND VOMITING AS SYMPTOMS. 51 3. NAUSEA AND VOMITING, AND THEIR INDICATIONS. 1. These symptoms especially point out either original, local, or sympathetic affections of the stomach, or superior portion of the digest- ive apparatus, as opposed to the bowels or intestinal canal, which consti- tute the second diA'ision of this portion of the system. If, therefore, these symptoms be simultaneous Avith unhealthy evacuations, it is to be deduced that both the stomach and bowels are affected either simultaneously or sympathetically, or by communication of the irritability from the one to the other. But they may be occasioned by mere sympathy, without any actual local affection, as:—1, by sympathy Avith the avomb in females, and indicative of the earliest stage of pregnancy; or, 2, by sympathy Avith the lia'er, as evinced by the pain or other symptoms emanating from that organ ; or, 3, by sympathy with the brain, as the result of irri- tation, or of oppression occasioned by determination of blood, concussion or water; or, 4, by sympathy Avith the intestines, as particularly evinced by perverse and continued constipation. All these relations should be duly considered; and, in the absence of any such remote causes, we may trace the origin of these symptoms to the stomach itself, as: — If habitual, 1, to an organic derangement of that and the neighbor- ing portions of the system. 2. If both food and drink are thrown up as soon as SAvalloAved, to inflammation. 3. If accompanied Avith foulness or enlargement of the tongue, and evinced in the state of the matter thrown up, especially if the suffering be immediately relieved after vomiting, to the presence of obnoxious and indigestible substances in the stomach. 4. If attended Avith sudden paroxysms of cramp-like pain, and abrupt suspension of breath, to increased irritability of a purely spasmodic char- acter. 5. If both symptoms occur habitually in the morning, and there be no further indication of irritation of the stomach itself, and if further ex- amination of the urine, and other symptoms lead to the same conclusion, they may be attributable to gravel. 4. THE APPETITE, AND ITS INDICATIONS. The appetite may be equally great, or greater, in disease than in health, but there are very distinct indications which distinguish these op- posite conditions. The appetite of health should be even, regular, (not capricious or fitful) varing in the frequency of its return only according to the habitual periods of meals; but, if not governed by any habit calculat- ed to modify the intervals between the returns of hunger, it should recur, in the adult, about every four to live hours, and in infants and children at intervals of from one to three hours; and satiation (that is. the meal), should not he accompanied Avith flushing of heat, but rather with a sen- sation of chilliness. As an indication of disease we find the appetite de- ficient, or absent-excessive and irregular—fitful—capricious—craving after particular substances, with absolute repugnance to others—charac- terized by a desire for unnatural things, as chalk—or by a particular long- 2 OUR FAMILY PHYSICIAN. ing for stimulants, etc., in the majority of which cases the stomach is the seat of derangement, but occasionally, also the boAvels (as when worms are present in the intestinal canal); except as regards suspension of appetite, which, in most cases (particularly if supplanted by thirst), indicates con- stitutional irritation (fever), whatever be the original seat of the af- fection. In other instances, we may remark an habitually excessive or' craving hunger (not neccessarily either capricious or fitful), but particularly qualified if flushing of lieat, or peculiar heat of the hands follow a meal when we may have reason to apprehend a hectic or consumptive dis- position. In some cases, however, in which excess of appetite occurs (unaccomp anied with these qualifying conditions) especially in young persons, it may be attributed to worms alone—to over-rapid growth—to violent exercise and excessive transpiration, or to any other cause which would tend to absorb or to consume the substance and nutriment of the body. Absence of appetite may more particularly be attributed: 1. To organic derangement of the stomach or simply to weakness of the first process of digestion. 2. And more frequently, to the overcharge of the stomach, or the pressure of injurious and indigestible substances, even in moderate or small quantities. 3. To fever of any kind, otherwise determinable by the pulse, etc., except, indeed, to hectic or rheumatic fever, neither ©f which necessarily subdue the appetite. 4. To nervous, hysterical, and hypochondriacal conditions—or to nervous derangement resulting from emotions, as from excessive grief, alarm, etc.; or to the like, resulting (without fever) from undue physical exertion (a rare case) when the nerves of the stomach are implicated; or frequently from undue mental labor or anxiety. Natural appetite, that is, appetite neither increased nor decreased, may occur, associated with hectic or rheumatic fever; Avhen, hoAvever, it is generally qualified by other circumstances:—in both cases it is more likely to be irregular or excessive. Excess of appetite, as a symptom of disease, is an evidence of poorness of blood, frequently attended with the secretion of an acrid, irritating phlegm; but, without such conditions, it may result from purely nervous and sympathetic irritability—as during pregnancy, or in diseases of a purely hysterical character;—or again, from some habitual cause of irri- tation, such as worms. In hectic or consumptive complaints it indicates the insufficient distribution of nutriment by the tributary apparatus, that is, a want of proper action in the digestive function to appropriate the nutritive constitutent of the food. Excess of appetite Avill also often ap- pear associated with habitual vomiting, or continued relaxation of the bowels, owing to the deficient distribution of nourishment. 5. THIRST AND ITS INDICATIONS. In the majority of cases, continued thirst indicates fever or inflam- mation ; but, inasmuch as it will result from any dryness of the mouth and throat, and from lack of moisture in the stomach (without disease), Ave must be careful to distinguish the thirst of health. THE TONGUE. -><> The thirst of health may be the consequence of any condition cal- culated to absorb the moisture of the mouth, throat, gullet, and stomach- such as—severe physical exertion, greatly elevated temperature, par- ticularly in a dry state of the atmosphere, or even when the temperature is much depressed by the deficiency of moisture in the air, particularly if strong exercise be taken during the prevalence of such atmospheric con- ditions ;—or, again, eating salt food, or eating solid food, especially heating- food (chiefly animal) in excess, or continuing too long without food (with- out necessary abatement of appetite) after the return of hunger, whereby the saliva has been exhausted, etc. When, however, there is no apparent cause for the thirst, especially if accompanied with increased heat or dryness of the skin, etc., and if, upon investigation of other symptoms, further indications should warrant the conclusion, we may infer that the thirst arises from internal heat, and is consequently a symptom of fever. If in such a case the thirst be intense and insatiable (the pulse being full, hard, and frequent), the character of the fever is distinctly indicatect—it is inflammatory; that is, there is a deficiency of the Avatery constituent in the blood. Thirst may, however, arise purely from acidity; when it will be charac- terized by the risings and acrid sensations in the gullet, etc. It may also be associated Avith spasm; when, hoAvever, it will be characterized by deficiency, not by excess of heat. THE TONGUE, AND ITS INDICATIONS. The tongue affords many of the most important indications associated with derangement of the digestive functions. Tongue thickly furred, dirty white, or brownish white, without either unusual dryness, enlargement or redness, indicates that the derangement involves rather the lining membranes than the nerves of the stomach, and that not to a serious extent. The derangement is then identified as comparatively recent, and easily remediable. Tongue furred with slimy matter, and with vivid red tip and margins, indicates also an affection of the lining membrane, but one of a more serious and continuous character. Yellow tongue, also qualified by one or more of the last-stated condi- tions, indicates the liver, etc., as implicated. Clean tongue, of bright redness, naturally moist, but Avith the papilhe unnaturally prominent, indicates that the derangement affects the nerves of the stomach, and is of recent date. Dry, red, glazed tongue represents a similar affection to the last, but more severe, and of longer standing. Swollen, red tongue, but slightly charged with white fur, represents such a degree of nervous derangement of the digestive organs as to react congestively upon the brain, and implicate that organ. Cracked, furrowed, fissured, swollen tongue, conveys to our apprehen- sion the most severe degree of derangement of the nerves of the stomach. Swollen tongue, thinly coated, white but bright red at the tip and margins, indicates a complication of both A'arieties of indigestion—viz., OUR FAMILY PHYSICIAN. that of the lining membranes, and that of the nerves of the stomach, which is of old standing, and of an obstinate character. We may look for irregular operation of the brain, as associated with this symptom, as Avell as extreme despondency, neivous irritability, and depression of spirits and activity. Tongue indented on either side is a modification of the sAvollen tongue, already mentioned as associated Avith derangement of the nerves of the stomach, and consists of a A'ery severe degree of tumefaction. Tremulous tongue, or tongue trembling when protruded, is often dis- tinguished amongst habitual drunkards, and distinctly indicates a com- plex variety of the nervous form of indigestion, implicating the spinal marrow. Blackish, dry, furred,and tremulous tongue, is a symptom in abdominal or putrid typhus. THE NERVES, BRAIN, SENSATIONS, AND SENSES, AND THEIR INDICATIONS. This section includes the consideration of suspension, or acuieness of sensation, perception, consciousness, volition, motion, rest, etc. 1. LOSS OE CONSCIOUSNESS, DELIRIUM, FAINTING, ETC., AND THETR IN- DICATIONS. Loss of consciousness may be of three kinds (as we shall haAe occasion to consider it), two of Avhich are primarily referable to the brain, and one to the heart, namely: Aploplexy (considered as a symptom), Avhich con- sists in total suspension, of the activity of the brain, and consequently also of neivous irritability and Aitality ; Delirium, Avhich consists in disturb- ance or irregularity in the activity of the brain; and Fainting, which consists of temporary suspension of the activity of the heart, but which also iiiA'olA'es the like prostration of general neivous activity. Apoplexy, which is distinguishable by unaltered strength, or by increased strength of pulsation, accompanying total suspension of mo- tion, or motive power (which does not always return Avith consciousness), indicates an organic affection of the substance of the brain more or less critical. Delirium, Avhich is distinguishable by loss of consciousness or more properly, perhaps, of connected ideas (generally of the nature of sleep, without rest), with or without frantic movements, but ahvays with increased or diminished actiA'ity of the brain of an irregular nature, af- fords various indications, according to the particular conditions and cir- cumstances Avhich precede, accompany, or folloAV it, or to the particular disposition of the patient, Avhich may serve to qualify it. 1. When it becomes continuous, and is divested of any other symp- tom of derangement, and the functions of the system continue in regular operation, it ceases to be a symptom, assumes the individual character of an independent disease, and would seem to indicate a greater or less al- teration of the substance of the brain. INVESTIGATION" OK DELIRIUM. 55 2. When there is a continual predisposition to the return of attacks ol delirium, Avithout a permanent and continual duration, qualified, moreoA'er, by other symptoms of hysterical or hypochondriacal suscepti- bility, it is of comparatively little importance as a symptom of diseases Avhich exhibit tbat character (hysterical, etc). 3. Persons of a habit of body and temperament, characterized by a peculiar actiA'ity, susceptibility, and excitement (easily proA'oked or aggra- A'ated) of tli-e brain, so iiiA'ariably exhibit this symptom with the least acceleration of circulation, and arc so prone to become wholly abstracted by the continued actiA'ity of the organ in question, that avc should weigh Avell the accompanying indications, Avhich further characterize disease.', before attaching much importance to delirium atom., in patients of such a disposition. 4. If, however, there be active delirium—that is raA'ing, occasioned by sudden determination of blood to the brain, Avith or Avithout frantic action, Avith considerable derangement of the system, as eA'inced by other symptoms, especially if this symptom occur in persons ay ho are not subject to a manifestation of the kind, Ave should first consider—Avhether there be continuous and active kkyee. in which case Ave have an indication of the most inflammatory disposition of disease, and it remains to be considered Avhether the brain itself, or its membranes be the primary seat of inflammation,—or Avhether there has previously lieen some cutaneous eruption or efflorescence, which has suddenly dis- appeared, or Avhether there are such symptoms as forebode an eruption; or whether, again, there baA'e been cA'idenccs of inflammation, developed in some other organ, Avhich suddenly subsided or disappeared. Or, if no such manifestations be present, we may consider the delirium as result- ing from a sympathetic affection of the brain, of which the primary cause is seated in some other part,—such as the stomach or the bowels, or both, arising from the presence of irritative matters (as, for instance, Avorms, bile, etc.); or, again,—if any such cause can be identified,—the influence of narcotic and poisonous drugs, etc. 5. There is also another kind of delirium which appears as a very important symptom, especially associated with any cause of pressure on the brain, generally the immediate or remote result of— Inflammation;—Immediate, Avhen it appears as a concomitant symp- tom of the actual disease,—in which case it distinctly indicates the pres- ence of blood disengaged, and accumulating in the substance of the. brain, or suffusion of extravasated blood in the enveloping membrane ;—Remote, Avhen acute organic inflammation is not present, in which case it identi- fies the presence of water. This is what is termed drowsy delirium. It is identified by a de- ficiency of nervous and cerebral activity, the absence, even (in many cases), of any motion of the body, a species of dull, inanimate sleep, total helplessness, and complete silence, or, at the most, a low internal mur- mur ; and it is characterized by prostration of nervous action. Drowsy delirium, moreover, may appear in neivous and typhoid fea'ers, as an indication of general debility. * 56 OUR FAMILY PHYSICIAN. In any case it may be considered as a more critical manifestation, than active delirium. Fainting,—swooning, should also be considered Avith due regard to the disposition of the patient, and to the circumstances which qualify it. 1. If it be habitual, especially as the termination of violent attacks of palpitation of the heart, Avhich generally, if not invariably, lead to this issue, there is reason to apprehend organic derangement of the heart. 2. If, on the other hand, it should occur casually, after violent emo- tion—as joy, fear, grief, etc., or after severe loss of blood, etc., or as the result of casual, but very excruciating pain, or as the consequence of an accidental injury of no great moment, it is not to be looked upon as a very important symptom. 3. If, again, it be the habitual result of mere nervous excitement in persons of a highly susceptible hysterical or hypochondriacal disposi- tion,—in which case it is merely spasmodic,—it is not of great moment. 4. If, however, one or more fainting fits should usher in an attack of fearer, Ave have a positiA'e indication of the subsequent neivous type of the disease. 2. MOTION OR MUSCULAR ACTION, REST—AND THEIR INDICATIONS. Although not in accordance with technical classification, avc shall include under this head of "motion and rest," every circumstance, inter- nal as well as external, in Avhich the motary poAver is called into play, or subdued. Wherefore, it must be premised, that motion and rest are either healthy and natural, or symptomatic of derangement, and conse- quently unnatural. And, first, with respect to motion :—it is clear that to be healthy and natural, it must be subject to the will, and the consciousness; that is, that until the resolution to effect a certain movement (as of the arm or leg) instinctively calls the proper muscle into play, that muscle should remain inactive (but not incapable of action). It is also clear that it should not exceed the limit prescribed by the will (except in so far as the physical impulse prevents an abrupt arrest—as, for instance, if running at great speed, the runner should be unable to stop himself suddenly, when at the top of his speed upon the sudden intervention of circum- stances requiring it. It is further eAridently clear, that eATen if the avill, excited by sensations (Avhich are painful), does prompt motion—such as change of position—such motion is not to be considered as a healthy moATement properly so called. An apposite instance of this occurs in any restlessness caused by suffering. With respect to motion, which occurs Avhen nature in health would have prescribed rest—as in the case of rest- lessness at night,—this is evidently a case in Avhich the motion is not subject to the will, and therefore unhealthy and unnatural; because sleep is totally independent of Arolition. The active and motary con- dition of health, as the general rule for an adult male, should not con- tinue (in spite of the will) more than from sixteen to eighteen hours out of the tAventy-four. In the earliest days of infancy, it should occur during little more than the time required for feeding. Young persons INVESTIGATION OF MOTION AND REST. 57 under tweh'e or fourteen years of age, should haA-e a natural tendency to actiArity during about fourteen to sixteen hours out of the tAventy-four. Secondly, Avith respect to rest:—if understood purely in the sense of muscular inactivity, during the actiA^e and conscious operation of the avill, it is also clear, that in order to be truly denominated as healthy and natural, it must, likeAvise, be subject to the avill, which has the poAver of determining its duration, and of jireseribing its recom- mencement at any moment. Each if prompted or disturbed by the sensations, the avill is yet, to a certain extent, the mediating pow- er. As sleep is not purely a degree of muscular inactivity (Avhich it does not even necessarily induce) it is totally exceptional. But, even here, if the will be retained in proper ascendency, by being habit- ually exerted, it is well knoAvn that it has the poAver of determin- ing the duration of sleep; for many persons can Avake precisely at a giAen moment after many hours' sleep, merely by having preAdously resolved to wake at such a moment. It is e\ren admissible, that the will has an initiating power in inducing sleep, because sleep would not in many cases occur, without a resolution to permit it; and, if it occurs in spite of the avill, it is exceptional, because it must either be an unhealthy symptom in itself, or the absence of it must have been an excess of exertion forced upon nature by the avill. That sleep can be induced even Avith a disposition to rest—by a mere resolution of the Avill —has been asserted, but is far more problematical. If, however, it does not occur Avhen the will composes the body for it, it is again exceptional and the absence of it is a symptom of derangement (not healthy). It can not, nevertheless, be denied that the avill cannot coerce it; and if the avill, AvEich is refinement of nervous poAver, combat the irritation and irritability Avhich repels sleep, it becomes a mere combat between one portion of the nervous system and another (resulting perhaps in fever), both become more and more irritated, and each repels the other more Adolently. Thus the very thought that one cannot sleep, and the wish to do so, makes one more restless. The sleep of persons of all ages should be calm, neither interrupted, nor of too long duration, undisturbed, evincing a placid countenance and no evidence of pain, uneasiness, or fantastic dreams and visions. The only motion Avhich does not identify irregularity during sleep, is the occasional turn from side to side. The more noiseless the breathing, the more perfectly healthy the sleep. The skin during sleep should be warm, but neither very hot, dry, nor excessively moist. Restlessness, therefore—that is, doubly, the inability to rest, in spiteof the Avill, and the muscular motion prompted by the will (under such conditions), may be considered as an unhealthy and unnatural con- dition of activity or motion (either internal or external). As a symptom of fever, it identifies an excessive susceptibility or irregularity, and ir- ritative activity of sensation. It is a symptom rather of an inflammatory than of a debilitated state. Contraction of the txtremeties towards the belly, identifies pain in those parts (chiefly colicky pains). 5S OUR kaaiiey physician-. I'ontinnal starting up in bed, indicates great oppression and anxiety, or simply delirium. Continual sinking down towards the foot of the bed, denotes great prostration of vital energy. Throwing off the clothes—when the patient lays himself bare, denotes excessive oppression and anxiety, or simply aetiA'o delirium, which may likewise be identified by evident inability on the part of the patient to hear the bed-clothes upon the body, or Avhen they seem to oppress him like heavy weights. if the pain be occa- sioned by inflammation, irritation, or irritability of the passage, it will be qualified by a scalding sensation i when urinating toAvards the termi- nal part of the passage, \yith or Avithout discharge of matter; i3) if the pain be dependent upon inflammation, irritation, or irritability of the kidneys, the AYaler evacuated will be hot, and the seat of pain will be investigation of pain. 63 chiefly in the loins and small of the back; or, (4) if the pain be occa- sioned by spasm of the bladder, or neck of the bladder, there will be continual urging to pass Avater, but total inability to effect it; that is sus- pension of urine, Avith cutting, cramp-like, agonizing pain in the part, relieved, hoAveA^er, by pressure; that is, by doubling the body forAvard, and pressing the hands firmly upon the lower part of the belly. 4. Absence or sudden suspension of pain, in severe cases of organic inflammation, is, in all instances, a most ominous manifestation, but it may indicate two distinct conditions, namely, (1) the sudden transition of the inflammation to another organ, (in most cases to the brain,) Avhen it requires the utmost care, but is, nevertheless, not so alarming as Avhen such reappearance of the disease in another quarter does not quickly folloAV; for, in this case, the change, in the majority of cases, has been one from inflammation to mortification, (and consequent loss of sensation.) 5. Intermittent pain, which is also either periodical or irregular, or that Avhich is very seA-ere for a certain period, often accompanied by local heat or general flushes of heat, sometimes by the palpitation of the heart, and frequently by a degree of irritative fever during its continu- ance, and terminating Avith local or general sweat (and that only), and by an acute degree of nervous susceptibility and irritability, often aggravated by heat, or by slight contact, (the patient having, however, an inclination to press severely upon the part), but Avhich totally subsides during regu- lar or irregular intervals, and Avhich is of a nervous character. 6. Remittent pain, or that Avhich becomes modified from time to time for certain intervals, especially at certain periods of the day, or under particular conditions of heat, cold, access or exclusion of air, or owing to palliative measures, but which never totally subsides during the intervals, but continues dull, heavy, and persistent, instead of being highly acute, pulsating, or shooting, and which is further qualified by severe feverish symptoms during the acute stages, which, hoAvever, also become modified though never wholly subdued, during the inteivals of comparative relief. This description of pain is generally associated with organic inflamma- tions or Avith obstructive causes of irritation, with a strong tendency to organic inflammation, and identifies a tendency to chronic or continued inflammatory action in such parts or organs. 7. Inflximmatory pain, in its genuine distinctive character, is very plainly distinguishable from pain of any other nature, as, for instance: If is ever accompanied with increased heat of the particular part af- fected (if purely local), and then even in some cases, especially, if it be of long continuance, by general increased heat of the body, or alternate heat and chills, frequent and hard pulse, and other signs of fever. And if it be internal, and affecting one or more of the important or- gans, the adjacent parts, as also the Avbole body (except the lower extremeties), will manifest greatly increased heat, and the general symp- toms of fever will run high, the thirst being generally considerable, and often intense and insatiable, tin highly inflammatory subjects). It will be continuous, proceeding from bad to worse, until die crisis or other issue, 64 OUR FAMILY PHYSICIAN. It will be relieved by moisture of the skin, and general or even local perspiration. It will be greatly aggravated by pressure, or even by the least touch, as of the clothes or bed clothes, but still more so by severe pressure, which is usually insupportable. If local, there will be redness and often swelling of the parts ; if affect- ing the outer membranes, particularly of the intestines, again, redness will often be discernible externally. There will be sometimes more or less strong development of the adja- cent vessels, which will be observed to be swollen and dark, their course being palpable, where in general they are externally imperceptible. There Avill be often more or less throbbing or pulsation in the part with the pain, especially in the after or suppurative stage, (although this symptom may also accompany nervous pain.) If local, it will usually be much aggravated immediately by warm applications, such as fomentations, but will afterwards decrease, and it Avill be generally relieved as first by cold applications, but in such cases the pain Avill often return more severely, as soon as the cold application is removed. Whether local or affecting internal and important organs, it Avill be aggravated by stimulants, motion, exertion, mental or nervous excite- ment, fatigue, etc., and will have a tendency to grow worse towards night. If natural discharges have occasion to pass oA^er the inflamed sur- faces, as, for instance, of the bladder or bowels, the pain will usually become excruciating. If internal, the natural discharges will be qualified by the eA'acuation of blood, and either by being very liquid (of the excrements), or Aery dry; in any case (of all discharges) they will be deficient in quantity, occur fre- quently, and there Avill be continued urging to discharge, The external surface, Avhether attending local or internal inflamma- tory pain, will invariably be dry until the crisis, when the pain will subside, Avith the development of moisture. The pain will insuperably prevent or disturb proper rest, (sleep; a con- dition which only applies to inflammatory pain, because pains, either of a nervous or spasmodic character, may be overcome by sleep, Avhich fre- quently occurs in spite of them, especially of the latter). Consequently ex" treme and insuperable restlessness, Avith such indications as above stated, identifies pain as inflammatory. The most perfect crisis, or resolution of inflammatory pains of any kind, consists in gentle, undisturbed, and placid sleep, with proper mois- ture of the skin. 8. Nervous pains are of a fugitive, irregular or periodical, pulsating, dragging, darting character, Avith or without local beat during the entire continuance of local suffering, but then often attended Avith local sweat (simultaneously—which never occurs of inflammatory pain), flushes of PAIN AS A SYMPTOM OF DISEASE. 65 heat Avithout fea'ER or with temporary irritative fever (in modified degree) restlessness, depression of spirits, hysterical disposition, or fantastic ideas aggravated by thinking of them, and relieved Avhen the attention is dis- tracted by objects of interest, or aggravated by apparent contact,, or slight touch, and relieved by pressure, unattended Avitb any variations of appe- tite or thirst; characterized by the occurrence of involuntary motions, as by jerking, or the sensation of twittering (vibrating) in particular parts, in the latter case, frequently Avithout external perceptibility of such action—by extreme restlessness and uneasiness, Avith or without a degree of irritative fever (and often Avith a peculiarly low pulse), by intermittency or periodicity, by being usually dispelled during motion, or absorbing oc- cupation, and by a peculiarly intractable persistency continuing to recur, in spite of eA'ery resource, (when they cannot be traced to a precise point or cause), Avithout, hoAveA-er, affecting the general health, or detracting from the A'igor of the functions. 9. Spasmodic pains are of a cramp-like, contractive, and very severe cutting character, but they are usually of brief duration, though they may be of frequent recurrence. In their distinctive and peculiar qualifica- tions they are totally unassociated with heat, or any other inflammatory symptom, and are rather, except in highly excitable subjects, habitually at- tended Avith depressed than over-active circulation; but by long continu- ance they will frequently engender a reactionary inflammation, and assume all the characteristic features of inflammatory pain, sometimes becoming, in such cases, very severe and intractable. As affecting important organs, they may first accelerate, then temporarily suspend the circulation and breath. In their distinctive character they are relieved by stimulants, heat, contraction of the parts, or of the whole body (doubling up), pressure, and especially friction. In their excess they render expansion of the parts impossible. They are either local, affecting particular motaory muscles, or they are internal, affecting the muscles Avhich are connected Avith or constitute important organs. A constant and severe degree of spasmodic pain, affecting important organs (as, for instance, the heart or stomach), is indicative of organic derangement. A casual spasmodic pain, however severe, is attributable chiefly to the accidental presence of irrita- tive matters, especially in the stomach or boAvels. 10. Partial pain in the head, that is, if developed in one spot, or on one side of the head, is indicative of hysterical (in the female), or if hypochon- driacal condition (in the male). 11. Pain in the back of the head usually denotes determination of blood to the head. 12. Pressing pain in the forehead, accompanied with giddiness, com- monly implies the presence of irritative or impure substances in the stom-; ach; or, in some cases, excessive weakness:—that is, if it occur after a severe attack of illness, confinement to the bed, or more especially loss of blood, or other animal fluids. 13. Pain, particularly and persistently occurring in the back or loins, may (in females) be associated Avith pregnancy, or Avith a high degree of hysterical excitement, but in such cases as in the more general definition, it may be held to intimate the presence of, or a tendency to piles. 5 66 OUR FAMILY PHYSICIAN. 14. Pain, in the anterior part of the stomach, etc., occasioned by pres- sure (although there be no actual or positive pain without pressure), when occurring as associated Avith fever, or at the onset of fever, and further qualified by heat of the parts, and retelling (if of the stomach), or straining (if of the bowels),—denotes respectively inflammation of such part or organ as thereby typifies the fearer. 15. Stitching, or prickling pain, may denote a spasm, but more fre- quently determination of blood to a part,—or inflammation, especially of the enveloping membrane of an organic part. If it be occasioned by spasm—as of the stomach—it will be (usual, generally severe, sometimes even to the degree of suspending the breath, but passing off without return, or with a similarly casual return, in the majority of cases, upon the dislodgement of wind, especially belching; pressure and friction will relieve it. If it be the result of determination of blood, such as when it occurs on the right or left side (about the spleen), provoked by rapid motion im- mediately after eating, or the like conditions,—or when it occurs without such immediate causes (as in the right side), and continues to be percep- tible upon drawing a deep breath for some time without striking consti- tutional derangement, — pressure does not always aggravate it, unless severe, motion does: relaxation of the parts, as by bending the body for- ward, relieves. If it be the decisive symptom of inflammation, as in pleurisy, we may thereby distinguish inflammation of the pleura (the membrane which covers the lungs, etc., and lines the cavity of the chest) from inflammation of the substance of the lungs, especially if there be little (if any) pain, until the parts are expanded, as by drawing breath deeply; and its inflam- matory character will be distinguishable in the general derangement and high degree of fever which accompanies it, with local and general in- crease of heat (except sometimes of the extremities), dryness of the skin, thirst, etc. Sensations of discomfort, such as the following: 1. Restlessness has been already mentioned under the head of Motion. 2. Giddiness (simply), except in the cases reserved as important, is a symptom of no great moment, but it often serves to determine the indi- viduality of disease. It may identify a nervous condition, generally speaking, occasioned by an irritation of the stomach, when we may identify the cause as an over- loaded stomach, with a tendency to expel the irritating substances, upward. In many cases, particularly as occurring in persons of a full habit of body, it denotes congestion of blood to the head. 3. In persons of advanced age, or of apoplectic tendency, it may be looked upon as one of the unpropitious indications of imminent apoplexy. Sensations of heat and cold are of tAvo kinds,—those (l)with which there is actual heat or coldness, and those (1) which merely convey these sensa- tions, the parts affected with such feeling being neither hotter nor colder (neccessarily) in a degree which should occasion such feeling. These are HEAT AS A SYMPTOM. 67 subject to many modifying conditions—of which we shall briefly notice the most important—and are generally to be held as of very great importance in the investigation of disease. Actual increase of heat, if unqualified by any particular local determin- ation, or by particular and local pains, etc., denotes (1) increased activity of circulation, that is, fever (simply), more or less inflammatory, as the de- gree of heat is greater or less; (2) local inflammation, whether of particular parts, if purely local, or attended with general inflammatory action throughout the system, if the heat be general, and simply characterized by local determination and other particular identifying symptoms. This heat, as regards a particular spot, may or may not be externally apparent to another person,—it is sufficient that it is internally felt by the patient; (3) a dermination of blood to particular parts or organs, without active inflammation, when the heat, whether internal or external, is confined to the spot, part, or organ affected, and to those which are contiguous, (4) when inflammatory and general heat is present, it is identified by the simultaneous frequency, hardness and strength of the pulse, which increase with tlie increase of heat, and by its com^eying no unpleasant sen- sation on contact to a healthy person; and further, by the part of the healthy body thus brought into contact with it becoming so accustomed to it, after a short duration of contact, as to lose the distinct sensation of greater heat in the sick body; or (5) in the last stage of putrid fever, or as an indication that fever has assumed a portentous putrid character, it may signify incipient decomposition, in which case, hoAvever, it will in- crease as tlie pulse becomes more and more feeble, it will convey a most disagreeable sensation of a burning, stinging character to the part of a healthy body on contact, becoming more and more disagreeable the longer the contact continues, and leaving the same unpleasant sensations for some time after the contact has ceased; this is a chemical, not an animal heat. Heat in the anterior portions of the stomach, etc., and chest, and especially if conveying a burning sensation internally, to the patient, accompanying a high degree of fever, identifies, especially a general, inflammatory condition of the tributary organs of life. Heat of the hands, after eating, denotes a disposition in the disease to become habitual, or if there be no distinct disease, a predisposition to hectic complaints. Fugitive heat is particularly associated with a hysterical condition; it is, therefore, more common among females, (at certain periods espe- cially), but it may occur in either sex, associated with neivous debility, irritability, or susceptibility. Coldness of the extremities, associated Avith a severe degree of fever, denotes a high degree of inflammation in one or more of the important organs of life, such as may impede the thorough distribution of the blood throughout the system. Wherefore, it is one of the distinctive features of inflammation of the lungs, etc. But it may also denote deficient circula- tion or deficient strength of the blood, as associated with other symp- toms of an enfeebled condition, and as such it identifies depression of 68 OUR FAMILY PHYSICIAN. vital energy. Or, again, it may be the result of spasm, either of partic- ular parts or of a superior organ (as of the heart in particular), if associ- ated with other spasmodic symptoms. Numbness or deaduess of particular parts may (1) be indicative of latent and insiduous gout, and if from other symptoms there be such further analogy as to identify this condition, it may bo of much conse- quence; or (2) it may be purely nervous, and then quite superficial, in Avhich case it will generally be palliated by cold applications; or (3) it may be occasioned by temporary arrest of circulation in the parts, in which case there Avill be no contraction or rigidity, and hot applications, friction, or rapid motion Avill palliate or remove it; or (4) it may be the result of spasm, in Avhich case there Avill generally be contraction and rigidity, and heat or friction Avill likewise relieve, but motion Avill be, commonly, arrested. Itching (without the presence of any eruption), especially if preceded by chill, and accompanied by heat (as associated Avith fever) usually announces the approach of a critical SAveat; or if unattended with fever, commonly denotes an acrid condition of the humors. Chill (or the sensation of coldness without actual coldness), is a purely neiwous indication of irregularity. It may consist of a spasm of the skin. The conditions Avhich precede, accompany, and folloAV it, must indispensably be considered, in order to form a correct judgment of the various important indications Avhich it affords, and Avhich qualify every fearer; as for instance : 1. Acute fevers are characterized by the single and unrepeated occurrence of the chill. Intermittent fevers by the more or less fre- quent repetition of this symptom, according as the repetition of the fever fits return. 2. If the feaer be of an intermittent character, and the chill be slight Avith great predominance of heat, there is reason to anticipate that the disease Avi 11 run into a distinctly acute character; but if the chill be seA^ere, of long duration, and very predominant, the occurrence of heat being imperfectly developed, the disease exhibits a tendency to become sluggish and of long duration, and to assume a chronic form. 3. Chill, Avhich is very severe, and Avhich precedes the heat, may first be generally designated as identifying either \-iolent, acute, or even in- flammatory fever, or, on the other hand, intermittent feArer. 4. Chill, which is imperfect, or comparatively feebly developed, and which alternates Avith heat, (that is, is successively preceding and suc- ceeding it), usually identifies, first: fever of a nervous character, or of a rheumatic, or, secondly, catarrhal description. .">. Chill (rigor, coldness attended Avith shivering), which occurs during the course of an acute fever, possesses many important significa- tions ; as, for instance : If there be inflammation of any particular and important organ,'especially of the lungs, we may anticipate an issue into suppuration, or the still more urgent result of mortification, Avhich Avill be further identified by subsidence of pain ; or, in cases, particularly, in Avhich no decided and local inflammation has existed, or in Avhich the INVESTIGATION OF THE SENSATIONS. m general symptoms are faArorable, the approach of the crisis is identified, namely, the thorough development of an eruption, or, more frequently, the occurrence of copious perspiration, followed by general abatement of the disease ; or, Avhen inflammation of one particular organ has existed, and any abrupt arrest has taken place, such as the irregular suppression of discharge, etc., Ave may anticipate a transition to other organs; if no inflammation of any particular organ has existed, and there be evident susceptibility of any particular part, or evident tendency to determin- ation of blood to such part, or obstruction to the operation of its func- tions, we may anticipate inflammation of such part; or, if none of these circumstances be so combined as to Avarrant deductions, such as haA'e been suggested, the chill may forebode the succession of intermittent EEA'ER. Sensations of anxiety: a name Avhich is applied to a cer- tain feeling of weight or pressure, Avith oppression of the breath, of which the seat appears to be the anterior part of the stomach and chest. No pains (or very few) are so distressing as these sensations, in which there almost appears to be a struggle for life, although, except in cases of organic disease of the heart or lungs, or of inflam- mation of some important organ, or of general dropsy, etc., they are not so immediately urgent as they appear. They may be the result of an accumulation of blood in the lungs, (congestion), in which case, if the patient Avere of a consumptive habit, the symptom Avould be urgent. They may occur as a spasmodic affection of the lungs : or, again, from local derangement of the same organs, such as irregular reception and expulsion of the blood, OAving, perhaps, to the obstruction occasioned by enlargements, (as of any important gland), deposits of matter, etc., in Achieh last case, as distinguishable by the pulse, etc., much importance should be attached to them. Such sensations may be the result of merely sympathetic nervous ir- ritation of the lungs, most frequently when the stomach is affected, as by deleterious drugs, tobacco, coffee, excess of fermented liquor, or obstruc- tive and indigestible substances, in which case the affection must not be attributed to the lungs. They may be occasioned, as last indirectly stated, by overcharging or overtaxing the powers of digestion, especially if the stomach be Aveak, a condition easily identified in those Avho have been treated with copious use of purgatives, emetics, or even tonics, or who have been addicted to ex- cesses in eating or drinking, or in young persons affected with Avorms ; in such cases, if the patient has partaken of flatulent substances, or of A'ery rich, heavy, or irritating food, or of mixed liquors, or has been affected with bilious symptoms, the occasion of the anxiety is sufficiently ap- parent. They may be associated with inflammation of the heart, stomach liA'er, lungs, or bowels, or Avith dropsy of the belly, general dropsy of the system, or water on the chest; or, again, Avith permanent or organic dis- ease of the heart or lungs, or with determination of blood to any of these organs, in the majority of which cases they are of great consequence. 70 our family phasician. They may be purely spasmodic, in which case the apparent suffering of the patient Avill be greater than in any other, and it is not uncom- mon, eA'en without serious disturbance of pulse, to see the patient, as if in the last struggle of existence, either speechless and prostrate, or occa- sionally grasping at the bystanders, and feebly expressing an apprehension of immediate death. Such cases especially occur from comparatively slight causes of derangement (of the stomach in particular) in subjects of a high- ly hypochondriacal disposition, if males, or amongst females of excessiAre hysterical susceptibility, particularly if there be actually some affection of the womb. Women subject to frequent miscarriages are particularly sub- ject to be affected in this manner. Under such circumstances, these symptoms are of comparatiAely slight importance. 2. THE ORGANS OF SENSE AND THEIR INDICATIONS. This section involves, to a certain extent, not only the investigation of the condition of the sense, which may be deranged Avithout apparent derangement of its organ, but also of the external manifestation of one organ itself (especially)—namely, of the eye, as well as of the sight. The other organs of sense—namely, the ears, nose, and palate, com^ey no such very distinct or important external manifestations, or none which are not included under A-arious heads in the course of this article ; and we shall, therefore, rest contented, in alluding to these, to treat of the senses Avhich they convey—namely, hearing, smell, and taste. The eye affords a multitude of external eAi'dences of derangement— as, for instance: 1. A dilated pupil may be engendered by sympathetic irritation of the brain, as associated with irritation of the stomach and bowels, par- ticularly from the presence of worms ; or it may indicate a local affection of the brain itself—as inflammation of the membranes—or Avater—and is then the result of direct pressure upon the brain ; or, again, it may re- sult from total inaction, or suspended action of the bowels, in Avhich case the symptom would identify a sympathetic affection of the brain ; or it may be associated with insensibility of the nerve, which communicates the representations of the eye to the brain, in which case it need not be otherwise than a, purely local symptom. 2. A contracted pupil may be caused by great tenderness of light, when it consists of a convulsive effort to exclude the light from acting too powerfully upon the eye. If attended with sensibility to light, it exhibits over-due irritability of the nerves connected with the sight, and consequently an irritative inflammatory tendency. If attended with insensibility to light and as- sociated with fever, it is an indication of the utter prostration of the vital energy. Languid expression of the eyes, occurring as a distinct and appreciable symptom, may indicate (1) if associated with anxiety—overloaded stomach, or sometimes the action of fermented liquor on the stomach, or of deleter- ious substances, or of heavy and indigestible food; in such cases it fore- bodes vomiting, especially if cold sweat transpire from the forehead ; (2) THE EYE AND TASTE AS SYMPTOMS. 71 if associated with general debility as the result of sudden and severe loss of animal fluids, or of very severe acute disease, it denotes the sinking of the A'ital energy, and often forebodes fainting. Squinting or distorted sight, is always symptomatic, when it is not habitual, and constitutes a very important indication in children, especi- ally, and affords a decisive index to the case, when other symptoms con- spire to evince the probability of acute Avater on the brain. OtherAvise, it exhibits a sympathetic affection of the brain, originating in irritation of the stomach and boAvels, especially, if worms be the direct cause of such irritation. Staring expression of the eye, or fixed stare at one object, with or with- out raving, or muttering, if consciousness be absent, identifies delirium; or eA'en if consciousness be not absent (in the usual acceptation of the phrase), there is a degree of abstraction amounting, to momentary and accidental suspension of consciousness, absorbed by a fixed thought, or Avith vacancy of thought, in Avhich case also it may be termed the indi- cation of a degree or species of delirium (in its strict sense). Sunken or retracted eyes denote debility. Protruding or prominent eyes, particularly if they be glittering, and characterized by suffusion of redness, combine to identify considerable congestion of blood in the head. The sight is attended Avith some variations of distinctive import; ance—as, for instance: 1. Double sight, or half-sight, either of which may exhibit a degree of spasm, and which may be simply associated with a hyporchondriacal or hysterical disposition, but Avhich may also arise from irritation of the stomach, especially, as the result of \*ery stimulating food or drink ; in which case, hoAveArer, it is usually characterized by giddiness, droAvsiness, dread of motion, talkatiAeness or extreme taciturnity, or excessive rest- lessness, and excitement; or, again, as one of the premonitory symptoms of imminent apoplexy. 2. The appearance of a profusion of dark spots before the eyes, gen- erally coiiAreying the idea of a slow descending movement aggregately; but sometimes also of irregular oscillation, Avhich, even when the patient wanders, is often to be distinguished in some fantastical expression of dread of insects, as, in health, he or she abhors, may (according to other symptoms present) identify ox forebode:—depression of vital energy, and fainting, if the patient has suffered from A'ery debilitating affections— such as excessive loss of blood or other animal fluids, or from very rapid or severe acute disease—determination of blood to the head—or a de- ranged or over-loaded stomach ; and, perhaps, in the latter case vom- iting. 3 Obscuration of sight, affords indications analogous to those of dark spots before the eyes, as just stated: The taste affords Arery important indications in respect of its alter- ations,—as, for instance: 1. Foul taste may originate either in local affections of the mouth, teeth, throat, etc., or in irregularities of the nervous system, as occurs OUR FAMILY PHYSICIAN. particularly amongst women of a highly susceptible, hysterical disposi- tion, or, sometimes, also, without such causes, during pregnancy ;—or, v again, as associated with fea'er, in a tendency to putridity in the blood, Avhich it, therefore, denotes to a certain extent;—or again, if saltish and putrid, as occurring in persons of a consumptive constitution, or under circumstances likely to provoke consumption, it may originate in a suppurative condition of the last-named disease. Furthermore, a SAveet- ish, saline, bitter, slimy, or harsh and acrid taste, especially if consider- able phlegm be constantly in the throat, may be traced to the presence of an irritative condition of the stomach, occasioned by the presence of im- pure matters. 2. Loss or absence of taste may arise from some organic neivous affection; or, again, from cold, or derangements dependent, upon cold. The hearing may constitute a characteristic symptom, either in its excessive or deficient sensibility. 1. If deficient, as associated with fevers, and particularly with typhus, this very irregularity constitutes a who/some indication. 2. If excessive, as associated with fever, Ave may identify either a degree of inflammatory action involving the brain, or, in general, too acute a susceptibility of the nervous system. 3. Buzzing or ringing in the ears, as associated with inflammatory action, or occurring without any apparent cause, or without either of the other conditions here mentioned—in persons of a full habit of body, may be attributed to congestion of the blood in the part ; or, if associated with cold, to that Avith or without' increased secretion ; or again, to determin- ation of humors to the ears, when more or less deafness usually qualifies the case. The sense of smell is also qualified by two chief conditions, name- ly: (1) deficiency or loss of smell, which is attributable to nervous dis- turbance, or to the effect of cold (Avhen associated with cold), or to indi- gestion; and (2) unnatural conditions of smell; as for instance:—the preA'alence of putrid smell in the nose, Avhich is attributable either to local disease of an ulcerative and putrid character, in the nose or palate, or to tendency to putridity in the blood, or developed as an early mani- festation of disposition to apoplexy;—or peculiar smell (which is not putrid, but may be very disagreeable), and Avhich consists of an affection of the olfactory apparatus of a spasmodic character. CHAPTER III. GENERALITIES. 1. COUGHS, AND THEIR INDICATIONS. Coughs are of various significance, and point to various derange- ments, or seats of derangement, according to the conditions which precede, accompany or MIoav them, or by which they are immediately proAroked. They constitute a series of manifestations which should never be overlooked in the investigation of disease, because it is clear that whether associated with direct or local inflammation of the respiratory apparatus, and of the lungs in particular, or Avith sympathetic affections COUGH AS A SYMPTOM. 73 of these organs, originating in other organic causes of irritation, whether in the stomach and digestive process generally, or particularly in the spleen, liver, etc.; the presence of cough indicates, for the time being, one of tAvo conditions respecting the respiratory apparatus, namely:— either 1) that there is in the system some cause of irritation oppressing these organs directly, or reactlug upon them from other parts. If the affection be merely sympathetic, caused, as is very frequently the case, by irregularity in the process of digestion, chronic derange- ment of the lining membrane of the stomach, etc., or by the presence of any impure substance in the stomach or bowels, either received from without, or spontaneously engendered from within, it does not indicate circumstances of much consequence, as regards the organs of respiration, and should be dealt Avith purely as an affection of the stomach or bowels, etc.; Avith this reservation, hoAveA'er, that if the increased irrita- tion of the lungs, etc., be allowed to continue too long, for Avant of the removal of such provoking cause in the digestive process, it may lead to congestion of blood to the lungs themselves. If the respiratory organs themselves be clearly the seat of the affection, it may be the product of the congestion of blood, suppuration, tubercles, etc., or of a purely neiwous affection ; or, again, of inflammatory action in the lungs, or the ramifications of the wind-pipe, or primarily of common catarrh, etc. The condition of perfect health, as respects the respiratory or- gans, is, therefore, in any case, inconsistent Avith the presence of cough; for Avhen no cause of irritation, either local or sympathetic, is present, there Avill be no cough, nor anything to impede the breath, and a deep in- halation may take place, the air being retained for many seconds in the lungs, without the slighest disposition to cough. If the habit of body be such as to lead to the suspicion that there is some latent taint in the system; or, if again, the taint be testified by morbid affections of the glands, skin, or bones, or by tendency in eA'ery affection to assume a sluggish, chronic character, or by continual inflam- matory or ulcerative affections of the eyelids or gums, every cough may be of momentous importance, and should lead us to investigate its cause, and to treat the affection, of whateA'er character, Avithout delay, lest, Avhile avc pause, it should run on to organic affection of the lungs, and degenerate into consumption. Short dry cough, accompanied by watering of the eyes, and frequent fits of sneezing, in the early stage of acute fe\rer, usually prognosticates measles. It may likewise (Avithout such particular accompaniments) announce an eruption of another character. Cough,(generally),painful, hacking cough, associated with acute fevers (other than those originating in, or associated Avith cold), may often be the foreboding symptom of incipient inflammation of the lungs ; when the manifestation of crepitating (crackling) breath Avill frequently be decisive. Predisposition to cough, as the result of every exertion of the lungs- such as the accelerated breathing caused by the rapid motion, or speaking, or laughing; or e\ren as occasioned by mental or moral excitement—such 74 OUR FAMILY PHYSICIAN as emotions, etc., or, again, as the result of every derangement of the sys- tem, usually identifies a tendency to organic affections of the lungs. Chronic, dry cough, especially if associated Avith more or less difficulty in breathing, and readily provoked by the slightest causes, and accom- panied from time to time with stitching sensations, or pains in the chest, A\-ould lead to the belief tbat tuberculous disease had set in. 2. TRANSPIRATION FROM THE SKIN, AND SAVEAT, AND THEIR INDI- CATIONS. The more distinctive method of dividing the consideration of this cutaneous process, Avould be to consider "transpiration," properly so called, as a healthy, natural operation—indicative of derangement only, when qualified by excess or deficiency. Excess of transpiration, under the name of sioeat, and deficiency of transpiration, under the name, of dryness of the skin. 1. The transpiration of health, is evinced by softness, with slight moisture of the Avhole surface of the skin, in an equal degree, and Avithout any roughness, crackling, extreme tension, shriA^eling, or Avithering, or flaccid, flabby looseness of the skin, but Avith natural fullness and elastic- ity ; and it consists of a continual, imperceptible, gaseous exudation. 2. Sweat is a disturbed degree of transpiration, characterized by ex- cessive discharge of humor of the skin; it may be perfectly consistent with health as the result of severe corporeal exertion; but in relation to disease, sAveat must be considered as of two distinct kinds: (1) that which accompanies the healthy determination or crisis of disease, or by which such healthy determination is effected, Avhich is called critical, and (2) that which occurs before the critical period, which is folloAved by no relief, but rather by aggravation, or which is excessiA'ely profuse, which forebodes, or ushers in, or originates from the peculiar operation of disease itself, especially characterized by the eruption of pimples (and not of a healthy reaction), which is called symptomatic. Of the latter variety—symptomatic sweats—Ave may particularly no- tice (1) SAveat occurring in the morning (without preA'ious habit of the kind) and which, if associated with fever, identifies its hectic character; (2) offensive SAveats, which, as associated with fever, identify putrid typhus ; (3) sweat emitting a sour smell, which commonly characterizes the feArer as miliary; (4) local sweats, as, for instance, on the chest, or about the head, which are characteristic of determination of blood to those parts; (5) cold SAveats, which denote a depression of vital energy, and which, in the last stage of prostration, forebode dissolution ; (6) transitory SAveats, as opposed to the continuous sweat of a wholesome crisis. (7) Symptoma- tic sweats may, hoAvever, be caused by a mere accessory mismanagement —such as Avant of ventilation, and excessiA-e heat of the apartment. The use of feather-beds, which is much to be deprecated, especially in cases in which feA'er becomes de\reloped, or the superfluous (and Arery mistaken) excess of covering; (8) otherwise we may generally attribute them either to great debility of the Avhole system, as associated with depressed pulse, etc., especially if occurring after long and debilitating diseases, seArere loss of blood or other animal fluids, or other exhausting causes ; or to aecumula- THE COMPLEXION AND ITS INDICATIONS. 75 tion of noxious matters or substances in the stomach, Avhen they will appear more particularly about the foreheadand face, and will usually be cold and clammy; or again, to overdue actiA'ity of the circulation, ac- companied with comparative deficiency of energy in the functional'pro- cesses of the skin. Critical Saa'eat, on the other hand, is to be distinguished (1) by affording general relief, and by the simultaneous modification of every source of suffering and the subsidence of the irregularities of the pulse; (2) by being warm and clammy; (3) by being deA^eloped over the whole surface of the body simultaneously ; (4) by the subsidence of all restless- ness, nervous irritation, or mental uneasiness, and the occurrence of calm, even, undisturbed sleep ; (5) by continuity; (G) by the period of its deA'elop- nient, in relation to the duration and course of a fever—viz., on what is termed the critical day of those fevers which run a regular course, and usually resolve themselves into an issue about a given period, as on the seventh or fourteenth day, etc. 3. THE COMPLEXION, AND ITS INDICATIONS. Red florid complexion, commonly identifies determination of blood to the head, or a full habit of body in general. White (cold, dead Avhite) complexion of young females at the critical age, denotes a difficulty in the sexual transition—green sickness. Faint-yellow complexion, usually denotes intestinal disease—disease of the bowels. Deep-yellow complexion, on the other hand, identifies jaundice, or even organic disease of the liver. Pallid complexion, with (more usually) meagreness, want of fullness of the skin, commonly identifies the stomach and intestinal canal as the seat of disorder, and may be caused by any obnoxious or impure matters therein—such as Avorms (in particular), or associated with acidity of the stomach; with a draAvn, sunken appearance (especially), it denotes spasm ; with (more usually) puffin ess of the flesh, it is associated with constitutional Aveakness, qualified by sluggish circulation or congestion, or excess of watery humor (as a constituent) in the blood, or by deficiency of blood 6. Patchy redness of the complexion—that is, redness as of a flush- spot on the cheek, denotes a hectic disposition. 7. Sudden and total change in the appearance of the complexion, is often to be considered as a very serious manifestation. 8. Livid spots, may, in advanced age, lead to an apprehension of ap- oplexy, as indicating inactive accumulations of blood upon important organs (with stagnant circulation); the general indication, however, afforded by this manifestation, is that of a putrescent condition of the blood (as associated with scorbutic habit of body). 9. Blue, or livid complexion (habitual)—organic affection of the heart. 4. SOUNDS EVINCED BY' THE CHEST, AND THEIR INDICATIONS. The only varieties which have been considered susceptible of general investigation, or which appear appropriate for the consideration of un- 7G OUR FAMILY PHYSICIAN. professional persons, are such as are plainly manifested, by Avhat is termed percussion— that is, by tapping upon the chest, etc., Avith the tips of the first tA\'<) fingers of the right hand, or upon the index finger of the left hand being laid flat upon the surface,—and which we shall con- fine to the clear and dull sounds. Auscultation, or the act of listening py the application of the ear to the chest, [immediate, or by the unassisted ear—mediate, or by the stethoscope), requires anatomical knowledge, and considerable experience, to insure a correct interpretation. 1. The dear sound,—ox that Avhich conveys the idea of an unoccupied cavity—is a sufficient evidence that the cavity of the chest and the lungs are free from any abnormal formations or accumulations of obnoxious matters—such as blood, matter, water, etc.; and therefore indicates soundness. 2. The dull or muffled sound, or that Avhich conveys the idea of a cavity, the resonance of Avhich is impeded by repletion, indicates the presence of accumulations, Avhether of blood, matter, or Avater, etc.,—and consequently unsoundness. The sounds elicited anteriorly, posteriorly, and laterally, on one-half of-the chest, ought to be carefully compared with those of the other, but as the sound is naturally dull, over the re- gion of the liver, Ave must not expect to find it clear beloAV the sixth rib anteriorly, the eighth rib laterally, and immediately beneath the shoul- der-blade posteriorly. 5. THE A'OICE, ANT) SPEECH, AND THEIR INDICATIONS. 1. Loss of voice,—Avhich maybe occasioned by paralysis, or by sim- ple spasm in the organ of A-oice,—generally, hoAvever, indicates inflam- mation of the upper part of the Avind-pipe; and if this symptom become permanent or chronic, it denotes organic disease of the part, 2. Hoarseness—is likewise a symptom which originates in the upper part of the Avind-pipe; and may consist of a temporary congestion or in- flammation resulting from cold, or may denote organic disease of the part. 3. Stammering,—as associated Avith fever, is a symptom of great moment, and which may sometimes be distinguished and foreshadowed in the earlg stage of disease, by the imperfect pronunciation of particular voAvels or syllables,—in Avhich case it should be held to forebode seA'ere affection of the brain. It is a frequent premonitory symptom of ap- oplexy. 4. IjOSS of speech,—is a A'ery graA'e symptom Avhen it occurs associ- ated with concussion of the brain, apoplexy or typhus. Or it may be associated with Avorms or other noxious matters in the intestines, or simply with hysterical disposition: or, again, it may be the result of spasm, in Avhich case it may assume a periodicity. 6. TEARFULNESS AND LAUGHTER, AND THEIR INDICATIONS. 1. Copious icatering of the eyes,—in the early stage of fever, common- ly forebodes measles; or, if occurring in the course of acute feA7er it usually denotes determination of blood in the head. SNEEZING, YAAVNING, GROANING,. ETC. 77 2. Tearfulness or weeping,—provoked by the most trivial causes, is one of the chief manifestations of hysterical disposition, the same being the case of laughing ; wherefore, the tAvo symptoms are generally com- bined, and the one succeeds or runs on into the other. In such cases, hoAvever, laughter is generally the first symptom, which, becoming pro- longed and convulsive, is conA^erted into weeping. An excessive susceptibility and tearfulness, or weeping upon the slightest vexation, or upon fantastical grounds of vexation, is similarly indicative of a hysterical disposition, and is one of its chief indications. 3. Laughter—in every case denotes a great degree of nervous irrita- tion, both as regards the "superior faculties, and the animal functions; if there be a predisposition to laughter, which is provoked by very trifling causes, a hysterical disposition is clearly identified, as already stated, un- der the head of tearfulness,—if associated Avith fever, this symptom often forebodes coriA'ulsions or delirium. 7. LOSS AND UNHEALTHY INCREASE OF FLESH, AND THEIR INDICATIONS. 1. Accumulation of flesh (fat),*—Avhich is sudden, excessive, or other- wise irregular, is usually associated with organic disease of the liver, but may, at any rate, be very closely Avatched to detect the first manifestations of distinctive indications of disease. 2. Emnciation, or loss of flesh, when it does not occur as the result of fever, or of distressing affection of the mind—such as deep and gnawing grief, or continued mental excitement, etc.,—may be attributable (1) to undue and irregular discharges of blood, etc., evacuation of water, and the like; (2) to disease of the lungs, or of other organs connected Avith the res- piratory apparatus; (3) and most frequently to derangements involving the digestive functions, and seated either in the stomach or boAvels. 8. SNEEZING, YAWNING, GROANING, ETC., AND THEIR INDICATIONS. 1. Sneezing is directly caused by irritation of the nerves connected with the lining membranes of the nose, and consists of a convulsive respiration; —it may be the result of irritation in the bowels, and as such, Avhen it occurs very frequently in children, without being associated Avith any more direct cause (as here stated) avc may infer the presence of avorms, as the provoking cause;—or it may occur as an incipient symptom of measles, if associated with eea'er Avhich cannot be traced to cold; or again, it may be the mere manifestation of cold in the head. 2. Yawning is the result of sluggish passage of blood through the lungs, and if associated with feaer, Avhether acute or intermittent, in its incipient stage, it identifies one of two conditions, either a spasmodic or a debilitated state. 3. Groaning may be attributable to purely mental causes, with which, indeed, this symptom is generally associated:—otherwise it affords the same clue to the distinctive nature of the affection as the preceding sym- tom (yaAvning). * It is not unworthy ot notice, that the same symptom has been identified amongst the inferior animals as accompanying the earliest stage of diseases, resulting from obstruction oi the biliary ducts. 78 OUR FAMILY PHYSICIAN. 9. THE SALIVA, AND ITS INDICATIONS. The distinctive features respecting the saliva, as indicative of more or less derangement, are either an increased or a deficient and diseased flow of this fluid, as compared with the habitual condition of health respect- ing it. 1. Deficieiv;y of Saliva, or dryness of the mouth and throat, denotes either (1) a deficiency of the watery humor as a constituent of the blood, and consequently an inflammatory or feverish condition,—in Avhich case it Avill occur as a continuous symptom, associated Avith extreme thirst;—or (2) may orginate purely in spasm, in which case it Avill occur but casually, and if attended Avith unnatural thirst, the latter symptom Avill disappear Avith the direct cause, and with the resumed action of the salivary glands. A diseased state of the saliva, which is so frequently associated with indi- gestion, may be manifested in the form of a thick and tenacious, or — though less often,—a thin and acrid fluid. 2. Increased flow of Saliva may either be critical, as, for instance, in smallpox, or in sluggish neivous fevers, or in fearers generally, as occa- sioned by, suppression of transpiration (through the skin); or it may be symptomatic (in which case it may either identify a purely local affection of the salivary glands, or be associated with sympathetic disorders orgina- ting in the stomach or intestines,—such, for instance, as that deranged state AA'hich gives rise to the existence of worms); or again, it may be asso- ciated with sore throat. 10. THE EXPECTORATION, AND ITS INDICATIONS . 1. Expee;toration, Avhich indicates a wholesome determination or crisis of disease, especially inflammatory diseases affecting the lungs, is technic- ally termed "critical," is identified by the facility with which it is detached and expelled, by the absence of pain associated with it, and, on the con- trary, by the relief which it affords—and by exhibiting a thick agglomer- ative consistency and yelloAvish color, occasionally modified by a few slight streaks of blood. 2. Expectoration, which is expelled by an effort, such as repeated hawk- ing or coughing, or which causes more or less acute pain or soreness in the effort to detach it, may either denote the presence of accumulations of obstructive and obstructed matters in any of the air-cells or tubes, or in the windpipe, or Avhence the discharge of expectorated matter proceeds, as the result of a continued irritation. If jelly-like, or sticky and rusty-colored, it will usually indicate inflam- mation of the lungs. If transparent, stringy, or sticky, sometimes streaked with blood, and expectorated with much difficulty and without relief to the patient, it commonly identifies acute inflammation of the tubes of the lungs (bron- chitis) ; in which affection a change in the expectoration to that of an opaque yellow, or greenish-white colored substance, which is easily coughed up, and is folkrwed by considerable relief, gives evidence of sub- siding inflammation. If it be of the character of matter, or if whitish streaks are seen, or small whitish-yellovv, sometimes globular, masses, connected together by DIET AND REGIMEN. 79 or floating amongst sticky phlegm (continuously), it is usually a symptom of suppurative (the second stage of) consumption; again, if it consist of masses of substance of a brown or greenish-white color, and which flatten at the bottom of the vessel, into a shape resembling a piece of coin, it is an indication of an advanced stage of consumption. If it be of pure blood, it may be the result of inflammatory action, or of consumption; but it is very frequently the offspring of congestion, or an overcharged state of the vessels of the lungs. If a permanent symptom (and not a critical expectoration), it is generally of much import. If yelloAV, and particularly if also bitterish, affection of the liver is identified. CHAPTER IV. DIET AND REGIMEN. These excellent rules on diet have received the approbation of all classes; the self-denial imposed seems more stringent than it will prove on being carried into effect. Many individuals, in the author's own ex- perience, have pursued the same system of diet, after they had no further occasion for medical assistance, thus continuing from choice what they had begun from necessity. These dietetic rules consist merely in the avoidance of medicinal and indigestible substances during treatment, both as calculated to interfere with the action of the medicines and the proper functions of the alimen- tary system. Consequently, among liquids, the articles generally pro- scribed are green tea or strong black tea, coffee, malt liquors, Avine, spirits, and stimulants of every description ; lemonade, or other acid or alkaline drinks, and natural or artificial mineral waters. On the other hand, co- coa, unspiced chocolate, toast, rice or barley-water, oatmeal gruel sweet- ened with a little sugar, or raspberry or strawberry syrup, if desired; whey, milk and water, or pure milk not too recent from the cow, boiled milk, and, in some instances, butter-milk, or, in fact, any non-medicinal beverage is allowable. The diet should, however, be accommodated to the peculiarities of constitution in individuals; for instance, some persons cannot take the smallest quantity of milk without serious incon\'enience; others throw out a rash after partaking of fish ; and, again, others loathe the very sight of animal food. These peculiarities should also be taken into account in the selection of the remedies. Of the varieties of animal food, pork, young or salted meats, and, amongst poultry, ducks and geese, were better avoided, particularly when derangement of the digestive functions exist. Beef, mutton, venison, and most descriptions of game, if not too long kept (high), pigeons, larks, rabbits, etc., are allowable at discretion. (Refer to the Synopsis.) Fish is a wholesome article of diet, and may, in most cases, be par- taken of occasionally, with the exception of the oleaginous species—such as eels, salmon, etc.; or shell-fish—as lobsters, etc.; and all kinds of salted, pickled, potted, or smoked fish. 80 OUR FAMILY PHYSICIAN. Eggs, when knoAvn to agree; butter, if free from rancid or unusual taste; cream, plain unseasoned custards, and curds, are also admissible in moderation. stimulating soups and high-seasoned or rich-made dishes are directly opposed to this regimen. Beef tea, veal and chicken broth, etc., thickened with rice, macaroni or sago, and seasoned merely Avith a little salt, are of course alloAvable. Amongst Aegetables, all of a pungent, aromatic, medicinal, or indiges- tible description, or greened Avith copper, are prohibited; such as onions, garlic, eschalots, asparagus, radishes, horse-radish, celery, parsley, mint sage, mushrooms, etc., but others free from such qualities, such as pota- toes, french-beans, green peas or beans, cauliflower, spinach, seakale, mild turnips, carrots, etc., may be used Avith the needful precaution of avoid- ing any particular article of diet, Avhether of the animal or vegetable, king- dom, that may seem to disagree in the particular case in question. Lemon or orange-peel, laurel leaA'es, bitter almonds, peach leaves or kernels, fen- nel, aniseed, marjoram, etc., are objectionable; acids, and the ordinary condiments, such as pepper, mustard, pickles, etc., and salads, ought either to be sparingly partaken of, or entirely abstained from, particu- larly by persons prediposed to indigestion. Salt and sugar in moderation are admissible. All kinds of light bread and biscuit, free from soda or potash, and not neAvly baked; also simple cakes, composed of flour or meal, eggs, su- gar, and a little good butter ; or light puddings, such as bread, rice, sago, semolmo, Avithout Avines, spices, or rich sauces, are admissible; but col- ored confectionery, pastry, and in some cases also honey, must be rejected. Regularity in the hours of meals should be observed, and too long fasting, as Avell as too great quantity of food at one time, should be avoided. It is not sufficiently considered that excess in eating, even Avholsome and digestible food, is a most grie\'ous error. The lightest diet will impede the operation of the digestive functions if the stomach be overloaded. It Avere ahvays better to leave the table unsatisfied than to indulge in any excess in this particular. Nor should it be forgotten, that a craving ap- petite, Avhich induces an inclination to eat excessively, is in itself an un- healthy condition, Avhich requires to be counteracted, rather than to be encouraged. During fevers and inflammatory affections, the patient must of course be kept upon a Ioav regimen—gruel, barley-Avater, etc., and at the com- mencement of convalescence a light pudding, Avith a little Aveak beef tea, or mutton or chicken broth, should form the Avhole of the nourishment giA-en. Nature, hoAvever, is our best guide ; and Avhenever she takes aAvay appetite, the necessity of not taxing the digestive functions must, Avith rare exceptions, be deemed imperative. (See Fever and also Si/nopsis of the Rules for Diet). CLOTHING AND HABITS. Upon the first point it Avere scarcely worth Avhile entering into any obserA-ations, Avere it not simply to remark upon the impropriety of Avearing garments impervious to air, and fitting closely to the shape, and ADMINISTRATION AND REPETITION OF HOMCEOPATIIIC MEDICINES. 81 the custom of exposing the extremities and chests of young children to the chilling atmosphere of our peculiarly variable climate, un- der the absurd idea of making them hardy. The evil consequences arising from the check given to perspiration, by the first-mentioned practice, are too well known to require any particular comment; but as the other is an error widely prevalent, I consider it my duty to mention it; and I feel assured, that, if mothers would only reform their system, and clothe their children in a more rational manner, they would make no slight advance towards the prevention of serious affections, not only during childhood, but in after life. Cotton, linen, and even leather worn next to the skin, are generally preferable to coarse woolens. As regards habits, it may be briefly observed, that a regular method of living, a\roiding ill-ventilated apartments, late hours, dissipation, over-study, anxiety, and other mental emotions, and taking sufficient air and exercise, are the best preservatives of health. The frequent use of hot-baths is injurious and liable to retard the cure under treatment. The idea that sea-bathing is almost universally beneficial is exceedingly erroneous; there are many constitutions on Avhich it acts prejudicially. Medical baths, either natural or artificial, are strictly forbidden. Bathing the whole frame daily with a sponge or wet towel, with cold or scarcely tepid water, and the use of the flesh- brush, are by no means objectionable, and frequently indeed strongly to be recommended. (See Notes on the Use of the Bath.) ADMINISTRATION AND REPETITION OF HOMCEOPATHIC MEDICINES. The method, quantity, potency, and frequency to be selected and ob- served in the administration of the remedies, will be stated more explic- itly as regards particular cases in the subsequent directions for the treatment of diseases. There will also be additional particular in the Remarks on Internal and External Remedies ; and material assistance may be derived from the Repertory. Yet much will still be left to the discrimination and judgment of the administrator; because it is obvious, that a multiplicity of exceptional cases and conditions will arise, to which no general rule and few special regulations will apply. In instances of this description the particular character of each symptom distinguishable by the conditions under which it is manifested—or still more properly the assemblage of symptoms similarly qualified by conditions, will be the safest guide for the judicious selection of the remedy ; and the continuance, return, suspen- sion, aggravation, palliation, modification, or change of such particular features of ailment, Avill serve to regulate the repetition, suspension, or change of the remedy. The same circumstances will also frequently guide the administrator to change the potency, when the remedy he has se- lected is evidently indicated, but has not been followed by adequate results; or in other instances to adopt an analogous remedy, when both of the previ- ous methods have equally failed. In pursuing such changes, great care should be taken in turning to the Table of Analogous Remedies, and from thence to the Repertory, and in 6 82 OUR FAMILY PHYSICIAN. thereby selecting the remedy or potency whose operation assimilates most nearly to the aggregate features of symptoms and conditions in the case. The form of the medicine.—With respect to the form in which the medicines should be used, see the leading notification under the head of "Remarks and Regulations respecting Internal Remedies and Doses." Repetition and selection.—The following are a few of the gen- eral rules to be observed in the domestic employment of the homoeopathic medicines:— In diseases which are severe, and run their course rapidly, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or improve- ment declare itself, but the disease seems to gain ground, repeat the med- icine. In cases of high inflammatory action, Aconite or Belladonna, etc., should sometimes be repeated at intervals, varying from fifteen minutes to two, four or six hours. If a medicinal aggravation take place, followed by improvement, we must let the medicine continue its action, until the improvement appears to cease, and the disease again makes head ; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, however, no perceptible medicinal aggravation take place, but improve- ment follow, we may safely await its approach to a termination, ere we again administer. If any symptoms remain, from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine, which seems best fitted to meet them; but refrain from changing the remedy as long as benefit results from its employ- ment. In diseases whose symptoms are obstinate and long-continued, and in those which are virulent, but of short duration, as well as in those which partake somewhat of these features of violence, when a very striking improvement takes place, it will generally be found ad- vantageous to cease to administer the medicine as long as the improvement continues, and only to repeat as soon as the slightest symptoms of activity in the progress of disease reappear. But when a sudden or marked improvement, of comparatively short duration, follows the first dose of a remedy, and on repeating the dose, the symptoms of the com- plaint increase instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, and that another must accordingly be had recourse to, in the selection of which it will be necessary to choose one related or analogous to the remedy first prescribed. The distinguishing of the medicinal aggravation from that of the dis- ease, being a point of material consequence, Ave shall here give the leading and most usual characteristics of each. The medicinal aggravation comes on suddenly and without previous improvement; the aggravation of the disease more gradually and frequently following an amelioration. Lastly, the pulse is also a discriminative .guide, particularly in fevers and inflam- mations. Thus, when it becomes less frequent, or when, at all events, it does not increase in frequency, on an accession of aggravation, the ex- acerbation is to be attributed to the medicinal influence; but Avhen the selecting and repeating homoeopathic remedies. 83 reverse is the case, the aggravation of symptoms must be considered as depending on the advance of the disease. We cannot attach too much importance to the necessity of careful watching the effects of each dose, as, in addition to the temporary aggra- vation of the symptoms which sometimes set in, a development of col- lateral or medicinal signs occasionally takes place, particularly after fre- quent repetition of different remedies, in susceptible patients. By a want of attention, therefore, to this important point, we may incur confusion, and may be unconsciously treating a temporary medicinal disease of our own creation. We must also guard against falling into the opposite ex- treme—that of allowing the disease to gain head unchecked. Slight diseases are often removed by a single dose of a well-chosen medicine ; the more severe and deeply-seated disorders are also frequently removed by a single dose of a well-selected, or specific remedy; but in general cases, and particularly those which have been long and rudely treated by other means, a frequent repetition is usually required. As a general rule, however, a given number of repetitions, more or less, according to the severity of the case, will serve to place the patient thoroughly under the influence of the medicine, after which the pause may be protracted so long as the indications of progressive improvement are present. If, then, it becomes necessary to resume the administration, it will generally avail at remoter intervals than during the previous course. In complaints which are of a mild, though sluggish type, and which are unattended with any critical characteristics, the intervals, in the first period, may vary according to circumstances, from six to twelve hours. But in most complaints, in which constitutional or local inflammation is present, the intervals, in the first period, should not ex- ceed four hours, and when important organs are involved, and consti- tutional fever runs high, these intervals should not, at first, exceed two luours. In severe acute affections, such as inflammations, fevers, etc., we may often repeat the same medicine in the same dose, at regular intervals, as long as it does good: but this rule has many exceptions, and the directions already given at the commencement of this article should be borne in mind. In obstinate and lasting cases, by a long-continued administration of the same medicine, the patient often becomes less suscepitible to its ac- tion ; in such instances, if the improvement remains stationary, or pro- gress slowly, we may gradually increase the dose, or, still better, give, at suitable intervals, some other remedy or remedies, of as nearly analogous medicinal properties to that first administered as possible, and then return to the original remedy, if needful; if, on the other hand, decided amelior- ation follow each administration, we should allow a longer interval to elapse before repeating, by which means the system gradually recovers itself, and the susceptibility to medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases ; in such instances a higher potency should be selected—provided the remedy still appears to be ap- 84 OUR FAMILY PHYSICIAN. propriate—and the intervals between the doses should be lengthened. This occasionally occurs when the medicine has been frequently repeated, and given in solution. When the beneficial effect of a medicine is interrup- ted by any intermediary irregularity, such as, attack of cold, looseness of the bowels, etc., some other medicine must be given for the new affection, on the removal of which, the medicine, which was previously acting fav- orably, must be again used. In the Selection of the Remedy, it is not necessary that all the symptoms noted should be present; at the same time care must be taken that there are no symptoms uncovered by the medicine, or which more strongly indicate another remedy. REMARKS RESPECTING INTERNAL REMEDIES AND DOSES. PRELIMINARY OBSERArATIONS AS TO THE FORM OF THE MEDICINES. The Form in which Homoeopathic Medicines are employed for inter- nal administration requires some particular notice, in order that the reader may have an additional opportunity of administering the medicine with the medium or vehicle which may be most likely to promote its ac- tive operation in the case under consideration. It is well known that the medicines are prepared in three distinct forms, namely : GLOBULES, TINCTURES, AND TRITURATIONS OR POWDERS. 1. Globules (or pellets of sugar of milk saturated with the tincture), are, in the great majority of cases, the only form required for domestic treatment, and so greatly facilitate the explicitness of the directions for doses, that in the first instance, all the medicines comprised in the list of the remedies which are quoted in this work, must be understood to be recommended in globules, (at the potencies, also, stated in that list). Dose.—For adults eight globules, either dry or disolved in a little water (a teaspoonful). For infants two globules in the same manner. 2. Tinctures might, as far as practical purposes are concerned, be coupled with Triturations, the latter being the form in which those reme- dies which are insoluble &xe first made, and consequently which represents those lesser degrees of attenuation which are administered in a fluid form —of such remedies as do not require such pulverization to render them soluble (or approximately so). It is this fluid form of soluble substance which is called the Tincture. Tinctures at low potencies (i. e. from the 1st to the 3d, and even, in some exceptional cases, the mother tinctures) have, upon the whole (like Triturations), been found better adapted to the treat ment of acute diseases and some forms of scrofula, ague, etc. Dose usually employed—For an adult, two drops to a spoonful of Avater • or, in cases in which the substance medicating the tincture is pre- cipitated (becomes thickened) by water—as, for instance, camphor — then give tAvo drops on a small piece of pure loaf sugar. For a child above tAvo years and under twelve years old, one drop- constituting from two to three doses, according to the strength of the child. ° For an infant under Iavo years old, one drop, similarly divided into six to eight doses, Doses for children, potencies. 85 3. Triturations, as has already been explained in speaking of nc- tures, represent the lower potencies (as administered in the latter) in powder, of substances which are not susceptible of immediate (approx- imate) solution, and Avhich require previous and repeated pulverization, and extreme and minute distribution. The administration of Triturations is adapted to circumstances such as those just mentioned in relation to the Tinctures (of completely soluble substances). The objection to THturations for unprofessional persons is, that being in ponrler, we have noother means of naming a precise quantity for the dose than by indicating the weight. Persons, therefore, who are in the habit of using them, should furnish themselves with appropriate and well- approved scales. Dose usually employed. For an adult, from half a grain to a grain, about what Avould lay on the point of a penknife blade of medium size. For a child between two and twelve years old, half a grain distributed as equally as possible into three portions—one of these third por- tions constituting a dost. For an infant under two years old, one-sixth part similarly. 1. Previous to undertaking the treatment of any affection it is advis- able that the article on the administration and repetion of the med- cine should be carefully studied. 2. Should the progress of the malady, notwithstanding treatment, without a distinct change in the nature of the symptoms, indicate a change of the remedies, it is advisable that the table of analogous remedies should be consulted in the selection of the new remedy. 3. In cases in which the distinctions between the indications for dif- ferent medicines prescribed are so slight as to leave the least doubt on the mind of the administrator, as to which he should select, the decision will be determined by making out the list of symptoms and referring to the Repertory. This difficulty may frequently arise Avhere two or more medicaments are of closely analogous operation. 4. Of doses for infants and children.—Where no particular di- rection is given for the treatment of young children, or children under the age of twelve years, it is to be understood that the dose in general cases, should be in the proportion of one-third of that directed to be taken generally, or especially for an adult, as nearly as that proportion can be ascertained. The general dose for an infant, under six months of age, may be stated at the proportion of two globules to three tea-spoonsful of water, which solution should be administered by the tea-spoonful at each dose. The general dose for an infant, between six and tAventy-four months old, may be stated at two globules to the tea-spoonful of Avater for each dose. 5. Of potencies.—With respect to the potencies or dilutions to be employed, although it is by no means an essential point, still, as all the di- rections for treatment hereinafter given have been drawn in conformity with that scale, it is well that they should be in accordance with those quoted in.the table of medicines and dilutions prescribed in this Avork. 86 OUR FAMILY PHYSICIAN. 6. Of the division of doses and solution.—The doses prescribed in this Avork are all directed to be taken in solution, as that is doubtless the most efficacious method of administration. But when that is not con- venient, oris rendered impossible by the state of tlie patient, the globules may be administered dry, by being placed on the tongue. When the solution of any medicine in water has to be kept more than three days before the whole is consumed, it is necessary to preserve the water from decomposition, by adding six drops of proof spint to the two table-spoonsful of solution. In very hot weather, one day should be the limit beyond which no solution should be kept without such infusion of spirit. When it is not convenient to add the proof-spirit to the solution, the only way of obviating deterioration is to make afresh solution at the ex- piration of every such stated period of time. The best medium of solution is distilled water; the next, filtered or pure rain-water; the next, water which has previously been boiled or pure spring water. 7. Of the recurrence, suspension, etc., of doses.—It were im. possible, as has been already stated, in laying down a general rule for treatment, always to assign a given recurrence of the dose of any remedy, without being as egregiously wrong in one case as one might be positively right in another. The discretion of the person who uses the med- icine, guided by a careful study of the article on the repetion of medicines must indicate the frequency of the doses—the pause— the renewal—and the change—according to the conditions of each partic- ular case. As far as the frequency, suspension, and resumption in the exhibition of medicine can be reduced to a systematic scale, this has been done in the subjoined Table, from which the patient may occasionally deiive assist- ance, but to which he must not trust in the least exceptional instances. Great care must be taken in distinguishing between the scale set forth for acute, and that designed to direct the treatment in chronic disease. The constitution, temperament, and habit of body must also modify all set regulations in respect of the recurrence, etc., of doses Highly susceptible subjects require more sparing treatment, and must be closely watched to obserA'e the earliest indications in the cessation of effect, medicinal aggravation, or other exceptional conditions. 8. Of consecutive treatment.—It is a manifest error, in treating of any malady, to direct a patient positively to begin by the administra- tion of this or that remedy. Every malady may develop itself in a variety of ways. The incipient stage of the same disease, even, is scarcely ever identical in two cases. In all instances, the development of complaint must depend upon constitutional tendencies, atmo- spheric influences, external circumstances especially relating to each case, condition of the system of previous treatment, etc. All the remedies which are applicable to the treatment of any com- plaint within the proper province, of domestic management, together with the symptoms which indicate the exhibition being detailed, the only way in MEDICINES, WHEN TAKEN, ETC. 87 which an unprofessional person will avoid error is by invariably selecting the REMEDY INDICATED BY THE SYMPTOMS THAT ARE PRESENT, 'and I the circumstances which attend them, irrespective of any ORDER OF succession, except where (as next stated) a particular course of medi- cines is directed to be taken in rotation. When the medicines prescribed in this volume are intended to be taken in succession, one after the other, or in alternation, etc., they will be invariably indicated by figures, viz.: (1.) MERCURIUS. (2) SULPHUR. (3) CALCAREA. As a general rule, however, when consecutive treatment is required with medicines of analogous properties to those below stated, it will be found that such as are named as operatiny beneficially after others, will be prefer- able for selection in such relation to former treatment, viz.: After ACTDUM-NITRICUM—Calcarea, Petroleum, Pulsatilla, Sulphur " ACIDUM-PHOSPHORICUM—China, Lachesis, Rhus, Veratrum. " ACIDUM-SULPHURICUM—Pulsatilla. " ACONITE—Arnica, Arsenicum, Belladonna, Bryonia, Cannabis Ipecacuanha, Spongia, Sulphur. " ALUMINA—Bryonia. " ANTIMONIUM CRUDUM—Pulsatilla, Mercurius. " ANTIMONIUM TARTARICUM—See Tartarus-emeticus. " ARNICA—Aconite, Ipecacuanha, Rhus, Sulphuric-acidum. " ARSENICUM—China, Ipecacuanha, Nux-vomica, Sulphur, Ve- ratum. " BELLADONNA—China, Conium, Dulcamara, Hepar, Lachesis, Rhus, Stramonium. " BRYONIA—Alumina, Rhus. " CABCAREA-CARBONICA—Acidum-nitr., Lycopodium, Phos- phorus, Silicea. " CARBO-VEGETABILIS—Arsenicum, Kali, Mercurius. " CHINA—Arsenicum, Belladonna, Pulsatilla, Veratrum. " CUPRUM-ACET.—Calcarea, Veratrum. " HEPAR-SULPHURIS—Acidum, Nitr., Belladonna, Mercurius, Spongia, Silicea. " IPECACUANHA—Arnica, Arsenicum, China, Cocculus Ignatia, Nux-vomica. " LACHESIS—Acidum-phosph., Alumina, Arsenicum, Belladonna, Carbo-veg., Causticum, Conium, Dulcamara, Mercurius, Nux- vomica. " LYCOPODIUM--Graphites, Ledum, Phosphorus, Pulsatilla, Si- licea. " MERCURIUS—Acidum-nitr., Belladonna, China, Dulcamara, Hepar, Lachesis, Sepia, Sulphur. " NUX-VOMICA—Bryonia, Pulsatilla, Sulphur. " OPIUM—Calcarea, Petroleum, Pulsatilla. " PHOSPHORUS—Petroleum, Rhus. " PULSATILLA—Acidum-nitr., Bryonia, Sepia. ss OUR FAMILY PHYSICIAN. After RHUS-TOXICODEXDROX—Acidum-phos., Ammonium-c, Ar- senicum, Bryonia, Calcarea, Conium, Phosphorus, Pulsatilla, Sulphur. " SEPIA—Carbo-v., Causticum, Pulsatilla. " SILICEA—Hepar, Lachesis, Lycopodium, Sepia. SPOXGIA— llcj)ar-sulphuris, (for instance, in croup.) " SULPHUR—Acidum-nitr., Aconitum, Belladonna, Calcarea, Cu- prum, Mercurius, Pulsatilla, Rhus, Sepia, Silicea. " TARTARUS-EMETICUS—Baryta-c, Ipecacuanha, Pulsatilla, Sepia. " VERATRUM—Arsenicum, Arnica, China, Cuprum, Ipecacuanha. 9. Of Accessory or Palliatia-h Treatment.—In cases of obsti- nate constipation, the use of the injection, or laA^ement, is allowable. The injection should consist of cold Avater, or, if that disagree, of tepid water ; in some cases it may, also, be requisite to add a tablespoonful of SAveet oil. The quantity of Avater necessary for the different ages may, under ordinary circumstances, be stated to be a pint for an adult; fof a pint for a youth of ten or fifteen ; £ a pint for a child between one and five years of age ; and about one ounce for an infant at birth, or soon after. In cases of acute, external, and local inflamaiation, or more particularly, with wounds in Avhich there is a lodgment of foreign substances, Avhich cannot be extracted, or, Avhere suppuration is not suf- ficiently progressiA'c, Ave may have recourse to an application, of the na- ture of a poultice, such as that which is described in the ensuing page, (93.) All appliances and methods, such as bleeding, cupping, leeching, blisters,—all medicines resorted to according to the old practice—and all patent medicines are strictly prohibited. 10. Precaution to insure a proper dose.—When the administra- tor is not certain that the patient will adhere rigidly to the dose prescri- bed, or Avhen giA'en doses of medicines have to be sent to a distance, the simplest and safest expedient is to drop the globules into as much sugar of milk as Avill enA-elop them securely, fold the contents together in a slip of clean unglazed paper, and crush them from the outside with the blade of a knife, or some other hard and even substance. 11. When medicines should be taken, etc.—The medicines should invariably be taken fasting (save the understated exceptions), and absti- nence from food or drink for about an hour after the administration, is equally important. It is also of great consequence to abstain from exces- sive bodily or mental exertion, during treatment, and to keep perfectly quiet, if possible, for about an hour after the administration of medi- cine. There are exceptional cases, such as modify this rule, which may arise out of accidents or sudden emergencies, but the rule should be folloAved as closely as possible, even in cases of this kind. HOW to preserve homoeopathic medicines. 89 INDISPENSABLE RULES FOR THE PRESERVATION AND MANAGEMENT OF HOMCEOPATHIC MEDICINES, ANTIDOTES, ETC. 1. Keep your chest closed or your phials in a dark, dry, clean, and cool place, free from odor or scent of any kind, or, if in a hot climate, in as regular a temperature as possible. 2. Do not change the corks, or use the same phials to contain a dif- ferent remedy Avithout having previously been assured that it has been thoroughly cleansed, first with boiling and then with cold water. It is better at all times to rinse a phial, which has already contained medicine, with spirits of wine, and to expose it uncorked to the action of great heat before it is filled Avith a different medicine. The cork or stopper should be submitted to the same process. The safest way of all is to destroy empty bottles. 3. Let all the medicines be carefully marked and labelled, and abstain from handling two at one time. 4. In preparing your solution for administration, be assured that the glass, or spoon, or other vessel in Avhich you are about to mix it, is per- fectly clean. 5. If it is necessary to prepare solutions of two or more medicines at one time, take care to keep them apart, and to mark them so that no mistake can occur. 6. Do not use the same spoon or other vessel to administer two dif- ferent remedies, without having previously ascertained that it has been scrupulously cleaned. Porcelain spoons are preferable to any metal, on this account, because you are more certain of the thorough removal of any former medicinal substances. 7 If you dissolve your medicines in open vessels, such as tumblers, take the precaution to have them well covered down during the intervals between the administration, and keep them in a dark, dry, clean, and cool place, totally free from odor or scent of any kind. 8. Do not resort to any other medicinal agency during homoeopathic treatment, and abstain from any external applications, except such as are prescribed homceopathically. 9. Avoid the use of all articles of perfumery, restoratives, cosmetics, and the like. Camphor, and other popular appliances for cleansing the mouth, etc., etc., are strictly prohibited. The same may be said of smel- ling salts, etc., etc. 10. The saturated tincture of camphor, as it is used homceopathically, must be kept entirely apart from any other medicines, or from any ves- sels or vehicles, such as powders, in which it is proposed to convey or to administer other medicines. 11. Do not change your course of treatment or your remedies (when change becomes necessary) too suddenly, or without allowing a sufficient pause to elapse, viz., at least two hours, if possible, six hours, in general cases of a severe inflammatory nature, and in malignant fevers—and at least from two to three days (48 to 72 hours), in disease of a chronic kind. 90 OUR. FAMILY PHYSICIAN. 12. If the symptoms be so violent as to compel you to resort to imme- diate change after any previous treatment, administer one drop of spirits of camphor on a lump of sugar, or a teaspoonful of strong coffee, and then wait one hour, half an hour, or only a quarter of an hour, in urgent cases, before you proceed Avith further treatment. When, as occasionally happens with persons avIio are extremely suscep- tible to the effects of the homoeopathic remedies, an undue medicinal action is developed, giving rise to considerable local pain, or general con- stitutional disturbance, camphor is, generally speaking, the most effective antidote, particularly to the vegetable medicaments. (See the Table of Medicines, etc.) It may simply be inhaled by the nostrils, or a drop of Tincture of Camphm may be taken on a piece or lump sugar. Coffee, with- out milk or sugar, is also a useful antidote, provided the patient has not been long accustomed to its use. The same may, in a measure, be said of wine. SYSTEMATIC TABLE, FORMING A SUMMARY OF THE RULES FOR THE ADMINISTRATION AND REPETITION OF THE MEDICINES. In summing up the general regulations for the administration and repetition of medicines, the following particulars may be deduced : OF ACUTE DISEASE, NOT CRITICAL. GENERAL INITIATORY REMARKS. In Acute Diseases, not critical, when, after the lapse of four, or at the most, six hours, no amendment results, another remedy should gener- ally be selected, or the general state of the patient and the nature of the disease should be re-investigated. When, on the other hand, in the course of an hour or two, symptoms of improvement ensue—such as moist skin, a clear state of the intellectual faculties, a happier frame of mind, or a gentle and undisturbed slumber, no repetition or change of medicine must be thought of, until a cessation of the improved condition of the pa- tient becomes manifest. In Acute Diseases of a severe and critical kind, however—such as severe inflammatory complaints, cholera, croup, nervous fevers, asthma- tic affections, etc., the repetition of the dose sometimes becomes necessary, every five, ten, or fifteen minutes—or, at all eA^ents, at intervals of from one to three hours, subject to the like conditions. 1. That there are two distinct periods in the course of treatment:— the first period, or that in which the medicine is more rapidly repeated to establish a medicinal ascendency over the disease; and the second peiiod, or that in which the treatment is resumed and continued to complete the cure, or, until change of treatment. That these two periods are advantageously divided by a pause, during which the medicine may be suffered to exhaust its action, and the varia- tion of symptoms, etc., observed. That during the first period, in the treatment of acute disease, which is not of immediately critical character, the intervals between doses SUMMARY OF RULES FOR GIVING MEDICINE. 91 should extend over from two to four, or eA^en six, hours, accordiug to the severity of the symptoms. That as a general rule, a course of tAvo, three, or four doses, according to the length of the intervals, will constitute the first period; the great- est number of doses agreeing with the shortest intervals. That the pause, at the conclusion of the first period in the treatment of such diseases, should extend over from four to twelve hours, accord- ing as the progress of the disease has been checked by the previous treat ment or not. 2. That the disease continuing to make head after the pause, whether modified or not (if no suspension or change should appear desirable in conformity Avith the exceptions below stated), the same treatment should be resumed during the second period. That during the second period in the treatment of acute disease, which is not of immediately critical character, the interval between doses should extend over from four to eight, or even twelve hours, according to the severity of the symptoms. That, as a general rule, one, two, or three doses, according to the length of the intervals, Avill constitute the second period; the greatest number of doses agreeing with the shortest intervals. 3. That, in tjie event of no alteration, or, at most, a merely tempor- ary mitigation of the symptoms, by the remedy or remedies administered during the first period, another remedy must be selected as closely anal- ogous as possible to the symptoms present. 4. That, after the completion of the second period, in the event of the re-appearance of symptoms, which have yielded to the use of the remedy or remedies preA'iously administered; the same remedy or remedies shall be administered at still more extended intervals. That, in this after-treatment, the intervals between doses shall ex- tend over from 12 to 48 hours. OF CRITICAL CASES OF ACUTE DISEASE. 1. That critical cases of acute disease,—such, for instance, as of cholera, croup, or severe inflammatory disorders, which are excessively rapid in their issue, are not susceptible of the general rules applied to acute disease. That the majority of these are individually exceptional. That, in their critical acceptation, they are only susceptible of one period of treatment. That, in cases of this nature, such remedies as Arsenicum, Caprum, Digitalis, Lachesis, Sambucus, Hepar, Spongia, and Veratrum, may be ad- ministered at intervals, varying from five to thirty minutes, according to the urgency of the symptoms, until beneficial reaction takes place. That the evident (and progressive) decline of the vital principle, not- withstanding treatment, may, in such instances, warrant the change of the remedy, if there be any hope that the change may produce the desired reaction. That, otherwise, cases of this nature are susceptible of the same ex- ceptional conditions, as have been reserved for the previous class of com- plaints. 92 OUR FAMILY PHYSICIAN. OF CHRONIC DISEASE. GENERAL INITIATORY REMARKS. In Chronic Diseases of a severe and obstinate kind, it is often very advisable to administer a dose of the remedy selected daily, the first thing in the morning (fasting), for a period of from four to eight days ; or, in short, until such time as one or more symptoms become developed, Avhich the patient had not experienced, before commencing to take the remedy. When the remedy has been properly selected, the change in the patient's state will commonly occur Avithin or shortly after the periods just named. Should no medicinal manifestations of any kind become apparent, an- other remedy may be selected; from two to four days after the last dose of the previous remedy has been taken. In chronic diseases, sulphur * is very often the mpst appropriate remedy to begin Avith, if no other is better indicated, and particularly if the patient has previously been affected with any cutaneous malady (itch.) As soon as the symptoms developed by Sulphur have entirely subsided, a new medicament must be administered in accordance with the remaining symptoms (if any); but not for a longer period than from four to eight days. If improvement then sets in, the new remedy need not be repeated until the favorable change ceases to becorne progressively manifest. But, if no improvement ensues, although the remedy seems to be correctly chosen, Sulphur may again be resorted to, for from tAvo to four days; and so on. It is frequently necessary to fall back upon Sul- phur several times in this manner during a protracted course of treat- ment. 1. That there are two distinct periods in the course of treatment; the first period in which the medicine is more rapidly repeated to estab- lish a medicinal ascendency over the disease; and the second period, or that in which the treatment is resumed and continued to complete the cure, or till change of treatment. These two periods are advantageously divided by a pause, during which the medicine may be suffered to exhaust its action and the varia- tion of symptoms, etc., observed. During the first period in the treatment of chronic disease, the inter- vals between doses should extend to about tAvelve hours, and As a general rule, a course of twelve doses will constitute the first period. The pause at the conclusion of the first period in the treatment of chronic diseases, should extend, for the vegetable remedies, generally, over from three to six days, according to the severity of the case, and the effect produced; and for such remedies as Staphysagria, Conuim, etc., over from four to eight days; for the mineral remedies, generally, over from six to ten days; and for such remedies as Calcarea, Hepar-sulphuHs, graphites, Silicea, Siannum, Sulphur, Zinc, etc., from eight to twelve days. * See, also, the article on " Ebadicative Treatment." EXTERNAL REMEDIES AND APPLICATIONS. 93 2. That the disease continuing to make head after thepause, whether modified or not (if no suspension or change should appear desirable, in conformity with the exceptions below stated), the same treatment should be pursued during the second period. During the second period in the treatment of chronic disease, th e inter- vals between doses should extend over from 24 to 72 hours, according to the severity of the case. As a general rule, two, four, or six doses, should constitute the second period, according to the length of the intervals—the greatest number of doses agreeing with the shortest interA-als. 3. That in the event or mere temporary mitigation of the symptoms by the remedy or remedies administered during the first period, another remedy must be selected as closely analogous in its properties as possible to the symptoms present, for further treatment. That, after the completion of the second period, in the event of the re-appearance of symptoms, which have yielded to the use of the rem- edy or remedies previously employed, the same remedy or remedies shall be administered at still more extended intervals. That, in this after-treatment, the intervals between doses shall ex- tend over from two to six days. CONDITIONS CREATING EXCEPTIONS TO THE FOREGOING RULES, RESPECT- ING CHRONIC DISEASE. 1. That the repetition of any medicine be suspended. Upon the intermediate appearance of symptoms involving a com- plication not covered by the previous treatment. Or, again, as soon as a positive degree of improvement becomes ap- parent. To be renewed and re-continued upon the first indication that the natural and original disease is regaining its ascendency, from which we may judge that the medicine has exhausted its active agency. 2. That another remedy must be selected as closely analogous in its action as possible to the symptoms present: Upon the intermediate appearance of another symptom or symp- toms involving a complication not covered by the previous treatment. If no change, take place, ami the disease continue to gain ground progres- sively, notwithstanding the administration of ten or twelve doses. REMARKS AND REGULATIONS RESPECTING EXTERNAL Rp]MEDIES AND APPLICATIONS. Any remedy, which is prescribed for internal administration as Ho- myopathic to a local affection, may be applied to the parts as a lotion, either by dissolving the globules in water, or by using the tincture, to mingle with the water. External Application of the Nature of a Poultice—The sim- plest and best application which can be used in cases requiring external treatment of this nature, to forward and encourage suppuration, or for 94 OUR FAMILY PHYSICIAN. any other reason, consists solely of a piece of lint saturated with cold wa- ter, applied to the parts and kept constantly wet, the whole being care- fully covered with oiled silk so as to exclude the air. All medicated poultices should be avoided. External applicaton of the nature of fomentation.—As a palliative application pending the salutary action of internal treatment in cases in which local irritation and tension are excessive, it is allowable to bathe the parts with water moderately hot by means of a piece of flannel; or to expose the parts to the action of the steam rising from boiling water poured into an open vessel. In cases of sore throat, in which the obstruc- tion and burning sensation in the nostrils is excessively distressing, the patient may similarly inhale the steam of boiling water. Hop poultices and bread and milk poultices are good. Tincture of arnica.—This useful medicine, when employed as a lotion to wounds, should always be discontinued upon the appearance of any eruption, etc. Individuals, of Avhat is ordinarily designated as an in- flammatory habit, or who have very irritable skins, and are liable to be affected with erysipelas, must be very cautious how they use it, and must modify their treatment accordingly, and abstain from the application upon the earliest appearance of medicinal irritation or erysipelatous SAvel- ling or redness. Such patients should invariably dilute the tincture with tioo-thirds more of water {in proportion) than is indicated in the directions which occur in various parts of this work, when they have occasion to employ it; and, should this precaution not suffice to exempt them from excessive medicinal aggravation, they should have recourse to calendu- la-officinalis as a substitute. General proportions of the lotion..................Tincture of Arnica 1 part, to water 0 parts. Or for very susceptible subjects ...............___Tincture of Arnica 1 part, to water 12 parts. For the eye, or as a gargle for the gums after dental treatment.....................................Tincture of Arnica 1 part, to water 20 parts. For an infant under six months old.............Tincture of Arnica 1 part, to water 32 parts. For an infant over six months and under two years Tincture of Arnica 1 part, to water 20 parts. Tincture of calendula-officinalis-may be employed in the treatment of wounds of every description, by those avIio, from constitu- tional causes, are unable to employ Arnica externally, without subjecting themselves to the inconveniences generated by the character of that reme- dy. Calendula has moreover an important advantage over Arnica in very severe incised or lacerated wounds, where there are indications of a serious scar being otherwise left by the cut. It is also preferable in all severe wounds which cannot heal without previous suppuration. General proportions of the lotion—Tincture of Calendula one part, to water six parts : (for infants and children the same as Arnica.) Tincture of Rhus-toxkodendron is more especially adapted to the treatment of sprains, for the milder forms of which it is a specific remedy. General proportions of the lotion—Tincture of Rhus-tox, one part, to /cater six parts: (for infants and children the same as Arnica.) Tincture of Aconite.—Aconite has been used externally Avith great success for local inflammation arising from check of perspiration (or from external remedies and applications. 95 other causes), in conformity Avith its well-known characteristic properties. Care must be taken to distinguish such cases of inflammation, usually ex- tending to the membrane which invests the bone, and affecting joints in particular, from erysipelatous inflammation, to which it frequently bears a striking resemblance. The sudden appearance of symptoms of this na- ture in young persons, Avho are particularly liable to accidents arising out of carelessness, etc., and who, at the same time, have no predisposition to erysipelas, may be a strong ground of assurance in respect to the character of such inflammatory action, Avhich may further be explained by a brief inquiry into the previous circumstances. In such cases the external application of a lotion, composed of diluted Tincture of Aconite (simulta- neously with the internal administration of the same remedy), by means of a linen rag saturated thereAvith, and applied to the parts, will speedily subdue the symptoms, and preclude more serious consequences. General proportions of the lotion—for a person of adult age, Tincture of Aconite, ten drops to a wine-glassful of water. For a child under twelve years of age, Tincture of Aconite, six drops to a wine-glassful of water. Tincture of cantharis or cantharides.—The peculiar property Avhich Cantharis, or Spanish blistering Fly, possesses of creating a severe burning pain, followed by the effusion of watery fluid beneath the scarf skin, bears so close an analogy to the effects of a burn or scald, with the formation of vesication or blisters, that we can readily conceive it well adapted, according to the homoeopathic law, to be an admirable remedy for injuries of the like description, or attended with similar symptoms. Cantharis is, in fact, specific as an external remedy, in the treatment of burns or scalds, and is by far the most efficacious, if applied immediately ofter the injury has been inflicted (otherwise, see Causticum), and before the application of cold water, acetate of lead, or similar expedients have been adopted. Cantharis is, however, objectionable for persons Vhose constitutional peculiarity renders them susceptible of erysipelatous tumefaction of the skin, in the place of blisters, from the effect of a burn or scald. In these cases, Urtica-diaica is specific. In some instances, although very rarely, the external application of Cantharis may produce deranged action in the urinary organs, (exemplified by suppression of water); in such cases the mischief is readily counteracted by the internal administration of one drop of Tincture of Camphor on a lump of sugar. The lotion should gener- ally consist of the tincture at the second dilution and water, wherewith a linen rag is to be saturated, the linen being so wound round the parts as to exclude the air, and the moistening repeated as often as it becomes dry. General proportions—three drops of the Tincture of Canthandes, 2d, to every teaspoonful of water. Tincture of urtica-dioica, or urtica-urens—should be used in preference to tincture of Cantharides by those in whom a burn, or scald is apt to produce erysipelatous swelling in the place of blistering. But this is the only case in which Cantharides is superseded by Urtica. 96 OUR FAMILY PHYSICIAN. General proportion of the lotion..............Tincture of Uritca-dioica 1 part, to water 10 parts For an infant under six months old......Tincture of Uritca-dioica 1 part, to water 20 parts For an inlant over six months and under two years...............................Tincture of Uritca-dioica 1 part, to water 15 part a Proof Spirits of Wine.—In mild cases of burns or scalds, if Spir- its of Wine can be procured immediately (otherwise, see Causticum), speedy relief may often be obtained therefrom, and often suffering avoided. Apply it warm to the parts (as hot as the patient can bear it), the injured part having meanwhile been exposed to the heat of the fire. Causticum or Lime aaater, as already intimated under the head of Cantharis and Spirits of Wine, is a preferable remedy to either of the fore- going when an hour or two may chance to have elapsed before the use of any remedial application. The Causticum wash is also of much service in more serious burns, and in those of long-standing. General proportions of the lotion—to every teaspoonful of water, add six drops of the Tincture of Causticum, and apply frequently to the parts by means of a piece of linen rag saturated therewith. Raav cotton (excepting when the suppuration is excessive, and the weather hot, for which case see Soap),—is highly useful as an external ap- plication to burns or scalds of a serious nature, and more especially when the injury extends over a large surface. The method of use is as follows .-—Puncture any blister which may have arisen, bathe the sore well with tepid water, and then cover the parts with carded cotton or wadding in three layers—removing the outer layer only, and substituting a fresh one —When suppuration sets in. The soap plaster (Pure, white, Hard-Soap). This application is more particularly serviceable in cases of burns, where not only the outer or seurf skin, but also the inner or true skin has been destroyed. In serious cases, which have previously been treated with the lotion of Can- tharides, or Urtica-dioica, and in which the inflammation and pain have yielded to these remedies, but which are too severe (owing to the injuries in- flicted on the true skin and adjacent muscles) to heal without supperation, the soap plaster is a very useful accessory. It should be made and applied as follows:—Moisten the soap with tepid water, and make a thick lather or paste, and spread it upon linen; then puncture any blisters which may appear on the exposed surface, and remove all loose skin. After these precautions, apply the plaster to the parts, and secure it by means of a bandage, being careful that the whole of the injured surface is covered Avith the plaster. As a general rule, the plaster may remain undisturbed for twenty-four hours, when it should be gently removed and changed; but there are many exceptional cases, and the feelings of the patient should guide us in the removal and change of the plaster, whenever a re- turn of pain is complianed of This course of application should be con- tinued until the injured parts are completely healed. The application of the plaster will always be attended with increased pain at first; but this must not deter us from the employment of it, as it will soon be followed by marked improvement. Flour—may be used as a substitute for cotton or the soap plaster, when neither of the latter can be obtained at the moment. The method of application is simply to sprinkle the flour copiously over the injured THE BATH. 97 parts, after having taken the precautions directed to be observed under the heads of cotton and soap plaster. When it becomes necessary to remove the dry paste formed by the incrustation of the flour, this should be gently effected by first moistening and loosening it, by means of poultices (as di- rected under the head of external applications of tlie nature of a poultice), Tincture of Arsenium (at the third dilution),—applicable to bed- sores, and as a local resource, in many cases, of malignant ulceration. General proportions of the lotion—to one wine-glassful of water, ten drops of the Tincture. Tincture of Carbo-vegetabilis (at the fifth dilution),—in similar cases, as directed for the affection in question. General proportions of the lotion—to two table-spoonsful of water, twenty drops of the Tincture. Tincture of Cinchona (concentrated). See "Bed-sores," after typhus, etc. General proportions of the lotion—to a wine-glassful of water, fifty drops of the Tincture. REMARKS AND REGULATIONS RESPECTING THE BATH. The bath may be divided, according to modern appliances, into eight varieties, viz:—the hot and cold salt-water bath, the hot and cold fresh- water bath, the tepid, the shower, the vapor, and the medicated baths. Of these we shall here consider the two first-named only, viz. THE COLD SALT-WATER AND THE COLD FRESH-WATER BATH; Except as respects new-born infants, for whom a third variety is nec- essary, namely: THE HOT FRESH-WATER BATH. All the other varieties, especially medicated baths, are commonly pro- hibited. The consideration of the bath is a matter of essential importance to health, and has been acknowledged as such, from the remotest antiquity, and in every climate. It is almost as much a necessary of existence as food and clothing. It involves Avhat is a primarily essential, cleanliness; but, like all generalities, it is subject to exceptional modifications arising out of the condition of the system, or the temporary state of the body; such, for instance, as the presence of an eruption or rash, or the exuda- tion of perspiration after violent and prolonged exercise, both of which would render the bath obnoxious for the time. But for persons Avho are free from any morbid manifestation which may render the free use of cold water objectionable, nothing, perhaps, will tend so much to brace the nerv- ous and muscular construction of the frame, and to preserve the sturdy physical poAver of youth in advanced age, as the regular observances of the bath. GENERAL EXCEPTIONAL CONDITIONS UNDER WHICH COLD BATHING SHOULD BE AVOIDED. When (as is sometimes the case) it is found to induce constitutional disturbance, or is iiiA'ariably folloAved by headache, etc., of the same character. 7 98 OUR FAMILY PHYSICIAN. When it is followed by lasting chilliness instead of the glow which in- dicates its healthy action. There are comparatiA^ely feAV instances in which the cold fresh-water bath disagrees Avith persons in good health; in such instances, however, when they occur, the use of a sponge or Avet towel must be substituted for the bath, and should be followed Avith brisk friction. When any inflammatory action is present, or Avhen from exertion or from any other cause, the skin is moist and the pores are open the Cold Bath should be avoided. During the presence of headache, other than headache arising from irregularities of digestion or nervous causes. Immediately, or within one hour after a meal. Before any meal has been partaken, or, in other words, upon first getting up in the morning. Generally—with a declining temperature, as, for instance, late in the evening, Avhen the temperature of the water Avill not have declined equally Avith that of the atmosphere. When the atmospheric temperature is not sufficiently high, as com- pared Avith that of the water; or, in other words, when the water feels warm and the air cold. Generally—during the prevalence of cold east winds. GENERAL CONDITIONS UNDER WHICH COLD BATHING IS BENEFICIAL. When the temperature of the water, relatively to that of the atmos- phere, is as nearly as possible that Avhich it would reach and maintain, by being constantly exposed to the action of the same atmospheric tem- perature. When it is ahvays followed by a glow. In affections of a purely nerA^ous character. In the majority of affections resulting from debility of the digestive functions. During an ascending temperature; that is to say, in the earlier part of the day, generally about two or three hours after the first meal, and at an equal distance from the second. When the water is cold compared with the air, but not so cold as to produce a shock or numbness. In this climate, from the end of June to the middle of September, may be stated as the best season for out-door bathing. In-door bathing—may be continued throughout the year Avith great adA^antage, with the precaution that the thermometer in the apartment stand at from 50° to 60° of Fahrenheit, and that the water be exposed to this atmospheric temperature at least six hours (Avhen that is possible) or be raised to from 45° to 55° degrees, if beloAV it. The swimming bath, or bath in Avhich (if not in open wafer) there is oom to exercise the limbs, is preferable. SALT AVATEK. OK SEA BATHING. M GENERAL PRECAUTIONS TO BE OBSERVED IN BATHING. Do not bathe the loAver extremities first. The immersion should be complete at once This need not he effected by plunging, Avhen, as is not unfrequently the case, such a method is found to induce headache or temporary deaf- ness. Diving—Avhich is a A-ery common amusement, is very often preju- dicial without sufficient attention being paid to the fact. In general, you should abstain from diving. Never leap into deep Avater, feet foremost and in an erect position. The best method is to drop into it, the body and limbs being bent together. Do not stand still or remain motionless in the water. Do not remain too long in the water. Five minutes is quite long enough to deriA'e all the advantages of the bath. Never remain so long as to become thoroughly chilled. Leave the bath upon the first appearance of cramp. Apply a coarse toAvel, briskly, all over the body, as soon as you lease theAvater; and take pains to dry yourself as thoroughly and as expedi- tiously as possible. Dress as soon as you are thoroughly dry. The bath should be followed by a brisk Avalk, but not sufficient to heat you. THE SALT-WATER BATH OR SEA-BATHING. There has been a popular notion that sea-bathing is ahvays preferable to fresth-water bathing. Nothing can be a greater mistake, and there are a far greater number of exceptions to the proper use of the former than to tbat of the latter. It is indeed true, that the question of temperature is far less important in respect of sea-bathing, except, indeed, towards the fall of the year, when the temperature of the atmosphere, in our climate, becomes considerably depressed,—and when, in conformity with one of the "general exceptional conditions^ above stated, it were advisable for those, even with Avhom sea-bathing generally agrees, to dis- continue it. But it is a matter of experience that there are a great number of con- stitutional exceptions. And it is quite as important that all those Avith whom sea-bathing is found habitually to disagree, should abstain from Avhat, at certain seasons and in certain places, may be a great indulgence. There are instances in which sea-bathing produces a species of nau- sea similar to that of sea-sicliness in persons who are totally exempt from this inconA'enience on ship-board. This, then, is clearly a constitutional exception. In brief, hoAvever, it may be laid down as a rule, that when sea- bathing habitually induces any kind of constitutional disturbance, it should be avoided. THE FRESH-WATER HATH. The instances in which fresh-water bathing disagrees, may almost be summed up under the head of the "General Exceptional Conditions" 100 OUR FAMILY PHYSICIAN. above stated. The cases of constitutional exception are far less numerous than those Avhich occur Avith respect to sea-bathing, and there are feAver cases still in Avhich persons avIio cannot bear fresh-water can tolerate the sea-bath. When, however, they occur, they should indicate the course of the patient. TEMPERATURE OF THE BATH FOR INFANTS. The avarm bath, which is requisite for the treatment of newly-born or very young infants, should never exceed 98 degrees of Fahrenheit in heat. It should in general range from 92 to 9S degrees, according to the effect produced on the child. When the bath is used as a remedial agent, it is important to maintain the temperature at which the immersion had taken place; and it will, therefore, be desirable on all oceasions to have a thermometer within, so as to detect and regulate any variations. The cold bath should be, as nearly as possible, of the temperature at which the atmosphere Avould place or keep it. It is, therefore, desira- ble that cold spring Avater, which has not been exposed to the action of the air, for four hours at least, should be avoided in hot Aveather, when the atmospheric temperature would haA-e materially increased the heat of it. Exceptions to the use of the cold bath.—In almost all cases the use of the cold bath, with new-born or very young infants, is reprehensible. OF PREVENTIVE AND ERADICATIVE TREATMENT. It is too true that the eA*ery-day practitioner suffers himself to be too completely engrossed by the actual condition of disease to iiiA'estigate or to provide against its accessibility. The duty, however, of every man who deals with his profession as a noble and humane science, is rather to point out the method of preventing the occurrence of active disease, and of eradicating (if possible) the latent and slumbering defects of con- stitution, which may be described as dormant disease, than to confine his attention solely to the treatment of its active manifestation. This great and humane purpose should characterise the philosophy of every medical creed or denomination, and should ennoble, if it may not consecrate any system. By the term Eradication, I Avish to be understood to allude to the method of modifying or removing such unhealthy conditions of the system as neccessarily predispose the subject upon whom they operate as particular developments of active Organic Disease. I would first, however, be understood to confine myself, here, to such general hints as may, with due consideration of the regulations hereafter laid down for the treatment of each Disease as it occurs, enable the non-medical reader to form some idea of the mode in Avhich the rule is capable of being applied in the majority of individual cases, because it is obA'ious that this subject alone might require the whole space of more than one of such volumes as this, ere it was considered in detail. I Avould also hint that the rule is so distinct and positive, that the appropriate prea'ENTIVE treatment of any Disease may be readily in- preventive treatment. 101 ferred from the distinction of the medicines which are specific (that is of positively analogous properties) in its treatment. PREVENTIVE TREATMENT GENERALLY. In respect to the Prevention of Disease, men of all medical creeds Avho have devoted their time and toil to the consideration of the subject, hold opinions which are necessarily in accordance to a certain point; that is, as regards the modification or removal of the external and excit- ing causes of disease, such as local or general climate, and the substitu- tion of cleanliness, pure air, drainage, etc. There is, howeArer, a limit to the concurrence of opinion, even on some of these points. We are fur- ther agreed as regards some of those causes which proceed from irregu- larities of living, from excesses, and also from improper or insufficient food. Amongst these accessory measures, which are essential to the pre- vention of disease, I Avould, therefore, particularly draw the reader's attention to the following,—inATolving, first, those which concern the person immediately; and, secondly, those which concern the locality immediately, and the person indirectly. Those which concern the person, immediately, amongst others, are: 1. Exercise, in proper relation to the habits of the individual, to his strength and capabilities of physical exertion, the state of the weather, the method of taking exercise, whether active or passive, (the latter be- ing rather a modification of the accession of pure air than an application of exercise properly so called), and the circumstances of climate—involv- ing the degree of altitude, or depression of temperature, the time of the day, (the evening being very adverse to health, especially in districts in which thick vapor, lying close to the ground, is observable at and after sunset, marshes, etc.), and the nature of the atmosphere at the time—whether unduly charged with or deficient of moisture, or again, whether any particular wind preAail, which is known to be charged with noxious exhalations, as the Sirocco of Southern Europe, etc . 2. Cleanliness of person and habitation, which is subject to no excep- tional condition but those—of rare occurrence—which render it impos- sible. This action may also involve the free use of (cold) water in ablu- tion, except in particular cases. 3. Ventilatwn, partly applicable to the person, and partly to the local- ity, by which I understand the admission and free circulation of pure air, without the action of a direct current or draught, and the avoidance of closely confined apartments, sedulously closed against the external at- mosphere. In ninety-nine cases out of a hundred, such exclusion would repulse, more probably, a restorative of health, than an aggravant of dis- ease. For Nature is more surely in accordance with the requirements of human life, than any artificial means; and Science should be rendered not a repellant, but an assistant of nature. 4. Apparel, by which should be understood all coverings,—which should be as light as possible, consistently with weather, climate, and particular susceptibilities, or habits. The action of the skin is one of the 102 OUR FAMILY PHYSICIAN. most important functions of life, inasmuch as if irregularly performed, it reacts upon all or any of the organs most intimately connected Avith existence. Over-clothing or covering, on the one hand, therefore, may promote an irregular excess of action, Avhich Avill result either in contin- ued relaxation of the function, and consequent exhaustion; Avhercas exposure, on the other hand, may occasion a repression and suspension of action which Avill inevitably recoil upon the superior organs. The strict consideration of this question is more especially imperative in cli- mates in Avhich the transitions of temperature are sudden, or very con- siderable. 5. Aliments,—by Avhich I here understand both food and drink, should in eA^ery case be modified, in relative proportion, according to the climate, and to exceptional conditions arising out of the particular degree of strength or weakness of digestion, which characterizes particular persons or to any casual circumstances which may modify, alter, or deteriorate the digestiA'e functions, and consequently operate upon the appetite. The American natiAe, or the habitual inhabitant of a temperate climate, removing into a tropical zone, should decrease (if not totally escbeAv i the admixture of animal food, or, if removing into an arctic or very cold climate, might, Avith due regard to condition (especially Avhether salt or fresh) of such animal food, advantageously increase its proportion;—the habitual use of very salt or otherAvise highly seasoned food, is ahvays uniformly prejudicial;—he should also diminish the proportion of stim- ulating ingredients as the heat of the climate is increased ;—under the same conditions he should strictly abstain from the use of stimulating liquor, or if that has previously been habitual, be should decrease it gradually, until A-ery moderate indulgence (if any) remains;—and he should be very careful not to overload the stomach with either food or drink of any kind. It is A'ery important that the American, transplanted into a tropical climate, should neither eat nor drink more than Achat is absolutely necessary,—inasmuch as every disease to which the inhabi- tants of temperate zones are subject between the tropics, not only assumes complications particularly implicating the organs of digestion, but very frequently springs either remotely (by predisposition thus occasioned) or immediately from impeded or OA'ertaxed digestion. The person of Aveak digestion should carefully abstain from all indigestible or stimulating articles of food,—should select the plainest diet,—feed to supply the necessities alone, and not to gratify the palate,—should eat but little at a time, and not at all as the time of rest approaches,—should avoid all stimulating food or drink, and should never attempt to force an appetite. Regularity is indispensable to the health. 6. The habits of living.—Regularity is a great preservative in this respect, including the just appropriation of the period of rest, as indicated by the secession of light and the dormancy of nature generally, and con- sequently early hours, both in resting and rising, and a sufficient but not excessive proportion of rest. The relations of night and day constitute the best directions for the equable adjustment of the due proportion of rest. The summer of temperate zones indicates a less proportion than the w'inter, as also the tropical night and day indicate a greater equality CHOICE OF HABITATION, DRAINAGE. 103 in the disposition of time. (See also, " Rest," under " Investigation of Disease.") Excessive disposition to rest (indolence) is as injurious, on the one hand, ,as excessive duration of mental or bodily acuity; and the regular return of both conditions, afc corresponding and stated hours, is important. Regularity of habits also includes regularity in the period of eating or the hours of meals, Avhich is no less important than the former. The art of dividing time in every Avay is a powerful preservative. The preventive measures, which involve locality amongst others, are: 1. Drainage.—If the locality be subject to periodical, irregular, or casual saturation or flooding of water; that is, if it be nearly on a level Avith some adjacent surface of water, such as lakes, riA'ers with sluggish current or the sea, the generally applicable methods of preventing the exhalation of noxious A'apors, and the consequent impregnation of the atmosphere Avith miasma injurious to life, are (1) to create artificially, where practicable, such channels as shall lower the general level of the water, or comparatively elevate the general surface of the soil, and which shall prevent the stagnation of waters ; and (2) so to disturb the surface of the soil, as by furrowing, ploughing, etc., that the exhalations shall be rapidly emitted, and thereby be subject to dilution and dispersion, as soon as they transpire. Or, again, and especially to towns and crowded districts, in which the accumulation of decomposing or decomposed animal and vegetable matter must necessarily be great, to create so free a vent by means of proper sub- terraneous canals, and by the removal of all filth, etc., (exposed to the action of the atmosphere), that any such matters shall be rapidly dis- charged into such currents as shall remove impurities rapidly, or into such remote receptacles as shall secure the absorption, dilution, or dis- persion of all noxious vapors before they can impregnate the habitual atmosphere of the inhabitants. Wherefore, every dAvelling, to be whole- some should be accessible to the free passage of natural currents of air, and should be proA'ided with an ample and wholesome supply of water, and an easy discharge for all refuse deposits.* 2. Modifications of climate, by clearage, tillage, and every oilier result and accompaniment of industry—which thereby produces a doubly beneficial result (1) by removing the susceptibility of the inhabitant to disease; and (2) by removing the cause which too frequently generates disease, viz., the unhealthy exhalation of the soil. 3. The choice of habitation as to site, which should be removed as much as possible from particular geological influences; from localities in which the water is impregnated Avith mineral substances, as lead, iron, etc., from particular (local) and injurious currents of air, as in certain valleys; from the midst of Avoodland (and a sufficient clearage should be effected); from the adjacency of stagnant waters, and, lastly, above the * A'ested interests, stolid indifference, and an indolent disinclination to listen to the voice of reason, tno often oppose a formidable birrier to the removal of crying nuisances If there were any one act of- despotic government interference more capable of defence than another, it would be one which was di- rected towards effectual sanitary improvements. 104 OUR FAMILY PHYSICIAN. level of the mist or A'apor, Avhich consists doubly of the precipitated and of the continued exhalation from the soil, and which is readily distin- guishable—in marshy districts especially—by the dense Avhite fog, which lies like a separate atmosphere, an elevation of a few feet above the flat soil, after sunset. This subject has lately attracted much attention in the more populous countries, and is, therefore, of particular import to the colonist Avho may have to select the site of his oavii habitation. HOMOEOPATHIC MEDICINAL PREVENITA'E RESOURCES. No medicine, unless its action upon the human organs be analogous to disease, can be really, truly, and invariably preventive. The preven- tive measures, as regards the employment of medicinal agents, consist, in the repeated administration, usually in somewhat large doses, at intervals approximately of twelve hours, of one or more of such remedies (for alter- nation is occasionally requisite), as most closely assimilate in their specific action, and according to the indications stated for their selection in the case of each particular disease, or which, in combination, by alternate ad- ministration, most completely embrace the distinctiAe characteristic features of disease, when it assumes an epidemic, or even a local preva- lence. The first point is, therefore, to refer to the article hereinafter de- voted to the treatment of such particular disease, whereby to ascertain the principal remedies quoted, Avhether any, either singly or in combination (by alternate administration), are described as direct specifics, and then compare that remedy with all the symptoms by aid of the "Repertory." If, under the head of the particular disease, one or more remedies, under certain circumstances, and qualified by the presence of certain symptoms, are announced direct specifics, they Avill, doubtless, when early employed, be the unerring preventives or modifiers of the disease. Such, for instance, as vaccination against smallpox, which should be re- peated, if many years had elapsed since the former operation, or which should not fail to be resorted to by those who have not been previously vac- cinated:—Belladonna against Scarlet Fever cuiNAand Lobelia (chiefly) against Marsh Intermittent Fevers:—Mercurius-corrosivus against Dysentery, especially red Dysentery; Bryonta and Rhus-toxicodendron and Arsenicum against some varieties of typhus; Cuprum-aceticum, camphor, and veratrum, against Cholera and Diarrhoea respectively, or against excessive and sudden relaxation, with spasmodic pains and cramps Avhen the diseases just named are prevalent; Aconitum and Pulsatilla against measles; Aconitum, belladonna, and hyoseyamus, in cases and in particular localities in Avhich Inflammatory Fever, Avith prominent affection of the brain becomes prevalent, and similarly occurs amongst numbers of persons at once; Bryonia in cases and in particular localities in which inflammatory fever, Avith prominent derangement of the sto- mach, appears; Carbo-veg., etc., against Scurvy( see also "Eradicative Treatment,"); Sabina and secale, etc., against imminent Miscarriage (see also "Eradicative Treatment," for cases in which this casualty be- comes habitual); Camphor against severe colds (influenza), Avhen they are what is termed going through the house. In fact, every remedy, as ap- ERADICATIVE TREATMENT. 105 plied to the treatment of a particular disease, after it has set in under a particular aspect, is equally applicable to the preservation when the cur- rent complaint bears a similar stamp. The Doses—of Preventive remedies should usually be repeated at intervals of about tAvelve hours, until a degree of medicinal action has set in, when the course may be considered complete; but the action thus excited must be watched, lest it should occur that the prevailing disease (in a modified degree) has supervened. ERADICATIVE TREATMENT. No cure can be complete, Avhere there is a latent constitutional taint, without proper eradicative treatment. Scrofula, in one shape or another (or complicated with other diseases), may be considered as the predisposing cause of susceptibility to the recurrence of every disease- that is, as the great parent of disease, and the most common source of the malignity and fatality of other diseases, Avhen not itself the fell destroyer. Eradicative Treatment is applicable to the removal or subjugation of defects in constitution, habit of body, or temperament, which operate continually, not only as the predisposing causes of every preA^alent disor- der, but also as the complicating accompaniment of every disease; or, on the other hand, Avhich resolve or threaten to resolve, themselves into or- ganic decay, by attacking one or more of the important organs of life, es- pecially. Eradicative treatment is also applicable to the extirpation of those slow,.latent, or occasionally more active chronic diseases Avhich are gradually sapping the constitution, and Avhich Avould otherwise finally result in general disorganization, but which haA'e not hitherto permanent- ly destroyed the functions of any important organ of life. The space, which is necessarily confined in a work of this kind, will not admit of great detail, nor, indeed, could a Avhole A'olume such as this exhaust the subject, if compressed within the narroAvest compass. We have the intention, therefore, of confining our remarks to such general relations as may afford some idea of the mode in which the treatment is conducted, subject to the regulations severally laid down under the head of each disease (in the subsequent parts of this work), or, as it would then appear, in the character of a symptom, development, or manifestation of a more deeply-seated diseased condition—in conformity with the nature of the parent disease. The reasons for suspecting, and the grounds for ascertaining the exis- tence of such parent disease, will be gathered from the article on " The Investigation of the Patient," particularly if due regard be paid to par- entage (including near relations—uncles or aunts); to the part or organ most susceptible to the action of morbid influences, transitions of climate, the nature of the locality generally inhabited, the diseases which most frequently affect the patient, and the inveterate or peculiar or dangerous form, which all maladies, affecting the patient, assume. Of these, the question of parentage and near (blood) relations involves the most impor- tant and weighty considerations, as thence Ave may derive the origin of scrofulous habits of body in all their varieties of combination, complica- tion, and development. 106 OUR family physician. Indeed may not improperly attribute every family defect of constitu- tion, or every manifestation of a latent constitutional taint Avhich appears Avith greater or less intensity in several, or pre-eminently in one* of the members of a family, to an unwholesome or scrofulous inheritance. Thus to Scrofula we may attribute, amongst other derangements: Rickets, or enlargements and curvatures of the bones, and decay or exfoliation of the bones resulting from comparatively trivial circumstances; chronic disease of the skin, or extreme susceptibility to-the development of mor- bid appearances of the skin, of an endless variety, or especially to eruptions of the nature of tetters, to ringworm, etc., etc.; imperfect construction of the brain; and imbecility, or prevalence of susceptibility to derange- ments of the mind, especially if complicated Avith glandular swellings or their cicatrices ; torpid, or usually painless ulcerations, frequently char- acterized by a degree of putrescence, and commonly discharging a thin, watery, corrosive fluid; or which, if somewhat quickly dried up in one part are usually developed in someother; affections of the Lining Membranes, in general (as of the stomach and bowels, air passage, etc.); habitual or long- continued discharges of thin, watery fluid from any parts as the result even of very slight causes of irritation, manifesting a deficiency of vigor in the membranes, to which may also be appended obstinate or continuous Whites, and chronic discharges from the Ears; chronic Inflammatory af- fections of the eyes and eyelids, qualified by discharge of very adhesive gum, and continual adhesion of the lids in the morning, by excessive sus- ceptibility to the action of currents of air, or to irritation by reading, by excessive or even continual flow of tears, or susceptibility to Avatery eyes, by excessive sensibility of light; or, again, habitual susceptibility to Styes; chronic Inflammatory and Suppurative affections, or chronic enlargements or indurations, of Glandular parts in general: as, for instance, of the neck and under the jaw, the groin, the armpits, etc.; or abscesses; chronic en. largement and habitual hardness of the Belly; the prevalence of Avater on the Brain, water on the Chest, dropsy of the Belly, or general Dropsy in more than one member of any family: the like of what is called Tubercu- lar consumption, or of organic affection of the Mesentery, or of unaccount- able Emaciation and gradual decline; Worms, when they are evidently generated in consequence, not of casual circumstances, but of an inherited defect of constitution. The accessory means adapted to the eradication or modification of Scrofula, are, amongst others: 1. Diet—the most important consideration of all—which should be always as nourishing, in relation to its bulk, as much compressed or re- duced in bulk, as light and easy of digestion, and as regularly administered * Parents (or a parent) possessing the semblance of sound health, may yet carry the germs of scro- fula in the system, and consequently be capable of transmitting the disease to the offspring, hence the necessity for inquiry into the health of blood relations. Again, although there may not be any heredi- tary taint in the family of either parent, the capability of giving a scrofulous constitution to the offspring may be acquired by too early or too late a contraction of marriage, by disproportioned marriages (as to relative ages), by parental excesses, etc , and by any cause which may tend to injure the constitution of one or both parents—ae improper or insufficient food, impure air, etc. Lastly the germ of scrofu.a may be transmitted to an infant by the milk of a scrofulous or otherwise diseased nurse. AIR, WATER, CLEANLINESS. 107 as possible—sometimes frequently, but in small quantities at a time. An equal proportion of animal and vegetable food, or vegetable food prepared with a fair proportion of the pure gravy of sound and wholesome meat- Roasted meat in preference to any other—especially mutton and beef. Eggs, when found to agree, lightly boiled (soft), and eaten with a fair pro- portion of good, home-made, stale, Avheaten bread, but not in combination with other ingredients. Sometimes milk (when it does not disagree, as is sometimes the case in particular instances). Of beverages water is the only fluid which is universally safe. Stimulants of all kinds should usually be strictly avoided. 2. Air is second only to diet in the treatment of scrofulous habits; pure country air, in a healthy, dry, rather elevated situation, not exposed to the prevalence of bleak winds:—free access and circulation of air within doors, in all apartments inhabited, and particularly in the sleeping room ; as great a proportion of the day-time as possible, without severe fatigue, particularly in fine or favorable weather, should be spent in the open air. 3. Exercise should be as free and unrestrained as is consistent with the avoidance of excessive fatigue, or any of its consequences, and with due precaution that check of perspiration does not occur; no person should remain uncovered, or even still for some time after strong exercise; proper protection of the skin from the arrest of transpiration and gentle motion are indispensable; nor should strong exercise in the open air be resorted to in extreme conditions of temperature, and especially when there is great moisture in the ground, and consequently much exhalation. But when ex- ercise cannot, owing to extremely unfavorable Aveather, be consistently obtained out of doors, it should be sought in doors. With these, and other like precautions, active sports, appropriate gymnastic or calysthenic exer- cises, and every such occupation as calls the muscles and sinews into play, will go far to promote a vigorous operation of all the organic functions. 4. Water, used not only in the sense of ablution or cleansing, but for the purpose of promoting a healthy action of the skin. The cold fresh- water bath should be used daily (in the absence of particular reasons for abstaining), either in doors or out of doors according to circumstances, Avith due regard to the precautions mentioned under the head of the "Bath," and to the habitual temperature of the body (Avhich at the time of bathing should, if possible, neither be above nor below the natural standard) and with careful observance of the process of brisk friction afterwards, and of avoiding permanent chill. Washing and rubbing the body, especially the chest, stomach, and neck, daily, first with a coarse wet toAvel, and then Avith a coarse dry one, will frequently form a good substitute for the bath. 5. Cleanliness of person, dwelling, clothing, bed clothes, etc., is im- perative. If it be possible, the clothes, both of the person and bedding, should be frequently changed; the bed itself, even, should be frequently emptied, purified, and replaced, feather-beds being wholly objectionable; and the greatest precaution should be observed against the use of damp ap- parel or bedding. 6. Habits of regularity, mental, moral, and physical, should be strictly observed; excesses of all kinds are prejudicial; mental or moral ex- citement should be as much as possible avoided; the habitual observance 108 OUR FAMILY PHYSICIAN. of duties, as tending to obviate irregular habits on the one hand, and evil consequences on the other, is not to be overlooked; a proper degree of mental and physical occupation, Avithout either undue physical exhaustion or excessive mental application, and above all in a methodical and regular manner, is indispensable; a proper proportion, without excess, of rest, or without indulging an indolent disposition, is to be enforced. (See " Investi- gation of the Disease," part " Rest"). Regular hours, and hours consistent with the natural division of night and day, should be observed, and the contrary strictly avoided; gloomy thoughts should, as much a possible, be dispelled by averting the attention to interesting occupations, but not by recourse to excitement; frequent change of scene is often very advanta- geous to those who have means to procure it, but this should be understood of changes which do not occasion great excitement. HOMCEOPATHIC MEDICINAL ERADICATIVE RESOURCES. In cases in which an inherent defect of constitution either provokes the development of particular diseases, or appears in complication with them, we not uncommonly find that remedies whieJi in every respect cor- respond with the symptoms, and which would, under other circumstances, operate as specifics, are i epeatedly administered without the least apparent effect. The reconsideration of the symptoms having more than once con- firmed our selection, we should turn our attention to more deeply-seated causes which are present to thwart us. It is obvious that the presence of inherent constitutional defects may occasion external appearances in disease, which are especially susceptible of erroneous inferences, and, therefore, without this very important clue, the special directions for the treatment of any particular disease may frequently tend to discourage the unprofessional reader. In every case of disease, therefore, in which a remedy, after repeated reconsideration and ineffectual administration, is still apparently ho- moeopathic, or analogous to the manifestations present, I would beg of the reader to investigate very closely all details of parentage, antecedent circumstances, etc., (as above stated), in order to ascertain the indication of inherent taint, whether strikingly apparent or extremely remote and obscure, and as far as in him lies, to make a judicious selection from eradicatia'e remedies, such as Sulphue, which is especially appropri- ate Avhen there are chronic affections of the skin :—Calcarea-carb, when the glands, in general, are particularly affected: Merwtrius, Avhen the bones vare prominently involved, unless this be traced immediately to abuse of mercury, in Avhich ease Nitric-arid will be particularly useful, or perhaps Hepar-sulphuris may be required: or again, Mercurius, when the salivary glands are especially involved, saving under the excep- tional condition just named: Carbo-veg, against what are termed scorbutic complications: Sabina and Secede occasionally, generally, how- ever Avith an occasional course of Sulphur against predisposition to mis- carriage. These are only to be considered as a few general suggestions; but I Avould further add, with respect to Sulphur—that repeated occasions in which I, in common with many other homoeopathic practitioners, have employed this medicament the dose. 109 under the circumstances above detailed, and Avhen the remedies seeming- ly appropriate to the external evidences of disease had signally failed, have confirmed its pre-eminent utility. Very often, after the patient had been submitted to a few doses of Sulphur, the dormant susceptibility of the system becomes awakened, and a subsequent return to the par- ticular and appropriate remedy which had hitherto failed, has been attended Avith the most decided benefit. In cases in which the constitu- tional taint is deeply seated, or A-ery virulent, a long course of such alter- nations becomes necessary, continually returning to one or more doses of Sulphur when the effect of other remedies becomes less apparent, and again employing the intermediary remedies, or those appropriate to spe- cial indications as before, if still required. In many cases it is either highly beneficial or absolutely necessary, in treating chronic diseases of all kinds, to commence with a consecutive course of Sulphur in single daily doses, continuing for a week or ten days, or until a more or less distinct degree of medical action had set in ; then pausing for about four days to watch the subsidence of such medicinal action, or to detect any particu- lar symptoms requiring an intermediary remedy, or, sometimes suspend- ing treatment for seAeral days, or eAren weeks. These A'ariations of treatment must be subject to the discretion and judgment of the administrator, because no two cases are strictly analogous, and, therefore, a rule would be merely one of many exceptions. So long, however, as greater activity of the skin, etc., is manifest after a course of Sulphur, it Avill be advisable to pause in the administration. If there be intermediary and distinct symptoms not appertaining to Sulphur, but identifying a special remedy, it should be given till such particular symp- toms are subdued. Or, so long as general improvement makes steady progress, however slow, it Avill be advisable to abstain from repeating the doses of Sulphur, resuming the administration, however, immediately the malady becomes stationary or retrogressive. If acute or active disease has superA^ened, and yielded under the influence of intermediary or spe- cial treatment, we are not to consider the cure complete, but should return to extended courses of Sulphur at remote intervals. By persevering in such treatment, the most obstinate chronic diseases, short of actual organic decay, are overcome; and even if actual organic decay has set in, we have frequently found means to arrest its progress, and to prolong existence, and eAren comparative health for a surprising length of time. The Doses.—As a general rule the recurrence of the administration should take place once in tAventy-four hours, namely :—the first thing in the morning, fasting. The quantity should be sufficient to develop slight medicinal action, which is usually essential to the eradication of deeply- seated disease; but avoid the error of plunging into extremes. Eight pills, daily. General conditions and injunctions respecting eradicative treatment. It is natural that the vigor of animal as of vegetable life is in the ascendant in the spring, and in the decline at the fall;—it, therefore, follows that the spring will be the season in which eradicative resources, backed by the greater buoyancy of the vital energy, will be most success- ful. I would also strongly enjoin every person who has occasion to under- 110 OUR FAMILY PHYSICIAN. take the treatment of disease characterized by conditions of the nature above detailed, above all things not to be discouraged, but, so long as all circumstances correspond to identify the accuracy of his treatment, to per- severe steadfastly, assured that, especially if the patient does not lose ground, he is pursuing a course towards ultimate success. When a mother has given birth to one or more sickly children, she ought to undergo a course of constitutional treatment forthAvith, eAen though she may again ha\re fallen into the pregnant state. In the latter case, hoAveA'er, somewhat more than ordinary caution is required in watching the progress of treatment. SYNOPSIS OF THE RULES FOR DIET UNDER TREATMENT. ALIMENTS alloaved. Soup or broth (in special cases of illness or indisposition) made from the lean of beaf, veal, or mutton; to Avhich may be added Avell-boiled sago, tapioca, vermicelli, rice, semolina or macaroni, pearl-barley, and sometimes carrots, young peas, or cauliflower, seasoned merely Avith a little salt. Meats and animal products. Mutton, beef, lean pork, of good quality, in a feAV exceptional cases in which it is known not to disagree (poultry rarely, except in particular cases), pigeons, larks, rabbits, (venison, and game in general, may, if tender, in most cases be partaken of in modera- tion, but never when high) plainly cooked and roasted, stewed or steam- ed, in preference to boiled ; further, soft-boiled eggs, good fresh butter and curds. Fish {occasionally^. Soles, Avhiting, smelts, trout, cod, haddock, mul- let, perch, turbol, oysters and flounders, boiled, in preference to fried; when cooked in the latter manner, the white must alone be partaken of and the outer or fried portions rejected. Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, mild turnips, carrots, parsnips, French beans, beans, seakale, vegetable marrow, stewed lettuce, well cooked, and prepared with the gravy of meat, where required, instead of butter. Condiments, Salt and sugar in moderation. Bread. All kinds of light bread, not newly-baked ; and biscuit, free from soda, potash, and the like ingredients. Light puddings, such as those made from vermicelli, semolina, corn starch, sago, arrow-root, rice; macaroni (without cheese), simple cakes, composed of flour or meal, eggs, sugar, and a little good butter. . Fruit. Baked, stewed, or preserved apples and pears ; also gooseber- ries, raspberries, grapes or any other fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occasionally be partaken of. " Beverage. Water, toast-water, sometimes milk, milk and Avater, cocoa, chocolate (unspiced), arroAv-root or gruel, made thin, barley-water, sugar and Avater, rice-water, and Aveak black tea in cases Avhere it has long been taken habitually, and has not been productive of injurious effects. Salt should be used in great moderation. ALIMENTS—ACCLIMATION 111 ALIMENTS PROHIBITED. Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups. Meats. Pork, (except in the instances named as allowable), bacon, calf's head, veal, turkey, duck, goose, sausages, kidney, liver, tripe, and every kind of fat meat. Fish. Crab, lobster, and shellfish in general; and almost all other fish not specified amongst the aliments allowed, as likewise all kinds of salted, smoked, potted, or pickled fish. Vegetables. Cucumber, celery, onions, radishes, parsley, horse-radish, leeks, thyme, garlic, asparagus; and every description of pickles, salads, and raw vegetables, or vegetables greened with copper. Rich or high-seasoned made dishes. Pastry of all kinds, whether boiled, baked, or fried. Spices, aromatics, and artificial sauces of all kinds; as also the ordin- ary condiments, mustard and vinegar must be used in moderation. Cheese. Chestnuts, filberts, walnuts, almonds, raisins, and indeed the entire complement of a dessert, except what has been mentioned amongst the aliments alloioed, under Fruit. The above regulations are subject to considerable modifications in par- ticular cases, both as regards the aliments alloAved and those which are prohibited. When it it necessary to make a Arery material alteration in the diet and habits of a patient, it ought, in general to be done gradually and cautiously. Regularity in the hours of meals should be observed • and too long fasting, as well as too great a quantity of food at one time should be avoided. ACCLIMATION OR ACCLIMATIZATION. The process by which an inividual or a species, on being removed to a different climate, becomes modified in constitution and adapted to the changed conditions. The two words, however, are not strictly synony- mous. Acclimation is generally used in speaking of particular individuals, and more especially of those belonging to the human species, and refers to the alterations which the system undergoes spontaneously in a foreign climate, by which it at last becomes no longer subject to the maladies pe- culiar to new comers. Acclimatization, on the contrary, expresses the ar- tificial care by Avhich man succeeds in naturalizing, under his own super- vision, a species of animals or vegitables of exotic origin. Acclimation. Man inhabits all the zones and nearly every region of the earth, and has been enabled in repeated migrations to change the place of his habitations and to occupy new countries. The human species is therefore regarded as cosmopolitan; and yet two facts are important to notice in this respect: First, most of the great migrations, historic or traditional, have been made in the direction of longitude, and not in that of latitude; the migrating tribes instinctively or intentionally keeping nearly within the same par- allels of latitude, and consequently not suffering very great alterations of temperature, nor meeting in their neAV homes with a flora and fauna very 112 OUR FAMILY PHYSTCTAN. dissimilar to those of their native country. Secondly, at the present day, although an individual may migrate either westward or eastAvard, as a general rule, without suffering from the change, a removal into a different latitude is almost always accompanied with peculiar clangers during the first few years of his residence in the new locality. The most marked in- stance of this kind is, Avhen a person from the temperate zone visits for the first time to a tropical or subtropical region. The dangers that first beset him are fevers, Avhich are so marked in type and so ready to attack newly arrived immigrants, that they are sometimes called the "strangers" fever. The yellow fever of West Indies and the southern United States, and the coast fever of Avestern Africa, are Avell knoAvn examples of these affec- tions. They are not absolutely restricted to neAV comers, the natives being also subjected to them, but the recent immigrant is so much more likely to be affected, and is attacked by the disease in so much larger propor- tion, it is evident that his system has in it something which offers a pe- culiar attraction for the febrile prison, and which does not exist, at least to the same extent, in that of the native or the old resident. After passing through a period of general ill health and debility, extending over some years, and perhaps one or more severe attacks of illness, the immigrant approximates in his appearance and habit of body to the older denizens of the place, and is no longer peculiarly liable to disorders which affected him on his arrival. He is then said to be acclimated. No doubt, part of the immunity enjoyed by old settlers in a tropical or sub-tropical climate is due to the fact that they have learned prudence in regard to exposure, and have come to regulate habitually the mode of life to correspond \vith the climate of the country. Recent immigrants often neglect these essential precautions, because they have not found them necessary in a temperate climate; and it is only after repeated experience of their value that they come to adopt them habitually and as a constant protection. APPARENT DEATH. Apparent Death, Asphyxia.—In eA-ery instance where an individ- ual has, to all appearance, suddenly expired from external causes, anima- tion may only be suspended. There are many cases, of course, where sudden death is no mere suspension of animation ; but there are others Avhere apparent death is far from uncommon; in all cases, therefore, where there is the least uncertainty, care should be taken to do nothing that may cause death, and interment should be avoided until certain signs of putrefaction set in. Apparent death from hunger.—Give small injections of warm milk, repeatedly; great care should be taken to give the food when the patient begins to rally, in the smallest possible quantity at a time. Milk may be given, drop by drop, and gradually be increased to a teaspoonful, and after some interval, a small quantity of beef tea, and a feAV drops of wine. After a sound sleep has succeeded, but not till then, a small meal may be given ; but it is best that the patient should eat little at a time. Apparent death from a fall.—Place the patient cautiously on a bed, with his head high, in a place where he can remain quiet. Put a little Arnica on his tongue, and Avait till a medical man visits him to see APPARENT DEATH. 113 if there is any fracture, or Avhether there are still signs of life; bleeding may be here some times of benefit, but it requires great caution. Arnica .may be repeated, and also administered in injections. If the patient has been bled, give China or Quinine ; but it is obvious that if much blood has been lost by the fall or Avound, venesection would be injurious. Apparent Death from Suffocation, (hanging, pressure, chok- ing).—Remove all tight clothing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently, but constantly, Avith cloths ;| give an injection of a dozen or tAvo globules, or a few drops of Opium, dissolved in a half pint of Avater, and injected slowly. This may be repeated every quarter of an hour, whilst the ribs are being rubbed gently. Hold, from time to time, a mirror before the mouth, to see if the breath dims it; open the eyelids and see if the eyes contract; put Avarm cloths on; hot stones, wrapped in blankets, to the feet, between the thighs, to the sides, neck, and shoulders. If, in an hour, no change is produced, take a bitter almond, pound it fine, mix it in a pint of water, put a few spoonsful into the mouth, or into the nose, and give the rest in injections. Apparent Death from Lightning.—The body should be immedi- ately removed into a current of fresh air; and cold water dashed fre- quently on the neck, face, and breast. If the body be cold, warmth, by friction, must be employed in the same manner as recommended for the droAvned, in the next article; as well as the means therein prescribed for inflating the lungs. A few globules of Nux Vomica may be put upon the tongue, and repeated in half an hour, when, if no effect is produced, a little Nux Vomica, in water, rubbed on the neck, and some injected, may be of service. Or, better still, place the patient in a half-sitting, half- recumbent posture, in a cavity freshly dug in the earth, cover him over Avith newly excavated earth (leaving the face, alone, exposed, which should be turned toAvards the sun, until the first signs of returning ani- mation become apparent), after which, Nux V. is to be had recourse to, as above directed. Apparent Death from Droavning.—Place the body in a horri- zontal position, face down, Avith one wrist under the forehead. Now, Avith one hand upon the back, and the other upon the abdomen, press gently for about tAvo seconds, then turn the body well upon its side, and after a couple of seconds, place it again upon the face, and repeat the pressing as before; in this way strive to induce artificial respiration by the alternate pressure upon the abdomen, and rotation of the body. Again, should our efforts still fail, we may, in order to restore the natural heat of the body, move a heated, covered, warming pan over the back and spine, place bottles or bladders, filled with hot water, or hot bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet;—put the body in a Avarm bath, in the sun, or at a proper distance from the fire; use friction Avith hot flannels, flour of mustard or other stimulants; rub the body briskly with the hand, and at the same time do not suspend the employment of other means. To restore breathing, introduce the pipe of a common bellows into one nostril, carefully closing the other, and also the mouth, at the same 8 114 OUR FAMILY PHYSICIAN. time drawing doAvnwards and quietly pushing backwards the upper part of the wind-pipe, to allow a more free admission of air; I)1oav the bellows gently, in order to inflate the lungs till the chest be a little raised, the mouth and nostrils should then be set free, and a moderate pressure made with the hand upon the chest; continue this process until signs of life appear. . Electricity, or a stream of galvanism passed through the chest, is of Apply pungent salts, as Sal Volatile, or Spirits of Hartshorn, to the nostrils. These means should be persisted in for several hours, and till there are eA'ident signs of death. When the patient shOAVS signs of life, and can swallow, small quanti- ties of warm wine, or spirits and water, may be taken; but till then, nothing should even be poured down the throat, either by a flexible tube, or otherwise. At this period, the patient should never be left alone, as some have been lost from want of care, who, otherwise, might have been saved. Apparent Death from being Frozen.—When a patient is found in a state of frostbitten asphyxia, arising from exposure to intense cold, he should be moved with great gentleness and caution, to guard against any injury, as fracture, etc., to a place of shelter, such as a barn, or un- healed apartment, since only a moderate degree of heat might annihilate all hope of restoring animation ; at the same time, the patient ought to be protected from the slightest draught. He should then, especially if the limbs have become stiffened by the frost, be covered over with snow to the height of several inches—the mouth and nostrils, alone, being left free. The patient ought to be put into such a position that the melted snow may run off readily and its place be supplied by fresh. When there is no snow, a cold bath, the temperature of which has been reduced by ice (or a bath of cold sea or salted water), may be substituted, and the body im- mersed therein for a few minutes. The process of thawing is, by these means, to be effected, and when every part has lost its rigidity, the patient should be undressed by de- grees, or the clothes cut from the body, if requisite. As the muscular, or soft parts, become pliable, they may be rubbed with snow until they be- come red ; or the body should be wiped perfectly dry; if snow is not to be had, placed in flannel, in a moderately Avarm room, and rubbed with Avarm hands of several parties, simultaneously. In the event of no signs of returning animation declaring themselves soon after the foregoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symp- toms of approaching restoration become preceptible, small injections of lukewarm black coffee (coffee without milk) may be throAvn up: the bowels, and as soon as the patient is able to SAvalloAV, a little coffee may be given, in the quantity of a teaspoonful at a time. The measures above detailed ought to be persevered in for several hours against the excessive pain which is generally experienced Avhen life is restored; Carbo veg, should be prescribed in repeated doses, and if it VERIFICATION OF DEATH. 115 fails to relieve the suffering, Arsenicum may be given. The party rescued must avoid subjecting himself to the heat of fire or stove for a consider- able length of time after his recovery, as serious consecutive ailment, and particularly disease of the bones, is likely to follow. Apparent death from noxious vapors.—The treatment consists in removing the body into a cool, fresh current of air; dashing, frequently, cold Avater on the neck, face and breast; if the body be cold, applying warmth, etc., as above recommended to the droAvned; inflation of the lungs, early and judicious application of galvanism or electricity ;—after life has been restored, Op., or Aeon., may be given with advantage. VERIFICATION OF DEATH. The prize of five thousand francs given to the Acadamy of Medicine, France, to be awarded to the discoverer of a simple and easy process by which any illiterate person might be able to ascertain, without a doubt, Avhether death had really and irrevocably taken place, was divided among four competitors. 1. If a portion of the body be rubbed with a coarse wet towel, or with the back of a knife, and then be left exposed to the air, in the course of a feAv hours the skin will have become transparent and like parchment, if death has really occurred. 2. If a light be held to the back of a finger at a moderate distance'a blister will be formed; if this contain serosity, there is still life in the body. If the skin be touched with a piece of burning charcoal, if death is com- plete, it will become livid, a blister will be raised filled with vapor and having no serosity nor appearance of reaction. Petrifacation is also satis- factory evidence of death, but this can not be waited for. 116 OUR FAMILY PHYSICIAN. I*a,i*t Second. DISEASES OP THE BRAIN, THE SPINAL CORD, AND THE NERVOUS SYSTEM, GENERALLY. CHAPTER VI. MENINGITIS CEREBRO-SPINALIS. SPOTTED FEVER—CEREBRO-SPINAL MENINGITIS. This disease has appeared in various parts of the United States and Europe as an epidemic. It is of a most serious and often malignant char- acter. The symptoms are not constant, but vary in each epidemic ; indeed the variation is so great, that of the reports of some thirty physicians which we haAre consulted, we find no two alike. Our own experience in this disease, is confined to three cases of undoubted Spotted Fever, two of which recovered, the third coming into our hands after the disease had continued five days, and the patient was then dying. We Avill, therefore, in view of our own inexperience, transcribe the symptoms, as given by Professor Felix Niemeyer of Berlin, in his exhaustive report of the epi- demic in the Grand Duchy of Baden, 1865, and after that, the symptoms as giA7en by Dr. Bushrod W. James, of Philadelphia, as he observed them Avith his A'ery extensive opportunities, in the United States. Symptoms by Niemeyer: "Without any other precursory symptoms, the patient is at once attacked with a chill, attended Avith violent head- ache and Aromiting. The headache speedily increases in intensity, the patient becomes exceedingly restless, tosses about, the pupils remain con- tracted, the sensual consciousness remains unembarrassed. The pulse rises to 80 or 100 beats per minute. At the end of the first, or on the second day, much less frequently at a later period, we notice that the head is some- what draAvn backwards; the patient continues to complain of violent headache, and the pain spreads from the head to the back of the neck and to the fjack. The restlessness becomes excessive, the thoughts of the pa- tient become confused, the pupils remain contracted, the abdomen caves in, the boAvels are constipated. The frequency of the pulsations and res- pirations iioav increase to about one hundred and twenty of the former) and upAvards of seventy of the latter, per minute; the bodily temperature continues moderately low. In the course of the third and fourth day, the tetanic spasms of the posterior cervical and dorsal muscles become more and more prominent, and patients are sometimes attended Avitb lock-jaw. Opisthotonus (bending backAvard) superA'enes Avith an extraordinary de- gree of intensity ; the consciousness is gone, but the patient still continues SPOTTED fever. 117 to toss abou*o in bed, the pupils still continue contracted, the boAvels con- stipated, the abdomen sunken ; the urine is discharged involuntarily, or else the bladder remains distended and the urine has to be drawn off Avith a catheter. The patient hoav lapses into a profound stupor, (unna- tural sleep), the moaning breathing is accompanied by a rabl (rattle), and death takes place Avith the phenomena of an acute oedema (collection of a liquid serum in the lungs so as to fill them up) of the lungs." I dislike Niemeyer's use of the Avord oedema here. "This picture of the disease is sometimes modified by the occurrence of a short preliminary stage, which is marked by slight pains in the head and back, or by the breaking out of herpatic Aresicles (eruption of blisters), or of scattered, dark colored, roseola (red) spots on the first, second, or third day of the disease, or else the aboA'e described symptoms develop themselves in a much shorter period, which circumstance constitutes one of the most im- portant modifications of the disease ; so that the consciousness vanishes, eA^en on the first day of the attack, and a Adolent tetanic spasm (spasm Avith unyielding stiffness) of the back of the neck and back begins; or finally, may set in Avith such A'iolence, that a fatal termination of the dis- ease is reached eAren on the first or second day. This cursory picture of cerebro-spinal meningitis, and of the general course of the disease, applies indeed to most, but not by any means, to all cases of the epidemic. This picture does not comprehend phenomena that occur in a A'ariety of cases, such as: deafness in one or both ears, diplopia (double vision), from a diseased condition of the optic nerves, ptosis (palsy of the upper eyelid, softening and destruction of the cornea (front coating of the eye), and finally, paralysis of the facial nerves and of the extremities, either on both or only one side of the body." Symptoms as quoted by B. W. James, M. D., from experience and a careful study of the disease, as it has appeared in the American epidemics. In many of the epidemics, prostration appears to have been a very prom- inent symptom: "It sometimes sets in with such a sudden violence, that persons who were afflicted with heart disease, dropped down dead in the street in conse- quence of the sudden shock. This happened in a number of cases. Many persons died twenty-four or forty-eight hours after being seized with the chill. Persons over tasked with labor would very often die in fourteen or sixteen hours from the chill. The general features of the disease Avere: vertigo with headache; diarrhoea, sometimes of a very prostrating charac- ter, in other cases diarrhoea alternating with constipation; moderate fever, flashes of heat mingled with creaping chills, piercing pain thrr ugh the head, soreness and stiffness of the upper portion of the spine, with aching pains in the spine, or tingling soreness and tenderness of the skin, severe muscular pains, numbness of the limbs with partial paralysis; spasmodic twitching* of the muscular system, sometimes amounting to tetanic con- vulsions with lock-jaw; the consciousness not much affected, except when the disease is at its hight, Avhen a more or less active delirium, and finally coma and death set in. In most cases the eye looked injected and red, and the hearing Avas impared, the pulse had a moderate frequency, generally about one hundred per minute, the tongue remained moist, and in the 118 OUR FAMILY PHYSICIAN. course of the disease, became covered with a dark, brownish fur; the breathing was somewhat accelerated and interrupted by moaning inspira- tions; during the tetanic spasms the expirations had a hissing sound, the air seeming to be forced out Avith an effort, the skin has a peculiar bluish pallor in this disease, owing to the general turgeseence of the venous sys- tem; the spots which have given to this disease its name, spotted fever, broke out on different parts of the body, generally however on the chest, abdomen,and thighs; sometimes the skin had a mottled appearance, or the spots looked like measle-spots, or had a rose colored tint. One hour the patient will seem quite well, and the next the most alarming symptoms may be present." Treatment. Give, as soon as the nature of the attack is known, a good, full sweat; the hemlock sweats of easy application where hemlock branches are obtainable, are always efficacious. Two teaspoonsful of best alcohol to four of water, one teaspoonful of this solution every half hour, until there is a decided abatement of the symptoms. In cases threatening immediate dissolution, the dose may be doubled for a short time. ALLOPATHIC TREATMENT. This disease is an essential fever, attended with inflammation of the membranes of the brain and spinal cord; hence its name. It is popularly called spotted fever. The disease is very fatal, in some epidemics, reaching as high as four fifths of all the cases, in other epidemics, not over one fourth of the cases die. The boAvels should at once be unloaded, but beyond that, purgation should not be practiced. Ice in bladders may be applied to the head and spine, if agreeable to the patient, otherwise they should not be used. The cold or warm wet pack, according to the degree of fever, should be used once a day. If the temperature is 104° or over, the pack should be cold. If not so high as this, cool sponging of the skin will suffice. When the pack is used, the patient is to be Avrapped in a sheet wrung out of water, and then enveloped in blankets. In about an hour free sweating occurs. The pack is then removed, the patient Aviped dry and placed in bed. Opium should ahvays be given to the extent of relieving pain. This is the most useful known remedy in this disease. The physician Avill ob- tain the best results by the hypodermic use of morphia. When effusion has taken place, and there is stupor and insensibility, the usefulness of opium is at an end. Ergot is the remedy calculated to diminish the con- gestion of the cord, and should be given in large dose; a teaspoonful of the fluid extract every six hours is a good rule. In the beginning of the dis- ease, quinine is useful in controlling the fever and inflammation. If, how- ever, a single large dose—tAventy grains—is not followed by benefit, it should not be repeated, unless malarial disease consists. In the cases having high fever the Fluid Extract of Gelseminum given in five drop doses, two or three hours apart, will be found useful in moderating the action of the heart and producing a general calm. Ice, acid drinks, cold tea, and lemonade should be freely allowed to re- lieve thirst, milk, eggs,nourishiing broths should be given in sufficient variety and quantity to maintain, as far as possible, the strength of the patient. congestion of the brain. 119 In case food is not taken, from vomiting or other cause, nourishment should be given by injection into the rectum; half a pint of strong beef tea with two or three tablespoonsful of rich cream, or a half teacup each of beef essence and milk, can be given tAvo or three times in the twenty- four hours. The injected nourishment should be caused to be retained by pressure upon the auns with a napkin or towel. Stimulants should be avoided until the symptoms denote that the vital forces are beginning to fail, and just in proportion to this failure are they demanded. Their bene- ficial effect is shown by a fuller, stronger, and more regular pulse and re- duced febrile and nervous excitement. A tablesoonful of Avhisky or brandy, from one to three hours apart, is a good rule varied according to the judgment of your physician. In Spinal Meningitis (inflammation of the membrane of the spinal cord), the principles of treatment are the same as is given for acute Men- ingetis- Cerebral. The disease generally proves fatal Avithin a week. HOMOEOPATHIC TREATMENT. Gelsemilium, Belladonna, Veratrum Viride, Hyoscyamus, during con- gestive stage, Avhen the congestive and inflammatory symptoms predom- inate. Gelseminum and Veratrum Viride, both of which may, Avithout hesitation, be alternated Avith Bell., or Hyos., if the inflammatory and typhoid symptoms seem to co-exist. Bell., and Hyosc, may be relied on, if a more or less actiA^e delirium has set in, the patient is inclined to sleep, the conjunctiva (coA-eringof the eye) is found congested, the pupils are alternately contracted or dilated, or one pupil contracted and the other dilated, and spasms drawing the head and body backward. Bryonia or Rhus-toxicodendron should be resorted to, when the high inflammatory condition seems to give way to one of a typhoid character, and more particularly when the folloAving symptoms are present: Lock-jaw, partial loss of consciousness, stupor Avith an ex- pression of deep suffering in the countenance, difficulty of protruding the tongue, the corners of the mouth are drawn down, the muscular pains are very seA'ere. A great degree of restlessness and uneasiness is more especially indicative for the use of Rhus-tox. For more indications study the Repertory. HYPEREMIA OF THE BRAIN. excess of blood in the brain—congestion of the brain. By Hypesormia of the brain is generally understood an excess of blood in the arteries and veins (blood vessels) of the brain ; or, in other words, more blood in the brain than is natural in a condition of perfect health. This unhealthy increase of the volume of blood may be occasioned by three distinct causes. In the first place, the flow of the blood from the brain, being natural, a larger quantity of blood returns to the brain. In the next place, the flow of blood from the brain may be diminished by some disease of the blood vessels, or their surroundings, while the amount carried to the brain by other vessels, not so diseased, may be natural in 120 OUR FAMILY" PHYSICIAN. amount. Finally, the cause may be located in the brain itself, the brain substance (cerebral parenchyma) may become hardened or Avasted away {atrophied) or softened ; or the capillaries (very small ends of the vessels) may become enlarged. This diseased condition of the brain is confined either to a limited locality, or extends throughout the whole brain. It is scarcely ever pos- sible to establish, during the life of the patient, a sure diagnosis regard- ing the exact seat and the extent of the hyperemia, for the reason that congestions of very limited extent frequently excite much more striking symptoms than more extensive congestions. So far as treatment is con- cerned, such a diagnosis is scarcely ever of much importance. The most important terminations of this engorged condition of the brain, which impart to it a higher significance in practice, are : sudden death from paralysis of the brain, in consequence of excessive pressure of the blood ; dilation (Avidening) of the vessels, especially the capillaries, by which the tendency to congestion is increased, exudation and extravasa- tion (or throAving out and collection of blood in some of the cavities, or collection beneath some of the covering membranes). The causes of cerebral hyperemia are various and important, in a practical point of vieAV, since, in most cases, they determine the choice in the selection of the proper remedy. These causes arc of two kinds : Causis.—1st, Those which affect the brain directly, and 2d, Indirect causes, by Avhich, through the operation of influences that are partially unknown to us, the brain becomes involved in an affection more or less remote from the brain. Among the direct causes affecting the brain, the most prominent are : Concussions of the head by a fall, 1)1oav, or like accident; continued, persevering and excessive mental exertions; emo- tional excitement, such as joy, grief, anger, disappointment, chagrin, etc.; exposure to excessiA-e heat of the sun {sun stroke), or to artificial heat; likeAvise to excessive cold ; more particularly, if the influence of cold is siuldenly followed by the action of intense heat. In the second class of causes, Ave may range, according to circum- stances, almost all kinds of febrile (fever) affections, since almost all of them may be associated with this condition of the brain ; in this place Ave Avill content ourselves with mentioning diseases where almost ahvays congestions of the brain are present; they are: Erysipelas of the face; Diphtheria; Mumps; Inflammatory diseases of the eyes and cars ; diffi- culties during teething. Among the more or less chronic affections that may be mentioned in this connection, as casual circumstances, the most prominent in the list of those that impede the flow of blood from the brain, are : Defects of the heart, right side and tumors (morbid groAvths) on the neck. In the list of those that occasion a general increase in the impulse of the circulation, are: Diseases of the heart (left side), sup- pression of habitual losses of blood (such as the menses or piles). In this last list, we likewise include those cases caused by the abuse of alcohol, in all its varied forms, or of other narcotic substances—such as opium. Without doubt there also exists a tendency to congestions of the brain; in Avhich case, they may be excited by any perceptible change from a condition of health. This tendency is identical with the so called congestion of the brain. 121 apoplectic habit, but cannot be recognized, Avith any certainty, before its occurrence, by definite diagnostic signs, but has to be determined in most cases by the occurrence of the actual fact; it is a certain fact, that it is not alone indicated, as is popularly believed, by a thick- set frame and a short, thick neck. On the other hand, the idea of a probable occurrence of hyperemia of the brain suggests itself before it happens, in the case of indh'iduals, Avho, Avhile consuming quantities of nourishing fo»d, do not take bodily exercise in a corresponding ratio, and in Avhom this mode of lh'ing deAelops a condition that may justly be termed plethora, or excessh'e flesh. We have already stated, that the fre- quent repetition of attacks of this nature leads to a dilation (Aviclening) of the blood Aessels, which increases the disposition to reneAved attacks. Generally speaking, you can safely predict a favorable termination in this disease, since a fatal result need not be apprehended, unless some other complicating disease should supervene. In one respect, it depends upon the age of the patient. Whereas, in persons of middle age, the dan- ger is not A-ery serious; it is, on the contrary, much greater in the case of children and old people. In the case of children, death takes place A-ery frequently in consequence of the paralysis of the brain, occasioned by the excess of blood in that organ ; in old people the a-csscIs are generally so fragile that they easily tear, and their contents are discharged upon the brain. The apparent A-iolence of the disease is no adequate guide by which to judge of the danger likely to result from it, but the more fre- quently the trouble occurs, the more dangerous it becomes. When it de- pends upon pre-existing derangements, the prognosis depends almost exclusively upon the character of these derangements. The Symptoms by which hyperemia manifests itself, vary according as one or another locality of the brain is the seat of the affection, and according as the pressure upon the brain is more or less violent. The head feels heavy, confused, or as if encircled by a tight band ; the head- ache, which is scarcely ever wanting, is almost always throbbing, and is made worse by stooping, unusual exercise, and every mental effort; buz- zing in the ears, sensitiveness of the eyes, even seeing sparks and obstruc- tion or obscuration of sight, are generally present. Vertigo (giddiness, dizziness) is seldom wanting. If arising from hy- peremia, a characteristic sign is to become aggravated by stooping, but more especially by looking up. Generally the patient feels drowsy Avith- out being able to sleep, or else the sleep is anxious, disturbed, full of dreams. Feels very languid and his gait is rendered insecure by want of firmncsss in the loAver limbs. The pulse may continue natural, and there may be no fever present. This mildest form may be combined Avith con- stant restlessness and gloomy ideas ; sleep is disturbed by anxious dreams, which, in the more violent cases, do not altogether disappear Avhile the patient is awake; they even assume the character of hallucinations, and, if the trouble continues Avithout being checked, a permanent mental de- ran gument will not unfrequently result. Palpitation of the heart, ill humor, distrust,.total indisposition to Avork, and fitful mood are almost always present. This form of hyperemia mostly befalls indh'iduals, who, while enjoying good cheer, take but little bodily exercise, but perform a large amount of mental labor. 122 OUR FAMILY PHYSICIAN. The foregoing symptoms are almost characteristic, also, of hyperemia, consequent upon suppression of certain forms of loss of blood. The trouble is much more dangerous, if it sets in as an acute disease, and, although violent at first, continues to Increase in intensity, until it terminates in death. In such cases, the face looks dark-red, the eyes are streaked Avith red, the blood vessels of the head and neck pulsate violent- ly, the pupils of the eyes look smaller, all the senses are Arery sensitive, the headache is maddening, sometimes driving the patient to suicide. Delirium is apt to follow. This type of the disease is most common after sunstroke, and not unfrequently is an accompaniment of mental derange- ment, of which indeed it may frequently be said to be the cause. Not un- frequently the above described symptoms are suddenly folloAved by all the signs of apoplexy, regarding which the diagnosis cannot be establish- ed Avith any certainty, until the rapid course and sudden disappearance of the symptoms of paralysis haAe satisfied one that no pouring out of blood (extravasation) can haAre taken place, since the fluid could not have been reabsorbed so soon. In this category belong, most likely, all the cases that are said to have been cured so rapidly. This disease never exists during an epileptic attack, in Avhich the course of the attack alone gives perfect certainty concerning its true nature. Among children hyperemia is an almost habitual accompaniment of all fevers, and not unfrequently conceal, the symptoms of true disease, for the reason that the course of the hyperemia is marked by the more violent symptoms. In every considerable congestion of the brain coua'uI- sions of some kind almost always occur ; they are accompanied by droAvsi- ness even to the extent of sopor (sound but unnatural sleep), delirium, excessive restlessness, and anxiety and vomiting, in nearly all cases. HoAvever threatening such a condition may seem at first sight, in most cases it passes off speedily and Avithout leaving a trace behind, so that the congestion seldom lasts longer than thirty-six hours, and generally abates after the lapse of tAvelve hours. Treatment. In the acute form of the disease, applications of cold or ice water, to the head and keeping the extremities warm, is excellent. In the chronic form resort to frequent bathing and rubbing, and plenty of healthy outdoor exercise. ALLOPATHIC TREATMENT. Actiate congestion of the brain, not sufficient to produce apo- plexy or sudden coma (insensibility), is denoted by the following symp- toms : Pain in the head, sometimes intense, not limited to any special part, with a sense of fullness, bursting, or weight and throbbing. The head is hot, and the carotid, and other arteries of the neck and head, pulsating A'iolently. The face is flushed, the eyes injected, there is intol- erance of light. The mind is confused, and consciousness may be sus- pended ; there is dizziness, ringing in the ears, and difficulty in speech. If paralysis and insensibility exists, the trouble is greater than simple congestion, there is apoplexy from extravasation of blood. These symptoms (signs) are, also, those of the beginning of inflam- mation of the membranes of the brain, and a discrimination cannot, at CONGESTION OF THE BRAIN. 123 once, be made. The treatment is the same. The intensity of the con- gestion determines the prominence of the symptoms. Intense congestion calls for blood-letting, promptly, at the hands of a surgeon, as necessary in preventing apoplexy and sudden death, hem- orrhage upon the brain, watery effusion, or inflammation. Blood-letting gives relief by weakening the action of the heart, and diminishing the quantity of the blood sent to the head. If the congestion is not sufficient to call for bleeding, either general or by Avet cups applied to the back of the neck, relief may be obtained by ice to the head, hot foot-baths, made stimulating by the addition of mustard or red pepper, and an active purga- thTe ; one or two tablesponsful of Epsom Salts, dissolved in water, is as good a physic as any for the purpose, in domestic practice. The after-treat- ment Avill have reference to the removal of the causes, if possible; they are, aside from enlargement of the heart and sunstroke, principally some form of using alcoholic stimulants and over-stimulating food, excessh-e mental or emotional actiA'ity and anger. If the patient is strong or robust, the diet should be less hearty, and a cathartic of a smaller dose of salts, or a Siedlitz powder, taken occasionally. Let all the habits of life be goAerned by the word moderation. Passive congestion of the brain is caused by some obstruction to the return of the blood from the head through the veins, except it may be caused by Aveakened arterial circulation. The trouble is distinguished by droA\Tsiness, dullness of mind and perceptions, and sometimes by con- vulsions, in children. Active delirium, throbbing arteries and increased heat, are Avanting. Passive congestion may lead to watery effusion or extraA^asation of blood upon the brain. When caused by disease of the heart, or by tumors pressing upon the A'eins, and so producing the con- gestion, treatment has reference to a removal of the obstruction. For treatment of disease of the heart, sec Chapter xxni. For the treatment, or removal of tumors, the skill of a surgeon is neces- sary. To oAercome enfeebled circulation, everything Avhich produces ex- haustion is to be avoided and its force increased, and the blood enriched by nutritious food and tonics. The Citrate of Iron and Quinine, one dram, dissolved in four ounces of simple syrup: Dose, a teaspoonful; or the Soluble Citrate of Iron, dissolved in Sherry Wine, one dram to eight ounces: Dose, a teaspoonful, are good tonics taken before each meal. HOMOEOPATHIC TREATMENT. Belladonna. In plethoric persons disposed to rush of blood to the head, red, almost purple face, dilated pupils, nervous agitation, sensitiveness to all unusual sounds and motions, especially any sud- den jar, as of the bed or floor, delirium, constant or intermittent mut- terings, and, if present, a disposition to perspire, will be found reliable indications for Bell. Aconite. If the trouble is the result of violent emotions, such as fright or mortified feelings. This remedy is also very useful in alterna- tion with Bell., in cases of acute hyperemia among women and children, at times Avhere the latter remedy is indicated, but the symptoms show also a high fever and excited condition oft he heart. 124 OUR FAMILY PHYSICIAN. Opium is a more useful remedy in this disease than either of the others already mentioned, provided the trouble has not been produced by this remedy in some of its forms. Its use is indicated by continued sopor (sleep) Avith insensibility of all the senses, dark redness of the face, with paleness and coldness of the rest of the body, slow pulse, slow breathing. Tobacco is one of tAvo drugs which frequently cause this disease. Do not take or give it in any form. If this so-called innocent habit is one of your failings, be firm, shake off the demon you see so surely destroying your life, ana quit forever the habit which is costing you so dearly. Nux Vomica. When the disease is caused by a sedentary mode of life, or excessive mental labor, and more especially in the commencement, when caused by frequent use of spirituous liquors, attended with consti- pation or irritation of the kidneys, Nux is a good remedy. Arnica. When the derangement is the result of a concussion, fall, or blow on the head, etc., use Arnica. Veratrum Viride. When Bell, is indicated apparently, but after being ghren for twenty-four hours, a dose every half hour or hour, has produced no change for the better, you will find a change to Veratrum Viride a good one; it has been used extensively in this affection, both in general and hospital practice, Avith the best results. It is best given in a low potency. Dose for any of the preceding remedies, eight pills in three table spoons^ ful of water, to be given a teaspoonful every tAvo to four hours, except Ver. Vir. Sunstroke in hyperemia from the heat of the sun, applications of ice or cold Avater to the head and along the back, and to the extremities, is in- dispensable to re-awaken the paralyzed reaction of the organism, but this should not be an entirely constant application, but should have short interruptions at intervals. ANiEMIA OF THE BRAIN. LACK OF BLOOD TO THE BRAIN. Anemia of the brain is not, as generally considered, a separate affec- tion, but rather a symptom of, or an affection caused by, some other dis- ease. Anemia of the brain either consists in a diminished volume of blood in the brain, or in a supply of blood to the brain, destitute of red globules. In the former case, it is caused by constriction or compression of the arteries through which the blood courses toward the brain, or by any other circumstances, in consequence of which the space Avithin the skull is narroAved. In the second case, all the causes of anemia must be considered; whereas, the deficiency of blood consequent upon sanguin- eus losses, will have to be counted, since it is not only the decrease in the quantity of the blood, but, also, in the quality, that determines the anemia. LACK OF BLOOD TO THE BRAIN. 125 Then, again, there is no doubt but that changes of a spasmodic na- ture may induce a sudden decrease of the volume of blood to the brain ; a greater or less degree, Ave have observed, in consequence of powerful mental emotion or excitement. The symptoms of anemia of the brain differ a good deal, according as it develops itself more or less rapidly. If it develops quite rapidly, we have a most perfect image of syncope (fainting or swooning), uncon- sciousness, voluntary muscular movement are suspended, most gener- ally, amid slight convulsions, and both the breathing and the pulse are sloAver. This condition is most prominently seen, during metrorrhagia (hemorrhage from the womb) in confinement; or from some other mor- bid discharge of blood. Evidently such accidents are attended with great danger to life. If the anemia sets in more sloAvly, symptoms of stimulation always precedes the sinking of the activity of the brain. Here, as well as in excess of blood in the brain, Ave have violent head- ache, great irritability of the organs of sense, buzzing in the ears, dim- ness of sight, vertigo (dizziness); and it is only from the course, and a careful study of the causes of disease, that Ave are able to obtain light regarding their cause. It is characteristic of most cases of anemia of the brain, that the symptoms either abate or disappear in the horizontal position, and that the partaking of food or stimulating substances, cause an improvement. The course and duration of this disorder depends, of course, upon the aggravating causes. What is certain, is, that the appearance of anemia of the brain is ahvays a very bad symptom, especially in the case of chil- dren. Treatment.—We must content ourselves with mentioning only a few remedies, knoAvn to be most prominent for anemia of the brain, when manifesting itself as an independent, and more particularly in the form of an acute disease. Ipecac, as a remedy, is particularly suitable for children, after rapid losses of animal fluids, if the symptoms of convulsions are present, to- gether with more or less stupor. Dose: Eight pills, or four drops of solution, in three tablespoonsful of water. Give a teaspoonful every two or three hours. Secale cornutum is particularly useful in the hemorrhage from the womb of parturient females ; here it acts in a two-fold direction, against the hemorrhage itself, and against the symptoms arising from the brain and spinal marrow; upon both of these organs it acts in a very marked manner. Dose: As for Ipec. Cuprum is only suitable where the whole process is developed sloAvly, and is more especially characterized where there is some spasmodic phe- nomena, such as some mental excitement. Dose: A small powder, or eight pills, in Avater, as directed for Ipec. Home remedies—Ammonia or Camphor applied to the nose, or even a little cold water applied to the face, will often arouse from syncope aris- ing from anemia of tlie brain. 12fi OUR FAMILY PHYSICIAN APOPLENY. Apoplexy is a sudden loss of consciousness, beginning at the brain, depending upon hemorrhage upon the brain, congestion or embolism (a small clot from the heart lodged in an artery of the brain.) Characteristics.—Sudden or gradual loss of consciousness, sensa- tion, and motion, with greater or less disturbance of the pulse and res- piration. Few diseases offer a greater number of varieties in form than Apo- plexy; and there is scarcely a single classification of the many that eminent medical Avriters have given to the world, Avhich is not more or less liable to objection. It is also extremely difficult to distinguish clearly betAveen the different varieties, the external symptoms not ahvays bearing a uniform relation to the internal injury; thus all the indications of serious Apo- plexy may declare themselves from sanguineous extravasation ; and it is not ahvays possible to decide, in Apoplexy, whether effusion, or simple congestion of the vessels of the brain, has taken place. Premonitary symptoms.—Continued inclination to somnolence; heavy, profound sleep, Avith snoring respiration; nightmare, grinding of the teeth, shocks, or cramps, extreme droiosiness, or a general feeling of heaviness, or disinclination to the least exertion ; frequent yawning and fatigue after the slightest exercise. A sense of Aveight and fullness, and pains in different parts of the head, sometimes very deep-seated. Head- ache and megrim, or giddiness and fainting; pulsation of the arteries of the temples and neck, with swelling of the veins of the head and fore- head ; disturbance of the functions of the brain, evinced by the loss of memory, irritability of temper, or mildness and indifference, despondency and Aveeping; irritation of the conjunctiva, dimness of vision, specks or motes before the eyes, or flashes of Are or sparks during darkness ; acute- ness of vision, or double vision, sometimes, also, the words in a line appear to run into one another; difficulty of opening or closing the eyes ; noises, humming, singing, etc., in the ears; dullness of hearing; dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odor; sneezing, and slight bleeding of the nose; stammering, and indistinct pronunciation ; difficulty of swallowing; numbness or torpor or pricking sensation in the extremities, with inarticulate speech, and oc- casional partial attacks of paralysis in the face (distorting the features), or in some of the muscles of the limbs; pains in the joints; weak or unsteady mode of progression, difficulty of passing Avater, etc., Confirmed attack. Symptoms.—The attack itself is commonly ushered in by either of the following group of symptoms: The patient suddeniy falls to the ground, and is instantaneously de- prived of sense and motion. The limbs are relaxed and perfectly motion- less, or the Avhole of one side is rigidly contracted, whilst the other is relaxed and poAverless; in some instances one limb (such as an arm) is alone implicated. The speech is either entirely suppressed, or a few inar- ticulate sounds are all that can be uttered ; the countenance is flushed, or livid and pufled, and there is foaming at the mouth, with contortion APOPLEXY. 127 towards the affected side. The respiration is sIoav, impeded, and usually accompanied by a rough, harsh snoring. The pulse varies, but is usually weak at the commencement, and fuller and stronger, but slower, as reaction supervenes. In other cases, again, the patient is suddenly seized with partial paralysis, comprising either an arm or leg, or the Avhole of one side of the body, attended with loss of the power of utterance, and pale, sallow, or livid and bloated countenance. In the course of a few hours, all or the greater part of the symptoms mentioned under the first variety of apoplexy, are prone to supervene. Issue and results.—When in either form of the disease, recovery is about to take place, consciousness gradually dawns upon the patient; he begins to recognize persons and objects around him,ansAvers Avhen spoken to, or makes signs for writing materials, in order to express his wants on paper, when the power of speech is still denied him. But Avhen a fatal termination is to be apprehended, the breathing becomes more and more oppressed, the face becomes pallid, and a cold, clammy SAveat bedeAvs the broAV ; the act of swallowing is rendered difficult or impracticable, the teeth become clenched, the eyes dim and glazed, and the evacuations are passed involuntarily. Predisposing causes.—Chronic derangement of the primary organs of digestion, and, in some cases, disease of the heart, are the principal predisposing causes of Apoplexy. The conformation of the frame is also considered to predispose persons to attacks of Appolexy. Old age is more subject to this disease than the robust or mature periods of life. Particular seasons, such as the equinoxes (the transition from Avinter to summer, and from autumn to Avinter), increase the predisposition to at- tacks of Apoplexy. Sudden changes of the barometric conditions of atmosphere are also knoAvn to operate as predisponents. Exciting causes.—The exciting causes of Apoplexy are intemper- ance in eating and drinking; mental emotions; obstructed circulation, arising from tight articles of dress around the neck or waist, or from pro- longed stooping, or keeping the head in a dependent position; intense study ; blows on the head; the use of opiates; baths at too high a temper- ature ; violent vomiting, or strong muscular efforts; the suppression of habitual discharges; exposures to the rays of the sun ; extremes of tem- perature ; accidental loss of blood, or excessive venesection. ALLOPATHIC TREATMENT. Treatment of apoplexy will have reference to the period of at- tack, and to its prevention. If an attack has occurred, the patient is to be placed in a cool, well aired room, with the head raised and cold appli- cations applied. If the head is hot, and the arteries throbbing, and the face flushed, ice should be applied to the head, and hot foot-baths with mustard, or mustard plasters, to the feet and legs. The dress about the chest and neck loosened. If the stomach is full, a vomit (emetic) should be given ; but not oth- erAvise. A tablespoonful of mustard, in water, is as good as any. An emetic which produces straining should not be given. 12S OUR FAMILY PHYSICIAN. There is, generally, an advantage in an active cathartic. For this purpose three drops of Croton Oil is the best cathartic, on account of the briskness and quickness of its action. It can be given in a little syrup or glycerine. If free purgation does not occur in four hours, the dose should be repeated. The action of the physic can be hastened by injections of soap suds having a little salt added; one pint is the usual size for an injection. If the pulse is small or feeble, or the patient Aveak, a cathartic should not be given ; but if it is known that the boAvels have been consti- pated, they should be moved by an injection. If the patient is beloAv middle life, the condition is probably active congestion, particularly if the symptoms characteristic of this condition obtain, such as flushed face, congested eyes, throbbing carotids and other arteries of the head and neck, and a hard, resisting pulse, the life of the patient may depend on the immediate abstraction of blood. When paralysis exists, the apoplexy depends upon extravasation of blood from the rupture of an artery Avithin the skull, or upon embolism (plugging of an artery in the brain by a small clot from the heart), bleeding should not be resorted to. In the latter case, it can do no good, and in the former may do positive harm, by so weakening the patient that he cannot survive long enough for the clot of blood to absorb. If the patient regains consciousness, and paralysis of one side of the body (hemiplegia) remains, there is a clot. Cooling Avashes should be applied to the head, the bowels kept open, and the food nutritious, but unstimulating. Recovery Avill depend upon the absorption of the clot by the efforts of nature. The paralysis will be treated of, under that disease. Preventive treatment.—As there is liability of apoplexy recur- ring, after recovery from an attack, all possible precautions should be observed. The individual should avoid violent bodily exertion, or strong mental labor, venereal excitement, the use of alcohol in any form, the stooping posture, and tight neck cloths. The head should be Avell ele- vated at sleep, and every morning the head bathed in cold Avater. When dizziness, headache, with throbbing of the arteries, occur, a brisk cathar- tic should be taken. The rule of life, as stated in the treatment of acute congestion, is moderation. Head symptoms are sufficiently common without being followed by apoplexy, so that those Avho experience them need not become unhappy from fear of apoplexy, especially if they have never had the disease. HOMOEOPATHIC TREATMENT. Homeopathy possesses many remedies, by means of which it is fre- quently possible to Avard off an impending attack of Apoplexy. In order the better to facilitate the selection of the appropriate med- icines, inasmuch as the immediately exciting cause frequently serves to modify the course to be adopted, the subjoined table of medicines, espec- ially appropriate for the treatment of cases distinctly traced to particular causes, has been pre-attached to the distinctive indications afforded for each medicine, separately, further on this article. APOPLEXY. 129 But it is, at the same time, necessary to caution the reader against hold- ing the cause as paramount to the particular indications present, for the cause is ever the subordinate reason for selection. But when any one of tlie remedies named as appropriate for the treatment of eases traceable to par- ticular causes, is also found upon reference to particular and distinc- tive indications, to correspond with the requirements of the case, we have thus ascertained a double reason for being assured that the selection is correct. INDICATIONS AFFORDED BY PARTICULAR CAUSES, DURING THE PRESENCE OF PREMONITORY SYMPTOMS. When the attack is directly traced to a chill, select especially from :* Aconitum, Opium, Nux-vomica, and Mercurius. When the attack is traceable to a sudden fright, select especially either:* Aconitum or Opium, or both alternately. When concentrated grief is ascertained to be the exciting cause, select especially from : * Ignatia and Lachesis. When sedentary habits or over-application to study is distin- guished as the exciting cause, select especially: * Nux-vomica. When the attack is directly traced to a fit of passion, select espe- cially from: * Aconitum, Bryonia, and Nux-vomica. When excessive joy is distinguished as the exciting cause, select especially from: * Coffea and Opium. When the attack is directly traced to over-indulgence in vinous and spirituous liquors, select especially from: * Nux-vomica, Opium, Lachesis, and Pulsatilla. When derangement, from overloading the stomach, is recognized as the exciting cause, select especially from: * Pulsatilla, Ipecacu- anha, and Nux-vomica. When exposure to the sun or a hot bath (too hot) is distinguished as the exciting cause, select especially from : * Belladonna and Aconite, or both alternately. When the attack is directly traced to suppression of an habitual evacuation of blood, select especially from: * Nux-vomica and Pul- satilla. Aconitum is required in all cases where there are evident symp- toms of fullness of the vessels, determination of blood to the head, char- acterized by redness and fullness of the face, distension of the veins of the forehead, quick, full pulse, restlessness, and anxiety. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every hour, until amelioration or change ; but if, after three doses have been given, the improvement does not become speedily progressive, proceed with the next medicine. * The selection from one or more of the medicines thus enumerated, must, however, as already ob- served, depend upon the correspondence between the symptoms of the case, and those hereinafter .enumerated in respect of each of these medicines separately. But if the indications for two or more medicines (hereafter afforded) be so closely identical as not to be decisive between them—whereas both are not applicable to the treatment of cases arising from the same cause—then this discrepancy will be decisive between them, if the cause be clearly ascertained. 9 130 OUR FAMILY PHYSICIAN. Belladonna is of essential service when the symptoms of conges- tion do not speedily or thoroughly yield to Aconite, or should only a par- tial degree of amelioration have taken place, in which case this remedy should be administered four hours after the last dose of the foregoing,— or, further, should the following symptoms present themselves: redness and bloatedness of the face, injection of the conjunctiva (the mucous membrane Avhich lines the eyelids, and covers the front of the eyeball), violent beating of the arteries of the neck and temples, noises in the ears, darting pains in the head, with violent pressure at the forehead, increased by movement, the least noise or bright light; double vision, and almost all the symptoms relative to the eyes already mentioned; dryness of the nose, with unpleasant smell and bleeding of the nose; fiery redness of the throat; difficulty of SAvallowing; slight attacks of paralytic weakness or heaviness in the limbs. Dose: Of a solution of six pills to tAvo tablespoonsful of water, give a teaspoonful (or two pills dry on the tongue) every three hours, until improvement or change. Nux-a'Omica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits, addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or in those who have long been affected Avith indigestion, either bilious or nervous, and have, consequently more or less of the rheumatic or gouty constitutional tendency; and also Avhen the following symptoms pre- sent themseh-es; headache deep-seated or frontal, but more especially at the right side with giddiness, confusion, and humming in the ears ; nausea; and inclination to vomit; turgescence of the superficial vessels of the face, or redness only of one cheek ; drowsiness; feeling of languor, with great disinclination to exertion, either mental or bodily; cramps of the limbs, especially at night, and weakness in the joints; constipation, and difficulty in passing water; irritability of temper, aggravation of the symptoms in the morning, or after a meal, and also in the open air; bilious, sanguine, or nervous temperament. Dose: A solution of six pills, as directed for Belladonna. Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find the following symptoms: marked congestion to the head, indicated by stupor, giddiness, heavi- ness in the head, and violent pressure in the forehead; singing in the ears and obtuseness of hearing; sleeplessness, or agitating dreams, or frequent and almost overpowering drowsiness during the day; redness of the face, and constipation; pulse slow but full. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful (or two pills dry on the tongue), every two hours, until improvement or change. Ignatia is also indicated by many of the symptoms mentioned un- der the head of Nux-vomica, but it is chiefly called for when depressing emotions (particularly severe, and protracted grief), have been the excit- ing cause, and when the person affected is of a nervous temperament. Dose: Six pills in two tabespoonsful of water, a teaspoonful every four hours, until improvement or change. 0 PARALYSIS. 131 PARALYSIS. By Paralysis we understand a suspension of nervous action. It differs in character according as one or another or all the nerve trunks are at- tacked. And its symptoms must vary, just as the functions of the nerves vary. The name paralysis, implies the complete cessation of the action, both of the nerves of sense of feeling, and of the nerves of motion. 'If only one set of nerves are affected, it is called incomplete paralysis, or paresis, one side of the body affected is called hemiplegia. If the upper extremities, or one side and the lower extremities, or the other, are the seat of disease, we call it transverse paralysis. The Causes of paralysis are various. Diseases of the brain and spinal cord, are the principal causes. Of these apoplexy, inflammation, and soften- ing of the brain, are most prominent. There are many other influences to which paralysis many be traced as their result. The main causes of this class are: excessive exertions of the parts to which the paralyzed nerve is distributed, in which list must appear cases resulting from compulsions, continued; and excessive pains, swellings, neuralgia, ligatures, a stroke of lightning, rheumatism, husteria, gout, pregnancy, violent acute diseases; among which contagious and miasmatic diseases occupy a front rank, such as scarlatina, measles, variola typhus dysentery and finally poisoning by vegetable, animal, and more particularly by mineral poisons. The symptoms of Paralysis may readily be understood. There can only be doubt, when the paralyzed part is not accessible to our vision. The prognosis depends on the nature of the exciting causes, and upon the pos-° sibility of removing them. If from disease of the brain, or spinal cord, a cure is not impossible, but doubtful. If from some acute disease, there is very little doubt of an ultimate cure. That the prognosis is rendered much more doubtful by an advanced age, an enfeebled constitution, and an extension of the paralytic phenomena over a large surface, is but natural to expect. Treatment. Paralytic attacks, being almost without any exception, secondary affections, are results following some other disease, or injury. It is evident that in treating them it is of the utmost importance to learn the first, or primary cause of the present affection. It is not always possible to do this, but when the cause is once known, the treatment should be di- rected to its removal. If it is the result of disease, look for the treatment under the name of that disorder. If from some external cause, study and remove that. ALLOPATHIC TREATMENT. Paralysis. There are no diseases, the treatment of which ought more certainly to be directed by a judicious physician, than the treatment of the several forms of paralysis. The treatment, as a matter of necessity, will have reference to the diseased conditions causing the paralysis, the state of the system, and any independent affections which may be co-existing. Treatment is not to be addressed to the inability to make muscular movements directly, but to the cause and associate affections. The nature of the causes must, there- fore be determined with positiveness. Among the questions to be settled * 132 OUR FAMILY PHYSICIAN. before intelligent treatment can be begun, are: Is the cause of paralysis inflammatory, or is there a structural change of tissue (lesion), and where is this lesion or inflammation situated ? Is it in the course of a nerve within the skull or spinal canal ? If it is a lesion, Avhat is its nature and extent? Is it the result of poison, as lead or arsenic, copper or mercury? Or are all these causes absent and is the paralysis functional ? What in- fluence do co-existing diseases have on the paralysis? Is the system well nourished, or is there debility or anemia? The treatment Avill vary ac- cording to the conclusions arrived at in answer to the above questions, and the result will, therefore, depend upon the correctness of the conclu- sions, and the judgment with which the indications are carried out. There are cases in Avhich the structural changes (lesions) are such as are beyond hope of repair; in such cases the complete success of treatment cannot be hoped for. That part of the treatment having reference directly to the paralysis or to the paralyzed parts, and calculated to restore their function, promote the circulation in them and their healthy nutrition are chiefly electricity, passive motion, active exercise under the direction of the will, rubbing, shampooing, and stimulating applications. Strychnia is also given inter- nally for this purpose. It must be borne in mind that these measures cannot be effectual and may be injurious, so long as the paralysis is maintained by the lesions Avhich caused it. The general treatment having reference to the causes of the paralysis is considered under their respective heads as apoplexy, as a cause of hem- iphlegia (paralysis of one side of the body) and myeletis (inflammation of the spinal cord) as the cause of paraplegia, (paralysis of the lower half of the body.) The chief remedies are Strychnine and Electricity, but their use should be delayed until the acute stage of the causing disease has passed, though later on both these agents are useful in restoring the circulation to the brain in cases of thrombosis (obstruction of the circulation in the brain by inflammation of an artery) or to embolism (obstruction of the circulation in the brain, caused by a plug lodging in an artery) and to promote the absorption of a clot in case of hemorrhage in the brain. For this end, very mild galvanism (the direct electric current) should be used. One pole should be placed upon the nape of the neck and the other upon the forehead, or upon each mastoid process. Strong currents may do serious mischief. But sufficient time having elapsed for the immediate effects of the brain disease to subside, its judicious use will be beneficial. If there is headache or dizziness, the greatest care will be necessary, and in all probability electricity should be discontinued. It is also important to remember, that part of the paralyzing effects of these causing conditions is temporary, and may be the result of shock, contusion, or congestion, which are temporary. Even paralysis depend- ing upon no appreciable lesion (functional) is, for a time, stationary, be- fore improvement begins. Besides, paralyzed parts do not, of themselves, resume this healthy action, even after the conditions causing the paraly- sis are removed, so that it will not do to trust to nature alone, but appro- priate efforts must be made to restore healthy action. PARALYSIS. 138 It is a serious error to begin treatment addressed directly to the paraly- sis, Avhile that condition is maintained by the primary causes, further than to maintain the nutrition of the paralyzed muscles, by maintaining the circulation in them. It is a serious error to overlook the fact, that after the paralysis has existed some time, that recovery Avill not take place spontaneously. After paralysis has existed so long that degenera- tive changes have taken place in the muscles and nerves, recoAery cannot take place. So long as contractions take place upon passing the electric current through the paralyzed muscles, they have not yet reached a condition that renders them hopeless. If pain is produced upon passing the electric cur- rent through the paralyzed part, but no contractions are produced, the case is less hopeful than as if both contraction and pain were produced. The former is called electro-muscular contractility, and the latter electro- musrvular sensibility. When both are lacking, the case may be said to be hopeless. Electricity.—As before stated, the constant current may be applied to the brain for the purpose of improving the circulation and its nutrition (if the case is hemiplegia.) To the muscles usually the induced (or faradic) is used. This Avill prevent wasting and loss of function from disease, but as a rule, that current should be used which produces the greatest number of contractions and the least amount of pain. If the temperature of the paralyzed part is loAvered and the muscles weak and flabby, great benefit in all these particulars will follow the use of the faradic current. Large, well-moistened electrodes should be used, one being placed o\-er the mo- tor nei'A-e affected, and the other over the belly of the muscle. Every affected muscle should be faradized at each setting. The same principle Avill govern the use of electricity in all forms of paralysis. In facial paralysis one pole should be placed on the mastoid process and with the other stroke the face. Pain is an evil and the current should not be stronger than necessary to produce contractions. Nor should application be made long enough to one muscle to tire it. From ten to twenty minutes is long enough for an electric setting, nor should any muscle be subjected to the electric current for more than five minutes, nor oftener than every day or every other day. In infantile paralysis the most decidedly beneficial results are obtained from electricity. The electrical treatment should be begun early, but after all inflammation has subsided. So long as the electro-muscular contractility continues, especially if the joints have not become changed, the spinal cord and the nerve plexases, as Avell as the paralyzed muscles should be subject to faradization or galvanization. Strychnine.—Continuous with the use of electricity strychnine should be given. It is most useful in hempilegia, when the muscles are com- pletely relaxed; Avhen they are rigid it is not to be given. After the acute symptoms disappear strychnia is useful in promoting the nutri- tion of the nerve or nerve centers affected, as well as by kindling the contractile power of the muscles, whether the paralysis be hemiplegic, paraplegic, or of a local character. The most effectual method of admin- istering strychnine in paralysis is by hypodermic injection. One thirty- 184 OUR FAMILY PHYSICIAN second of a grain a day, by hypodermic injection, has a better effect than the same or a greater quantity three times a day by the mouth. A good formula is: Take of Sulphate of Strychnine one and a half drams, dis- tilled water one ounce. Mix. Apply heat to effect a solution. A drop contains one thirty-second of a grain and can be given once a day by hypodermic injection to an adult. In infantal paralysis one drop of this solution, diluted^ by the drops of distilled Avater and given once a day, is very beneficial, if the muscles have not lost their electro-contrac- tility. It promotes the capillary circulation and the growth and power of the muscles. In making the injection it is best to throw the solution into the muscle itself, taking the paralyzed muscles each in turn. To do this dextrously requires the skill of a physician. Passive Motion in cases of complete paralysis is important, i. e. move- ments of the paralyzed limbs in the hands of the attendants or the patient. It aids the circulation and nutrition and maintains them in a state of pre- paration to respond to the force of the will. Friction of the surface of the paralyzed limbs, kneading the muscles with a deep pressure, and shampooing, are useful in maintaining nutri- tion, and should be employed with perseverance. Persistent voluntary motion, in all cases or incomplete paralysis, is very important. There is reason to believe that in some cases, paralysis continues at a certain point, until it becomes incurable, when persever- ing exercise with other treatment would have resulted in improvement or recovery. With this view gymnastic exercises are to be enforced. The simplicity of this method does not prevent its being of great benefit. Cases of paraplegia, in the early stages, shonld doubtless be treated with Ergot and Belladonna. A teaspoonful of the fluid extract of Ergot and ten drops of the fluid extract of Belladonna should be given three times a day, but after three or four weeks have passed, they should give place to electricity and strychnine. In paralysis of the insane, there is scarcely any hope of cure from treatment, much less for permanent improvement. These patients should be removed to insane hospitals. The treatment consists, for the most part, of palliative measures, and a regulation of the diet, with a view of retarding the progress of the disease, and contributing, as far as possible, to the comfort of the patient, during the continuance of the mal- ady. HOMOEOPATHIC TREATMENT. Annexed are a few paralytic conditions and remedies, proven to be the best for that condition; asfurther study may be made by means of the Repetory. Causticum, while not supposed to be able to produce a cure alone, is still one of the most substantial helps in almost all forms of paralysis. When caused by suppressed erup- tions and ulcers, Caust, Ars., Sul. After excessive bodily exertions, Rhus-tox., Ars., Caust. After rheumatism, Caust., Fer., Bry., China, Am., Rhus-t., and above all, electricity; after apoplexy, Bell., Nux., Caust, Am. INFLAMMATION OF THE BRIAN 135 INFLAMMATION OF THE BRAIN BRAIN FEVER. PHRENITIS. MENINGITIS MENINGITIS cerebrale. The causes are sometimes veiled in obscurity; at others they are known to be the effects of excessive mental exertions, or the use of alco- holic drinks, or the effect of heat, or sometimes of cold, and other like causes, as mentioned under "Hypersemia of the Brain." Symptoms.—An attack of this disease may take place either gradu- ally, or very suddenly; generally the former. The premonitory symp- toms are, at first, depression of spirits, impaired appetite, mental uneasiness, and confusion of ideas, especially when in the recumbent posture, debility, and sometimes ringing in the ears, and blindness. These are succeeded, in most instances, by a more or less severe chill, and constant headache, Avhich are soon folloAved by severe fever, hot and dry skin, flushed face, red eyes, or a haggard, anxious, fearful expression of them; the pulse is quick, rapid, and forcible. The intensity of the headache increases, as also the ringing in the ears, sometimes changing to a humming or rumbling sound ; the senses become morbidly acute, as known by the sensitiveness or restlessness, as shown on exposure to either light or sound. The pupils of the eyes are constantly contracted, the patient is extremely restless or wakeful, Avith more or less deliri- um. They frequently imagine that some one designs to injure them and cannot bear restraint or contradiction, and the delirium is sometimes of a furious, raving nature. The head is remarkably hot, while the extremities are cold. The otngue is furred Avhite, red at its edges, dry, pointed, and the papilhe ele- vated ; the bowels are obstinately constipated, and nausea and vomiting are common. Respiration is accelerated and laborious, seldom hurried, as in fevers, but irregular and with frequent sighs. Generally there will be spasmodic movements of the muscles, and of the tendons. The urine is scanty and of deep color. As the disease advances, a change occurs in the symptoms, the pre- vious delirium changes for a stupor which gradually passes into coma. The formerly contracted pupils are now dilated, and there is less sensi- bility to the light, the eye loses its brightness; sometimes there is squinting, and the countenance is vacant or idiotic; picking at the bedclothes or grasping in the air are almost always present at this stage. The hearing is much diminished, and, indeed, all the senses are very much blunted; the limbs become perfectly relaxed, the pulse is slow, sluggish, and irregular or intermittent, the respiration is deep, sIoav, and often stertorous (noisy, loud); the urine is very scanty, if passed at all, and the feces are involuntarily discharged. Convulsions or paralytic attacks often ensue. Finally, the pulse becomes hurried, small, and unequal, the counte- nance pale and sunken, the skin has a cold and clammy perspiration upon it, the urine flows without any knowledge, the coma becomes more profound and death terminates the scene. It must be remembered that these symptoms vary, being very mild 136 OUR FAMILY PHYSICIAN. with some, and extremely violent Avith others, depending upon the degree of the system, the severity of the cause, and other attending circum- stances. Some care is necessary in discriminating inflammation of tlie brain from fever of some other form; the headache of brain feArer is more con- stant than that of fever, and appears to be confined to no particular spot. The sleep in this disease is disturbed Avith bad dreams and sudden starting or waking in fear, and with children a scream on awakening. The prognosis is generally doubtful. Much depends upon the cause of the attack; if it be produced accidentally by bloAvs, etc., it is more favorable than when OAving to some constitutional disease or difficulty. The milder the symptoms the more certain is a favorable termination, but we should not be discouraged and despair, even in the worst cases. ALLOPATHIC TREATMENT. Treatment of acute meningitis, cerebral, (inflammation of the membranes of the brain). In the first stage of the disease, the object of treatment will be to diminish the active congestion, and to limit the in- flammation and its products. The hair is to be cut close to the head, and cold applied by means of a sack of pounded ice, or constant Avashing with cold water ; the head should also be raised. An active cathartic is to be given : Ten drops of Croton Oil, in syrup or glycerine, is appropriate; or twenty grains of Calomel, in a tablespoonful of Castor Oil, may be given. Owing to the urgency of the case, and the extreme danger to life, if the patient is robust, and the arteries of the head and neck beating violently; in short, if the congestion is intense, blood-letting should be resorted to, preferably by Avet cups than general bleeding. The treatment, in this stage, is the same as in the disease called Active Congestion. These measures are only proper in the beginning of the disease, as exhaustion is one cause of death in cases of meningitis which do not die quickly. Food should be of the blandest kind, and taken cold. The restlessness and excitement should be relieved by Chloral Hydrate and Bromide of Potas- sium: Take of Chloral Hydrate eight scruples, Elixir of Bromide of Potassium four ounces. Mix. Dose: one to two dessertspoonsful from two to four hours apart, until relief is obtained. Opium is beneficial in re- lieving pain, and accomplishes as much as any other remedy, in control- ing the inflammation. After the stage of active congestion is over, the indications for treat- ment are to support the powers of life, and to promote the absorption of the products of inflammation (lymph and serum) The former indiea- cation is to be met, as far as possible, with nutritious, easily-digested food, of which meat essences and extracts, the preparations of milk, and milk beaten Avith eggs, form the principal part. Should the drowsiness and insensibility become so profound as to prevent sufficient food being given by the mouth to support life, as is frequently the case, half a pint of these strong liquid forms of food should be given, in addition, by injection into the rectum two or three times a day, and their retention effected by firm pressure upon the anus with a napkin. The absorption of the lymph will be aided by giving inflammation of the brain. 137 Iodide of Potassium. Take of the Saturated Solution of the Iodide of Po- tassium one ounce, and give five drops in sioeetened water flavored with Es- sence of Peppermint. Strict attention should be given to the bowels, that they do not become constipated. If the bladder is not emptied by na- ture's efforts, the water should be regularly draAvn, twice a day, with a catheter. Vomiting, during any period of the disease, should be met by a fly blister to the nape of the neck, and a mustard plaster to the stomach. The following mixture is as commonly successful as any internal remedy: Take of Carbolic Acid ten grains, Simple Syrup one ounce. Mix, and gi\re a teaspoonful each hour until relieved. Chroiiic Meningitis, Cerebral: In all probability this affection is the result of a poison in the system, known as syphilis, either acquired or hereditary, and a history of this constitutional affection should always be sought for. Even when it is not clearly found, if the inflammation can- not be traced positively to another cause, the existence of syphilis is to be suspected and gOA'ern the treatment. Iodide of potassium should be giv- en. Take of the Saturate Solution of Iodide of Potassium one ounce, and ghre at first five drops in sweetened water flavored with Essence of Peppermint, three times a day. Increase the dose by one drop each day until relief is obtained. Thirty or forty drops may be given at a dose, if relief is not sooner obtained. Give after meals. Quiet of mind and body is necessary. Nutritious food and warm clothing should be provided, and a Avarm bath be given tAvo or three times a week. If the patient is pale and weak, Iron and bitter tonics should be given. The Citrate of Iron and Quinine is an eligible form in two-grain doses; one dram of the drug dissolved in four ounces of syrup or water, is a convenient mixture. Dose: a teaspoonful given before meals. Let us repeat, Iodide of Potassium appears to be the remedy for chronic meningitis not dependent upon Tubercle or an injury. The writer is of the opinion that cauterization, blistering, etc., in this disease, are not, in the slightest degree, beneficial in arresting the disease, but add to the discomfort of the patient. They are not to be used except in obstinate vomiting, when a fly blister should be applied to the nape of the neck. Treatment] of Tuberclous Meningitis: This disease, depending upon the presence of tubercular deposit, offers very little encouragement for treatment, if the diagnosis is clear. We are bound, however, to do what we can to give relief. The general principles of the treatment of acute and then of chronic meningitis obtain, that depletion should not be prac- ticed. Cathartics should be limited to the relief of constipation, which is the rule. For this purpose, Calomel, in one or two-grain doses to a child, and ten grains to an adult, followed, in six hours, by Castor Oil—a tea- spoonful to a child ; to an adult, a tablespoonful, if the bowels have not opened. In the main, measures to relieve pain and prolong life, are alone indicated. For the relief of pain, restlessness, etc., the use of Opium, Chloral and Bromide of Potassium, are indicated. The dose of Opium will vary from 1.8S OUR FAMILY PHYSICIAN. one-tenth of a grain to a child a year old, and a grain to an adult, repeal ed at interA-als of fvvo hours, until pain is relieved. Or Chloral Hydrate can be given in combination with Bromide of Potassium, as follows : Take of Chloral Hydrate two scruples, Iodide of Potassium two scruples, Syrup two ounces. Mix, and give a teaspoonful, three or four hours apart, to a child one year old. The dose for an adult Avould be twenty grains of each drug. To prolong life, stimulants, in doses of a teaspoonful of whisky or brandy, may be ghren to a child, and one or tAvo tablespoonsful to an adult, in addition to nourishing, easily-digested food—as milk and eggs, either alone or beaten together; cream, meat essences and extracts, and raw lean meat, minced fine. Preventive treatment is by far the most important and hopeful. It is that for the consumptive predisposition, and is generality hereditary. If a baby, he (or she) should be brought up by a hearty wet nurse, and should not be Aveaned until he has cut all his teeth. Flannel should be worn next the skin, and the clothes should be warm. OATer-exertion of mind and body should be avoided, but free exercise taken in the open air. The diet should be plain and nutritious. Milk should be freely taken. If the patient is reduced or decreasing in strength, Cod Liver Oil should be given. The Syrup of the Phosphates Avith Iron, is, also, an appropriate remedy. Exposure to measles, and whooping cough, should be avoided, being especially liable to be followed by some form of consumptive disease. HOMEOPATHIC TREATMENT. With regard to the treatment of this disease, we may begin by stating that medical aid should always be procured, if within reaceh; but when it is impossible or difficult to secure such assistance, the following remedies may be resorted to: Aconite is invariably required at the commencement of the attack' when the skin is hot and dry, and the pulse rapid, with the ordinary indi- cations of pure Inflammatory Fever, which is especially liable to be the case in young plethoric subjects. Dose: Dissolve six globules in three table-spoonsful of Avater, and give a teaspoonful of the solution every hour, until the pulse dimin- ishes in force and frequency, and the skin becomes moist or covered with profuse perspiration; after which the intervals may be extended to two hours, and the administration be proceeded with, if no other medicine appears to be indicated, until general and progressive im- provement becomes apparent. But if any of the subjoined symp- toms remain or supervene, consider the following medicines, and select that which is indicated by the symptoms present. Belladonna seems to possess a certain specific influence over inflam- mation of the brain and its membranes, and is generally the remedy we should select, when the following, amongst other symptoms, present them- selves: great heat of the head; redness and bloatedness of the face, with violent pulsations of the arteries of the neck ; burying the head in the pillow, and increase of suffering from the slightest noise, with extreme sensibility to light; violent shooting and burning pains in the head; eyes red and sparkling, with protrusionor, wild expression; contraction or dilatation of the pupils; violent and furious delirium ; loss of conciousness; sometimes inflammation of the brain. 139 low muttering; convulsions,—occasionally symptomatic hydrophobia; vom- iting; involuntary evacuations of feces and urine. Dose: Of a solution of six globules to three table-spoonsful of water, give a teaspoonful every two hours, until a change. But if distinct improvement supervene (without intervening apparent aggravation), the intervals should be extended to four hours, and, again, after two more doses,—if the amelioration be regularly progressive—to eight hours; and so on, until permanent improvement or change. But, in very urgent cases, and when repeated doses of Belladonna have pro- duced inadequate results, consider the next medicine, and proceed accordingly. If in alternation Avith Zincum, a similar solution of each (separately) administered by tea-spoonsful, at intervals of half an hour (or even of fifteen minutes), in rotation, until the urgent symptoms abate. Zincum may be had recourse to, after, or in alternation with Bella- donna, when that remedy effects only partial amendment. In those ex- treme cases where symptoms of threatening paralysis of the brain are manifested by the following indications: loss of conciousness—half-closed eyes — dilated, insensible pupils—icy coldness of the extremities, or of the entire surface of the body—blueness of the hands and feet; impeded res- piration; small, weak, scarcely-perceptible pulse—Zincum has been found, effectual in averting a fatal issue. Dose: If singly, dissolve six globules in three tea-spoonsful of water- and give a tea-spoonfulof the solution (or, otherwise, three globules dry on the tongue), every hour (or in very urgent cases even every quarter of an hour), until the lividity and coldness, and the indica- tions of the pulse assume a more natural aspect,—and then every three hours, until general improvement or change. If in alternation with Belladonna, as directed for that medicine. Bryonia. This remedy will frequently be found of great efficacy in children, when Aconite and Belladonna have produced but trivial improve- article on avater on the brain. ment, and the symptoms manifested resemble those enumerated in the Dose: Dissolve six globules in four tea-spoonsful of water, and give a tea-spoonful of the solution every two hours, until amelioration or change; but if partial improvement only should become apparent within two hours after the third dose of Bryonia, pause tAvo hours longer, and proceed with the next medicine. Helleborus-niger is required after Bryonia in cases exhibiting the characteristic features of Water on the Brain, when the last named medi- cine has been inadequate to overcome the disease. In such cases, and when partial improvement only has resulted from the previous adminis- tration of Bryonia, Helleborus should be given four hours after the third dose of the last-named medicine. Dose: As directed for Bryonia. Hyoscyamus is appropriate when there are—drowsiness, loss of con- ciousness, delirium about one's own affairs—inarticulate speech—tongue coated white, with frothy mucus about the lips —dilation of the pupils- fixedness of vision—skin dry and parched—redness of the face, and picking of the bed clothes with the fingers. Dose: Of a solution of six globules to two table-spoonsful of water, give a teaspoonful every one to three hours, until amelioration or change. 140 OUR family physician. Opium. When there is lethargic sleep, with snoring respiration; half- open eyes, and confusion or giddiness after waking; congestion of blood to the head; complete apathy and absence of complaint. Dose: Of a solution of six globules to two table-spoonsful of water, give a tea-spoonful (or otherwise three globules dry on the tongue), every hour, until amelioration or change. Stramonium. When there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind after Avaking, but sometimes attended Avith moaning and tossing about; vision fixed, and the patient frequently appears in a state of dread, and utters cries; redness of the face; feverish heat, Avith moisture of the skin. In many of the symptoms this remedy bears a close resemblance to Belladonna, Avith the exception of being indicated by signs of a more spasmodic character, and by less acute pain in the head. Dose: As directed for Hyoscyamus. HYDROCEPHALUS. DROPSY OF THE BRAIN. WATER ON THE BRAIN. In general Ave understand by Hydrocephalus every unhealthy accu- mulation of fluid in the cavity of the skull. It may be either acquired or exist from earliest life. Acquired Hydrocephalus is seldom an independent disease, but rather is generally symptomatic of some other constitutional disease. It be- comes an important symptom Avhen the disease sets in as a chief compli- cation in meningitis; or when it develops itself so rapidly that it acts like apoplexy, and speedily terminates fatally, (when it Avould be called serous apoplexy.) It is very hard, indeed, always uncertain to diagnose this disease. It scarcely ever calls for a special treatment, and had better be treated Avithout medicines by means of care and diet. Congenital hydrocephalus (that which exists from earliest life) com- mences before the child is born, but may increase after birth. The quantity of accumulated fluid may be very large, and hence the skull may acquire an extraordinary size. Its effects upon the child are sometimes imperceptible, but at other times very decided; the mental actions of the brain are mostly involved. It is only in A-ery fully deAcl- oped cases that the motions of the muscles are interfered with, in which cases a more or less complete paralysis sets in. The life of the patient is not absolutely threatened ; it may be admitted that hydrocephalic chil- dren, who have got over the period of infancy, have pretty nearly escaped the most imminent danger of death from this immediate cause. But they always remain weakly, irritable, and unusually disposed to fre- quent and malignant diseases. Hydrocephalus, or dropsy of the brain, is a curable disease, but such a cure is mostly spontaneous, taking place in proportion as the bodily development progresses, and if the body does not develop, the limbs remaining small, or paralyzed, the chances of cure are proportionately less. A cure may indeed be facilitated by artificial means, but not by medicines. A main point is to bring up such children with great care, to accustom them to light and nourishing food and to HYDROCEPHALUS. 141 active bodily exercise, and not to excite their mental faculties until the body is well developed. Such children should not be allowed to attend school until they are fourteen or fifteen years of age, and there need be no uneasiness about them falling behind their companions of the same age. If so held back they Avill, almost Avithout exception, excel in study when permitted to apply themselves. Among medicines, if Ave do use them at all, there are none which offer more hope than Carbonate of Lima, (Calcaria Carb.), and Arsenicum, but they must be given in small and very rarely repeated doses. Do not bandage the head of infants tightly for this disease. A very moderate bandage, in very early life, will likely be beneficial, while the tight band- age Avill be likely to cause inflammation and death. ALLOPATHIC TREATMENT. This disease unfortunately gives very little hope of benefit from treat- ment. Physicing, bleeding, blisters, and salivation are to be avoided. Gentle laxath'es or injections should be depended on to keep the bowels open. Plain nourishing food and Cod Liver Oil or Cream should be given. A child can take a teaspoonful of Cod Liver Oil, two or three times a day, while a tablespoonful is enough for an adult. The active remedies Avhich appear the most useful are Iodide of Potassium and Iron. A conA'enient prescription for a child is: Take of Iodide of Potassium thirty-two grains, Phosphate of Iron sixteen grains. Dissolve each salt in a little water separately, then mix and add simple syrup sufficient to make a two ounce mixture. Give a teaspoon half full four times a day, to a child one year old. One drop each of the Tincture of Squills and Tincture of Digitalis can be given to a child three or four times a day to keep the kidneys active. As a last resort, the physician would be barely justified in resorting to puncturing, to draw the water, and compressing the head by strapping. Preventive measures should be closely followed. The strength of the child having a tendency to hydrocephalus, should be increased as far as possible. Nourishing food with as much milk as can be digested, meats, and, if the child is reduced in strength, Cod Liver Oil should be given- Warm clothing, a daily bath, good sleep every night, in a well ventil- ated room, and exercise in the fresh air, are all helpful. Stimulants should be avoided. When the child has become of an age to commence its education (7 or 8 years) only short and varied lessons should be given, and mental fatigue avoided. Congenital Hydrocephalus, or dropsy of the brain.—If the disease is congenital (from birth), it may be questioned Avhether anything should be done to relieve the infant, except attending to its general health. There are medicines which, in many instances, diminish watery accumu- lations in internal cavities; the parents are very anxious for the recovery of the little one; some recoveries are reported. These facts, and the hopelessness of the disease, if left to nature alone, lead the physician to resort to medicinal treatment. Medicines which act on the kidneys (diuretics) are generally sup- posed to be called for, and with reason. The best of these is Iodide of Potassium, as an efficient diuretic, and, possibly having a direct influence 142 OUR FAMILY PHYSICIAN. over the disease. The dose for a child, six months or a year old, is one or two grains three to six hours apart, dissolved in a half teaspoonful of syrup of peppermint. Pressure of the head by a closely fitting cap, or very narrow strips of adhesh-e plaster (one-third of an inch Avide) and applied evenly over the skull, from side to side, and then from back of the neck to the orbit may be of great use. Care in the use of pressure should be exercised not to produce compression of the brain. If pressure is tolerated, and health good, the prospect is better. Generally the fluid accumulates so the straps must be loosened in two or three days. This process should be managed by a physician. Tapping is sometimes resorted to, and, also, sometimes after the re- moval of the fluid a solution of Iodine, £ of a grain, and Iodide of Potas- sium 1 grain, to an ounce of distilled Avater. This requires a physician. I can see no indication for irritating applications. Attention to the general health is necessary. Constipation of the bowels should be relieved by an occasional purgative, as a half teaspoon- ful of Rochelle Salts ; three to five grains of Calomel, or a teaspoonful of Castor Oil. The diet should be of the breast milk, Avith cream or Cod Liver Oil, and raAV meat minced fine. The treatment of acquired dropsy of the brain will be noticed in the diseases leading to this affection. Generally there is but little encourage- ment for treatment. Diuretics are called for. Iodide of Potassium and Acetate of Potash, are the best; the dose of the former is one or two grains, and the latter three to six grains, four to six times a day. Blistering should be produced behind the ears with the Blistering Collodion. Active congestion will call for cold to the head, cathartics and Bromide of Potassium in doses of five to ten grains, three or four hours apart, for a chiid a year old. Constipation should be relieved. TETANUS. TRISMUS. LOCK-JAW. A painful disease, the leading symptom of which is persistent spasm of the voluntary muscles. When the muscles of the lower jaw are af- fected it is called trismus or lock-jaw. The disorder is chiefly occasioned, either by exposure to cold or by some irritation of the nerves resulting from local injury, particularly of tendinous parts, (example in the hand or foot), it is then called trumatic tetanus or trumatic trismus. The amputation of a limb, or the pulling on a nerve by some ligature used in tying some of the blood vessels, cut into either accidentally or during some surgical operation. When it takes place in consequence of such a cause, or from any other external in- jury, the symptoms generally set in about the eighth day, sometimes later, but when they follow exposure to cold, they usually set in much earlier. In some cases the attack comes on suddenly, and with extreme violence, but it more generally approaches gradually, a slight stiffness being first experienced in the back of the neck, with an uneasy sensation at the root of the tongue, and a difficulty in performing the act of swallowing, TETANUS. 143 an oppressive tightness is complained of across the breast or in the chest, Avith a pain at the lower end of the breast-bone, or in the pit of stomach, (scrobiculus cordis), extending into the back, the breathing is hindered, the face pale, pulse small, bowels constipated and urine high-colored; a stiffness takes place in the lower jaAV, which soon increases to such an ex- tent and presses the jaws so closely together that the smallest opening is unattainable, and now the patient has the lock-jaw. In some cases the spasmodic contractions proceed no further; in others they return with great frequency and intense severity, and also extend to the arms, the abdominal muscles, the back and lower extremities, so as to bend the body forcibly backward (Opisthotonos), even to such a degree that the back of the head touches the heels, or forward (Emprosthotonos) until his nose touches his toes, or sideways (Pleurosthotonos). Finally the arms, lower extremities, head and trunk become rigidly extended, caused by an equal contraction of all the muscles. The tongue is also seized with spasm, and is, not unfrequently, injured by the teeth becom- ing clenched together just as it happens to be convulsively darted out. As the affection advances the eyes become fixed and immovable, the whole countenance is frightfully distorted and expressive of extreme an- guish, the pulse irregular, the strength completely exhausted, and a termination is put to the sufferings generally about the fourth day, in acute cases, by one concentrated spasm. In some cases the fatal termin- ation is protracted considerably beyond the stated period. The spasmodic action does not continue unremittingly, the muscular contractions occasionally admitting of some abatement, but is generally renewed as soon as the patient makes an effort to speak, drink or move. Prognosis.—This disease is so intractable that under any known treatment, the most stolid practitioner can but consider the attack as un- fortunate in the extreme, and his prognosis must be unfavorable, although not always fatal. ALLOPATHIC TREATMENT. " Lock-jaw" is so dangerous an affection, that none would scarcely venture to assume the responsibility of the treatment, unless he be a phy- sician, such a person would be foolhardy. Most, if not all, plans of treatment prove unsuccessful in a large pro- portion of cases. The remedies which appear to be most successful are: Bromide of Potassium and Hydrate of Chloral. Forty grains of Bromide of Potassium, dissolved in water A\dth syrup or sugar, should be given every two or three hours, or a dram (60 grains) every three or four hours apart, during the day, until half an ounce (240 grains) has been given. At bed time a full dose of Chloral Hydrate, forty grains, dissolved in water with syrup or sugar, should be given for the purpose of securing sleep. In the morning, thirty grains of Chloral may be given, if the temperature reaches 101° Farenheit. Nitrite of Amyl has been used with success in a very limited number of cases. It appears to control the spasms and may be administered by inhalation, three to six drops on a handkerchief. A fullness of the head dictates the removal of the handkerchief. It should be repeated suffi- 144 OUR FAMILY PHYSICIAN. ciently often to relieve the spasms. I would recommend giving Chloral Hydrate at bed time, as directed above, even if the nitrite is depended on. Calabar bean.—Of late years this remedy has come largely into vogue in the treatment of tetanus. Out of fifty-nine cases treated with this drug thirty-two recovered. Dr. Fraser recommends beginning with one-third of a grain of the extract by subcutaneous injection, and increase the dose continuously until the reflex excitability is sensibly diminished, then continue the injections at that dose. In milder cases the medicine may be continued by the mouth in doses three times as large as the largest given by hypodermic injection. It is possible that if a good quality of extract could be used every time the result Avould be better. In all cases attention should be strictly paid to nourishing the patient and so support the poAvers of life. Four ounces (| of a pint) of good, rich milk with brandy, should be given every four hours, and a raAV egg beat with milk and brandy, four times in the tAventy-four hours. In cases of traumatic tetanus (caused by injury), all remaining sources of irritation, such as fragments of bone, bullets, pieces of cloth, or any thing else should be removed. Oftentimes the surgeon is justified in am- putating the injured part, as a means of cure of the lock-jaAV. This pro- cedure is the more hopeful, if the spasm is confined to the jaw. Tetanus of infants is best prevented by cleanliness, Avarmth, fresh air and dry apartments. On southern plantations, Avhere the disease appears endemic, it is arrested by having the cabins whitewashed with lime both inside and out; raising the floors up from the ground that air may circu- late freely under them ; removing all filth from and about the houses; particular attention to cleanliness of the bedding and clothing of the mother and child, and preventing any matter from the navel coming and remaining in contact with the skin. A Avarm or tepid bath should be given the child daily. A dressing of one part turpentine and two parts sweet oil or lard is highly recommended. After the disease has become developed, the foregoing hygenic meas- ures should be carried out rigidly. The medicinal agents, which in my judgment are preferable to all others, are the Bromide of Potassium and Hydrate of Chloral given after the same manner as directed for adults. The dose for an infant would be three grains given every two or three hours, which may be increased to five, or even ten, grains, if the spasms are not relieved. When desirable to produce sleep I would give two grains of Hydrate of Chloral with the Bromide of Potassium until sleep takes place. After a couple of doses of the Hydrate of Chloral, if sleep has not taken place, the dose should be gradually increased until five or six grains are given' or until the desired effect is reached, namely, sleep. Eight scruples of the Bromide of Potassium dissolved in two ounces of simple syrup con- tains ten grains to a teaspoonful. Of this mixture one fourth of a teaspoonful will be a dose to begin Avith. Six scruples of hydrate of chloral dissolved in two ounces of syrup gives eight grains to the tea- spoonful and one fourth of a teaspoonful the dose to beein with If the spasms are so severe that the child cannot SAvallow, I would not hesitate to give at once, by injection, a teaspoonful of the Bromide of Potassium 'delirium tremens. 145 mixture and a half teaspoonful of hydrate of chloral mixture. The dis- ease is very dangerous, too dangerous to be treated without a physician. A blister the size of a dollar oArer the navel is said to be useful when the disease does not yield to remedies by the mouth. The spine may also be thoroughly rubbed with some stimulating ap- plications, as turpentine, or hartshorn liniment. Brandy should be gh-en in doses of ten drops to half a teaspoonful Avith milk or beef essence at short intervals to preA'ent the rapid exhaus- tion of the disease. HOMOEOPATHIC TREATMENT. Aconite is useful in lock-jaw where there is frequent alternation of red and pale face Avith distorted eyes, thumb turned into the palm of the hand, and the hand clenched, pulse full and bounding. Arnica.—In cases arising from an injury, such as a true bruise or cut of the flesh, or the puncture of a needle, pin, bay fork, or like sharp- pointed instrument, it should be ghTen internally, 10 drops in a \ glass of Avater, two teaspoonsful eA'ery hour or half hour, if the case is urgent, at the same time it should be applied externally to the wound ; take one part tincture arnica to five parts water, moisten a soft cloth, and keep it on the parts injured. Opium.—Is a useful remedy in some of the seA^erest forms of tetanus as well as lock-jaAv, either from an injury or from a cold. The muscles of the whole body tremble, there is foam at the mouth, and finally the whole body is bent backAvard in the form of an arch, when opium is useful. Nux Vomica or Strichnia.—When there are extremely severe spasms folloAved by a short period of relaxation, then another spasm at periods of three to six minutes. Belladonna. —In attacks of trismus among children, Avhen a jar of the bed will bring on a spasm. DELIRIUM TRKMENS. This is a disease frequently occurring in persons A\ho are in the habit of using intoxicating liquors, eA^en Avhen they do not drink enough, at any one time, to become intoxicated. It is a dangerous disease Avhich frequently destroys life, or causes a state of insanity. Symptoms: It usually commences with sonic degree of nausea, A'oiniting and loss of appetite, especially for breakfast, Avhich are, sooner or later, followed by constant Avakefulness. incessant talking, Avalking about restlessly, and, sometimes, raving from the first. There is a con- stant trembling and unsteadiness of the limbs; the band is unsteady; the tongue is tremulous when protruded; the Avalk is staggering; the skin is cold, and the pulse is weak and rapid. As the disease progresses, the symptoms become worse; the patient is not silent for a moment; he is constantly talking, scolding or laugh- ing ; changing from one thing to another, rapidly; arranging his clothes, room, bed, etc., with more or less agitation and mental suffering. He 10 146 OUR FAMILY PHYSICIAN. imagine* the presence of things which he knoAvs are mere illusions, or they may appear so real as, for a time, to make him actually believe that they truly exist; but, most generally, this deranged perception may be explained aAvay, for the moment, by some kind friend. Among these imaginary objects, are: rats, mice, serpents, fiends, witches, guns, drag- ons, bugs, insects, etc., to free himself from Avhich he will have the most fearful struggles, Avith expressions of disgust, distress, and even fear and horror. It is impossible to name the various fancies which he creates ; at one time laughing, at another begging, with tears in his eyes, for life ; then humbly asking pardon for some imaginary wrong. Again, point- ing, with raving expressions, to the objects conjured up in his disor- dered mind ; and, finally, raving almost like a maniac. His eyes are bloodshot and in constant motion, Avith a peculiar glare, glancing fearfully and suspeciously, at every object around him; the countenance, is usually, pale, haggard and distressed, the tongue coated with a thick, yellowish mucus, the head hot, and the bowels costive, with occasionally nausea and vomiting. If the patient is not relieA'ed, he becomes worn out and is compelled to lie down from sheer weakness, and may die suddenly, in an apoplec- tic or epileptic fit, or, he may gradually .sink, the surface becoming cold, with clammy sweats, low, muttering delirium stupor, picking at the bedclothes, twitching of the tendons and death. Sometimes the first symptom is an epileptic fit, or apoplexy, on recovery from which, well marked delirium tremens occur. The development of the disease most frequently follows a sudden abstinence from the use of liquors, among those Avho haA-e become addic- ted to their excessh'e use, by Avhich means the brain becomes excesshe- ly weakened and impaired. It likeAvise frequently happens while the person is in the full tide of his "spree" and, also, occasionally after a continued but moderate use of alcoholic drinks. It usually comes on in from one to fh'e days after the discontinuance of the inordinate alcoholic excitement. In the treatment of a patient with delirium tremens, opposition and the use of force should be avoided as much as possible, because they give rise to irritation, and increase the difficulty. Gentle and persuasive measures are the best, with a degree of firmness; and at no time must you yield to the fancies of the patient, but rather reason or laugh them out of them. This course will accomplish much more than an opposite one. Take of the Sulphate of Quinine eight grains, Sulphate of Mor- phia one grain, mix and divide into four powders ; one of these powders should be given every hour, for two or three doses; afterAvard, lengthen- ing the time, so that too much Morphine be not given. Give the patient, shortly after the first powder, a tablespoonful of good brandy in water and sugar, as a reward for a promise from him that he will lie still and try to go to sleep ; repeat, if need be, until he does sleep ; then let him rest three hours ; after he awakes, give light food. AL LOPATHIC TREATMEN T. The success of treatment in this disease, attended with prostration, depends on nourishment, relieving the restlessness, and inducing sleep. DELIRIUM TREMENS. 147 Milk, raw eggs, beef essence, or strong beef tea, should be freely given. Both the ends are aided by the administration of Quinine, in two or three grain doses every three or four hours. The nervousness and rest- lessness, preceding the active delirium, is best relieved by the Bromide of Potassium, during the course of the disease ; it is, also, equally useful to relieve the same symptom; but, to be effectual, it must be given in doses of forty to sixty grains, eArery four hours, dissolved in water or syr- up. For the production of sleep, there is no remedy so uniformly suc- cessful as Hydrate of Chloral, gh-en Avith the Bromide of Potassium, in doses of tAventy to thirty grains. In old drunkards, it should be used with great caution. After a second dose of thirty grains of Chloral, if sleep is not induced, Morphine, in doses of one-third of a grain, may be given, and repeated, if necessary, in two or three hours. It is best given by hypodermic injection. However necessary sleep and quiet is, it is still more necessary to establish digestion, and support the powers of life, by suitable nutrition. In most cases, this, of itself, will quiet the delir- ium, induce sleep and carry the patient to recovery. Digitalis is found useful in this disease, in doses of a teaspoonful of the tincture, or a tablespoonful of the infusion, made to two drams of the leaves to a pint of hot water. After four hours, the dose may be repeated. Pouring cold water on the head, and the free use of hop tea, are frequent- ly of adA'antage in quieting the delirium. The patient should be treated kindly, and left in charge of an attend- ant in whom he has confidence. Visitors should be excluded from his room. Treatment of alcoholism.—The chief point in the treatment of the mania for drink is to enforce at once total abstinence; this is more easy than to practice moderation. The sleeplessness may be guarded against by forty to sixty grain doses of Bromide of Potassium at bed time. If necessary, with this can be com- bined fifteen to twenty grains of Hydrate of Chloral, or two teaspoonsful to a tablespoonful of Tincture of Hyoscyamus, gradually diminishing the dose as the symptoms disappear. Tonics should also be given. Of these the Citrate of Iron and Quinine, in doses of live grains, dissolved' in water or syrup, two drams and a half to eight ounces; dose, a dessert- spoonful three times a day. The Phosphate of Zinc with extract of Nux Vomica in pill form, a quarter to half a grain of the former, and a quarter of a grain of the latter, three or four times a day, Avill aid greatly in restoring the nervous system to a healthy state. The diet should be strong and nourishing, consisting largely of milk and eggs, beans, oatmeal, Avheat and vegetables, with an absence of lean meat. This rule of diet should be observed after health is established. There is no more deplorable practice, both among physicians or in domestic practice, than the frequent giving or taking of alcoholic stimu- lants. It is not to be doubted that a habit of using liquors as a beverage not infrequently begins by "taking a little brandy and water occasion- ally," or " a glass or two of wine," for Ioav spirits or a temporary indispo- sition. The practice is both harmful and useless. its OUR FAMILY PHA'STCIAN HOMOEOPATHIC TREATMENT. SPECIAL INDICATIONS. Arsenicum.—Pale, yellow complexion ; bloated face, and cold, blue skin ; fainting fits, particularly during A'omiting. The patient imagines that A-ermine are craAvling about the bed, and ugly animals are staring him in the face. Great restlessness and fear of death. Extreme thirst ; drinks little and often. Dose: Six pills to a tablespoonful of Avater, one teaspoonful every thirty minutes. Bolladonna.—Persons of a full, plethoric habit of l>ody. Flushed face and red eyes, Avith dilated pupils. Boisterous delirium, with desire to escape. He tears the clothes, strikes, bites and shrieks, in his rage. Sud- den starting and jumping, while sleeping. Dose: As for Arsenicum. Camphor.—Features distorted; eyes sunken; face, hands and feet, icy cold. Confusion of ideas ; maniacal delirium ; convulsions ; frothing at the mouth, and insensibility. Retention of urine, Avitb constant de- sire to pass Avater. Dose: A drop or two, on a little lump of sugar, every hour. Hyoscyamus.—Twitching and jerking of the muscles, especially of those about the face and eyes. Furious delirium, Avith Avild, staring look; dilated pupils, and throbbing of the carotid arteries. Grasping at imag- inary objects ; muttering. Dose: As directed for Arsenicum. Nux-vomica.—Trembling of the limbs, and spasmodic twitching of different parts of the body. Incapable of thinking correctly. Makes frequent mistakes in talking. Delirium, Avitb frightful A^isions, and efforts to escape. Very irritable, and Avants to be alone. Constipation with large and difficult stools. Apprehensive of death. Dose: Double that recommended for Arsenicum. The best remedies for the inclination to drink, and the eA-il effects of drunkenness, are Ars., Nux-a\, Sulph. EPILEPSY. MORBUS D1VINAS, MORBUS HERCULEUS. This is a disease marked by sudden and temporary seizures of uncon- ciousness, accompanied by convulsions, and is one of the most terrible diseases that afflict mankind. There are so many varieties of epilepsy that it is impossible to give a definition of the disease that will apply to them all. Tn most cases it is characterized by convulsions and loss of con- ciousness, occurring at longer, or shorter intervals, during Avhich the patient is almost in good health. The absence of fever in epileptics serves to distinguish their affection, meningitis, and other inflammations accom- panied by convulsions. ' The complete loss of conciousness, also, dis- EPILEPSY. 149 tinguishes epilepsy from hysteria, as in most nervous diseases, a hereditary tendency is among the most frequent predisposing causes of epilepsy. Epilepsy often appears in the offspring of persons avIio have had various other nervous complaints, such as epilepsy, insanity, paralysis, apoplexy, and hysteria. There is no doubt that women are much more frequently attacked Avith this disease, then men. The most frequent periods, at which epilepsy begins, are early infancy, and puberty, although, no period of life is exempt from its first attacks. Various malformations of the body, and especially of the cranium, are certainly among the most frequent predis- posing causes. Weak constitutions are favorable to the production of epilepsy. Among other predisposing causes, are dentition, the first ap- pearance, and the cessation of menstruation, onanism, and the abuse of alcoholic drinks. Almost all kinds of diseases may produce epilepsy, but among the principal, we must place those affections in which the blood becomes altered, or diminished, and organic affection of the cerebro-spinal axis, and of other certain parts of this nervous sentnc. Another power- ful cause, is excessive loss of blood. Pregnancy, parturition, (confine- ment), menstruation, frequently cause epilepsy. A tumor, or a nerve, or any cause of irritation on the trunk, or the terminal part of any sensitive nerve, and especially, in the skin, or mucous membrane very often pro- duces it. A wound, a burn, worms in the bowels, or elsewhere, stone in the bladder, or in other places, foreign matter in the ear, etc., are known to have caused epilepsy. It is quite certain that great mental excitement has orig- inated it in many cases, but it seems probable that the disease Avas not in- troduced by those causes, but Avas only brought on by them to manifest itself. When a fit is about to take place, it is usually preceded by some sen- sation, or some change in the mind of the patient. If a sensation precedes the fit, it comes most frequently from some part of the skin, and especially from that of the fingers and toes. This sensation is well known under the name of auraepileptica. There is as much variation in the kind, and in- tensity of the sensation, as in its point of starting. Most frequently the aura is a sensation of cold, or burning, or that kind of sensation produced by a draft of cold air on a limited part of the body. Sometimes the aura starts from the eye or the ear, and then a flash of light, or some other sen- sation comes from the retina, or peculiar sounds are heard. The stomach and bowels are also often the starting point of the aura. Some epileptics become gay, others mournful when they are about to have a fit; in others, the attack is announced by some change in the digestive function. A com- plete attack, usually begins with an extreme paleness of the face, and at the same time, or nearly so, there are contractions of several muscles of the face, the eye, and the neck. Observers do not agree as regards the first manifestaion of a fit, probably, because the seizure does not always begin with the same phenomena. Not only have Ave knoAvn the first symptom, not to be the same in different epileptics, but in the same one we have seen differences, in three different attacks. Many physicians think the scream, the first symptom. It often is, hue the paleness of the face usually precedes it. Some epileptics do not scream ; as soon as these symptoms haveappeared a rigid spasm takes place in the limbs, and the patient falls. Respiration is suspended, and the face becomes quite in- 150 OUR FAMILY PHYSICIAN. jected with black blood, and assumes a hideous aspect, both from the spasm of its muscles and its blackish, or bluish hue. Sometimes a mom- entary relaxation is then observed in the limbs, but all at once clonic (jerk- ing), convulsions occur everywhere in the trunks, the limbs, the face, and often, in the various internal organs, as the bladder, the bowels and the uterus. The mouth then ejects a frothy saliva, often reddened with blood from the bitten tongue. The respiratory muscles, after the first spasms which produce the scream, and suffocation, causing a gurgling or hissing sound, become relaxed and then those employed in inspiration contract, and almost as soon as air has reached the lungs, the convulsions cease or notably diminish. Ordinarily the fit is over in a few minutes, but it is not unfrequently the case, that after a general relaxation, another seizure comes on, and sometimes many occur with very short intermissions. During the whole time the fit lasts, the patient is deprived of conscious- ness, and Avhen he recovers he remembers nothing that has taken place in the meantime. In some cases the seizure is followed by prolonged coma ending sometimes in death. When a patient recovers from a fit, even if* it has not been very se- vere, he usually feels fatigue and suffers from headache. Fortunately he soon falls asleep, and ordinarily is almost as Avell as usual, Avhen be wakes up, except that the headache and fatigue still continue, though much diminished. When many fits have taken place, CA'en at some- what long intervals, such as several Aveeks mental derangement often supervenes, and in this way epilepsy often leads to insanity. In some cases the fits recur at regular periods, in others they return with CA-ery return of the circumstances which seem to have caused the first, such as menstruation, pregnancy, the influence of certain seasons, etc. There is sometimes, although seldom, perfect regularity in the length of the inter- vals between the fits, and they come every day, every Aveek, eArery month etc., at irregular hours. Many patients have very different intervals be- tween their successive fits. Some haA7e many fits a day, others every six months or eArery year. The greater the number of fits, the less violent they generally are. In the complete fit of epilepsy there are two distinct features. 1. The loss of consciousness ; 2. The muscular convulsions. Each of these may exist alone. In the case of a seizure consisting only in the loss of consciousness, without compulsions, we have the so-called epilep- tic vertigo, Avhich is a form of epilepsy which frequently exists alone, and also co-exists often with the form of the disease in which the attack is complete. In this last case the patient sometimes has a complete sei- zure, sometimes only an attack of vertigo. Whether vertigo exist alone or co-exists with complete attacks, it is very dangerous, not for the life of the patient, but because fits of simple vertigo lead more frequently to in- sanity than complete fits of epilepsy. The cases of epileptiform convul- sions without loss of consciousness are not so frequent as the cases of simple vertigo. They are particularly produced by injuries to the nerves or spinal cord. The first thing to be done for an epileptic fit, is to find out, if possible, the cause which produced the attack, and, if it still exists, try to get rid of it. Very often epilepsy depends on some external cause of irritation, EPILEPSY. 151 which may easily be removed. It is of the greatest importance to discover if there is anywhere such an irritation, and as the patient may not be aware of its existence, it is necessary to look for it everywhere. This is a proper place to point, out the fact, not generally known among the masses of the people, that onanism or self-abuse, among children and young people of both sexes is one of the most prolific causes of this truly terrible disease, and if the patient can be induced by any means to break aAvay from the practice in any reasonable time, the epilepsy is virtually cured. Pa- rents should not rest easy under the impression that their children would not be guilty of such a thing, but know of a certainty that such is not the case. My young friend, troubled Avith epilepsy, you, know whether this is one of your habits, contracted by the influence of companions in school or elsewhere, and if such is the case, you may rest assured that if you con- tinue in the habit, absolute and certain ruin of your body and mind are the inevitable consequences. Patients and their families should remem- ber that the rules of hygiene must be folioAved much more closely by epi- leptics than by those afflicted by almost any other disease. ALLOPATHIC TR VATMENT. The treatment of Epilepsy will have reference to the management of the paryoxisms (fits), and, also, to measures for effecting a cure, which are to be employed during the interA-als between the fits. During the fit the patient should be laid on a large bed, or eAen on the floor, Avhere the fresh air'can freely circulate around him. No effort should be made to restrain the convulsive movements. The necktie and all tight clothing should be loosened. A cork, roll of linen, or piece of soft avooI should be held between the teeth to prevent the patient biting the tongue. Cooling Avashes may be applied to the head. In those cases Avhich haA'e a brief warning of an approaching fit (which is called the aura epilejitica) the paroxysm may be Avarded off by inhaling nitrate of amyl at the beginning of the warning. The patient should carry a small \'ial of nitrate of amyl and inhale from three to five drops upon a handkerchief. The handkerchief should be removed Avhen fullness of the head is experienced. Also those cases charcterized by fre- quent repetition of the fits the same remedy is \rery useful in stopping their recurrence. It is also recommended as a means of mitigating severe attacks, but in advanced stages of the paroxysms, it should be used very cautiously, and the writer cannot recommend it for domestic use. But of all the remedies Avhich enjoy a reputation for preventing or mitigating a fit, this occupies the first rank. Among other remedies which are recommended for the purpose of preventing a fit, Chloric Ether, Hoffman's Anodyne and Fluid Extract of Valerian, are to be mentioned, the dose of Ether is a teaspoonful. These same remedies are, also, used to prevent the frequent recurrence of parox- ysms before alluded to ; Tinctures of Belladonna or Opium are said to be useful for this end, given in doses of from fifteen to thirty drops. The physician is often led to try the inhalation of Chloroform. But all these remedies are, in my opinion, inferior to Nitrate of Amyl. If other meas- ures fail, or are not at hand, compression of the carotid arteries may be 152 OUR FAMILY PHYSICIAN. tried, first upon one side of the neck, for ten or fifteen minutes, and then upon the other side. If the convulsions are very severe, both arteries may be compressed at once. The compression is produced by pressing the artery, Avith the finger or thumb, firmly against the spinal column. The treatment of epilepsy, as far as a permanent cure is concerned, has not been very successful. IOndeaA'or must be made to improve the patient's general health, and to this end all the vital functions must be carefully enquired into, Avith all the penetration of the most skillful phy- sician. All advanced physicians are agreed that every thing Avhich de- presses the vital poAvers does harm. The habits of life must be regular and moderate; daily exercise; early hours, and plenty of sleep; quiet occupation ; attention must be given to regularity of the bowels, and uri- nary secretion. Mental excitement should be avoided, and if the patient is a child, be kept from school. The diet should be simple, but generous and nutritious, including animal food, milk and eggs. Frequent bathing, two or three times a week, should be practiced. The habits of life which arc pernicious, and may stand in a causative relation to epilepsy, and are to be prohibited, are : over-tasking of the mind or body, either undue exposure or sedentary habits, the free use of alcoholic liquors, or tobacco, and sexual excesses, or self-pollution. There is no better established fact, in the healing art, than the benefit of the Bromides (usually the Bromide of Potassium) in the treatment of epilepsy. It is not to-be understood that the remedy is infallible, but it is true that it has been more useful than all other remedies combined. It is Avell determined tbat Bromide of Potassium is most valuable in those cases of epilepsy which are characterized by A'iolent and frequent convul- sions. It is also noticed that the beneficial effect of the remedy is more marked in attacks occurring in the day time than those occurring at night. The nice discrimination, in the use of remedies in epilepsy, requires the skill of an accomplished physician. But, roughly, it may be said, that Bromide of Potassium should be given in all cases which have a congested, (flushed), or full appearance of the face, rush of blood to the head, (or more accurately to the brain, this is most accurately determined by the physician, by examination with the ophethal- mascope). The dose of the Bromide of Potassium at the beginning, should be about fifteen or twenty grains three times a day, increasing the dose by ten grains each week, until from forty to sixty grains are taken at a dose, three or four times a day. The medicine should be continued in these doses until the peculiar effects of the drug (called bromism), are produced, or the fits have ceased. Bromism is shown by mental Aveakness, heavi- ness of intellect, failure of memory, partial loss of voice, drowsiness, de- pression of spirits, pallor and an eruption of the skin and sometimes by abcesses. The remedy, if it prevents the fits, should be continued for several weeks, or even months, at the dose, Avhich has proved effectual, and gradually decreasing the dose until tAventy or thirty grains are reached three times a day. The drug should not be discontinued, until fifteen or eighteen months have passed without a paroxysm. It is better for the patient to lake the bromides all his life, than to have fits. The ad- dition of the bromide of iron from one half a grain to a grain, to a dose of the bromides, Avill do much to prevent the impoverishment of the blood EPILEPSY. 153 due to bromism. The following is a good formula: Take of Bromide of Potassium, six drams, Bromide of Ammonium, tAvo drams, Bromide of Iron, six grains, water, six ounces, mix. give a tablespoonful three times a day. It is a good rule, even after the case has been free from fits, for fifteen or eighteen months, to give a dose of from two scruples, (forty grains) to a dram, (sixty grains) every night for a couple of years. Many of those cases of Epilepsy, Avhich are not benefited by the bro- mides, are greatly benefited by strychnine, especially in subjects Avhich have the lighter seizures, {petit mal) as Avell as the severe poroxysms {grand mal), and also, in those cases having the attack at night, though in the latter cases, if severe, the bromide Avill be required also. The dose (f strychnine is one thirtieth of a grain. It had better be given in solution, though it is disagreeable to take on account of its bitterness. The follow- ing is a suitable formula: Take of Strychnine, one grain, dissolve in two ounces of Dilute Phosphoric Acid and two ounces of Avater. The strych- nine dissoh'es sIoavIv, and plenty of time should be given for solution to be effected before taking it. If the appetite is poor, thirty grains of quinine should be added to this mixture. The dose is a tea-spoonful three times a day. Should it be found impossible to take this mixture, the pills of strychnine, of one thirtieth of a grain each, may be given instead. 1 pre- fer the pills of Phosporus, one hundredth of a grain with strychnine, one sixtieth of a grain;—dose, tAvo pills three times a day for a grown person. The phosporus is valuable in improving the nerve nurtrition. The direct gah'anic, (electric) current, is sometimes of great service, and may be used in connection Avith either strychnine, or the bromides or both. It can only be of service in essential or idiopathic epilepsy, {i e cases not dependent on structural changes, or other obvious cause). The current should include the Avhole brain, having the poles of the battery be- hind each ear; or on the forehead and nape of the neck; or one pole on the nape of the neck, and Avith the other folloAv the course of the sympa- thetic, and also the nerves along Avhich the aura, or Avarning is transmit- ted. Each method of application may be used for one third of the time at each sitting. If beneficial, the use of the galvanic current should be con- tinued for several months or a year. In some cases, it is necessary to pass a seton quite deeply through the back of the neck, in addition to internal remedies. This is particularly ser- vicable in connection with the bromide. Both it and the bromide, seem to relieve the so called reflex irritation. Cases of Epilepsy caused by injuries to the skull, which is not relieved by the bromide of potassium, may call for surgical operation. If the patient has had syphilis or has syphilitic par- entage, the Iodine of Potassium should be given either alone or in con- junction Avith other treatment, until all syphilitic symptoms disappear, when, if the fits cease, the further treatment will be that appropriate to that diseased condition. For this complaint, medical advice should be sought. Belladonna and Hyoscyamus, are recommended by high authority. They are applicable to these cases, in which strychnina is most useful, viz, in epilepsy occurring at night, in the lighter fits (petit mal), and in pale, 154 OUR FAMILY PHYSICIAN. delicate subjects, with cold hands and feet, a blue skin and feble circula- tion. Belladonna, if used should be given as follows: one fifth of a grain of the solid extract of belladonna, or a hundred and twentieth (1-120) grain of atrophium, its active principle, each night for a month, when the dose should be doubled for the second month, tribled for the third month, and so on until as large a dose as can be borne should be reached. Trouseau speaks very highly of this remedy, and recommends its continuance for from one to four years. Hyoscyamus may be used in the same way, be- ginning with one half grain of the solid extract. These remedies can be had in pill; for the first month, the dose is one pill, for the second, two pills for the third, three pills, and so on until the largest possible dose is reached. The existence of anaemia (impoverished condition of the blood), de- mands the use of tonics of iron and quinine. The Citrate of Iron and Quinine, two to five grains in syrup, before each meal The Pyrophos- phate of Iron will be found useful in one or two grain doses, instead of the Citrate of Iron and Quinine, if the appetite is not diffident. Cod Liver Oil is always useful in improving nurtrition of the body. It should be given in doses of a tea-spoonful, gradually increased to a tablespoonful. HOMCEOPATHIC TREA TM ENT. Belladonna has among its pathognetic symptoms the Avhole series of the phenomena which characterize an epileptic fit. It is most useful Avhere the disease has not continued long, and has the fits rather close to- gether, and especially if an attack of A'ertigo is apt to supervene; rush of blood to the head, red and bloated face, reneAval of the attacks by contact, distention of the eyes Avith dilation of the pupils, full, hard, and hurried pulse, sudden starting from sleep Avith a cry and fear, obstinate, malicious temper, desire to tear eAerything, to bite, spectra Avhich cause anxiety, fear, deep sleep Avith smiles and distortion of the features. Cuprum is one of the few remedies Avhich Ave knoAV positively has cured many cases. In cases where epilepsy is a primary or original dis- ease, and not merely a symptom of some other disease. Cuprum is one of the first remedies to be thought of and used. It may not be any the less suit- able in complicated cases. In this latter class of cases the accessory symp- toms will be found the best guide in the selection of the remedy; probably in cases Avhere the disease breaks out in the night, this medicine will be found the most beneficial, the aura commencing in the extremities and moving upward, until the speech is gone. In the treatment of epilepsy, use the higher potencies in less frequently repeated doses. AVe intend this last re- mark to apply to all the remedies in the Homoeopathic treatment. And Ave may further say, that a careful arrangement of the symptoms, and careful selection of the remedy, by the use of the Repertory, Avill be decidedly the most satisfactory mode of selecting the remedy. Plumbum is very nearly related to copper. Plumbum is particularly adapted to epileptic attacks Avith a well-defined aura, or to attacks Avhere paralytic conditions, entire or partial loss of consciousness, remain for some time after the attack. Plumbum acts very slowly, but on the other hand, its action lasts long; it is very penetrating, so it, for this, if no other rea- son, is suited to cases of long duration. ECLAMPSIA 155 Conium, in epilepsy arising from self-abuse. Opium, in epilepsy arising from a fright, or where it supervenes during insanity. Rana bufo is undoubtedly a capital agent in the treatment of epi- lepsy, especially if the patient is the victim of onanism and will discon- tinue the practice. Bromide of Potassium.—Three grain doses three times daily and gradually increased, until the dose is ten grains for an adult; dissolve in a little water. ———.---—•-------- ECLAMPSIA. ECLAMPSIA INFANTUM. FITS OF LITTLE CHILDREN. Eclampsia occurs most frequently at an age when epilepsy is least frequent; that is, during the first months of infancy, until the fourth year. Symptoms and course of the disease. Eclampsia sets in without any premonitory symptoms, only, Avhen it is the first symptom of the begin- ning of some other acute disease. As an independent disease, it is almost ahvays preceded by preliminary symptoms. These are: ill humor, a Avhining mood, obstinacy, indisposition to play, sudden starting when touched ever so lightly Avithout expecting it, sleeplessness or restless sleep, during Avhich the lids are not entirely closed, with a peculiar twist of the mouth, gritting the teeth, change of color from the least cause, cry- ing out without any apparent cause, sudden relinquishing of the nipple, uneasy, unequal breathing, sometimes a peculiar livid color around the mouth and eyes, and pointed appearance of the nose and] chin. After these premonitory symptoms have lasted for a longer or shorter time, the actual paroxysm breaks out Avith the same suddenness as an epileptic attack, only with this clifferew;e: tlie patient utters no cry. Othenvise the attack has all the characteristic features of an epileptic fit. At the begin- ning the convulsions are for some time tonic (stiff and still), after which they become clonic (jerking), and in less frequent cases they affect only one side. The features become distorted, the eyes stare, generally squint- ing upwards, the body is tossed to and fro, but the extremities are not as stiff or rigid as they are during an epileptic fit. The breathing is hin- dered, the abdomen distended. The face is either blue-red and bloated, with considerable fullness of the blood vessels, or else it is pale and sun- ken, the bodily temperature is rather decreased than raised. During the highth of the convulsion the consciousness and sensibility are complete- ly extinct. Usually the paroxysm ends with a deep, moaning inspiration, after having lasted a few minutes, or even a number of hours, and the patients sink into a deep sleep, from- which they awake in apparent health. The paroxysm does not always have such a fearful degree of intensity. Eclampsia, as well as epilepsy, has a series of gradations, the attack being sometimes marked, only by partial convulsions, movements of the muscles, a staring look with some squinting and drawing up of the mouth. The conciousness remains either entirely undisturbed, or is only partially interfered with, sometimes the attacks consist in a camatose soper, (death like sleep), which lasts for hours, with the characteristic half 156 OUR FAMILY PHYSICIAN. closing of the eyelids, and a few convulsive twitchiugs,. taking the place of the convulsions, even the face may retain its natural expression and color. A single fit is scarcely ever the end of the trouble. In the first place, there generally remains a disposition to relapse, and in the second place, several fits usually follow, one after the other, the intervals between the fits, being of uncertain duration and the intensity varying in de- gree, sometimes increasing at others decreasing in violence. Eclampsia may terminate in recovery, partial recovery or death. Re- covery may take place after any fit, sometimes quite unexpectedly, so that a child may be playing about one morning, which the day before was the victim of terrible fits. In partial recovery, some of the symptoms either remain permantly, or disappear only gradually. In such cases it is a question whether such remaining symptoms arc not the result of disease of the brain, which may also have been the cause of the fits. Among such remaining symptoms, we mention paralysis of the eyes, less frequently the muscles of the back, idocy, or only a certain degree of backwardness in the development of the mental faculties, and an unusual degree of nervous irritability. Death results either during the attack, or else the death like sleep (coma), terminates in death. The prognosis depends on many accessory circumstances, and is al- ivays doubtful. Age is an importent consideration; the younger the child, the more likely they are to die, especially infants at the breast, but even they frequently recover, if the treatment is in careful hands. Where the disease is inherited, there is little probability of recovery. The more rap- idly the fits follow each other, the more danger there is. especially if they continually increase in violence. Convulsions setting in at the commence- ment of some acute disease, are scarcely ever dangerous. If they set in during the course of the disease, they are more dangerous; they generally mean death. For Allopathic Treatment—See Convulsions of Children, Chap. XXXIV. HOMOEOPATHIC TREATMENT. Belladonna is Avithout doubt, the main remedy in eclampsia. It is particularly indicated in the case of robust fleshy children, who show un- mistakable signs of congestion of the brain, with very red face, the pupils expanded, the eyes stare, or constantly vibrate, the lower jaAv firmly pressed against the upper, the head drawn backward, possibly the urine may be discharged involuntarily. Hyoscyamus acts very similarly to Bell. The sight of the eyes con- tracted, face dark red and bloated, the Avails of the abdomen drawn firmly in, and the attack being caused by a fright, are indications for the use of Hyosc. Cuprum. See indications under Epilepsy. Ignatia. If the attack is sudden and violent, the lit being more tree from jerking than common, if the spinal cord appears to be the seat of the disease, that is an additional indication for Ig. Chamomilla is seldom useful for the fit, but may be needed to remove trouble with the bowels, before or betAveen the fits. The child moans and worries, and wants to be carried. Ciua or Santonine. if the attack arises from worms. (See Worms). CATALEPSY.—HYSTERICS. 157 CATALEPSY. TRANCE. We mention this disease, only because you expect us to, and can only say that it is one in Avhich the consciousness and the voluntary motion of the muscles is suspended ; though they retain the faculty of passh'e mo- tion. There are very few well established cases on record. It is Aery generally conceded, among physicians, that no treatment yet knoAAm amounts to anything. It may be necessary, in order to main- tain life, to inject food into the rectum, or, by means of the stomach pump, into the stomach. HYSTERIA OR HYSTERICS. It is not only difficult, but almost impossible, to furnish a satisfactory and sufficiently comprehensive definition of hysterics. It is a nervous, spasmodic affection common to females, but knoAvn by some other name, when it appears, (as it rarely does), among males, usually as Hypochondria. It attacks pregnant as avcII as non-pregnant females, and hoAveA-er alarming any single attack may appear, it is, in fact, seldom attended with any danger, unless it should pass into epi- lepsy. Symptoms: Usually the lady, from a calm or excited condition, but in which no symptoms of disease are sboAvn, by an umvise word, and often from no apparent reason, commences crying and laughing at intervals, perhaps also venting reproaches; peal upon peal of immoderate crying and laughter, sobs, floods of tears, stolid silence, wringing of bands, tear- ing of hair, stiff (tonic) convulsions, clonic (jerking) spasms, and smiles, are all irregularly combined and folloAved by a profound calm of the con- stitution, and a feeling of complacency. During these symptoms the female, at the commencement, is attacked Avith a sense of tightness about the throat, Avith throbbing, or repeated attempts at swallowing. Some- times a sensation as if a ball passed upAvard to the throat and lodged there is experienced, and Avhich is called the " globus hystericus." She may roll about from side to side or she may lie perfectly still and motion- less. She frequently presses her bands to her breasts or carries them to her throat, as if to remove some pressure or obstruction, the face is usu- ally pale, though not always, and is not distorted ; no froth issues from the mouth, nor are there convulsive motions of the loAver jaw, but the large muscles of the back arc violently contorted, so as in many in- stances to cause the body to describe an arch backward. The trunk of the body is twisted forward and backAvard, the limbs are variously agi- tated and the fists are firmly closed. Sometimes there is obstinate con- stipation and retention of urine; generally, however, the urine is pale and copious. The paroxysm continues for a longer or shorter time, the sobbing becomes more Adolent, or the patient screams and sheds tears and thus the fit ends. Sometimes they will lie apparently insensible and immov- able for a longer or shorter time. The attack is often preceded by lo« OUR FAAHLY PHYSICIAN. dejection of spirits, anxiety, yaAvning, shedding of tears, difficult breath- ing, nausea, palpitation of the heart, numbness of the extremities, etc. It is not uncommon for ladies affected by this terribly annoying dis- ease, to complain of dreadful and excruciating pains in the hips, knees, spine, etc., with great tenderness to the touch, and which is owing to the severe muscular contraction caused by the spasms, rather than by any disease of these parts. Sometimes a species of paralysis accompanies hys- teria, and occasionally ladies will imagine many strange things, and even practice more or less deception, speaking in a Avhisper, pretending to vomit blood, meat, etc., etc. In some women, and especially during pregnancy, with a Arery slight warning, they may be attacked Avith a seA'ere fit of hysterical convulsions which may occur daily, eAery other day or at longer intervals, and which, if not removed, Avill induce miscarriage, Avhich usually occurs at the time of a fit. Causes: Hysteria is a disease that attacks only women, after the be- ginning of menstruation, and may be produced by various causes, as: Avant of sleep, excessive fatigue, disordered digestion, sudden mental shocks, as, joy, fear, grief, etc., excitement of the reproductive organs, onanism, excesshre sexual intercourse, or more frequently, abstemious- ness among unmarried or AvidoAV ladies. Females of a nervous, irritable temperament, are most likely to be attacked. The paroxysms occur more frequently about the monthly period than at any other time. Excessive discharges or debilitating diseases frequently gh'e rise to attacks of hys- teria Avhich occur during convalescence, and are renewed frequently and from the slightest causes. Hysteria may be distinguished from Epilepsy by observing, that in the former there is no frothing at the mouth, no profusion of the tongue, and after the paroxysm is over, the patient recovers her usual state and does not fall into asleep as in epilepsy. It may be distinguished from apoplexy by observing that in this the patient loses consciousness and voluntary motion first, and finally all motion ceases, and the breathing is stertorous. From puerperal convulsions, by observing that in these, the action of the muscles are violent and irregular, the head is strongly rotated to the right and left, and backward, Avith violent jerking compulsions of the muscles of the back, abdomen, and upper and lower extremities, spasmo- dic action of the muscles of the face is rapidly repeated, the lips and teeth are firmly closed, the breathing is loud and hissing, the tongue is very livid, protruded forward, and often bitten so that the blood and saliva is thrown to some distance through the compressed lips, the face becomes livid and the attack usually occurs in first labors among females with short thick necks. HOM. Palsy, occurring suddenly and without premonition, which is at- tributable to an oppressive accumulation of blood, is also amongst the affections of the nervous system, Avhich are attributable to the same condi- tions as the last. [When both portions of the nutritive organs are simultaneously affected, these results may appear in combination.] The lungs and respiratov apparatus are liable to be organically affected by sympathy with the stomach, when the tributary nerves of the organs of nutrition are affected. The liver may be fitfully or occasionally implicated in the general derangement, resulting from such affection of the nerves of the stomach; but important functional or organic derangement of this organ is gener- ally associated with disturbance of the stomach, consisting of morbid condition of the lining membrane. The heart is, necessarily, more or less affected by both conditions of disturbance in the digestive apparatus, because in both is there either de- ficient, irregular, or morbid assimilation and distribution of the constitu- ents of the blood. 1. Accelerated action, Avith, howe\er, imperfect, incomplete,and irregu- lar operation of the circulative process, with too abrupt, sudden cont raction and, analogically, a spasmodic condition, characterized by quick, pointed diseases of the stomach and intestines. 243 pulse; or, generally, identified by sudden flushes of heat or chills, is asso- ciated in the generality of cases with disturbance of the nerves of the stomach. 2. Retarded action, with, at the same time, the distribution of vitiated blood, or with deficient supply of the constituents of the blood, and, con- sequently, insufficiency of the volume of that fluid, generally character- ized by a slow and tardy, but hard pulse, and attended with coldness of the extremities, and general deficiency of the animal heat, may usually be attributed to derangement existing in the lining membrane. [When both portions of the nutritive organs are simultaneously affect- ed these results may appear in combination.] The skin almost immediately sympathizes with the stomach when the slightest derangement occurs, being doubly susceptible of the effects of impaired circulation of blood, and of irregular nervous action or sensi- bility. Whether one or the other, or both portions of the organs of nutri- tion be affected, and, whether functionally or organically, the skin manifests its immediate sympathy, either in sensation, appearance, feeling to the touch, or all three. 1. Extreme susceptibility to sensation of cold (or chills,) is more or less associated Avith eA-ery variety of derangement of the stomach. 2. Sensations of pricking, tingling, crawling, shuddering, itching or irritation, burning (flushes of heat), with redness, further characterized by the appearance of marked spots, pimples, and other eruptions, etc., are generally associated Avith derangement of the nerves of the stomach. 3. Turgid, sallow, dirty hue of the skin, without loss of softness, moisture, or elasticity, though usually associated with derangement whose seat is in the lining membrane, may be observed in both varieties. 4. Flaccid or withered, or deadened skin, having the appearance of parchment, with general deficiency of sensation, though usually attrib- utable to the continuance of derangement of the membrane, may also be identified in cases in Avhich every other indication identifies the nerves of the stomach as the seat of the affection. 5. Dryness of the skin may be associated Avith derangement, whether functional or organic, of either portion of the apparatus of nutrition. The eyes and sight readily sympathize with the stomach, owing to the uninterrupted continuity of the mucus membrane of the various pass- ages to that Avhich comes into contact with the external portions of the eye. Whence watery eyes, dark appearance around the eyes, redness of the edges and inner surfaces, or swelling of the eyelids, bloodshot eyes, glutinous discharge from the eyes (adhesive gum), which occur as mani- festations of irritation or accumulation of blood about the membranous surfaces-extending along such membranous surfaces from those of the stomach,-—may generally be associated with disturbance of the lining mucous membrane. 1. Even blindness, from palsy of the nerve of sight, is generally de- pendent upon pressure occasioned by similar local accumulation of blood, and is, therefore, associated with a similar cause; although, in some cases, 244 OUR FAMILY PHYSICIAN. it may result from affections of the nerves of the stomach. The associa- tion of other symptoms will be distinctive in such cases. The ears and hearing are also most frequently affected by irrita- tion, accumulation >f blood, or dryness (deficiency of wax) extending to these organs from the lining membrane of the stomach. It is, hoAvever, obvious that exces-sively acute hearing, or total deafness, etc., might re- sult from affection of the nerves acting sympathetically on the brain. 2. Excessive dryness of the ears, sometimes characterized by increased sensibility of the organ of hearing, and sometimes by sensation of heat, or by burning pain, is usually attributable to derangement of the lining membrane of the stomach ; and the same may be said of a sensation as if the ears Avere muffled, a dead ness of sound, the internal passages being sAvollen, and the orifice being, consequently, lessened. DISTINCTIVE CLASSIFICATION OF VARIETIES. It is apparent from the foregoing remarks, that we should distinguish five modifications of that form of disease which is popularly termed in- digestion or dyspepsia; namely— 1. That Avhich is merely functional, or which consists in irregularity in the operation of the organ hiAotved. 2. That which is organic, or which consists in some change in the structure of the organ affected. 3. That which affects the lining membrane of the organ—which is at first evidently superficial, and is generally conveyed to contiguous or- gans by the irritation extending along the uninterrupted surface of the membrane—but which, inasmuch as it embraces the extremities of the nerves, may sooner or later become complicated with— 4. That which is seated in the tributary nerves of the organs of nu- trition—which may therefore We conveyed directly to the substances of the brain and spinal cord, through the medium of the nerves which are in direct communication with these concentrating points, and from which we may anticipate a more immediate development of sympathetic manifestations in the nervous system generally. 3. That in which the nerves and membrane are both implicated. The third and fourth distinctive varieties are those which require the most particular investigation ;. not only because they may or may not in- volve the first two, but, more particularly, because, Avhether the disease be organic or merely functional, the distinction between the nervous and membranous A-arieties will afford the real clue to, or at all events materi- ally facilitate, the treatment. The initiatory condition both of nervous and of membranous derange- ment of the stomach is the same; it consists in determination and accu- mulation of inactive blood in the vessels associated Avith the tributary nerves, on the one hand, or in those connected with the lining membrane on the other. In both eases, the first unnatural condition is increase of the natural irritability—that is, irritation—respectively of the portion af- fected ; and in both cases the exciting cause is something Avhich impede- or unduly hurries the natural operation, and consequently excites an irritative effort in the organ cither t<> repel the matter which oppresses or DISEASES OF THE STOMACH AND INTESTINES. 24"> disturbs it, or to fulfil its functions with that degree of acceleration to which it is impelled. Disturbance or oppression of the functions of the tributary nerves may therefore be occasioned (chiefly) either: 1. By the reception of irri- tating, stimulating, or indigestible substances into the stomach. 2. By snperabund a me of food, howeA-er plain and digestible, too suddenly cram- med into the stomach. ."». By the imperfect preparation of the food (by mastication, etc.) before it is conveyed to the stomach. 4. By over-exer- tion of the mental faculties of the brain, which operates directly to the medium of the communicating nerves. ">. By sudden depression or excitement of the moral faculties of the brain (as by passions or emotions conveying pleasure or pain.) 0. By deficiency of physical muscular action las in sedentary habitsi, Avhereby the evacuation of matters rejected (se- creted) from the nutritive apparatus is impeded, and whereby, therefore, the organs Avhose function consists in the appropriation of the aliment and the expulsion of the residue are opposed with the latter, Avhich gives rise to an irritative effort to expel the obnoxious matters. 7. By excess of physical muscular action, which compels the organs of nutrition to make an undue effort for the supply of the necessary sustenance OA-er and above what is ordinarily required, s. By the abstraction or undue discharge of animal fluids (such as blood, SAveat, etc.) which equally renders an undue effort necessary for the supply of the deficiency. 0. Generally—by irreg- ularity of habits, or by dcA-iation from habitual method, Avhereby the organs of nutrition are either checked or accelerated, or otherwise com- pelled to proA'ide for the disturbed balance between the tributary functions and the A'ital energy to Avhich they are subservient. 10. By external influences (such as cold, heat, etc.,) Avhereby the circulating and secreted fluids arc either too quickly absorbed or dispersed, etc., or, on the other hand, are arrested or suspended in their progress, and consequently driven back upon the secreting organs, or left to impede the channels through Avhich the successive course of secretions, etc., should be circulated or dispersed. 11. Which may be superadded to the foregoing general causes —by abuse of bitter tonics, sal-A-olatile, sedatives generally, opium, iodine, and mercury, as also by depletive measures in nervous feA-ers—all of com- mon occurrence. Respecting disturbance or oppression of the functions of the lining membrane; it may be said in general that the conditions 1, 2. 3, 6, 7, 8, 9, and 10, just mentioned, operate as exciting causes; but that conditions 4 and e> more rarely (if eA-er) operate as direct exciting causes. A twelfth class of causes may, hoAveA-er, be added with regard to this A-ariety ; namely—12. By abuse of arsenic and other mineral tonics, and still more frequently of saline purgathre medicines. Respecting disturbance implicating both the nerves and the mem- branes, it Avill readily be distinguished that any or all of the conditions above mentioned may operate as exciting causes. GENERAL SYMPTOMS EXHIBITED BY IRRITATION, ETC., OF THE LININO OR MUCOUS MEMBRANE. This variety of the disorder is more apt to be developed at the stage of maturity, or within the period of life which is termed middle age; 246 OUR FAMILY PHYSfCfAN. and in general, individuals who are little susceptible of excitement, whose sensations are not acute, and Avhose temper is eA-en, or Avbose disposition is indolent or listless, are more likely to become thus affected. Distinctively it consists of tardy, insufficient, or oppressed functional operation, and of inacth-e accumulation of blood in Aarious parts. The first characteristic manifestation which springs from it is Acidity—usually, however, attended with little pain ; regurgitation of food, insipid or acrid risings in the gullet, and heartburn ; occasionally nausea, but more rarely vomiting; habitual deficiency of appetite; habitual or continued predominance of thirst, especially in obstinate and continuous cases; dryness of the mouth and throat from deficiency of saliva, or thick, adhesive saliva or phlegm in the mouth; bitter SAveet, or salt taste in the mouth;—or, again, insipid, clammy, or metallic taste; ex- treme susceptibility to change of temperature and weather, affecting the throat and nostrils, and consequently to relaxed or inflammatory sore-throat, or to cold in the head, excessive discharge from the nostrils, or continual dryness or itching in the nose, with or without altered or diminished sen- sation of smell; offensive breath, internal dryness with heat of the ears and acuteness of hearing, or internal swelling with impeded hearing; humming or buzzing in the ears; red suffusion of the eyes and bleared appearance, especially on waking in the morning; dark rim around the eyes, with red ness and swelling of the inner side and margin of the eyelids; watering of the eyes; oscillation as of fluctuating vapors before the sight; flashes of light or appearance of sparks before the eyes; dark shade as of clouds or flickering of black spots before the eyes; adhesion of the eyelids—es- pecially on waking in the morning; yellowish or waxy appearance of the eyelids—with glutinous matter; in recent or casual cases, and Avhen the affection is neither severe nor inveterate, the tongue may be flabby or coated with a brownish-white fur, but neither very dry nor enlarged; in cases in which the liver and first portion of the intestinal tube are affected, the tongue will generally be coated in the center with a yellowish fur, somewhat dry, the tip and margins being of a bright-red color and free from fur; in cases in which the affection is confined to the stomach, but is of a severe character and of long standing, the tongue will usually be covered in the center with a slimy fur, the margins and extremity being in this state also free from fur, and exhibiting bright redness; in cases in which the nerves of the stomach are also implicated, and in which the irrita- tion of both portions is of a most severe and inveterate character, the tongue will usually be enlarged, and will exhibit a glistening, white, and thin coating in the center, the margins and extremity being free from fur and of a bright-red hue;—or, again, it may be so much swollen as to be- come indented along the lateral margins by the impression of the teeth; progressive decay of the teeth; constant or casual toothache or predispo- sition to toothache; accumulation of brownish and offensive matter on the teeth; yellowness, blackness, or other discoloration of the teeth; offensive exhalation from the gums; soreness or tenderness of the gums; unhealthy and spongy puffiness, or redness and swelling of the gums; the gums bleed spontaneously, or are easily provoked to bleed; unhealthy and spongy puf- finess or excessive redness and swelling of the lips, usually indicative of recent affection—when associated with such symptoms as identify the DISEASES OF THE STOMACH AND INTESTINES. 247 Lining Membrane as the seat of disease, but occurring irrespective of de- gree and length of continuance when associated Avith such symptoms as identify the Nerves as the seat of disease.;—seal in ess of the lips: in cases in which the liver and first portion of the intestines are implicated in the derangement. Ave may notice the mottled appearance of the lips ; in similar cases of longer standing, and of the most inveterate and incorrigible char- acter,—especially if continual excess in the use of fermented liquors, and particularly of ardent spirits, has been the exciting cause of disease,— salloAV Avhitenessjand hardness of the lips may be exhibited, or what has been oppositely described as a ivaxy appearance; pressive headache, seated in the anterior part of the head, or what is called sickhead- aehe; dull or intense, fixed, aching pains in the head, Avith sensation of confusion, heaAaness, and sometimes, also, with giddiness or numbness; general uneasy sensations about the head, or as if the contents Avere ex- panded; determination of blood to the brain, and sudden attacks of apo- plexy Avithout premonitory symptoms; dullness and confusion of thought; general dullness of sensation; tardiness of perception, reflection and motion; vacancy and incapability of fixing the attention for any length of time; droAvsiness, or even lethargy, general indolence, and inaction, or even torpor of mind and body; excessive reluctance to move or exert one's- self in any way; deep depression of spirits, with listlessness; deficient vigor of Avill and consequent irresolution and indecision; hard but tardy pulse, generally also decreased in frequency; unhealthy puffiness of the body, morbid accumulation of fat; flabby skin, muddy sallow complexion; and in severe and obstinate cases, chippy deadened, parchment-like skin; in" action, or even torpor of the boAvels, and, therefore, suspension of evacua- tion, sIoav, tardy evacuations, or evacuated matters paler than in health; habitual constipation. GENERAL SYMPTOMS EXHIBITED I'.Y IRRITATION OK THE NERVES. This variety of the disorder is more apt to be developed amongst fe- males and young persons; and, in general, individuals of acute sensibility, of active, restless habits, of quick impulses, excitable and irritable dispo- sition, and choleric temperament, and of spare, Aviry frames, are not liable to be thus affected. Distinctively it consists of inordinate, irregular func- tional operation resulting in defect in the distribution of blood, or even of the quality of the blood distributed. The first characteristic manifestation which springs from it is Flatulency, this variety of the disorder being also characterized by the multiplied development of paw and painful or other- Avise acute sensations,—or, in the worst and incurable cases of organic dis- order, total suspension of pain, which has previously been acute, and of which the cause is not removed; intense and pressive pain at the lower part of the chest, sometimes extending through the body; wrenching gnawing pain at the pit of the stomach; sinking at the stomach; heart burn very predominant; nausea, and generally vomiting; irregular, fitful, capricious appetite, either inordinately voracious and insatiable or very deficient, or more generally greater than in health, but some- times also, in very severe cases, totally suspended; eating provokes or, aggravates the suffering; stimulants, and even hot plain drinks have the same effect; eructations and hiccough, and in fact, all mani- 24 S OUR FAMILY PIIYSTCIAN. testations of spasmodic contraction of the muscles, connected with and operating upon the stomach; —consequently, general spasm of the stomach; thirst usually absent, occurs fitfully or irregularly, but some- times of excessive temporary intensity;— morbid taste in the mouth, chiefly the metallic; thin, acrid salh'a; fitful or periodical pains in the teeth, of the most intense and distressing description ; lips habitually of an over-Advid redness, or spongy ; morbid acuteness of the senses of smell and hearing ; occasional darting, fugitive or distracting pains in the cav- ity of the ear and deep in the head ; the tongue generally free from coat- ing, but of a bright red, fiery hue; in cases which are of recent occurrence there will not usually be either swelling or dryness of the tongue, but the extremity will exhibit a species of roughness from papillary elevations; in more severe and old-established cases, the redness of the tongue Avill be further qualified by dryness and glistening appearance (glossy surface); in cases in which the intensity of the irritation may have become com- plicated with sympathetic affection of the brain, the redness of the tongue Avill be further qualified by general sivelling, and sometimes, also, by a slight degree of Avhite coating,—not sufficient, hoAveA^er, to conceal the characteristic redness of the surface beneath ; the tongue much swollen, and deeply intersected with fissures, indicates a very serious advancement of the disorder; the swollen tongue, with a bright, glistening, white sur- face, (whereby is coirveyed a distinct indication of severe sympathetic affection of the brain, as in highly hypocondriacal subjects, especially those who haA'e been treated with large doses of Mercury); the co-exist- ence of both Aarieties of the disorder of considerable duration is evinced in the swollen tongue, of Avhich the margins and extremity are red, but the center is slightly covered Avith a glistening white coating; the tongue quivers on protrusion (wherby is identified a sympathetic affection of the spinal cord). The change from vivid redness, with or Avithout swelling, but without coating, to broAvnish hue and more or less thick coating im- plies a modification of the disorder, or progress towards cure. In general, moreover, we may notice every variety of hysterical or hypochondriacal excitement; unaccountable uneasiness and restlessness; sudden fits of laughter, or the contrary,—the one terminating in, or alternating with, the other, apparently Avithout a cause, or proA-oked by very slight causes; sudden starting or shuddering ; incessant tossing about or moving from place to place ; general or local com-ulsive moArements of e\-ery descrip- tion,—such as trembling, jerking of the limbs, cemghing; convulshre cough, difficult respiration, and sensation as of a ball rising in the throat; cramps in muscular parts; chattering of the teeth, or clenching of the hands and teeth, or grinding of the teeth during sleep; an interminable variety of erroneous impressions, upon which the mind harps with per- sistency, and Avhich appear to haunt the patient more painfully at stated periods ; intense and restless anxiety about one's self, one's affairs, one's health, with impulses even to self-destruction; extraordinary exaggeration of eA-ery feeling ; intense sensitiveness of temper and disposition ; intense impatience, not only of contradiction, disappointment, vexation or pain, but even of one's own moral feelings; excessive irascibility and excita- bility ; temporary suspension of control over the muscles of A'oluntary motion; sudden local and temporary paralysis; apoplexy; pains in the DISEASES OF THE STOMACH AND INTESTINES. 24fl head, of Aarious descriptions—giddiness, sensation of Aveakness in the head; ticdouloureux or nerve-pain in the face, etc.; pains on one side of the head ; darting pains starting from one point and piercing the head in every direction ; pains of the back of the head ; darting pains in the eye- balls; pains which seem to run from one extremity of the body to the other, leaving an indiscribable sensation after them ; pdljoitation of the heart; quick, and sometimes small and frequent pulse ; anxiety and op- pression of the chest; flushes of heat, with patchy, circumscribed, or suffused redness; craAvling, pricking sensations in the skin ; redness and SAvelling of the gums and lips; spare, meagre, or eA-en Avithered frame; great deficiency of flesh ; scanty and wiry flesh ; irregular operation of the bowels, both as to the frequency and the nature of the motions, Avhich Arary in color and consistency. GENERAL SYMPTOMS OF COMBINED DERANGEMENTS OF THE NERA^ES AND MEMBRANES. These Avill obviously consist of a combination of symptoms associated Avith each variety in its distinctive form, and will, therefore, need no further description. ALBOPATHTC TREATMENT. This is one of the diseases in which the patient ought to give but lit- tle thought to his trouble, and every one guided only by the advice of his physician. Indeed it might be better, if a single line upon this subject bad neA-er been written for a popular work, because they direct the im- agination of the subject to his disease in a way that creates such a state of mind which tends to prolong the trouble. All fears which the patient expresses, probably proceed from the condition of the body and don't indicate a disordered mind. They should be submitted promptly to the physician in whom he has most confidence, who will doubtless be able to trace them to the cause suggested. Exemption from inconvenience, with the mind pleasantly occupied during eating and digestion, as is the case when in agreeable company, frequently enables the patient to indulge the appetite freely without inconvenience, but when they dine alone they experience trouble during or after the meal. In the latter case they watch carefully the sensations of digestion, while in the former case the diversion of the mind causes the unpleasant experiences to disappear. Good cheer and a good moral are A'aluable both in the way of prevention and cure of dyspepsia. As to diet, there is no doubt that when the dyspepsia succeeds overindul- gence of the appetite, one of the first things to be done is to give the stomach rest for a time, by abstaining from food or by taking less than the patient requires. The period to which this is appropriate is of short duration, and must not be continued long enough for the system to be- come reduced. This abstinence may, of itself, become a cause of dyspep- sia, as is the case when persons attempt to live on as little and as coarse food as possible. The food should be simple, but nutritious, and taken in ample quanti- ty and variety. Often it is an object of treatment to overcome the erroneous idea, that various healthy articles of food do not agree with 250 OUR FAMILY PHYSTCTAN. him. Food Avhich is Avholesome for most people cannot be harmful for any. It is often said that " what is one man's meat is another's poison," but there is scarcely a maxim Avhich is more generally untrue. Almost all cases of dyspepsia can and should conform to the ordinary rules of diet, and not to any particular rules. He should take, from time to time, any and all articles of Avholesome food, and aim to eat like a well person Avithout the need of selecting food to suit his particular case. In most cases of dyspepsia lean meat is digested the best, especially from mature fat animals. They should be plainly but well cooked, ne\rer fried. Some- times milk with starchy articles of food, such as bread, rice and the like agree best. Doubtless milk is not healthy when taken on a full stomach, in large quantities, but if taken with the understanding that it is hearty food, it will almost never disagree. Bread to be in its best condition should be in that state betAveen fresh and stale. Cornmeal, oatmeal, and cracked wheat or Graham mush, and boiled rice are easily digested. Ripe fruits partaken of moderately are beneficial. Pastries, rich puddings and sweetmeats are inappropriate. The kind of food most appropriate will vary, as it is found that the digestive derangement is in the stomach or intestines. If in the former, starchy articles and fat Avill agree best, but if in the latter, meats, eggs, and milk will be found most appropriate. The habits regarding eating should be regular, but at the same time the dyspeptic ought never to go hungry. If no breakfast or an insuffi- cient one has been taken, a lunch in the early part of the day is desirable. His most hearty meal should be at an hour that can be folloAved by leisure and recreation. A little food often had better be taken before retiring at night. No one ought to go to bed hungry. Hearty indulgence of the appetite is not to be permitted, but moderation is to be practiced until the digesth'e poAvers increase, when food may be taken in larger quantities. Only a moderate amount of liquid should be taken at the meals, but may be freely taken between meals. Regular habits of life, early hours, plenty of sleep and such changes in the occupation as will secure sufficient bodily exercise and relieve from harrassing care and troubles of business, a rest of one day in seven, horse-back riding, a daily cool or tepid sponge bath and abandoning the use of tobacco and alcohol will cure most cases of dyspepsia. It is a common, and truthful saying in the main, that exercise will cure dyspepsia, but if taken simply for exercise it becomes neglected and tends to keep the mind of the patient on his disorder which is harmful. It is, therefore, desirable that the mind of the patient may be turned from his dyspeptic trouble, that he adopt such a mode of life as will of itself require a requisite amount of exercise in the open air. Most, if not all, these requisites are secured by an overland tour in our own country and mountains, or by foreign travel. I believe exercise never should be carried to the point of exhaustion, but should be sufficient to have earned a good sleep of eight hours at night. The benefit which can be derived from medicines is secondary, but important. The uneasiness of the stomach may sometimes be relieved DISEASES of the stomach and INTESTINES. 251 by a counter-irritant over the stomach as a small blister, or rubbing the skin with a liniment made of equal parts of Ammonia water (hartshorn ( Turpentine and Olive Oil, or a couple of drams each'of Croton Oil, Tur- pentine, and Olive Oil. If the blood is impoverished, and the appetite is poor, bitter infusions (teas), made of Columbo Gentian. Cinchonia Bark, or Quassa, etc., in the strength of one ounce of the crude (dry) drug to the pint of hot water. Dose: Tavo or three tablespoonsful before eating. The Tincture Muriate of Iron may be ghren in doses of fifteen drops in sweetened Avater, after eating. The Citrate of Iron and Quinine, in doses of three to five grains, in solution, in water or syrup, almost always answers the same purpose as both the foregoing. Digestion is often greatly helped by the use of Lactic or Hydro- chloric Acids and Pepsin. A good formula is this: Take of Glycerole of Pepsin three ounces, Lactic Acid an ounce. Mix, and ghre a teaspoonful after each meal. If Iron is required, half a dram Lactate of Iron can be added to this mix- ture. In case the Hydrochloric Acid is used, if Iron is also given, it should be the Muriate Tincture of Iron. In case of acidity and heart- burn, the acid mixture should be gh7en before meals instead of after. Should this not relieve, Bismuth, in doses of fifteen or twenty grains, Avith a little baking soda, or salaratus, may be given after meals upon the development of this symptom. Flatulence and wind in the intestines is best relieved by the contin- ued use of Nux-A-omica. Ten drops of the Tincture of Nux-vomica, in water, or a quarter of a grain of the Extract in pill, may be given three times a day. In extreme instances, when everything is vomited, the so called milk cure is often appropriate. In its use all other food is omitted. A couple of tablespoonsful, with lime-water, is given every three hours during the day, and the quantity gradually increased until the invalid can take one or two tablespoonsful four times a day. One or two quarts is generally the amount that can be taken in the day. It is best given a little warm. The quantity of lime-water should be one-fourth that of the milk. If necessary, the milk can be flavored with a little coffee. Other useful pro- ceedures are counter-irritation, as above suggested, a drop of Creosote, in water, after each act of vomiting. Bismuth and Nux-vomica, also, as above directed, etc. It is probable the length of this article is already too great for the good of the dyspeptic, because it induces him to study and brood over his case. He is best off under the direction of an intelligent, regular phy- sician. HOMOEOPATHIC TREATMENT. Nux-vomica is particularly applicable to the treatment of indigestion in hypochondriacal subjects. It covers the following symptoms, either when they have arisen in consequence of sedentary habits, excessive mental exertion, or long watching, or of overloading the stomach, of ex- cessive draughts of milk, or even of water, or of eating or drinking acid things, or of using spices and seasoning to excess; or, again, in cases in O/jO OITK FAMILY PHYSICIAN Avhich all food or drink, however plain, light, and digestible, provokes indigestion; or from the abuse of coffee, tobacco, Avine or ardent spirits; or, again, when the irregularity of digestion has been induced or con- firmed by loss of animal fluids (profuse sweating, bleeding, and the like;, or by habitual recourse to aperients; the head confused, Avith, occasionally, a feeling an if resulting from intoxication, and giddiness, with sensation of turning and Avavoring of the brain ; headache, unfitting for, and increased by, mental exertion ; tearing, drawing, or jerking pains in the bead or cheeks, and pulsative pains, and a sensation as if a nail mere driv- en into the brain ; congestion of blood to the head, Avith humming in the ears. The headaches are often deeply seated in the brain, or in the back part of the head, frequently confined to one side, or oA'er the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Yellowness of the lower jWt of the Avhite of the eyes, with a mist before them ; a sensation as if one were about to fall; sparks, or small gray or black spots before the eyes ; short-sightedness ; pale or yel- lowish color, or redness of the face, especially about the mouth and nose; frequent headache, and impaired powers of digestion, with insipidity of food ; foul, dry, white or yelloAvish tongue; A'ivid redness of the margins of the tongue; thirst, with water-brash particularly after acids or rich food ; accumulation of slimy phlegm or water in the mouth ; metallic, salt sulphurous, herbaceous, bitter, sour, sweetish or putrid taste, chiefly in the morning, or after meals ; bitter eructations, or continued nausea, especially after meals, or eA-en after drinking cold water or milk—or on going into the open air after a meal, or after parta- king of acids; heartburn, hiccough, acidity, flatulence, frequent and A-iolent vomiting of food, phlegm, or bile, ineffectual efforts to A-omit ; distension and fullness in the region of the stomach, with excessive tender- ness to the touch; a feeling of tightness of the clothes round the upper part of the Avaist; cramps of the stomach ; constipation; reddish urine, Avith brickdust-colored sediment; sleep, unrefreshing and restless, either from suffering or otherwise, Avith disagreeable dreams, and drowsiness in the morning; tendency to exacerbation of symptoms during the preva- lence of a northerly or easterly wind, or Avhen the atmosphere is loaded Avith vapor ; better after Avarm food. One of the most distinctive indications for the employment of this remedy, in preference to the next mentioned, is the temperament, which is restless, irritable, lively and choleric. A disposition to piles is also a good indication. Dose: Three globules in a teaspoonful of water, night and morning, for a week; then pause four days, resuming the same remedy in a similar course, or suspending treatment, or proceeding with another medicine, according to the circumstances which are present. Cocculus is appropriate to the treatment of highly bilious subjects, or when the derangement can be traced, however remotely, to long Avatching or intense application to study; or when coffee, tobacco, or brandy, can be traced as the exciting cause. It may generally be employ- ed in cases in which moroseness and hypochondriacal disposition are marked characteristics either before, after, or in alternation with Nux-c, DISEASES OF THE STOMACH AND INTESTINES. 2-53 according as the characteristic effects of the one or both most clearly cor- respond with the case. Dose: Three globules in a teaspoonful of water every twelve hours, until amelioration or change. Or if, again, Co<;culns be apparently inadequate to complete the cure, consider the next remedy. ( arbo-a-eg. is especially appropriate to the treatment of derange- ments of this nature occurring amongst persons of advanced years; or when the derangements can be distinctly traced to long watching, to abuse of Avine, of ardent spirits, of coffee, to milk diet or casual use of milk, to excessive use of butter, or to rancid butter, to fat and greasy things, such as pork, to fish, especially if tainted, or to shell-fish in par- ticular, to fl,atideut A'cgetables, etc., to pastry or acid things, to excessh'e use of salt, or unguarded use of ices or very cold drinks. This remedy is particularly indicated by excessive and constant flatulence, with heavy respiration, repugnance to animal food, or especially to fat or greasy things, or to milk, and Avhen acidity is constantly provoked by such food; bitter taste in the mouth ; accumulation of phlegm in the gullet and sto- mach, frequent empty, sour, or bitter eructations, etc. Dose: Three globules in a tablespoonful of Avater every tAvelve hours. Pulsatilla is indicated by a series of symptoms very analogous to those Avhich have been enumerated under the bead of Nu.r-v., but Avith this distinction, that it is particularly adapted for females generally {es- pecially for hysterical subjects), children, individuals with light hair, and a marked predisposition to purulent exudations at the edge of the eyelids, or to styes, and for mild or phlegmatic dispositions. Under such condi- tions it is appropriate to the treatment of derangements of the stomach occasioned by exeessh-e application to study, overloading the stomach, abuse of wine, spirits, beer, coffee, or rich chocolate, by excessive draughts of milk, or e\en of water, by new, slack-baked, or otberAvise unwholesome bread, or butter, fat or greasy things, tainted or unwholesome meat (pork especially), by eating oysters or tainted fish of any kind, by pastry, flatu- lent A'cgetables, fruits, or by icecream; or even when an external injury {as a strain) has been the exciting cause of the ailment. Amongst its characteristic indications, we more frequently find a taaut of thirst, than thirst; a repugnance to fat and rich meat, and suffering after taking pork or pastry : general chilliness, or great difficulty in keeping the hands and feet sufficiently warm ; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils; frequent and loose, or difficult and loose, or sluggish evacuations; hypochondriasis, and convulsive lils of laughing and crying. Dose: Three globules as directed for Mu.r-v. Ignatia may in some cases be employed tweh-e hours alter the fourth dose of Pulsatilla, if the latter has failed in affording permanent relief, and does not promise to complete the cure. It may also, in some cases, be employed before or instead of Pulsatilla, when there is a tendency to alternations of exuberant and depressed spirits, or particularly if grief be associated Avitb the derangement. Ignatia is also appropriate for the treatment of derangements of digestion occurring amongst highly hys- 254 OUR FAMILY PHYSICIAN. terical females; or of cases Avhich result from abuse of coffee, beer, bran- dy (or even ardent spirits in general), milk, sAveet things, or tobacco. Dose : Three globules in a teaspoonful of Avater three times a clay. Bryonia is often appropriate to the treatment of derangements of the stomach, associated eitlter Avith a hypochondriacal or hysterical dis- position, or Avith IxabituaUy sedentary habits; or when occasioned by depressing emotions, by chocolate, milk, neAv or slack-baked bread, tainted sausage-meat, flatulent fruit or \regetables, or pastry; the indicative symptoms are as folloAv: Headache, burning or expansive, particularly after drinking, attended Avith bewilderment of the head and giddiness ; tongue glazed, dry, and red, or covered with a Avhity- yelloAV fur; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately Avith unnatural hunger; craving for acid drinks; great thirst; insipid, clammy, putrid, sweetish, or bitter taste in the mouth; acidity and flatulence, or bitter risings after every meal, or after partaking of milk. Hiccough, nausea, Avater-brash, vomiting of food or bile, par- ticularly at night; tenderness, in the region of the stomach, to the touch, sensation of sAvelling in the pit of the stomach, especially after a meal, or on walking ; sensation of burning in the pit of the stomach, especially when moving. Constipation, temper, restlessness, irascible and obsti- nate ; also Avhen Avant of exercise or anger are frequently the exciting causes of the derangement, or the means of aggra\rating the indiges- tion. The indigestion is more apt to manifest itself in summer, or in damp Aveather, with a northerly or easterly Avind, and is frequently accompanied Avith chilliness. Dose: Three globules in a teaspoonful of water, every twelve hours, until amelioration or change. In cases in Avhich the sufferings are very great, the like dose should be repeated every three hours during the attack, until the symptoms subside or change. Kiius-tox., which is particularly appropriate for the treatment of indigestion resulting from mechanical injuries (such as a strain), or Avhen beer, spirits, coffee, milk, copious draughts of cold water Avhen heated, neAv or slack-baked bread, tainted sausage-meat or fish (especially shell-fish, as muscles), may directly haA'e provoked the attack. The specific symp- toms are as folloAvs: Flat, sticky, sAveetisb, or bitter, or foul taste in the mouth ; drowsiness, eructations, and sensation offullness, languor or gid- diness, after eating; a sensation of repugnance to food, especially to meat, bread, etc., or sensation of satiety: or Avant of appetite, Avith hankering after dainties ; continual, empty, painful and noisy eructations; off'ensh'e and very abundant flatulency ; the derangements of the digesth-e func- tions more apparent and troublesome at night; distension and pressure in the region of the stomach. Extreme depression of spirits, despond- ency, insuperable anxiety and uneasiness respecting affairs. Dose: Three globules in a teaspoonful of Avater every four hours, until the symptoms are modified,—and then tvery twelve hours, until positive change. Natrum-ai. is particularly appropriate to the treatment of chronic rases occurring amongst hypochondriacal subjects, or, sometimes, of preg- diseases of the stomach and intestines. 255 nant females; or when habitual excess in the use of fermented liquors has been the chief cause of derangement; or when milk diet, mineral waters of particular localities (unless brackish), or the water of hard springs and mountain streams,—or unwholsome bread, or fat and greasy food (especially pork),—or excess in the use of fruit or tobacco, may be distinguished as associated with the origin of the affection. Natrum-m. is generally useful in such obstinate chronic cases as have resisted the operation of Bryonia, Nux vomica, etc., and which are characterized by frequent attacks of morning sickness, or by heartburn after every meal, Avater-brash, constant nausea, occasional sensations of faintness, pressure in the stomach, or intractable humor after eating, and obstinate costive- ness, or when milk, and liquids in general, invariably disagree. Dose: Six globules in a tablespoonful of waterv every morning, the first thing (fasting), for ten days (unless earlier improvement en- sues), then pause four days, resuming the same course, if necessary, and so on. Kali-bicii. is particularly applicable to the treatment of chronic cases in which milk, bread, fish, or pastry, constantly disagree Avith the patient. The distinctive symptoms are as follows : Indigestion, with aggraA'ation of symptoms in the morning and dur- ing movement, relieved after eating (sometimes, however, a distressing feeling of Aveight is experienced after a meal); mouth and tongue dry; thick yellow fur on the tongue ; conflux of Avater in the mouth ; metallic, acid taste; Avant of appetite; nausea, flatulence, frequently accompanied by colic. Constipation or hard stools, attended with straining and burn- ing in the outlet; alterations of hard and relaxed motions, great sensi- bility to cold air, complications Avitb affections of the liver and spleen ; extreme depression of spirits, hysterics. Dose: As directed for Natrum-m. Ciiamomilla is of great service in some derangements resulting from or associated Avith excess in the use of coffee or of sweet things; or more especially depressing emotions, such as vexation, disappointment, a,fit of passion, and the like; or, again, if the derangement has been provoked by check of perspiration. The characterizing symptoms are as folloAV's : Headache, with, sometimes, semi-lateral pulling, shooting, fullness, and beating in the head ; giddiness and staggering in the morning when getting up; oppressive heaviness, sAvimming in the head, and sensation of a bruise; headache, felt sometimes during sleep, with obscuration of the eyes, and yellow color of the Avhites ; toncue dry and cracked, Avith a thick and yelloAvish coating; mouth dry, Avith occasional presence of frothy phlegm ; excessive thirst and desire for cold drink; bitter taste of the mouth and of food ; want of appetite and dislike to food. Acidita" or sour risings, regurgitation of food, nausea, A'omiting of food, phlegm and bile; oppressive pain in the region of tlie heart, distention at the pit of the stomach and upper part of the waist, chiefly after eating and at night, at- tended Avith inquietude and terror ; burning pain in the pit of the stom- ach ; uneasiness, and feeling of sinking in the stomach ; cramps in the stomach, especially when traceable to col fee ; sometimes constipation, but generally relaxation of the bowels. 256 OUR FAMILY PHYSICIAN. Dose: In casual cases, of a solution of six globules to three table- spoonsful of Avater, giA*e a teaspoonful eA-ery three hours, until ame- lioration or change. In chronic cases, three globules in a teaspoon- ful of Avater night and morning, until similar A-ariation occurs. Ipecacuanha is available for the treatment of indigestion occurring nmongst children and pregnant females, or when occasioned by overload- ing the stomack, imperfect mastication of food, hurried and voracious feeding, or by irregularity of meals, or by abuse of tobacco, or even of coffee; or in cases in Avhich veal or other young meat particularly disa- grees ; or Avhen cold, nervous excitement, late hours, or over-application to study in particular, are to be traced as the exciting causes of derange- ment. The distinctive symptoms are : Pale face and yellowish ; tongue sometimes clean, at others coated white or yellow ; aversion to food, and particularly to fat or rich indigestible food, such as pork, pastry, etc., or suffering from indigestion on partaking of such ; vomiting of drink, food, phlegm or bile, sometimes after a meal; retching, easy A-omiting,generally attended with coldness of the face and extremities, and sometimes alter- nation Avith watery looseness of the boAvels, feeling of emptiness and flaccidity, and sensation of sinking at the stomach. Headaches attended with nausea and A'omiting; shooting pains, with heaviness and painful pressure on the forehead. Dose: Against the acute symptoms when present, of a solution of eight globules to a Avineglassful of Avater, gh'e a teaspoonful every hour, until amelioration or change; against the chronic aspect of the affection, that is, the recurrence of the acute symptoms, give - three globules in a teaspoonful of water, night and morning until distinct change. China is appropriate to the treatment of derangements of this kind, according to the subjoined indications, when occurring in aged persons, or in patients of a hypochondriacal disposition, particularly if the loss of animal fluids, or mental affliction, be distinguishable as the predisposing • cause, or when the suffering can be attributed to overloading the stomach, to excessive indulgence in strong tea, or, in some cases, to abuse of spirit- uous liquors or coffee, to milk diet, or to unguarded or too copious draughts of Avater ; or, again, Avhen bread, butter, fat and greasy things generally, disagree, or Avhen tainted fish has been the immediate cause of derangement; or. again, if the symptoms can be traced to flatulent food, over-indulgence in fruit or spices and other seasoning, or, in some cases, to tobacco ; or, again, Avhen every kind of food provokes an attack. This remedy is a valuable auxiliary in the treatment of this derangement, when there is impaired appetite Avith great weakness of digestion, which is more liable to be experienced on partaking of supper; flatulence, bitter taste, languor, hypochondriacal disposition, and particularly when avc can trace the affection to debilitating losses of fluids, such as the abstrac- tion or loss of blood, too great a drain upon the resources Avhen nursing, prolonged use of aperient medicines, etc., also in disorders arising from the abuse of tea, or from a residence in impure atmospheres, especially such as are overloaded with the exhalations of decayed vegetable matter, where the drainage is insufficient, the cultivation imperfect, where stag- nant pools or ditches, charged with rank matters, abound, more particu- dyspepsia. 257 larly in the midst or vicinity of half-dried marshes, or on a level with them, or in such position in relation to them as exposes the habitation to the current of prevalent winds from them, or near the beds of periodical streams, when the water ceases to flow, and the bed appears to be dried up (especially in Avarm climates), or when the rays of the sun have great power; or, again, in districts which are habitually dry and well drained, but Avhich have been extraordinarily saturated by a wet season, and are beginning to dry up again. Dose: Six globules, night and morning, one week ; wait four days, and if still indicated by the symptoms present, resume the admin- istration of the same remedy night and morning, every fourth day. DERANGEMENT OF THE STOMACH ARISING FROM CASUAL CAUSES—NOT HABITUAL. This should be understood to apply to those who are only casually affected, but whose digestion is habitually unimpaired. Causes.—The ordinary causes of this derangement are, hurried, im- perfect mastication; overloading the stomach; fat, greasy, indigestible or tainted food, flatulent vegetables, ices, stimulants, and others equally well known. HOMOEOPATHIC TREATMENT. When the symptoms of approaching derangement of the stomach declare themselves immediately, or a few hours after a repast which has been too freely partaken of, a cupful of strong coffee, without milk or sugar, is frequently a sufficient restorative. Should, however, this fail to relieve, and sick headache and inclina- tion to vomit be present, we should assist nature by various artificial means—the milder, if sufficient, the better—such as tickling the throat with a feather, and by giving tepid water to drink until the stomach has completely evacuated its contents. Bryonia is very serviceable when the following symptoms are pres- ent: bitter eructations; fever, alternately with coldness and shivering, a red- ness of the face, heat in the head, and thirst with coldness and shivering; also when looseness of the bowels or constipation, and peevishness or exces- sive irritability are present. In derangement of the stomach, arising from succulent vegetables, and attended with excessive flatulence, this remedy is frequently productive of speedy relief. Dose: Of a solution of six globules to two tablespoonsful of water, give a teaspoonful every two hours. Arsenicum. When there are acrid and bitter eructations with nausea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or colic, and griping in the lower part of the belly, particularly when arising from the effects of an ice Avhich had been partaken of, the patient being warm, or from fruit, stale vegetables, or acids Dose: Three globules in a teaspoonful of water, every three hours- until amelioration or change 17 258 OUR FAMILY PHYSICIAN. Carbo-vegetabilis is a very valuable remedy in this affection,either for the initiatory treatment, or after the previous administration of one or more of the other remedies, according to indications, for the purpose of removing any symptoms that may remain; it is, moreover, particularly useful where great susceptibility to the influence of the atmosphere, par- ticularly to cold, exists at the same time; or in suffering arising from abuse of wine, ices, or salt; further, in derangement of the stomach, aris- ing from having partaken of game or fish Avhich has been too long kept, or meat that has been recooked whilst in a state of fermentation, Avhich is liable to occur in warm weather; in the latter instances, Carbo-v. is to be preferred to any other medicine, and will rarely fail to afford relief. Dose: Of a solution of tAvelve globules to three tablespoonsful of Avater, give a teaspoonful every four hours, until amelioration or change* Nux-vomica is indicated by offensive or acrid eructations, constipa- tion, and confused headache, particularly when arising from previous in- toxication, or even slight over-indulgence in wine or otlier stimulants; when possible, it should be taken the same night, as when taken in the morning, although eventually relieving, it frequently causes an aggrava- tion for a few hours. In derangement of the stomach, with heartburn, flatulence, more or less nausea and headache, etc., in consequence of a chill or of indulging in mental or corporeal exertion immediately after a meal, this remedy commonly affords speedy amelioration. Dose: Four globules in a teaspoonful of water. Arnica is indicated in cases of derangement of the stomach, charac- terized by eructations resembling rotten eggs. Dose: Of a solution of eight globules to two tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change. Pulsatilla, in recent cases of deranged digestion, with rising of food, tongue foul, and covered with phlegm; chilliness and lowness of spirits; and also when a rash has been thrown out in consequence of the derange- ment. This remedy is almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastery, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid or impure wine, etc. Dose: Four globules in a teaspoonful of water. OBSTINATE CHRONIC CASES OF FUNCTIONAL DERANGEMENT. In cases of derangement of the functions of digestion, which, though modified, are extremely difficult of removal, the remedies hereinbefore noticed will be required for initiatory treatment; but in the majority of instances the patient will have to be subjected to an appropriate course of such remedies as those hereto subjoined, in order to complete the cure. Sulphur is one of the most important remedies for administration after the previous exhibition of Nux-vomica or Pulsatilla, and in cases which would otherwise correspond with the indications for either of those * A email quantity of finely powdered charcoal, in a littlle good French brandy, or water will be found an equally efficacious mode of administering this remedy, as a corrective against derangement the stomach, arising from having partaken of tainted meat or fish. * INDIGESTION. 259 medicines, but when either of them has been inadequate to effect a per- fect cure. Dose: Six globules in a wineglassful of water every morning the first thing (fasting), for ten days (unless there be earlier improvement or change); then pause four days, resuming the course similarly, if necessary, and so on from time to time, until positive amelioration or change. Hepar-sulphuris is also of great value in cases in which the diges- tion is naturally Aveak, and sour vomiting, with'burning sensation in the throat, colic and looseness of the bowels, are liable to be provoked by the slightest error in diet, and particularly when anything of an acid nature has been partaken of; or especially in cases in which the patient has preA'iously taken blue pill, or any other mercurial preparation for a con- siderable time. Dose: If singly, three globules in a teaspoonful of water night and morning for a week (unless earlier and decided improvement or change ensue); pause four days, and resume the course, if neces- sary, and so on, from time to time, until amelioration or change ensues. Sepia is also indicated by a sensation of coldness, and is to be preferred to either of the preceding remedies when this symptom is associated Avith a multiplicity of other equally characteristic indications, particularly if there be no appetite, or voracious appetite, and aversion to meat or milk, Avater-brash, especially after drinking: constant acidity of the stomach, aggravated by eating, and if fat things, milk, etc., continually dis- agree. Dose: Four globules night and morning. Silicea is especially indicated when the patient entertains a repug- nance to cooked food, and is particularly averse to meat; when the patient is subject to severe pains in the stomach, attended Avith excessive thirst and water-brash, bitter taste in the mouth in the morning, vomiting after drinking, and habitual nausea predominating after a meal, or upon rising in tlie morning. Dose: Six globules in a Avineglassful of water, every morning the first thing (fasting), until amelioration or change. Carbo-veg. —Here, again, this remedy is peculiarly valuable when annoyance or inconvenience is felt after every meal, amounting to nausea and vomiting, attended with excessive flatulency, and when the pit of the stomach is tender on pressure. Dose: Three globules in a teaspoonful of Avater, until amelioration or change. OBSTINATE CHRONIC CASES OF ORGANIC DERANGEMENT. In cases in which organic disease has been established, that is, in such cases as assume the critical aspect described in the general description of symptoms at the commencement of this article, it were desirable, if possi- ble, that the interference of an experienced Homa-opathic practitioner should be invoked. GENERAL DERANGEMENT OF THE STOMACH IN CHILDREN. The foregoing particulars applying to general cases are equally to be kept in view in considering this affection more particularly amongst 260 OUi; FAMILY PHYSICIAN. children ; but as the causes and features of such derangements are neces- sarily far less complicated anongst children than amongst adults, it may save the administrator much trouble to extract and render in a summary form, such details respecting the treatment of this affection amongst children, as Avill otherwise be gathered only in scattered portions of this article. Ipecacuanha, or Pulsatilla, or Carbo-a^eg. These medicines are of chief importance, either for independent, alternate, or successive administration in cases in Avhich hurried feeding {bolting the food) im- perfect mastication and overloading of the stomach, or rich, indigestible food, can be distinctly traced as the exciting causes of derangement. The particular indications for each may be gathered from those details which have already been afforded. Dose: If singly or successively of either remedy, tAvo globules in a teaspoonful of Avater, every three hours, until amelioration or change. If in alternation, dissolve eight globules of each remedy, separately, in a wineglass of water, and give a teaspoonful, first of one solution, then of the other, so that an interval of four hours shall elapse betAveen the doses; and so on, until amelioration or change. Pulsatilla, or Arsenicum, or Carbo-veg. These are in like man- ner appropriate in cases in which ices or cold fruits have been the excit- ing causes of derangement. In this instance, also, the particular indica- tions for each may be gathered from the foregoing part of this article. Dose: In every respect as directed in the foregoing prescription. Pulsatilla, or China, or Carbo-veg. These medicines selected according to the indications afforded in respect of each in the former part of this article, are particularly appropriate to the treatment of derange- ments of digestion occurring amongst children, in consequence of having eaten tainted meat or fish. Dose: In every respect as directed in the foregoing prescription. Carbo-veg., or Arsenicum. These medicines, respectively, accord- ing to the indications hereinbefore afforded respecting each, are most appropriate, in the generality of cases, to the treatment of derangements of digestion occurring amongst children as the result of excessive use of salted articles of diet, especially salt meat. Dose: Of either medicine, give two globules in a teaspoonful of water, every four hours, until amelioration or change. Aconitum, or Arsenicum, or Carbo-a-eg. These again occur as the most important remedies whence a selection should be made according to the special indications for each, which have already transpired in previ- ous portions of this article, when acids (such as vinegar, etc.) are identi- fied as the exciting causes of derangement. Dose: Of the remedy selected as directed in the last prescription. N AU SB A. With respect to this affection, which must be considered purely as a symptom, the reader is referred to the foregoing portions of this article, wherein directions have been given for the treatment. In the majority eructations, sick headache. 261 of simple and casual cases, liOAveA^er, it might suffice to consider the indi- cations afforded for Ipecacuanha, Cocculus, Nux-vomica, Bryonia, Chani- momilla, Pulsatilla, and Acconitum, folIoAving the same regulations re- specting the dose. In inveterate cases, hoAveA'er, in which this symptom occurs continu- ously, the accurate inA'estigation of all symptoms associated with it, and of the whole of the foregoing details, becomes necessary, and one or more of the following remedies, according to the directions hereinbefore offered, may become necessary. Natrum-m., Arsenicum, Lycopodium, Lachesis, Carbo-Areg\, Rhus-tox., or Silicea. ERUCTATIONS. With reference to eructations, as Avell as to nausea, as they must be considered purely as symptoms, the reader is referred to the foregoing portions of this article, wherein more distinct indications have been af- forded, to facilitate the selection of the appropriate remedy. In most cases of a simple and uncomplicated character, the consideration of such indications as are afforded for the administration of the folIoAving reme- dies (chiefly) both as to selection and dose, Avill be sufficient to meet the requirements of the case: Arnica, Nux-vomica, Pulsatilla, Sulphur, Bry- onia, Carbo-Areg., Chammomilla, Cocculus, China, Antimonium-crudum, and Antimonium-tartaricum. In cases of an inveterate nature, and which are eA'idently associated with complications involving the whole of the digestive and nutritive system in more or less continual derange- ment, it may be advantageous to consider the indications afforded for Sepia, Acidum-sulph., etc. BILIOUS, OR SICK HEADACHE. In ordinary cases, in which sick headache is evidently the result of a casual cause, it will suffice to consider the indications afforded for Anti- monium-crudum, Ipecacuanha, Nux-vomica, Pulsatilla and Sulphur; or Bryonia, if this symptom be associated Avith costiveness. SYMPATHETIC AFFECTION OF THE BRAIN AND NERVOUS SYSTEM., Depression of Spirits—Hysterical and Hypochondriacal Affections.— These most distressing results of long-continued or very severe derange- ment of the digestive functions, are almost invariably associated with what is termed "chronic indigestion," and not unfrequently afford an important clue to the treatment of the primary seat of disease. But nothing can be a greater source of error in most cases, than to deal with them as primary diseases of the brain and nervous system. Depression of spirits may occur as the consequence of derangment, either of the nerves or lining membranes of the stomach, but with very different char- acteristic features; for when the nerves are the seat of the disease, restless and uneasy anxiety, sudden fits of Adolent excitement, extreme irritabil- ity, impatience and despondency with violent impulses, are the result; when, however, the lining membrane is the seat of disease, extreme de- 262 our family physician pression of spirits occurs associated with languor, utter prostration, indo- lence, and listlessness. Sulphur is appropriate to the treatment of both Ararieties, but is more especially indicated by the indolence of mind and body, or by the vacancy of thought, or absence of mind and irresolution, which characterize the latter; it is however, also appropriate when the depression of spirits is associated Avith painful anxiety of mind, extreme solicitude concerning the future and respecting one's health and affairs, erroneous or exaggerated notions on given subjects, general Avretchedness without any ascertainable reason, sudden fits of violent excitement and periodical return of extreme impatience, restlessness, irritability and impatience, Avhen the following symptoms are also present:—sensation of fullness and Aveight at the pit of the stomach; habitual constipation, headache, and particularly pain at the top of the head; dullness and heaviness of the head, the patient being un- able to exert his mental faculties, or becoming exceedingly weary and ex- hausted after any application of this kind; disposition to piles; or when chronic eruptions and affections of tthe skin are associated Avith the complaint. Dose: Repeated doses are generally required, administered thus:— For adults six globules, or for young persons four globules in a wine- glassful of Avater, every morning the first thing (fasting), for ten days (unless neAv symptoms or a change in the nature of the symp- toms be sooner developed) then pausing for a Aveek, and resuming the like course, if necessary; and so on until distinct amelioration or change; if in alternation with Calcarea, commence with three doses of Sulphur, as just described; pause four days and then administer three doses of Calcarea likewise, and so on until amelioration or change. Calcarea is indicated by depression of spirits with disposition to tears; flushing of blood to particular parts associated Avith attacks of indis- cribable anguish, and generally palpitation of the heart, or painful sensa- tions in the region of the heart; general uneasiness with aversion to mental or physical exertion; despondency respecting one's health, and apprehen- sion of death; dread of mental aberration—or of contagion, or other causes of disease, or of imaginary misfortune; and when there is intense acute- ness of all the senses. Dose: In every respect as directed for Sulphur, whether singly or in alternation. Natrum-m, is indicated by depression of spirits accompanied with apprehensive foreboding, and with fretful, tearful disposition with des- ponding expression; love of solitude, which however nourishes the disease, • and dread of society, whereby hoAvever it is alleviated; occasional bursts of violence; disgust of life; habitual moroseness and incapacity of mental labor; weakness of digestion characterized by aggravation of the sufferings, mental as well as bodily, and by general and indiscribable uneasiness after a meal and until the proper maceration of the food is completed in the stomach and has been conveyed to the bowels, or by susceptibility to the recurrence of such symptoms provoked by the least excess or irregularity; headache and want of appetite; nausea occurring every morning, etc. Dose: Six globules, or for young persons four globules, in a wineglass- ful of water every morning, the first thing, fasting until amelior- ation or change. indigestion, nurvous sympathy. 263 Aurum met, is indicated by incapability to concentrate the reflective faculties and want of power of combination in the mind, characterized by crushing headache after the least exertion of the mind or attention, and a sensation as if the brain were dashed to pieces; painful anxiety of mind and excruciating restlessness; whining, fretful disposition and dread of death. This remedy is often of great service against the hysterical attacks of females. Dose: As directed for Natrum-m. Bachesis is particularly indicated when the patient is haunted by the idea that he is the object of dislike, suspicion, or even hatred amongst his friends. Dose: Three globules in a teaspoonful of water, morning and even- ing, until amelioration or change. Nux-vomica is indicated by almost every variety of nervous, hysteri- cal or hypochondriacal derangement, either characterized by indolence, or excitability, but especially the latter; deep dispondency Avith disgust of life, moroseness, and aversion to labor or exertion of any kind, character- ized by the following symptoms: excessive sensitiveness, and aversion to the open air; faintingfits, after the leaet exertion, especially after motion in the open air, or giddiness, sensation of being stunned, and sparks of black spots before the eyes under the like circumstances; sensation of heaviness in the body, Avith weariness, languor, and great desire to assume or retain a recumbent position, by which the symptoms are alleviated; emaciation, and wiry condition of the flesh; intense sensation of lassitude and fatigue, even in the morning after rest, and often excitability which renders the patient reluctant to retire to rest at night: drowsiness in the morning, after meals, or in the evening, followed by sleeplessness at night; sallow, pallor or yellowness of the skin; heaviness, with pressive, tensive and expansive pain in the head; intense headache seated in the fore pare of the head along the broios; or pain—often acute and piercing, as if some sharpe instrument were lodged there,—deep in the brain; swelling and redness of the eyelids, and red suffusion of the eyes, particularly in the morning; cramp-like, contractive gnawing or pressive pains in the region of the stomach and below the ribs, and at the pit of the stomach; extreme sensitiveness of the pit of the stomach to pressure; constipation character- ized by slow and sluggish action of the bowels, with dark, hard, dry, and large but unfrequent evacuations,—or by intermingled, loose, and lumpy evacuations;—particularly appropriate, if there be disposition to piles; frequent discharge of pale, watery urine,—dragging and rheumatic aching pains in the back towards night; contused pains in the loins and back; numbness of the arms at night. Dose: Three globules in a teaspoonful of water, night and morning, until a degree of good effect results, and then four globules in a tea- spoonful of water every night, until positive amelioration or change. After which a course of Sulphur as above directed will usually be beneficial. Phosphorus is particularly appropriate for the treatment of deli- cate and highly hystrical females, and fair subjects of a spare and slender frame, and is indicated by sadness, alternated with apparently good spirits (with mirth); attacks of indescribable anguish, affright— 264 OUR FAMILY PHYSICIAN. and even distressing hallucination, when left by one's self, or during stor- my weather ; timid disposition, startled at eArery sound and apprehensive of thieves and acts of violence, etc., painful anxiety, or uneasiness res- pecting one's health. Dose: Four globules in a teaspoonful of water every night, until amelioration or change. Suspending treatment for four days after a week's course. China is indicated by distress, languor, or dullness of mind, the patient being easily disheartened and laboring under the impression that insu- perable combinations are devised against him by adversaries to frustrate every undertaking; the patient gives way to despondency, and is over- come by a prevailing idea, that he is doomed to be unfortunate—symptoms which are characterized by the following: weakness of digestion, with recurrence or aggravation of symptoms generally, and with indolent dis- position, ill-humor and distention of the belly after eating; chronic relaxation of the bowels; loose, yelloAvish, or slimy evacuations, or char- acterized by discharge of undigested food ; or pale evacuations Avith dark urine ; small, detached eA'acuations with slow and sluggish discharge and with deficiency of muscular vigor in the intestines ; sometimes the organs of sense are acutely sensitive; sleeplessness occasioned by the crowding of ideas upon the mind, and by visionary projects, or sleep much dis- turbed by anxious, painful dreams, which continue to haunt the patient when awake, and attended with frequent change of position and tossing. Dose: Three globules in a teaspoonful of water, night and morning, until amelioration or change. Sepia is of pre-eminent service in many confirmed and inveterate cases, particularly in females, and when complicated with severe hyster- ical affections ; the patient being wholly abandoned to despondency and weary of existence, anxious respecting her own health, but averse to the consideration of household or other affairs, and often indifferent to every one but herself. Dose: As directed for China. Silicea is of great service generally, in obstinate cases of hypochon- driacal affection, resulting from stomach derangement, particularly if noise easily frightens or startles the patient, or if there be constant anxiety and agitation, weakness of the memory, incapability of reflection moroseness and taciturnity, intense irritability and tendency to be provok- ed to violence by contradiction, or excessive weariness of existence, further characterized by confusion of the head, or of ideas; pain ascend- ing from the nape of the neck to the top of the head; headache recurring every morning ; heat in the head, particularly in the forehead; lacerating or darting pains in the head, or pulsating headache, with flushing of blood to the brain; temporary defect or suspension of vision; confusion and mistiness of sight when reading; redness of the eyes and adhesion of the eyelids at night; the strong light of day is painful to the eye ; bleeding ah the nose; continued and watery discharge from the nose; con- stant sneezing; hardness of hearing; scabby eruption on the lips, or swelling of the glands of the lower jaw; toothache at night, aggravated or provoked by hot or cold things; soreness of the tongue, or dryness of A'OMITING OF BLOOD. 26.", the mouth; deficiency of taste or bitter taste; acid risings and Avater- brash, or pains in the stomach or boAvels, or even vomiting after eating; nausea every morning; colicky pains associated Avith constipation; piercing or nipping pains in the boAvels ; puffing of the belly and difficult expul- sion of very fetid flatulency; hard stools with constant urging, or consti- pation characterized by hard, knotty, detached motions, evacuated slowly and with difficulty; wetting the bed; looseness; suffocating cough at night; aching pain in the chest and impeded breath; numbness of the arms induced by lying upon them; trembling of the knee; offensive smell from the feet; cold feet, SAveating of the feet, or lastly, cramps of the legs, particularly during rest and after exertion. Dose: As directed for China. ACCESSORY TREATMENT AND DIET. In no class of disorders is it more requisite to adhere strictly to diet- etic regulations, than in those Avhich consist of derangement in the digesth-e system, whether so-called functional or organic; the patient' should, therefore, in such cases, regulate his regimen, as closely as possi- ble, by the rules laid down at the commencement of this treatise (pp. 79, 80), carefully aAroiding, moreover, all such articles as he may find disagree with him, eA-en if they be allowable as a general rule. HJEMATEMESIS, HEMORRHAGE FROM THE STOMACH. A'OMITING OF BLOOD. This is scarcely ever an original affection, but almost always sympto- matic of some other disease. Vomiting of blood may depend on a variety of causes, and if it inclines to become profuse and threatening, it is of the utmost import- ance in practice to investigate with accuracy and care the precise causes in each attack. As a complicating symptom bleeding occurs, more par- ticularly, in diseases characterized by a peculiar alteration of the whole mass of blood, such as typhus, scurvy, yellow fever, etc. The hemorrh- age may be very copious, although none of the larger vessels are ruptured. A second cause of the bleeding is a rupture of the walls of vessels. It may be caused by excessive accumulation of blood in the stomach depending upon disturbances, engorgements, etc., of the vena porta, liver, spleen—hence it is not of unfrequent occurrence in the case of individuals afflicted with piles; or the hemorrhage may be caused by menstrual suppressions and stoppages, on which account it occurs more frequently at the climacteric age; it sometimes seems as ii the hemorrh- age took place as a substitute for the menstrual discharge. The vomiting during pregnancy is very frequently stained with blood. The worst kind of bleeding arises from injuries of the stomach walls, consequent upon ulcerations of the mucous membrane. It is met with in chronic dyspep- sia and cancer of the stomach. If there is a disposition to bleeding, it may be provoked by a blow upon the stomach, a fall, or Adolent emo- tion. The symptoms of hsematemesis differ, according as the bleeding is more or less copious, and arises from different causes. If the bleeding is but slight, and the blood is not vomited up, the accident remains some- times entirely unnoticed. If the vomited substance only contains a few 266 OUR FAMILY PHYSICIAN. streaks of blood, it has no particular significance at the time, but the patient has to be watched with more care, because we can never be sure Avhether a more dangerous hemorrhage is not threatening. The blood should likewise be examined, with a A'iew to discovering disease changes that had remained latent heretofore. The bleeding likeAvise aeqaires im- portance from the circumstance, Avhether the blood is discharged with violent straining, or is vomited up easily; in the latter case, the bleeding is much more significant, on account of its indicating ulceration of the mucous membrane, or some important change, dilatation, etc., of the vessels, whereas a little blood may be discharged in consequence of A-io- lent straining, even if the vessels are perfectly intact. As soon as a someAvhat considerable quantity of blood is vomited a series of characteristic symptoms appear. The morbid symptoms that already happen to be present, become associated Avith a constantly in- creasing dull pressure in the pit of the stomach, and a distressing feeling of distention of the stomach, generally attended Avith nausea. If the bleeding takes place sloAvly, the preliminary symptoms may be confined to these few ; on the contrary, if the blood is expelled Avith rapidity and force, the patient experiences the usual symptoms of a considerable loss of blood, such as anxiety, paleness, cold sAveat, cold skin, vertigo, and eA-en fainting. A large quantity of blood is A-omited up at once, and with great force. The action of the gastric juice imparts to it a blackish hue, and has the consistence of coagulated sour milk. The quantity discharg- ed at one vomiting often exceeds one quart, so that it seems scarcely possible that the stomach could haA7e contained such a large quan- tity at once. Immediately after the A^omiting the patients feel faint and exhausted, and are tormented by an almost unquenchable thirst; at the same time a visible throbbing occurs in the pit of the stomach, of which the patient himself is conscious. After this par- oxysm, a period of rest and comparative ease sets in, until another attack of bleeding occurs. The interval to the next bleeding, lasts from a few hours to several days; in violent cases four or five attacks may occur on the same day ; of course, in such a case, severe symptoms of anaemia may set in even unto convulsions, and death may be the immediate con- sequence. If so much blood is expelled from the stomach, the stools are likwise black as coal, and A'ery thin ; it may even happen that the blood is not vomited up first, but that the black stools may be the first sign of the bleeding. Regarding a return of the bleeding, we cannot speak Avith certainty; it depends entirely upon the primary exciting cause. If there is a frequent return of the bleeding anaemia and dropsy are unavoid able results. Recovery from a single attack usually takes place slowly, the patients being at the same time tormented by a variety of gastric disorders, such as a burning distress in the region of the stomach, foul taste, sweetish or foul eructations, horrid thirst, and by a long-continued abdominal pulsation. Under all circumstances there is great danger lest the bleeding should return, hence the patient cannot be too careful in not overtaxing the stomach. Bleeding resulting from ulceration may not afford much relief, but in cases of hseinatemesis, of Avhich we are un- able to discover the exact cause, or which depend upon the suppression VOMITING OF BLOOD. 267 of other hemorrhages, the relief afforded by such bleedings may he quite considerable. As regards diagnosis, two circumstances may deceive us. In the first place a violent paroxysm of haemoptysis may be mistaken for vomiting of blood, and the deception may be kept up, if a physician does not him- self examine the vomit, since patients often are so overwhelmed with anxiety that they lose all calmness and presence of mind. In other re- spects the black color of the vomit, and the absence of the bloody expec- toration, which always follows a paroxysm of bloody cough, furnish the surest indications regarding the true character of the attack. It likewise happens that a person may ha\-e a violent attack of nosebleed over night, and that the blood may be swallowed; if the quantity of the swallowed blood becomes excessive, it aAvakens the person, and the blood is then vomited up, and may look precisely as it does when true haamatemesis takes place. It is difficult to distinguish one from the other; our diagno- sis has to be more particularly determined by the absence of all precur- sory symptoms and subsequent gastric derangements. The use of whor- tleberries and similarly colored fruit may likewise occasion a momentary deception, more particularly if the patients are Arery anxious. As a general rule, the prognosis in all ordinary cases, is favorable, except where the hemorrhage is at once so excessive that death results from the mere loss of blood. The prognosis, hoAvever, is ahvays doubtful in so far as a first bleeding leaves an inclination to a renewed attack, and the bleeding ahvays indicates the presence of dangerous alterations in the stomach. Hence a permanent cure is never absolutely certain. ALLOPATHIC TREATMENT. H^matemesis (vomiting of blood) is a symptom of some other affec- tion, the most serious of which are an Ulcer and Cancer of the Stomach. It may be well to enumerate the symptoms of hemorrhage of the stomach, and hemorrhage of the lungs, inasmuch as by so doing needless fears may be allayed by understanding fully the contrast between the symptoms accompanying each. The distinction may be more clear, if given in this table. In Bleeding from the stomach. ! In bleeding from the lungs. Sickness of the stomach. fullness in vicinity of stomach. Blood Tomited freely, Blood not frothy. Blood dark colored. Blood of a bright, red color. Blood mixed with food. Blood mixed with spittle. Symptoms refer to stomach. Symptoms refer to lungs and bronchial tubes. The first efforts in treatment will be to arrest hemorrhage. The pa- tient should be confined to the bed ; cold may be applied over the stomach ; small pieces of ice should be swallowed. If the bleeding is excessive there should be entire rest of the stomach and nourishment should be given by injection. Among the most suitable for this purpose is strong beef tea and milk. From four to six ounces may be used at each injection, four times a day. The addition of half a teaspoonful of pepsin will aid its digestion. If the return should be especially sensitive and does not retain the injec- Difficulty in breathing. Pain or heat in the chest. Blood coughed tip by mouth/tils. Blood frothy. 268 OUR FAMILY PHYSICIAN. tion, tAventy or thirty drops of laudanum should be added, and after the injection firm pressure should be made upon the anus Avith a napkin under the hand, until all efforts to expel it cease. It sometimes happens that vomiting of blood takes the place of the menstrual Aoav. If this is the case it should not be immediately arrested, but kept within proper limits. The swallowing of ice, cold over the stomach, and hot foot baths, are per- missible. Pain will require an anodyne—20 drops of laudanum, or a third of a grain of morphine every hour or two, until relief is obtained. Remedies addressed directly to the flow of blood may be called for. Those most likely to be in the house, ready for an emergency, are: Ace- tate (sugar) of Lead, Turpentine and Alum. Acetate of Lead may be given in poAvder in doses of a sixth or eighth of a teaspoonful, and re- peated in an hour, if necessary. The dose of Turpentine is ten to twenty or thirty drops, given on sugar or in mucilage or syrup. Alum may be given in poAvder, in doses of a quarter of a teaspoonful. Cathartics or emetics must not be gh'en. Mousel's solution of Subsulphate of Iron is the best remedy knoAvn to staunch hemorrhages. In these cases ten drops of the solution should be given in ice water, and after the first two or three drops, can be given frequently, from ten to thirty minutes apart, if the bleeding does not cease. Tannin is a useful remedy; the dose in this disease is from ten to twenty grains. It should be given in poAvder. Excluding the existence of ulcer, cancer or other lesion of the stom- ach, treatment will have reference to the debilitated condition of the sys- tem, and the prevention of a recurrence of the hemorrhage. To this end, easily digested food, Avhich is nutritious, as beef essence, milk, raw eggs, and broths. Ten-drop doses of Aromatic Sulphuric Acid may be given* before meals, in an ounce or two of some of the simple bitter infusions (teas), as Columbo Gentian, Quassa, Peruvian Bark, etc., made with an ounce of the drug to the pint of hot water. The Tincture Muriate of Iron may be ghren in doses of from ten to twenty drops, in sweetened water, after meals. The Citrate of Iron and Quinine frequently answers the purpose better than anything else. It should be given in solution, in water or syrup of orange flowers, in doses of three to five grain. HOMOEOPATHIC TREATMENT. Aconitum should be given when the premonitory symptoms detailed declare themselves, and particularly when a considerable degree of fever precedes the attack. Dose: Dissolve six globules in two tablespoonsful of water, and give a teaspoonful of the solution, repeating the dose in half an hour, and then every hour till positive amelioration or change. In this mode, if taken in time, we may often, by calming the circulation, prevent an attack. Ipecacuanha.—For a first attack we know of no better remedy than this; unless some very peculiar symptoms should render some other medicine necessary, we would use this. Against following attacks it is VOMITING OF BLOOD. 269 not so good. The less the vomiting of blood depends on some previously existing disease, the more this remedy is indicated. Dose: This must be large ; 5 or ten drops of the tincture and frequent- ly repeated every 30 to 60 minutes, if the case is urgent. Nux-vomica.—In a full habit of body, with a marked tendency to congestion of the stomach and bowels, particularly Avhen arising from suppression of haemorrhoids, or of the menstrual discharge, or from indulgence in vinous, spirituous, or fermented liquors; this remedy is Still further indicated by irritability of temper, and liability to constipa- tion. Dose: Four globules in a teaspoonful of water, every four hours, until amelioration or change. Pulsatilla.—The value of this remedy is noticed in the diseases of females above mentioned; it is also in many cases found more suitable than Nux-vomica for males, when of lymphatic temperament and mild disposition. Distinctive derangement of the digestive or menstrual func- tions constitutes the general indication for this medicine. Dose: As directed for Nux-vomica. China.—When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debili- tating losses, is clearly indicated; it should also be chosen when the patient has had a severe attack of vomiting of blood, which has ceased of itself, but still left great weakness. Dose: Six globules in a teaspoonful of water, every tAvo hours, until improvement or change; if, however, there be very palpable ameli- oration after the first dose, the repetition may be suspended until the symptoms recur, or for twenty-four hours. Arnica.—One of our most important remedies in seA-ere cases, and especially when occurring in individuals of a robust constitution, of a san- guine temperament and choleric disposition. It is further indicated when the patient complains of pains, resembling the results of a contusion, in all the extremities. Dose: Dissolve six globules in tAvo tablespoonsful of water, and give a teaspoonful of the solution every hour, until distinct improvement or change. Sulphur is useful in scrofulous habits, or when the affection has arisen from suppressed haemorrhoids; its value, also, in cases of unhealthy menstruation will be pointed out in the proper place. Do.se. Three globules in a teaspoonful of Avater, every four hours, for the first day, or until the violent symptoms subside. Then six glo- bules in a wineglassful of Avater, every morning the first thing (fasting) for ten days; pause four days, and resume the course, and soon from time to time when no acute symptoms are present. ACCESSORY MEASURES. The application of dry cupping-glasses to the stomach and under the ribs,—or of a cloth, which has been dipped in moderately cold water, to the lower region of the belly,—sometimes forms a useful auxiliary in arrest- ing the discharge of blood. See also the article on "Discliarge of blood from the Lungs." 270 OUR family physician. Diet and Regimen. The rules hereafter given under Spasm of the Stomach should be enforced, with the utmost rigor; solid food cannot be permitted, and all drinks should be cold; animal jellies, preparations of milk, light puddings and broths, merely tepid, may be allowed in cases Avhere the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose; immediately after the attack, no food should be given for some hours, and then very cau- tiously, and in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite. CARDALGIA. SPASM OF THE STOMACH. Symptoms. Contractive and spasmodic or gnaAving pains about the region of the stomach, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities ; the patient is sometimes relieved by emission of ascend- ing wind, and, Avhen complicated Avith heartburn, by a discharge of a quantity of limpid fluid; occasionally headache and constipation are present. In some cases the pain is very slight (but there is always more or less), and a degree of anxiety, with nausea, often increased by taking food. Complications. The disease is frequently accompanied by a disease of the liver, spleen, or of the pancreas gland, or even by cancerous degen- eration of the stomach or first portion of the small intestines, in its ad- vanced stages. It is a frequent attendant on gout. Age, sex, etc. It is a more frequent affection in the female than the male sex, often occurring after the cessation of the usual monthly dis- cbarge, or from any interuption of its usual course; in such instances it is frequently accompanied with hysterics and fainting, and may pass on to vomiting of blood. It Aery rarely occurs before the age of puberty. The paroxysms last for a longer or shorter time according to the vio- lence of the affection, and return in many instances periodically; and may be brought on by partaking of improper articles of diet, or, in severe cases, by any solid food whatever. Origin. This disease originates in an unhealthy state of the nerves of the stomach. The exciting causes are : Long fasting betAveen meals, very hot or cold drinks, an habitual use of ardent spirits, or of indigestible food, Avorms, and, in some instances, exposure to cold or damp weather. But coffee is the article to which most persons owe this pain. PRECAUTIONS TO BE OBSERVED BY THOSE AVHO ARE SUBJECT TO SPAsAI OF THE STOMACH. The chief articles to be avoided by an individual suffering from this malady, are: ('rude, uncooked A-egetable substances (such as salads;, cheese, new bread, sweet meats, cherries, nuts, olives, and roasted chest- nuts, and stimulants of all kinds, whether tea, coffee, alcoholic or fer- mented drinks. SPASMS OF THE STOMACH. 271 ALLOPATHIC TREATMENT. Spasm or cramp in the stomach. If the trouble occurs suddenly upon the ingestion of some article of food, which isjplainly irritating the stomach, the organ should be relieved by an emetic of twenty grains of powdered Ipecacuanha in a glass of warm water. If the trouble is not plainly referable to such a cause, neither emetics nor cathartics should be given, but the pain must be relieved. This is done most quickly by gh'ing thirty drops of Laudanum, and repeating the dose at intervals of half an hour to an hour, until the pain is relieAed ; or a third of a grain of Morphine may be given at the same intervals. A laxative of a couple of Compound Cathartic Pills may be needed after the pain is relieA'ed, to pre- ATent constipation from the opiate. In cases subject to frequent returns of the pain, it is not advisable to give opiates, on account both of the liability of producing the "opium habit" and of the disturbance its frequent administration produces in di- gestion. Sometimes cold and sometimes hot applications, over the stomach, relieves the spasm and pain. Rubbing the skin over the stomach with a liniment made of an ounce each of Chloroform, Tincture of Aconite and Soap Liniment, or laying a flannel, Avet with equal parts of Turpentine and Laudanum, and covering it Avith oiled silk. Tincture of Belladonna in doses of ten drops, or Tincture of Hyoscyamus in doses of one or Iavo teaspoonsful, taken internally, is useful in relieving pain. When pain occurs in the stomach, with spasms, the same proceedures are useful, but some remedies seem to have especial benefit. If there is indigestion and irritation of the mucous membrane, Bismuth, in doses of a scruple three or four times a day, may be given. In these cases the following is a good formula : Take of Sub-Nitrate of Bismuth two drams, Pepsin one dram, Dilute Hydrocyanic Acid half a dram, Mucilage of Gum Arabic and Peppermint Water of each Iavo ounces. Mix, and take a tablespoonful three times a day. The Purified Black Oxide of Manganese, in doses of ten to twenty grains, is also a beneficial remedy, and can be used in case of failure with the Bismuth. Cases accompanied Avith the formation of gas, should be treated with Nux-vomica, in doses of ten drops of the tincture, or one-fourth of a grain of the extract in pill, three times a day ; or Strychnine, in doses of one- thirtieth of a grain, may be gh7en instead. The Elixir of Bark, Iron and Strychnine, or Elixir of Quinine, Iron and Strychnine, in doses of one or two tablespoonsful three times a day, are appropriate to these cases. In cases resisting other remedies, FoAvler's Solution (Solution of the Arsenite of Potash), in doses of one or two drops, in water, after eating, is almost always beneficial. Some change in the mode of life may be particularly important a* from inactive pursuits indoors to an active life in the open air; as, also, in some instances change of scene and climate, may be of the greatest value. Intheuse|of stimulants, the advice of a conscientious physician 272 OUR family physician. should be rigidly followed. Harm will result from their use if taken at other times than with the meals, and in small quantities. The symp- toms of dyspepsia should be met as are directed in that article. The tonics recommended to be of use should be taken for a long time. Each recurrence should be met as directed in the first part of this article. Pyrosis. Sour eructations after meals may generally be prevented by taking fifteen drops of Dilute Hydrochloric or Bactic Acid, in SAveet- ened Avater, before meals. Sulphurous Acid, in doses of twenty drops, in sAveetened water, before meals, will sometimes have a better effect. Ei- ther of these Acids often has a better effect when gh7en in a teaspoonful of Glycerole of Pepsin. Alkalies, to be useful, should be taken Avhen the sour eructation be- gins to appear in an amount sufficient to correct the symptom. Bicar- bonate of Soda (Baking Soda) is best suited to this end. It is best given in milk or Avater. Alkalies are beneficial when the amount taken can be gradually diminished with relief of the symptoms. Bismuth is a very useful agent in most of these cases. It is best given with a little Carbolic Acid, as in this formula: Take of Subnitrate of Bismuth three drams, Carbolic Acid four grains, Mucilage or Gum Arabic one ounce, Peppermint Water three ounces. Mix. Shake the Adal and ghre a tablespoonful three or four times a day. When Bismuth is given alone it is best given in milk. HOMOEOPATHIC TREATMENT. Notwithstanding the usually intractable nature of this affection, it has been treated Avith marked success by the method about to be pointed out. Nux-vomh a is one of the principal, and, in a large number of cases, the most appropriate of remedies against spasms of the stomach, and particularly in cases where this affection can be attributed to the long- continued use of strong coffee, or an excessive indulgence in spirituous liquors; it is of essential service in many cases of the same disorder, Avhich have arisen after the suppression of chronic or hemorrhoidal dis- charges, or when the party affected is liable to fits of hysterics or nervous despondency. The folIoAving are the immediate symptoms Avhich call for the administration of this medicine: Constriction, pressure, squeezing, or spasm in the stomach, accompa- nied Avith a sensation, as if the clothes were too tight at the waist, or as if Avind were pent up in the sides, beneath the lower ribs. This sensation, as Avell as the pains before mentioned, become generally increased after a meal, or after partaking of coffee ; in addition to which, a feeling of de- pression or constriction is experienced at the chest, which, in many cases extends to between the shoulders and the lower part of the back. Fre- quently, also, we find nausea, accumulation of clear Avater in the mouth, or risings of sour bitter fluids, attended Avitb a sensation of burning in the throat and gullet (heartburn); the tongue tremulous, cracked or fissured, clean, of a A'h-id red, coated yellow, or covered Avith a Avhite mucus ; lips and gums Avhite, red and SAvoUen ; blanched, yellowish, and somewhat indurated lips ; eyelids inflamed at the margins; sour or putrid taste in SPASMS OF THE STOMACH. 273 the mouth ; vomiting of crude materials; flatulent distention of the bow- els; constipation: aching in the forehead; palpitation of the heart, and anxiety. When these symptoms are liable to be excited by a fit of pas- sion, or become aggravated in the morning, or when the patient is occa- sionally awakened out of his sleep by the spasmodic attack, this remedy is still more certainly indicated. Dose: Irr seA'ere cases, of recent origin, three globules in a teaspoon- ful of water, every three hours, until amelioration or change. In chronic cases, with more or less acute pain after every meal, of a solution of six globules to two tablespoonsful of water, give a tea- spoonful every e\Tening until the whole is consumed, or in the like proportion, until posith^e amelioration or change. When the spasm of the stomach returns periodically, or when from some imprudence in diet we haATe reason to apprehend an attack, three globules should be taken in a teaspoonful of water, three hours before the expected recurrence of the symptoms, or, in the latter case, immediately after the possible cause has transpired. This rule applies in respect of any of the remedies herein prescribed, which have been adminis- tered Avith success against former attacks. If temporary relief, only, followed by more intense suffering, has ensued, and continues three hours after a second dose of Nux-vomica, proceed with the next medicine. Carb o-a-egetabilis should be given three hours after the second dose of Nux-vomica, if that remedy has produced only partial good effect, and will generally complete the cure, provided the affection be not too deeply seated, and consequently one of long standing. Dose: Three globules in a teaspoonful of water, morning and even- ing, for four days. Chammomilla. For the employment of this remedy, the principal indications are: Pressure, as if from a stone in the pit of the stomach, or painful pressure and flatulent distention at the same part, as, also, of the region beneath the lower ribs and the belly itself, with shortness of breath, anxiety and throbbing headache; mitigation of the above symp- toms on partaking of coffee,—a distinguishing mark between the indica- tions of this remedy and those of Nux-vomica;—on the other hand (as in the case of the latter), it is also indicated when the symptoms as described are liable to be brought on by a fit of passion. Pose: Three globules in a teaspoonful of Avater, every four hours, until amelioration or change. Belladonna ought to be substituted tor Chammomilla, or should be administered four hours after the third dose of the latter, when it has not been followed by relief, notwithstanding the apparent similarity of these symptoms ; farther indications for Belladonna consist of gnawing,'press- ure, or spasmodic tension in the pit of the stomach, relieved on bending backward and'holding in the breath ; or, further, spasm of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to deprive the patient of consciousness; tremulous, vivid-red and* shining tongue, or redness of the tongue and elevation of the papillae; red and upongy lips. Dose: Three globules in a teaspoonful of water, every four hours, until the indicative symptoms are removed. If followed bv more suffering after the third dose of Belladonna, proceed with Gelsemi- num, as directed for Belladonna. 18 274 OUR FAMILY PHYSICIAN. Cocculus, in many cases of this complaint, is particularly indicated, when, in addition to the usual symptoms, there are constipation and con- strictive pains over the entire stomach, with flatulency, and accumulation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms. Dose: Of a solution of six globules to two tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change. Pulsatilla is useful in cases Avith shooting pains in the stomach, which are aggravated by movement, and particularly making a false step. Pulsatilla is also one of the most appropriate remedies when the attacks are folkrvved by vomiting, or accompanied by violent tension and squeez- ing, or throbbing and sensation of anxiety about the pit of the stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the boAvels, or a dispo- sition thereto. Disposition to hysterics or nervous despondency. This remedy is very serviceable in cases of this affection, arising from suppres- sed menstruation. Dose: Of a solution of twelve globules to four tablespoonsful of Avater, give a tablespoonful every six hours, until amelioration or change. Sepia is an efficacious medicine in spasm of the stomach, arising from suppressed or difficult menstruation, and may in general cases advantage- ously folloAv Pulsatilla; it is indicated when most of the sufferings arise after a meal, by pressure in the stomach as from a stone and by a burning pain in the pit of the stomach; an 1 by restoring singly, or in conjunction with Pulsatilla and Sulphur, the menstrual flux, it frequently removes the spasm at the stomach and hysterics consequent upon this derangement, or, at least, places the affection in such a position that it is easily cured by some other medicine, closely corresponding to the remaining symptoms. Dose: In recent (not chronic) cases, of a solution of four globules to two tablespoonsful of water, give a teaspoonful every four hours until amelioration or change. In chronic cases give three globules in a teaspoonful of water night and morning for a week, then pause four days and resume the course, suspend treatment, or change the remedy according to circumstances, the thirtieth potency is best. China is of great service in most cases of spasms of the stomach with general Aveakness, arising from loss of humors, the result of blood-letting, or repeated loss of blood, abuse of emetice or aperients, too long-ontinued suckling, etc.; and it is further indicated by great weakness of digestion, distention, and uncomfortable weight, pressure or pains in the stomach after eating, so that the patient feels much easier when fasting; these lat- ter symptoms are the more immediate indications for the employment of this medicine. Dose: Of a solution of four globules to tAvo tablespoonsful of Avater, night and morning for three days; and afterwards three globules in a teaspoonful of water every third night, until positive improvement or change. Bryonia. This medicine is more particularly adapted to the milder cases of spasm in the stomach, Avith painful pressure, or a feeling of disa- greeable fullness in the stomach after a meal, Avhich occasionally becomes converted into a feeling of constriction, cutting or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more SPASMS OF THE STOMACH. 275 clearly indicated when the symptoms are generally acompanied by severe headache or painful compression in various parts of the head, and particu- larly at the temples, which is liable to be excited whenever any article of diet disagrees in the slightest degree; increase of the sufferings by move- ment; habitual costiveness. Dose: Three globules in a teaspoonful of water every two hours, until amelioration or change. i"" Arnica-montana, in spasm or pains in the stomach, which have originated in the effects of a strain, or from a blow, etc., will be found spe- cific. It is, however, also an excellent remedy when there is a sense of fullness and constrictive pain in the stomach and in the fore part of the chest, shooting pain in the pit of the stomach, with painful pressure as from a stone, or aching, extending to the back, and tightness of the chest, increased by eating, drinking, and external pressure. Dose: Of a solution of four globules to two tablespoonfuls of water, or in the like proportion, give a teaspoonful night and morning, until amelioration or change. Arsenicum is required for periodic pains in the stomach, chiefly con- sisting of a burning character, and attended with acrid, sour eructations, vomiting of crude materials, or of mucus, sometimes even of blood; tremulous, swollen, or glazed, red and Assured tongue; blanched, waxy, and somewhat indurated lips; want of appetite; extreme debility, ema- ciation. Dose; Tavo globules in a teaspoonful of water, every three hours, until amelioration or change; or in very acute cases characterized by excessive prostration and livid aspect, give one globule in a tea- spoonful of water immediately, repeating the dose after half an hour, and again every two hours, until positive amelioration or change. But if little or no permanent relief ensue within two hours after the sixth dose, consider the various other remedies herein named. In chronic cases, give three globules in a teaspoonful of water, night and morning, until distinct amelioration or change. Calcarea.—In obstinate cases, occurring in individuals who are habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally be found of great service, especially after the previous employ- ment of Nux-v. It is further a valuable remedy in the cases of females of full habit of body, subject to discharge of blood from the nose, or to exces- sively copious menstruation ; and is generally indicated when the parox- ysms of pain come on usually at night, or after a meal, in which latter instance, vomiting sometimes results, or nausea and acidity, with painful sensibility on pressure at the region of the stomach. Constipation, haem- orrhoids, or chronic looseness of the bowels are additional general indications for the employment of this remedy. Do.se; Six globules in a wineglassful of water, every morning the first thing, for a week (unless earlier relief or change ensue) ; pause four days, and then, if necessary, resume the course as before, and so on, until positive amelioration or change. Diet and Regimen.—These are subject to the same general rules as have already been afforded in the article on Indigestion. 276 OUR FAMILY PHYSICIAN. HEARTBURN. BLACK-WATER. WATER-BRASH. This is not an affection of the organ whose name it bears, but a painful or uneasy sensation of heat or acrimony about the pit of the sto- mach, sometimes extending upwards. It is frequently accompanied with anxiety, nausea, and vomiting; or a violent gnaAving, spasmodic pain in the region of the stomach, from which the patient experiences no relief, until he succeeds in ejecting a quantity of limpid fluid. Treatment.—As Heartburn is, strictly speaking, a mere symptom emanating from derangement of the stomach, the general articles on " Indigestion " and its subordinate affections should be considered. CHAPTER XIII. DISEASES OF THE INTESTINES. DIARRHOEA. Diarrhoea, or Booseness of the Bowels, is a disease of frequent occur- rence, manifesting itself more especially during the warm months of the year, though it may take place at any season. All persons are alike sub- ject to it when exposed to the causes. Symptoms. Diarrhoea consists in frequent evacuations from the bow- els, of a more fluid nature than usual, each discharge being usually accom- panied with, or preceded by, a rumbling in the bowels, together Avith a sense of weight or pressing down, and commonly relieved as soon as the evacuation takes place, but are renewed before the one, which is to suc- ceed, ensues. More or less griping is present, and not unfrequently nausea and vomiting. Fever is not usually present in diarrhoea. When the discharges are very frequent, or in large quantities, they rapidly re- duce the strength of the system; emaciation takes place; the functions of the system become impared; the skin becomes pale, dry, rigid and eventu- ally sailor; and if the disease continues, the feet and legs become dropsi cal. The discharges become more and more offensive, a slow fever ensues from the exhaustion, and the patient dies. According to the character of the evacuations and the exciting causes, diarrhoea has been divided into several varieties, thus: 1. Lienteric Diarrhoea, in which the food is rapidly passed into the bowels, and appears in an undigested condition in the evacuations; and is DIARRHCKA. 277 due to an impairment or suspension of the functions of the stomach, with great irritatiou in the intestinal canal. 2. Chylous or Cceliac Diarrhoea, in which the discharges are of a milky white, or dirty white color, and is due either to a congested condition of the mucuouj membrane of the small intestines, or to tubercular (consump- tive) disease of the mesenteric glands (small glands in the membrane uniting the bowels). 3. Mwus Diarrhoea, in which considerable mucus is found in the discharges, being occasionally streaked with blood; due to colds and exposures. -L Bilious Diarrhoea, in which the evacuations are mixed with much yellowish or greenish looking bile, and most generally accompanied by nausea and vomiting, due to cold, anger, chagrin, etc. Causes.—Diarrhoea may be caused by improper exposure to excessive heat or cold; by the use of acid, unripe fruit, indigestible or other irrita- ting food, from the presence of Avorrns; from overloading the stomach with food; sudden frights; fits of anger, grief, and other depressing emo- tions ; certain articles of diet occasion diarrhoea in some persons which are quite agreeable and salutary to others. A very frequent cause of diar- rhoea, among infants, is the use of spoon meats and other gross articles of diet; it may also arise from the bad quality of the mother's or nurse's milk, from the irritation caused by teething, etc., the going-in of cutaneous eruptions; fermented liquors, etc., are also among the exciting causes; changes in the atmosphere, rendering the disease epidemic in certain lo- calities ; the unwise use of cathartics, is not an unfrequent cause. ALLOPATHIC TREATMENT. This dsisease is frequently transient, due to temporary indigestion, or following some dietetic error. In these instances little or no treat- ment is necessary, except guarding indulgence of the appetite more carefully. If the contents of the large intestine (bowel) is not spon- taneously expelled, a cathartic should be given. For this purpose, a tablespoonful of Epsom Salts, with ten drop3 of deodorized, or common Laudanum (Tincture of Opium), to allay irritation, or a Siedlitz powder answers a good purpose A tablespoonful of Castor Oil, or five or ten grains of powdered Rhubarb will also meet the indications. If the evacuations have been copious, and of a feculent character, a cathartic is not required. After the bowels have been thoroughly emptied, if diar- rhoea and pain, or uneasiness, still continue, it should be relieved by an anodyne, one or two teaspoonsful of Paregoric, or five or ten drops of Laudanum, in a tablespooful of Chalk Mixture, or Cinnamon water, with the addition of a little Prepared Chalk or Soda, or five grains of Dover's powder. Whatever the remedy chosen, it should be repeated every six or eight hdurs, if needed. The diet, for a few days, should be simple and restricted. A diet composed largely of milk is suitable. Care should be used that the bowels do not become over confined. If they do not move, spontaneously, they should be started again by one or two Compound or Improved Cathartic pills, twice a day, until an action is produced. It should also be stated that a free injection of warm water, followed by a 278 OUR FAMILY PHYSICIAN. small injection of warm Avater, or thin Starch, with half or two-thirds of a teaspoonful of Laudanum, will frequently cure a diarrhoea. Should the diarrhoea tend to continue, or frequently return, the prin- cipal treatment will refer to diet and measures to render digestion com- plete. Tender meats, cooked rare; eggs, chicken, and milk, are most generally found to meet the end required; but in some cases starchy arti- cles, such as Rice, Corn Starch, Tapioca, Sago, Arrowroot, Wheat or Oat- meal, with milk, are found best suited. If the patient has been deprived of fresh vegetables and ripe fruits, they should be supplied in moderate quantities. A moderate quantity of food, frequently taken, is generally better than a full meal once or twice a day. In some instances a change of climate is demanded. A removal from the city to the country is frequently curative in the hot weather, partly from the tonic effect of the country air, and partly from the use of fresh milk, and ripe fruits, which the system required. In these cases the use of Opium is only of limited and temporary value. It may be used as directed before, to relieve pain and irritation, but its continued use impairs di- gestion. It should be remembered that diarrhoeas are sometimes prolonged by the presence of hardened feces; in these cases Epsom Salts or Castor Oil should be given in tablespoonful doses every six hours, until a free motion is obtained; or injections of a quart of warm water frequently repeated until hardened feces cease to be discharged. Large doses of Bismuth, from twenty to thirty grains repeated two or three times a day is a most valuable remedy in continued diarrhoea, and is not accompanied by any disagreeable effects. It can best be given in some milk. Chronic diarrhoea is frequently of malarial origin. In these cases Quinine in five grain doses, two to four times a day, is curative without any other reme- dy. Quinine is frequently required as a tonic, in doses of two or three grains, three times a day. For the same purpose the bitter infusion of Quassia, Gentian, or Columbo, alone or combined, two ounces to the pint of boiling water, dose a tablespoonful three times a day, are useful. One or two grains of Pyro Phosphate of Iron may be combined with each dose of the bitters, or Quinine if the patient is much reduced. The addi- tion of Pepsin in doses of five or ten grains is frequently a great help to digestion. In chronic diarrhoea Bismuth, given as before mentioned, occupies the first rank ; anodynes before described may be given with it, but only as required to relieve pain or irritation. Sugar of Lead may, in rebelliou cases, be combined with the Bismuth, with or without the anodyne, in doses of one to three grains. The vegetable astringents blackberry-root, Logwood, Catechu, Kino, have been in their turn found useful. As their efficacy depends on the presence of tannin, I prefer to use it. It can be given in doses of ten to twenty grains in syrup, and repeated every few hours, and may be combined with Bismuth, or an anodyne, or both. One of the most effective prescriptions in chronic diarrhoea is the fol- wing: Take of Sulphate of Copper one grain, Sulphate of Morphine DIARRHEA. 279 one grain, Sulphate of Quinine tAventy-four grains. Make a mass and dh'ide into tweh'e pills. Take one pill three times a day. In some rebellious cases, the 1'olloAving is a highly useful combina- tion: Take of Ergotine (Watery Extract) twenty grains, Extract of Nux-vomica five grains, Extract of Opium ten grains. Mix well, and divide into twenty pills. Take one pill every four or six hours. If the druggist is not known to be skillful and careful, probably the folIoAving better be used instead. Take of fluid Extract of Ergot two ounces, Tincture of Nux-vomica three drams, Deodorized Tincture of Opium three drams. Take a teaspoonful four or six hours apart. In the treatment of chronic diarrlnca, it becomes necessary to change the remedy occasionally, as in some instances the system becomes habit- uated, in a measure, to its use. It is not, however, best to change a rem- edy as long as it is proving efficacious. The diarrhceas of children demand separate consideration. Those cases having the appearance of blood in the stools Avill be treated under the head of dysentery. If the roundness of the figure and firm- ness of the flesh is maintained, it shows that nutrition is sufficient and the diarrhoea is not harmful. On the other hand, if the child is begin- ning to waste, or the flesh become flabby, immediate treatment is required. Many of these cases are caused from poor food. If the child is at the breast, it may be the mother works too hard and so impairs the quality of the milk, or it is insufficient, and creamy coav's milk should be given in addition. A little penetration, guided by common sense, will discover the cause and correct it by better hygiene. A green or irritating stool shows the need of an alkali, lime water by preference, or a little prepared Chalk or Soda. When lumps or mucus pass in the stools a laxative is needed. For this purpose half a teaspoonful of Castor Oil, or syrup of Rhubarb a tea- spoonful. Previous constipation also demands these laxatives or the following may be given: Take of Epsom Salts one dram, Tincture of Rhubarb one dram, Syrup of Ginger one dram, Cinnamon Water or Avater nine drams. Mix. Dose a teaspoonful three times a day for a child a year old. If there is no improvement from this treatment we must rely on as- tringents and alkalies. If the evacuations are frequent and the child weak, no laxative should be given, but astringents should be used from the first. Often much precious time is lost by not following this rule. The physician finds generally when he is called that opiates and astring- ents are needed exclusively, attention being also given .to hygiene. The Compound Powder of Chalk and Opium answers the indications and may be given in doses of three grains every other hour to a child a year old. I often use the following: Take of Compound Powder of Chalk half a dram, Bismuth one dram. Mix and divide into ten papers. Give one powder three hours apart until the diarrhoea is checked. Or the following may be used. Take of Paregoric two drams, Tincture of Catechu two drams, Chalk Mixture one ounce. Mix, and give a teaspoonful every three or four hours to a child a year old. Often the diarrhoea is due to, or aggravated, by imperfect digestion; it is well to give Pepsin and Subnitrate of Bismuth. Take of Pepsin 28*1 OUR FAMILY PHYSICIAN. one dram, Sub-Nitrate of Bismuth one dram. Mix, and divide into twelve powders. Give one immediately after the child has taken milk or food. They can be given in milk or syrup. In children over tAvo or three years of age the treatment is similar to that for adults, making allowance for age. HOMOEOPATHIC TREATMENT. Dulcamara should be given in diarrhoea, occurring in summer, from cold. Particular indications for its use are the relaxation of the bowels, being attended Avith colic or cutting pain, chiefly in the region of the navel; the evacuations being liquid, slimy, and yellowish or greenish, generally coming on at night, and sometimes being attended with nausea or vomiting; want of appetite, and great thirst; paleness of the counte- nance, and lassitude. This medicine may, also, be judiciously adminis- tered in many cases in Avhich the relaxation of the bowels affords no ostensible specific or characteristic indications for any particular remedy. Dose: For adults, eight globules to each tAvo tablespoonsful of water, give a teaspoonful after each eA-acuation, until distinct relief or change. Children, one-half dose for an adult, given in the same way. But if only partial relief should ensue, in acute (casual) cases, in six hours after the second dose, or in chronic cases in tweh-e hours after the sixth dose, proceed with the next or study other medicines. Bryonia should be given in cases of diarrhoea arising from the be- fore-mentioned causes, and attended Avith many of the symptoms noted under Dulcamara, when that medicine has failed to afford the required relief, particularly if the looseness is liable to be aggravated after a meal, or after drinking, and the stools are passed almost involuntarily, and portions of undigested food are perceptible in the motions; also when looseness is experienced after partaking of milk. In looseness of the bowels occurring during hot toeather, when we cannot trace the cause in any errors of diet, requiring other remedies, this medicine is further indicated, and especially so in the following instances; diarrhoea, from checked perspiration or being overheated—cold drinks—a chill from remaining in any cold, exposed situation, or in draughts—or from exposure to an east- erly wind. When this affection has been produced by passion, particu- larly in individuals of what is called a bilious temperament, Bryonia is, again, a most useful remedy. It may also be remarked that the relaxa- tion of the bowels, arising from drinking impure Avater, or water strongly impregnated with vegetable substances, when heated, has frequently found relief in this medicine. Dose: In casual or chronic cases, and in all other respects, as more particularly directed for Dulcamara. China.—Looseness in consequence of indigestion, particularly if occasioned by partaking of fruit or flatulent food, such as ve'getables; evacuations very profuse and sometimes attended with but little pain ; and when the discharge comes on immediately after partaking of food, or espe- cially during the night; evacuations liquid and brownish and sometimes containing portions of undigested food; it is, in some instances, further indicated when considerable spasmodic or colic-like pain is present with flatulence, want of appetite, thirst and great weakness; and is also valu- DIAHRHOCA. 2S1 able after improper treatment of this affection, when considerable debil- ity remains. Dose: If singly, in casual cases (for adults), of a solution of eight globules to two tablespoonsful of water, give a teaspoonful after ev- ery motion, until amelioration or change. In the like cases for children, a solution of three globules to tAvo tablespoonsful of water similarly administered by teaspoonsful. If in alternation with Fer- rum, a similar solution (separately) of each medicine (as distinctly stated for adults and for children), of each of A\mich the like dose should be given, the one twelve hours after the other, in rotation, until amelioration or change. In chronic cases, if singly, three glob- ules in a teaspoonful of water (for adults), or two globules in a tea- spoonful of water (for children), morning and eAening, every other day, until amelioration or change. Ferrum-m. may be advantageously given, in alternation with China, when the eAacuations are partly composed of undigested food, and pass without pain. This remedy may, hoAvever, be administered alone, when the discharge from the boAvels js unattended with pain, or there are pains in the back and posterior passage, paleness of the face, watery evacuations —or looseness particularly observable at night, or after eating or drinking —loss of flesh, alternate absence of appetite and A'oracious hunger, disten. tion of the belly Avithout flatulency, spasm of the stomach, continued thirst, and weakness of the eyes, with great Aveakness of digestion. Dose: In all respects, whether for casual or chronic cases, and whether singly or in alternation with China, as directed for the latter medicines. Chammomilla is a remedy, as already stated elsewhere, particularly useful in children, either at the time of teething, or at a more advanced period, when the affection has been excited by checked perspiration ; and it is further particularly indicated when the evacuations are watery, bil- ious, green, yellow or slimy, or of a fetor resembling rotten eggs ; when there are fullness at the pit of tlie stomach, severe colic or spasm, pain, dis- tention, and hardness of the belly, bitter taste in the mouth, foul tongue, thirst, want of appetite, bilious vomiting and flatulency (in infants), at- tended with restlessness and screaming, and drawing up of the limbs towards the stomach. Dose: Of a solution of eight globules to four tablespoonsful of water, give a teaspoonful after every motion, until positive amelioration or change ; or in patients of a weakly habit of body, if this appears inadequate to effect a cure (although the symptoms be analogous) and if, after repeated administration and temporary effect the symp- toms recur in all their former violence, consider Sulphur. Ipecacuanha is indicated by looseness arising from indigestion, par- ticularly if caused by imperfect mastication, and attended with nausea and vomiting, paleness of the face, weakness, and desire to retain the re- cumbent posture (in the case of children). Dose: Four globules, in a teaspoonful of water, after every motion; but if, after three doses have been given, this medicine appears to afford only partial relief, consider the two following remedies, and proceed with the one or the other, according to the distinctive symptoms present. Pulsatilla should be administered six hours after the third dose of Ipecacuanha, if the latter affords only partial relief. It is also one of the 282 OUR FAMILY PHYSICIAN best remedies in simple looseness of the boAvels, arising from errors of diet, such as indulgence in acids, fruits, or rich, indigestible food, attended Avith foul tongue, and other symptoms of deranged digestion, as stated in the article on Indigestion. Another remarkable indication for this remedy is, one evacuation differing from another in color. Dose: Six globules in a teaspoonful of water, after every motion, un- til amelioration or change. Rheum is to be preferred to Pulsatilla, and should be employed after Ipecacuanha, or even before that medicine, when the sour smell of the eA'acuations is a predominant symptom. In general, howeAer, it may be advantageously employed, especially amongst children, when the symp- toms, in a great measure, resemble those of Chammomilla, but the pain is not so A'iolent, and the evacuations have a sour smell; paleness of the face is also an indication for this medicine. Dose: Six globules in a teaspoonful of Avater; or, for children, three globules in a teaspoonful of water, aj'ter eA'ery motion. Mercurius. When the diarrhoea arises from a chill, and the motions are copious, watery, slimy, frothy, bilious, or greenish, or streaked with blood, and cause a smarting or burning sensation on being evacuated; also, Avhen there is painful straining before, during, and after evacuation, frequently followed by protrusion of the lower intestine ; severe, cutting pains; moreover, nausea and eructation, cold perspiration, trembling or shivering, great lassitude, and disposition to fainting ; evacuations con- taining undigested substances. Dose: Of a solution of six globules to three tablespoonsful of water; give a teaspoonful after every motion, until distinct amelioration or change. Nux-vomica. Scanty evacuations or motions, consisting of slime and blood, attended with straining and great weakness; flatulency, and violent, cutting pains in the region of the navel; diarrhoea, alternating with constipation. For some of the accompanying symptoms, the reader is referred to the indications mentioned respecting this remedy, in the article on Indigestion. Dose: Six globules in a teaspoonful of water, every two hours, until amelioration or change. Arsenicum. Autumnal diarrhoea, or looseness arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, etc., the characteristic symptoms for its employment are: watery, slimy, greenish, or brownish, corrosive, burning evacuations, with violent colic, excessive thirst, enmciation and great weakness, and when the affection is more liable to come on at night, or after eating or drinking. This is, also, a most important medi- cine for the treatment of the Bowel Complaint of children, as hereafter, separately, considered. Dose: Of a solution of six globules to two tablespoonsful of water give a teaspoonful eA'ery half hour (in very acute cases); or every hour (when the symptoms are modified by intervals of respite), un- til amelioration or change. If in alternation with Veratrum, of a similar solution (separately), of each medicine, give, first, two doses (as just stated), of the one, then pause an hour, and continue Avith two doses of the other, similarly. If singly, however, and only partial relief ensue within half an hour, or an hour (respectively), after the third dose, proceed with the next medicine. DIARRKQSA. HHS Veratruai should be employed half au hour or an hour (according to the length of the interArals) after the third dose of Arsenicum, when similar symptoms occur which have not yielded to the previous use of the latter. Veratrum is, moreover, especially appropriate in cases in which the complaint is attributable to atmospheric causes. Veratrum and Ar- senicum are important when excessive exhaustion accompanies the com- plaint. Do.se: In all respects as directed for Arsenicum. Rhus-toxicodendron. Lumpy or pap-like diarrhoea, coming on only at night, and preceded by colic, which disappears after each evacua- tion ; looseness of the bowels occurring after a thorough wetting, or alter- nately with constipation. Dose: Three globules in a teaspoonful of water, after every motion, until distinct amelioration or change. DIARRHOEA ASSOCIATED WITH CONSTITUTIONAL DEBILITY. Sulphur is a most valuable remedy in diarrhoea, particularly during the night, occurring in persons of a scrofulous habit, or in very obstinate cases. In adults predisposed to. piles, or in children, when theloosness of the bowels is attended with excoriation and with papular eruptions, it is particularly efficacious; also in cases where the slightest cold brings on a relapse or an attack; or when milk disagrees and causes a looseness. Dose: Against the prevailing acute symptoms, of a solution of six globules to tAvo tablespoonsful of Avater; give a teaspoonful every six hours, until the frequency of the motions are diminished. Sub- sequently, give six globules, in a wineglassful of water, every morn- ing (fasting) the first thing, for ten days, unless collateral symp- toms, meanwhile, occur, requiring other treatment; after which, pause four days, resuming the course, if necessary, as before. Sepia is to be preferred in obstinate cases of diarrhoea, occurring amongst females ; especially when^associated Avith predisposition to hys- terical attacks, megrims, whites, sudden sweats, or flushes of heat and frequent attacks of shivering or shuddering, chiefly during stools. Dose: In every respect as directed for Sulphur, continuing'the course in like manner, until permanent amelioration or change. Diet and regimen. Acids, or acidulous wines, beer, coffee, strong tea and fruits, whether raw or cooked, should be carefully avoided. Solid food is likewise proscribed, during the prevalence of an acute attack, as tending to keep up the intestinal irritation ; and gruel, fresh milk, (un- less it should be known to disagree with the patient), broths, and light mucilaginous food should be substituted. The majority of A^egetables are objectionable, but potatoes in par- ticular. In every severe case, indeed, (during the prevalence of the attack) little more than thin arrow root or gruel should be taken. In milder forms of the complaint, well-boiled rice, moistened with good gravy, may be rather serviceable than otherwise. Beef tea (with or without the addition of a teaspoonful of isinglass to the half-pint) may, in some cases, serve materially to assist the operation of the medicines. Whe the attack is subsiding, and for some time after- ■JS4 OUR family physician. wards, young meat (such as veal or lamb) should be avoided; and sound, lender motion, plainly roasted, will be found, generally speaking, most easy of digestion. Fish should be aA-oided. Above all, the patient should guard against indulging a craving ap- petite, and eating too freely, or overloading the stomach. In protracted cases, attended with debility, but no symptoms of in- flammation or ulceration, generous, easily digestible food, and sometimes a little wine, or Avine and water, must not be Avithheld. In such cases, a basin (half a pint) of beef-tea, Avith the addition of a teaspoonful of isin- glass, and a few slips of toast taken daily, about three hours after break- fast, will usually prove a useful accessory. The use of a flannel bandage round the stomach, is often of service, especially for delicate children. In every case, the clothing should be Avarm; exposure to moisture, and es- pecially to having the feet wet, should be avoided ; fine woolen stockings or socks, and stout shoes, should be warn. Change of air Avill generally be of service to the com-alescent. When diarrhoea prevails as an epidemic, as is not unfrequently the case toAvards the fall, all these precautions, which may or may not be essential under other circumstances, become indispensable. The Home Remedies.—Take of Mayapple Root, pounded, one tea- spoonful ; White Oak Bark, pounded, or, if dry, powdered coarsely one teaspoonful; boiling water a pint; steep near fire for an hour or two, and sweeten with white sugar. Dose: A spoonful after each motion of the bowels. A little burned brandy, added, helps this. This is very val- uable. Take five or six clean corncobs, burn them, on a clean fire, to a coal; drop the cob-coals in two pints of boiling water; as soon as cool, take a tablespoonful every three or four hours. This is specially valuable where there is much bloating, or the evacuations are very offensive, the eructa- tions tasting like what has been eaten. CHOLERA MORBUS. Cholera Morbus is a disease common in Avarm seasons and espe- cially in warm climates. The principal features of the disease are vomit- ing, purging, and severe griping pains in the abdomen. Symptoms.—The attack is occasianally preceded by chills, headache, giddiness, and a numb sensation in the limbs, but more generally the attack is sudden, commencing with nausea and distress at the stomach, succeeded by A'iolent gripings in the bowels; these are followed by frequent vomitings of a thin, dirty-yellowish, whitish, greenish, or even colorless fluid, Avith discharges from the bowels of a similar character to that Aomited up, and which occur as frequently as the vomiting. During the intervals between the vomiting and purging there is much nausea and uneasiness at the stomach; but in some eases a sensation of relief is afforded by the discharges and the patient lies in bed, much fatigued, but apparently free from pain and distress. These attacks of vomiting and purging usually take place every ten cholera morbus. 285 or twenty minutes, being either simultaneous, or the vomiting immedi- ately followed by the discharge from the bowels or else the reverse. Sometimes the pain is so seA^ere as to cause the legs to be drawn up or even to cry out. Generally there is great thirst, but as soon as any liquid is swalloAved it is ejected ; the tongue is dry, the urine high-colored, deficient or sup- pressed, the pulse rapid, soon becoming small and feeble. If the disease is allowed to progress unchecked the pulse sinks, the extremities become cold, the countenance pale and indicative of much suffering, the breathing hurried, cramps in the limbs, hiccup, a cold clammy SAveat breaks out, great prostration and death. The disease frequently proves fatal in twen- ty-four hours, and, when malignant, even in a feAV hours; sometimes it subsides spontaneously. Sometimes patients with cholera morbus complain of a great burn- ing sensation internally, and in the more malignant forms of the disease, it is not uncommon for the last discharges to resemble the " rice water " evacuations of Asiatic Cholera. Cholera Morbus may be known from Diarrhcea and Dysentery by the character of the discharges from the bowels, which in this are of a purely bilious nature, not mixed Avith blood or mucus, and with scarcely any fecal matter. Causes.—Cholera Morbus is OAving to an irritation of the stomach and bowels, and a greater or less derangement of the liver, and is ordinar- ily caused by improper substances taken into the stomach, as unripe fruit, acids, much fat food, certain kinds of fish, lobsters, unfermented cider, improper use of alcoholic drinks, or any article that will irritate the mucous membrane of the stomach and bowels by undergoing an acid fermentation. It is also produced by exposure to sudden changes by sit- ting in a draught of cool air while in a state of perspiration ; by excessive heat rendering the bile more acid, or secreted in unnatural quantities, or by malarial influences. Persons of gross habits, or intemperate in eating and drinking and those of sedentary habits are the most subject to it. Prognosis.—When the symptoms gradually improve, vomiting ceas- ing or becoming less frequent and distressing, with a gentle moisture upon the surface, succeeded by sleep, they are favorable. But frequent and severe vomiting with great prostration of strength, swelling of the bowels, intermittent pulse, cold, clammy sweats, short, hurried breathing, constant hiccough, spasms of the extremities or convulsions are unfaAror- able symptoms. ALLOPATHIC TREATMENT. Sporadic Cholera occurs independently of epidemic influences and is commonly called Cholera Morbus. If the vomited matters haA'e not con- tained undigested food (the presence of which is probably causing the trouble) a mild emetic should be given, if there is reason to suppose such irritating material still remains in the stomach. For this purpose a tea- Bpoonful of ground mustard in a glass of water is as appropriate as any other remedy, and has the advantage of being almost always on hand. Other mild emetics may be given. Almost always the contents of the 286 OUR FAMILY PHYSICIAN. stomach are expelled during the first acts of vomiting, and an emetic is almost always uncalled for, and in that case will always do harm. The next indication is to overcome the vomiting and purging. This is best effected by the hypodermic injection of one-eighth to one-fourth of a grain of Morphine at the hands of your physician. This quickly effects the object. Other forms of opium may be used by the mouth, if the phy- sician can not be procured. A third of a grain of Morphine placed dry on the tongue will generally prove efficient. Thirty drops of Laudanum is also an appropriate dose for the relief of the immediate symptoms. The dose ought to be repeated in an hour, if the vomiting and purging have not ceased. If the remedy is \-omited as soon as taken it should be immediately repeated. In the absence of a physician, if the administra- tion of this by the mouth is not tolerated, a teaspoonful of Laudanum in a tablespoonful of thin starch or milk should be given by injection into the bowels. It should be remembered that this is a powerful remedy to handle and if carried too far there is danger of opium poisoning. Another important point in the treatment of Cholera Morbus is to withhold liquids as far as possible. The excessh'e thirst leads to an intense cnrving for drink. The presence of liquids in the stomach prolong the vomiting. The thirst may be relieved by letting small lumps of ice melt in the mouth, or ice water may be swallowed, but only a tablespoonful at a time. The immediate success of treatment depends largely on the strict compliance with this rule. The common practice is to meet the prostration which folloAvs the attack Avith small quantities of brandy or other spirits and water. They do not appear to be usually necessary. The appetite should be both carefully and moderately indulged after an attack. Many other methods of treatment are in vogue, but are not ghen here, because this one is habitually successful, and the best suited of any for employment by those deprived of the attendance of a physician. In epidemic cholera (Asiatic), the use of Opium is Aveil suited for use during the preliminary diarrhoea, but is decidedly inappropriate when collapse has occurred. After this stage has passed, the best results have been produced by the use of Chloroform and Camphor, internally. During the cold stage, the hypodermic injection of Hydrate of Chlo- ral is the best treatment discovered so far. HOMOEOPATHIC TREATMENT. Ipecacuanha corresponds to the less violent attacks as long as the discharges have a bilious tinge, and the vomiting and retching arc very seA'ere. Dose: Six pills of the -d or 3d decimal dilution every fiifteen to thirty minutes. Veratrum album is particularly adapted to a case where the evacu- ations are colorless ; these cases are always the most difficult to manage. This characteristic of the evacuations may be expected Avith tolerable certainty, if the disease sets in at once Avith violent, copious and frequent vomiting and the accompanying diarrhu a is equally violent. Do.se: As for Ipecacuanha. FEVERS. 287 FEVERS. GENERAL REMARKS. In all forms of acute disease, fever is present; in fever, properly so called, there is generally functional disturbance, accelerated action of the blood circulation with the participation of the nervous system, and a marked tendency to an increased development of heat. The symptoms common to most fevers are, at first, a feeling of coldness or shivering, then heat, accelerated pulse, thirst, restlessness, and languor. Fever, also, pos- sesses the property of passing from one (variety) species into another. Thus inflammatory fever may pass into a low typhus, or on the other hand, a simple fever, by injudicious treatment, may be changed into an in- flammatory one ; and that again assume the intermittent form; also, one attack may, if miserably mistreated, present all these different phases. Fevers terminating fortunately, and running a regular course, may be divided into five stages: the accession, (or first appearance), increase, crisis, decrease and convalescence. When the result is fatal, it may arise from a metastasis, (changing from one part to another more vital part), the exhaustion of the vital energy of the patient, or the disorganization of some important part of the body. The belief in critical days, is of very ancient origin, though there is some difference in the calculation of physicians upon this point. Some counting from the day the shiverings declare the onset, others from the first hot fit; except in cases where a marked periodicity exists, as in ague, such distinctions are of little value, because the treatment is directed to foi-Avarding the crisis, and thereby materially shortens the duration of the disease, and changing its virulence, so the value of the counting for the critical day, is very materially lessened. The best course is to Avatch the case closely, take careful note of the symptoms, and select with great care the remedy pointed as the best to meetsuccessfuly that condition. By so- doing, you Avill be most certain to have the pleasure of seeing your patient come safely through the attack, and arive speedily at a state of perfect health. A Crisis may make itself known by diarrhoea, profuse perspiration hemorrhage, or increase or alteration of other secretions, or by the appear- ance of'an eruption, after which, if the turn is favorable the skin be comes moist and resumes its functions and the pulse returns to its usual standard. Fevers have been differently classified by different medical writers. The arangement Ave shall adopt is as follows: Simple irritative fever, in- flammatory fever, typhus, putrid, gasteric or bilious, intermittant and eruptive fevers, such as scarlet fever, measels, etc. Although I have, for convenience in describing fevers and their remedies, so named them, I do hope no one will commit the error of treating the disease only by its name. Study carefully every case, and treat it according to its own indi- vidual peculiarities, as shown by its symptoms. Causes of Fever.—It cannot be denied that there exists, in certain individuals, a peculiar predisposition to acute diseases. The sanguine, nervous and bilious temperaments (see temperaments, page 30), possess 288 our family physician. this susceptibility in a more marked degree than the phlegmatic. The ex- citing causes are numerous; miasms, epidemic influences, contagion, pow- erful mental emotion, derangement of some important organ, external esions, excess or errors in diet, heat or cold, eruptions which have gone in—in fact, anything that causes derangement of the equilibrium of the system may produce fever. * FEVER. GENERAL TBEATMENT AND DIET. The great essentials, in the treatment of fe\Ter, are : Perfect rest—mental and bodily. Pure air and a cool apartment; the temperature of the sick room should be kept as near 60° as possible. Featherbeds should be avoided, and mattrasses substituted when practicable; let the bedclothes be light but sufficient. Nature herself generally prescribes the diet, taking aAvay appetite, while the thirst present is undoubtedly her loud and Avell considered call for water or fluid of some kind. Water is the best diluent; no solid food, broth or even gruel is permissible where the inflammation runs ATery high, and very great caution is to be observed in allowing gruel and weak broths during the decrease of the fever. An error here, often causes mis- chief which cannot be repaired ; it is always better to err a little on the side of abstinence, than on that of indulgence. Toast-water, or barley-water, or rice-water, sweetened Avith a little sugar, and flavored with raspberry, strawberry, orange, or, above all, lemon, may be allowed frequently, and only a little at a time. Avoid, until recovery is complete, any article of diet which might in the least degree over-tax the Aveakened digestive organs. Fruits fully ripe in almost any form are not at all likely to do any injury. GASTRIC OR BILIOUS FEVER. This is a form of fever in which, as its name implies, the digestive or- gans are chiefly affe ted. It someAvhat resembles typhus, but it is distin- guished from the latter by the absence of nervous symptoms—although, when it assumes a torpid character, these are occasionally deA'eloped—by the absence of the pressive aching pains in the back of the head ; and by the absence of disturbance or derangement in the senses of sight and hearing ; further, that the pain in the right side of the belly, which is so constant a s mptom in typhus, is not a feature of this disease. Fevers of this description have no definite course or duration. They not unfrequently fall short of the particular course to Avhich the defini- tion is especially aproppriate, as in such cases as result merely from indigestible substances, Avithout actual increase in the discharge of (acrid) bile. In su ch cases the successful effort of naiure to expel the obnoxious substance (as by A'omiting or purging, or both) is often sufficient to consti- tute a perfect resolution, and convalescence succeeds. In other cases nature is thus but partly reliered, the Avhole circulative system having BILIOUS FEVER. 289 become essentially involved, and the fever continues until some other crisis (as of sweat or urine) succeeds. Thus, Gastric Fever, if associated with mere foulness of the stomach, may run its course to perfect resolu- tion in a few days; or, if the lining membranes of the stomach or bowels be seriously affected, or the action of the liver be much deranged, and there be bilious fever, properly so-called, the fever may continue for weeks (if not properly or successfully treated), or may assume a highly inflammatory character, or degenerate into nervous or even Putrid or into Chronic or Hectic Fever. On the other hand, again, it may result in transitions of various character—the superficial membranes, either of the throat or external surface (the skin) may become affected, and Eruptions of various kinds, Abscesses, etc., may ensue. Complications and their treatment. In the case of any such complica- tions occurring, the treatment must be conducted according to the special directions afforded in the separate article respectively devoted to the dis- ease in question. Predisposing Causes. The predisposing causes may be identified in continued exposure to great heat—whereby the rapid sympathy existing between the skin and the liver and stomach, has conveyed to those organs an undue degree of irritability; exposure to excessive moisture of the atmosphere, particularly extreme accumulation of condensed A'apors (heavy deAvs) over a reeking, heated soil, which continues to emit exhala- tions ; exposure to great (especially sudden) transitions of temperature, particularly from great heat to comparative coldness, or to the alternation of heat and cold; whence it follows, that, under such circumstances, this disease may assume an endemic or epidemic character. The more par- ticular and predisposing causes are: weakness of tlie stomach, that is, a mor- bid sensibility of the lining membrane, and overdue irritability of the liver; habitual debauchery or excesses, sedentary habits, or anything, in fact, which may occasion derangement of the stomach, as considered in the article on " Indigestion." Exciting Causes. The presence of obnoxious, indigestible, or irritating matters in the stomach or boAvels—which cannot be dislodged by the ordinary action of those organs—either in the shape of excessive reception of food, Avhether or not in itself of an indigestible character, or simply the reception of indigestible substances in hoAvever small a quantity, or in the shape of altered or excessive internal secretions, such as bile. Other exciting causes are, taking cold, emotions, such as anger, grief, care, anxiety, etc., acute diseases; or, in fact, any cause of general irritation when acting upon persons already predisposed to this complaint by such conditions as have been mentioned abo\Te. Symptoms—of which the folIoAving are the principal : sensation of fullness and weight in the region of the stomach, or flatulent distention, with inclination to vomit; offensh'e, flatulent eructations, and sometimes vomiting of food and tenacious phlegm mixed with bile ; thickly furred, dirty-yellow tongue; belly soft; bowels costive; but in the advanced stage of the disease the evacuations are often very offensive, and contain portions of undigested food ; frontal headache; languor; sickly and dis- tressed expression of countenance, with yellow discoloration of the white of the eyes ; more or less chilliness, succeeded by heat and dryness 19 290 our family physician. of skin: pulse quick but soft, sometimes intermitting or irregular, par- ticularly the latter; urine thick, cloudy, and dark colored. When bilious symptoms are markedly predominant, all the symp- toms commonly appear in an aggravated form; the heat of the skin is very considerable, and the restlessness and thirst are excessive (the patient expressing a constant desire for acid drinks.) The region of the stomach is much distended Avith flatulency, but in addition to this symp- tom, the following are more or less marked ; the tongue is covered at first with a pale yellow fur, which gradually assumes a deeper or brownish color; the taste and eructations are bitter, and the substance vomited consists of a greenish, bilious matter; the bowels are either confined or relaxed, the motions presenting in the latter case a yelloAV, green, or brown color; the face exhibits an earthy, somewhat jaundiced aspect; sometimes there is also a greater or less degree of sensibility, hardness, tension and burning in the region of the liver ; the urine is dark-brown, bilious; the pulse full, accelerated, intermitting or double. ALLOPATHIC TREATMENT. Re-mittent fever (commonly called "bilious fever"). It is to be borne in mind that the exacerbations of fever, in this disease, are much longer than in intermittent fever or ague, and that the period of remission (diminishing) of the fever is of much shorter duration. It is not as con- venient to get the physiological effect of anti-periodic remedies during the remission (while the fever is down) as is the case in intermittent fevers. The one remedy which, par excellent, is a specific in this fever, is the Sulphate of Quinine, though the other preparations of Peruvian Bark hold a valuable place. As soon as it is discovered that the disease is remittent fever, by the occurrence of a distinct diminution of the heat (the degree of fever) as shown by the fever thermometer in the axilla (under the arm), the pa- tient should at once be given Quinine until its specific effect is produced, viz.: a slight deafness, a slight ringing in the ears or roaring in the head. This is best produced by giving large doses, not very frequently repeated. Ten grains of the Sulphate of Quinine, in solution, repeated every six hours, until the characteristic effects of the Quinine are produced, is a good practice in this disease or in ague. If this dose is not sufficient to produce the effect or prevent the paroxysms of fever, the dose may be in- creased to fifteen or even tAventy grains. An eminent authority advises the administration of twenty or thirty grains, at a single dose, once or twice a day, until the effects are produced. Other physicians give the remedy in doses of from three to six grains every two or three hours. It requires about five hours after its administration for the maximum effect of quinine to be reached, so that it seems to me unnecessary to repeat the doses any oftener than that; and, on the other hand, it seems unneces- sary to wait twelve or twenty-four hours before repeating the dose, if the desired end has not been attained. For the solution of Quinine, the following is a suitable formula: Take of Sulphate of Quinine four scruples (eighty grains), water five ounces, Aromatic Sulphuric Acid a dram and a half. Mix. A fair-sized table- BILIOUS fever. 291 spoonful will contain ten grains. The excessive bitter taste of the solu- tion is very much obscured by chewing some chocolate or extract of lic- orice, and taking the medicine while the mouth is still coated with the chocolate or licorice. The remedy may be taken in powder, easily, by enveloping it in a moistened medicine Avafer, or enclosing it in jujuba-paste capsules. Quinine can be made into pills, for immediate use, by moistening the powder with Glycerole of Starch, or Aromatic Acid, rolling out the mass and dividing into pills. If the acid is used, the operator must be expedi- tious, as the mass soon hardens. Sugar or gelatine-coated pills of Quinine may be used, and are an ele- gant form for the administration of Quinine, but slower in its action. They are liable to become hard Avith age, and so, unfit for use. Before buying these ready-made pills, one of them should be cut open; if the pill under the coating is hard, they are unfit for use; if soft, they are good. I have found Wm. Warner & Co.'s and McKassen & Robbin's make uni- formly reliable. This treatment is both curative and abortive. There is no complica- tion can occur in this disease which Avill prevent the giving of Quinine. If the stomach can not be made to retain the remedy, it should be given by injection by the bowel. Once in twenty-four hours, is often enough to repeat the injection. The dose for this purpose is generally thirty to sixtjr grains. It may be mixed with Glycerine, Milk, or thin Starch. Thirty drops of Laudanum should be added to the mixture for the injec- tion. If there is a disposition to expel the injection, firm pressure should be made on the anus (opening of the bowel) with a towel or napkin un- der the hand. A four or eight-ounce hard-rubber syringe is preferable for the purpose. Time need not be lost before the administration of Quinine for the action of cathartics, or any other preparatory treatment. Constipation should be relieved by the laxative effect of an Aloetic pill or two or three Compound Cathartic pills, or by an injection of tepid water. This plan of treatment will, in a large proportion of cases, succeed in arresting the disease, but if the disease should continue the treatment thereafter is essentially the same as in other continued fevers, which is more especially given in connection with typhoid fever. The antiperiodic remedies should be continued, but in more moderate doses. Five grains of Quinine two or three times a day, will probably suffice, but if the fever should run high the dose should be increased sufficiently to moderate the fever. When the fever continues high after the full effects of Quinine are produced, FoAvler's Solution (Solution of the Arsenite of Soda) may be given in doses of one drop three or four times a day. It may be given in water and is useful if the delirium lessens, the skin becomes moist, and the tongue clean. When this disease is associated Avith typhoid fever (known as Typho-Malarial FeArer) Fowler's Solution seems particularly serviceable Headache and delirium are due to the intensity of the fever and much good may be done by applying cold to the head by frequent bathing with 292 OUR FAMILY PHYSICIAN. cold water, or if the heat of the head is very intense with a sack or blad- der of pounded ice. Immediate relief from the intensity of the fever may be derived by sponging the surface of the Avhole body Avith tepid or cold water according as the feATer is moderate or high. The degree of cold should be governed by its agreeableness to the patient. The spongings may be repeated as often as the patient desires. If the fever rises as high as 104° F. or higher as shown by a fever thermometer in the armpit, the application of the cold wet sheet {cold wet pack) will prove serviceable. For its application a sheet or linen is wrung out of cold water and laid smoothly on a hard matress; the patient then lies or is placed upon it with his head upon a pillow. The sheet is then drawn over the body, one side at a time and tucked under the opposite side. Some blankets or comforters are then closely applied over the body. The patient may be placed in the Avet pack several times a day and alloAved to remain in it from five or ten minutes to an hour, according to the state of the temperature. The effect of cold water is only temporary and the treatment with quinine or other preparations of bark, must not be delayed or neglected. Water should not be applied to the body if the patient is sweating. Nausea (sickness at the stomach) and vomiting may sometimes be relieved by laying a cloth previously dipped in ice water and folded over the stomach or by a mustard plaster. Doses of one drop of Creosote or Car- bolic Acid in water frequently give relief. Bismuth and Oxalate of Cerium are generally successful. Take of Subnitrate of Bismuth a dram, Oxalate of Cerium half a dram. Mix, and divide into six papers. Give one every hour or two. The powder can be taken dry on the tongue and swallowed with a little water. Milk with one-third part of lime water can generally be taken by the stomach with benefit. Should the patient need nourishment and the stomach not tolerate food, nutritious injections should be given. Strong beef tea made with one pound of finely chopped lean beef, to a pint of cold water, by heat (the temperature should be raised to 160°.) The temperature should be maintained at that for four hours, water being added from time to time to keep the quantity at one pint. One-fourth of this can be given by injection or one-eighth by the mouth. Milk may also be given by injection. To the beef tea fifteen drops of dilute Hydrochloric Acid and two teaspoonsful of Glyeerole of Pepsin, or two-thirds of a teaspoonful of powder of Pepsin should be added. If milk is used the acid should be omitted. Twenty drops of Laudanum should be added to the injection, if the rectum is irritable, and the injection retained by firm pressure with the hand over a towel. Vigi- lance and restlessness will call for anodynes. For this purpose Tinc- ture of Hyoscyamus in doses of one or two teaspoonfuls may suffice. If not, ten to twenty drops of Laudanum may be added. A pill of one grain of Extract of Hyoscyamus and half a grain of Opium may be used. Protracted cases require the same treatment with more attention given to feeding the patient. Fifteen drops of Dilute Hydrochloric Acid in SAveetened water, three or four times a day. It assists the digestion and relieves the dryness of the mouth and throat. During covalesence, tonic doses of quinine or bark and iron should be taken. A dessertspoonful of the elixir of bark and iron is useful. Probably the Citrate of Iron and BILIOUS FEVER. 293 Quinine, or the Citrate of Iron and Cinchonidia in doses of three to five grains dissolved in Orange Flower water, taken three times a day, answers the purpose the best. A tea (infusion) of Dogwood, Columbo Gentian Quassa Boneset, and Wild Cherry and Poplar, is useful, taken before meals. The Tincture of Iron in doses of fifteen drops in sweetened water, may then be taken after meals. Should intermittent fever (ague) follow bilious fever, it should be treated as is directed for that disease. In Typhq-Malarial fever the disease should be treated in the first place, as is directed in this article for remittent feArer, aside from this the treat- ment will be as is directed for Typhoid fever. HOMOEOPATHIC TREATMENT. In simple cases associated with uncomplicated derangement of the stomach, or simple foulness, especially if the affection be casual, and can be traced directly to excess in eating or drinking, or to some particular indigestible substance, if all strikingly bilious symptoms be absent, such as those above enumerated, and if there be no bitterness of taste, or bitter eructations, the treatment should be regulated by the directions hereafter afforded in the section on " derangement of the stomach," under the general head of " Indigestion." In the seAerer cases, characterized by predominant bilious symptoms, or if the disease assumes an inflammatory character, the ensuing indica- tiors may advantageously be consulted. Aconitum. Belladonna. One or both of these medicines, either singly, in succession, or in alternation, will generally be required at the onset of the attack, and if administered appropriately, and in time, may often suffice to arrest the disease; the more particular in- dications for each are subjoined, which, if only aggregately covered by the combination of both, Avill serA-e to point out the necessity for alternate administration. Aconitum is indicated, more especially, when everything recieved in the mouth, in the shape of food or drink, except water, has a bitter taste, or Avhen there is continually a bitter taste in the mouth, the pulse being quick and frequent; when the tongue is coA-ered with a yellow coating; when bitter eructations or violent urging to vomit, and retching occur, Avithout discharge, or when there is vomiting of greenish, bitter, or slimy matters ; also by excessive nausea ; suspended eA7acuations, or frequent, scanty, small motions, attended with much urging; swelling and tight- ness across the stomach, sensation of heaviness and fullness in the fore- head and temples ; and if fresh air appears to afford some relief Dose; If singly, of a solution of ten globules to two tablespoonsful of water, give a teaspoonful every tAvo hours, until amelioration or change. If in alternation with Belladonna, dissolve eight globules of each medicine, separately, in a wineglassful of water, and give a teaspoonful, first of one solution, then of the other, so that a lapse of three hours intervenes betAveen the doses, and so on, until ame- lioration or change. Belladonna is indicated when there is violent throbbing of the ar- teries of the temples, reeling giddiness, and intense and unbearable head- ache, chiefly seated in the forehead, as if the contents of the head would fall out at the forehead; dryness of the mouth, and thirst; sometimes in- 291 OUR FAMILY PHYSICIAN. cessant nausea; tongue covered with a thick, whitish or yellowish coating; sour taste ; repugnance to all kinds of food, and even to drink; vomiting of food, or vomiting of sour, slimy, or bitter matters; suspension of evac- uations, or looseness of the boAvels, Avith slimy evacuations; quick and full pulse ; especially if the head-symptoms be aggraA'ated by moving the eyes, or by movement generally, or by shaking, or even by touch, and by the access of fresh air, or a draught, and if they be someAvhat relieved when the head is supported or held backwards. Dose: In every respect as directed for Aconitum. Nux-vomica is indicated in bilious fever by the following symptoms, amongst others: absence of thirst, or ardent thirst; attended with heart- burn ; constant nausea; bitter eructations; foul or bitter taste in the mouth, the tongue dry and Avhite, or covered with yellow coating toAvards the root; painful sensation of Aveight and tightness across the stomach, con- stipation, with repeated urging to evacuate, without discharge, or loose- ness of the boAvels, with scanty, insufficient, watery, or slimy evacuation ; spasm of the stomach ; great inclination to vomit, sometimes even with empty retching, or vomiting of food; full and frequent, or quick and in- termittent pulse; great prostration of strength in the first stage, and characterized by shivering, occurring Avith partial heat, or by heat follow- ing, preceding, or mingling with shivering, with or without coldness; coldness principally in the evening or morning, or provoked by the slightest movement with shivering and shuddering; headache with heat of the head; dullness, or confusion of the head, with reeling giddiness; buzzing, singing, or tinkling in the ears ; rheumatic pains in the limbs and in the teeth ; sallow appearance of the complexion, sensation of ex- haustion and weariness ; excitable, violent, restless or quarrelsome dispo- sition ; sometimes yellowish hue of the white of the eye, particularly of the lower part of the eyeball; great sensibility of light, especially in the morning. Dose: Four globules, dry, on the tongue, or in a teaspoonful of water, every two hours, until four doses have been given, and afterwards, if necessary, every six hours. Chammomilla is of eminent service, often after Nux-vomica, in very severe cases in which the last named remedy has failed to arrest the symptoms, Avhen the tongue is red and fissured, or when the tongue ex- hibits yellow coating ; or when further indicated by :—intense heat and redness of the face (particularly at night), restless and interrupted sleep, bruised pain in the head, with pressure, fullness, and heaviness ; inflam- matory redness, and burning sensation in the eyes, bitter taste in the mouth ; every kind of food conveys a bitter taste ; loss of appetite, nausea or eructations; vomiting of greenish, sour, or bitter matters; intense anxiety, and oppression of the chest; looseness of the bowels, Avith sour- smelling evacuations, having the appearance of stirred eggs; or greenish evacuations, or, on the other hand, constipation, with suspended evac- uations. Dose: As directed for Nux-vomica. Bryonia is particularly appropriate to the treatment of this disease in the hot season. The indications which identify it are as follows:—in- BILIOUS FFVER. 295 sipid, foul, or bitter taste, particularly on waking; continued thirst, tongue exhibiting a number of blisters, and covered with a Avhite or yellow coat- ing; desire for acids and stimulants, such as coffee, wine, etc., but repug- nance to solid or Avholesome food; vomiting of bilious matters, particu- larly after drinking, or sometimes frequent, but ineffectual retching; op- pressive headache. Avith sensation of extreme heat, dullness, confusion, and giddiness of the head; constipation of hard difficult stools as if burnt. Dose: As for Nux-vom. Pulsatilla is also a most important remedy in this, as in every other disease in which the digestive organs are particularly implicated,—the tongue being covered Avith whitish coating; particularly after SAvallowing food or drink, there is bitter, foul, taste in the mouth; all food conveys a bitter taste, especially bread; regurgitation of food ; extreme nausea, or in- clination to vomit, in the evening; excessive accumulation of phlegm in the stomach and gullet; A'omiting of food or of phlegm, or of bitter or sour matters, more severe at night; acidity of the stomach; flatulent distention of the belly, with rumbling of Avind in the bowels; looseness of the bow- els, with discharge of bilious or slimy matters in the evacuations,—or slug- gish evacuations, and insufficient activity of the bowels; splitting headache, with tightness and compression of the forehead; sensation of weariness and exhaustion, occasioned by the least mental exertion; slowness and fullness of the pulse (in general); fits of shuddering and coldness in the evening, or towards evening. Dose: h\ every respect as stated for Nux-vomica. Mercurius may frequently be employed with great advantage after Belladonna, and is more particularly required when indicated by the fol- lowing symptoms and conditions: Dryness, and burning heat of the lips; drowsiness in the daytime, but sleeplessness at night; severe and painful sensitiveness of the belly and of the region of the stomach, to touch or to pressure, these symptoms being aggravated, or developed at night, the tongue covered with white or yellowish coating,—or moist;—foul, or even offensive and loathsome, or bitter taste in the mouth; nausea or inclination to A'oinit, or, at other times, actual vomiting of mingled phlegm and bilious matters; the fever-symptoms are characterized by general coldness, shiver- ing and shuddering all over the body, irregular, or quick and intermittent pulse; heat of the head and face, with flushing, when all other parts of the body are affected with coldness, shivering, etc.; giddiness when the head is raised; intense headache, with desire to press the head between the hands; intense dejection, and listlessness. Do.se: Of a solution of six globules, to two tablespoonsful of water, give a teaspoonful every four hours, until amelioration or change. Ipecacuanha is indicated by inclination to vomit, with utter repug- nance to food; dryness of the mouth; the tongue either clean, or covered with a thick, yellowish coating; violent retching, without discharge, and attended with great straining, or easy, copious vomiting of slimy matters or of food, with a violent gush; looseness of the bowels, with discharge of yellowish and very offensive or even putrid evacuations; and accompa- nied with severe colicky pains; weight and sensation of fullness, with very severe pains in the region of the stomach ; pale, yellowish hue of the skin; severe headache. 296 OUR family physician. Dose: Of a solution of ten pills to two tablespoonsful of water, giv<= (if violent A'omiting occur), one teaspoonful every hour, until the symptoms yield. China is applicable to such cases as evince the folIoAving symptoms : —frequent emotions; vomiting or regurgitation of food ; loss of appetite, and a sensation of thorough repugnance to all food, or as if one had eaten enough, or more than enough; frequent emission of very offensive wind from the bowels ; evacuations containing indigested food; painful sensa- tion of tightness in the belly, and of weight in the region of the navel; sensations of chilliness and shuddering after drinking: looseness of the boAvels, with -watery, slimy or yellowish evacuation; heat with full and quick pulse; headache (someties delirium), burning sensation in the lips, red face, and dry mouth. Dose: Of a solution of ten pills to two tablespoonsful of water,' give a teaspoonful every two hours, until amelioration or change. Arsenicum, an invaluable remedy in the majority of very severe and urgent cases, either Avhen one or more of the preceding have failed to arrest the symptoms, or when the disease has run on to an adAranced stage before treatment has been resorted to. The chief indications for it are: dryness of the tongue, accompanied with severe thirst, and with continual inclination to drink, Avith, however, inability to drink more than a small quantity at a time ; bitter, or very acrid, pungent eructa- tions ; saltish or bitter taste in the mouth ; nausea, vomiting of food or of greenish, brownish, or bilious matters ; extreme tenderness of the region of the stomach to contact; burning and cutting, cramp-like, or spasmodic pains in the stomach and boAvels, accompanied Avith chilliness and an- guish,—or very painful sensation of weight and burning at one spot in the stomach ; suspension of evacuations, excessive and continued relaxa- tion of the bowels, attended with severe urging, and Avith brownish, yellow- ish or greenish evacuations; scalding sensation in passing Avater; the evacuations (or vomiting) are provoked by, or occur after, eA'ery move- ment, or after drinking, general heat of the body usually occurring at night, and accompanied with restlessness, anxiety, etc.; irregular, fre- quent, and quick pulse; extreme prostration of strength, and desire to assume or to retain a recumbent posture. Dose: As for Nux. ENTERITIS. INFLAMMATION OF THE BOWELS. We apply this name to an inflammation of the intestines. The Causes of enteritis are mostly the same as those of indigestion, dietetic transgressions; the use of irritating, readily decomposed, sour substances; overloading the stomach; abuse of spirits; a cold. In addi- tion, we have poisonous substances; mechanical irritation by fecal matter, the progression of which in the bowels is arrested, in consequence of which the vessels become compressed, or finally, though rarely, the inflammation may be caused by worms. Besides these causes, enteritis INFLAMMATION OF THE BOAVELS. 297 occurs as a. continuation of other inflammatory processes, gastritis, peri- tonitis, and as a form of reaction against ulcerations of the intestinal mucous membrane. Symptoms.—If at first the inflammation is not spread over a large sur- face, and confined to the lining membrane, the symptoms are not very grave. There are few local pains, little fever, loss of appetite, constipation, feeling of fullness in the umbilical region ; nausea occurs very seldom ; there is never any A'omiting. In this manner the affection may exist for a short time and disappear again almost imperceptibly, or it may increase and continue to spread; very rarely the disorder breaks out at once in all its violence. The pains now become intense, burning or tearing, or cutting like colic, until they sometimes grow intolerable ; they spread over the whole abdomen; are generally most violent in the umbilical region, Avhere the least pressure causes an intense aggraA'ation of the pain, Avhich is increased even by the act of breathing; coughing causes extreme pain, which is likewise intensely aggravated every time the patient attempts to turn the upper part of his body, on Avhich account he remains lying motionless on his back. At all times the pain has more or less pro- longed aggravations like colic, evidently caused by the progressive descension of the contents of the boAvels. At the same time the abdomen is distended, but not to excess. Where the small intestine is alone af- fected, there is obstinate constipation; where the large intestine is involved in the inflammation, Ave have sometimes, not always, diarrhoea, colored, frequently bloody stools, or alternate constipation and diarrhoea or, finally, obstinate constipation. In such cases, the colicky pains are more frequent and extensh'e, the distention of the abdomen more consid- erable. In violent attacks of this disease the constitutional symptoms are always very marked. A general chill only precedes a very sudden invasion of the disease. The patient feels the heat more perceptibly than others ; he is constantly complaining of an intolerable thirst; the pulse is accelerated, even to one hundred and twenty beats, small and contracted, not seldom unequal and intermittent; the skin of the body is hot and dry; the extremities are frequently cool; the forehead is covered Avith a perspiration as if from anguish ; the appetite is entirely gone ; the tongue has at times a light coating, at times it is clean and very soon be- comes dry. If the affection increases in violence, the first symptom generally is nausea, which soon becomes associated with retching and vomiting. At first, bile and mucus are vomited up Avith the food; but if the inflammation is extensive, eATen fecal matter may be thrown up; the vomited matter very soon acquires a smell like that of faeces. The signs of collapse now become more apparent; the face has a cadaverous appearance, expressive of deep suffering, Avith elongated features and sunken eyes. Under such circumstances, the pa- tient often wanders, the skin becomes cool, and is covered with a cool perspiration. Convulsions and fainting fits occasionally complicate these symptoms, and death may ensue under such circumstances. A rapid and complete recovery only takes place exceptionally. The Prognosis is always uncertain, because the disease is apt to pass into insidious chronic complaints, even after recovery seemed to be fairly 298 OUR FAMILY PHYSICIAN under Avay; at all events, enteritis ahvays constitutes one of the more im- portant diseases. The diagnosis of enteritis, although somewhat difficult, yet, Avith proper care, can be made in the majority of cases with positive certainty. The disorder is most easily confounded with incarcerations, simple choler- ine, colic. Thelast tAvo can become dangerous, if the trouble is esteemed too highly. Since it is not always possible to make a sure diagnosis until the disease has run along for a time, the employment of irritating remedies cannot be sufficiently guarded against in cases of colic and cholerine. ALLOPATHIC TREATMENT. Enteritis. The discrimination of acute enteritis (inflammation of the small intestines), will be very unsatisfactory, if made by unprofes- sional hands. If the diagnosis is made out, the treatment will be, essen- tially, as follows: The patient should remain in bed. Hot fomentations should be per- sistently applied to the abdomen, and some form of Opium given to the extent of relieA'ing the pain and checking the diarrhoea. Opium in doses of a grain, two to four hours, or longer, apart; but sufficiently often to procure relief from pain. Hyoscyamus or Belladonna may be advanta- geously given with the Opium, rendering the action of the Opium more pleasant. The dose of Extract of Hyoscyamus is one grain, of the Tinct- ure one or two teaspoonsful. The dose of extract of Belladonna is a quar- ter of a grain, and a dose of the Tincture is ten drops. Laudanum in doses of twenty drops^or Morphine in doses of a quarter of a grain, may be used instead of Opium. It is as well to administer the Opium by injection into the rectum. For this purpose a teaspoonful of Laudanum should be used, mixed with one or two tablespoonsful of thin starch or milk. An eight-ounce hard- rubber syringe is a suitable instrument for this purpose. After drawing the mixture into the syringe, the nozzle should be elevated and the air can be expelled by sloAvly pressing the piston. After the injection, firm pressure on the anus (opening of the bowel) with a towel under the hand, for a time, will enable the patient to retain the injection. Both these methods of giving the medicine may be alternated. It is not best to give cathartics, unless there is good reason to believe irritating substances are contained within the intestinal canal, and then it is better to resort to injections of warm water, if the bowels require moving. The diet should be of a character which will not require intestinal digestion, nor cause irritation by their presence in the intestine. Beef- tea, beef-juice, raw eggs, and milk, answer this purpose as well as any- thing of which we have command. Rice and barley-water, or arroAV-root boiled in water, may be drank. It is common to recommend Cod Liver Oil and Iron. They are well- suited to these cases. I believe tablespoonful doses of pure Glycerine, having dissolved in it three to five grains of the Citrate of Iron, or the Citrate of Iron and Quinine, answer the purpose better. The patient will require systematic feeding, if the disease be pro- INFLAMMATION OF THE BOAVELS. 299 longed, to support the powers of life, as in fevers, full directions for this will be given on the subject of typhoid fever. During coiwalescence, the usual diet should be returned to very cau- tiously. When the disease affects children, if is necessary to be very cautious in the use of Opium. The Camphorated Tincture of Opium should be used, Avith an equal quantity of Tincture oi Hyoscyamus. The usual dose of each being fifteen or twenty drops for a child one year old. For a child of five years, three grains of Dover's PoAvder, equal to one-third of a grain of Opium, may be used. If the stools become charged with mucus, a teaspoonful or two of Castor Oil, with an equal quantity of Glycerine, flavored with one or two drops of Oil of Cinnamon, may be given. Rochelle Salts is, also, an ap- propriate laxative, in doses of half a teaspoonful (in lemon syrup). Lax- athres should, hoAvever, be given Avith caution. The diarrhoea which folloAvs often, upon the subsidence of the inflam- mation, may be checked by appropriate doses of Paregoric, Dover's Pow- der or Opium, Avith ten-grain doses of Sub-Nitrate of Bismuth, or Tinct- ure of Catechu, or Kino, in equal quantity with the Paregoric, in Chalk Mixture. Local, and other general treatment, will be the same as for adults. HOMOEOPATHIC TREATMENT. Aconite in the early stages, Avhen the inflammation is just begin- ning, will cut the disease short. Dry, hot skin; full, frequent pulse; mouth and tongue dry, with intense thirst. Abdomen swollen and tender to the touch ; cutting, burning and tearing pains in the region of the na- vel. Great fear and anxiety of mind, with nervous excitability; bright- red and hot urine, are the leading symptoms calling for this remedy. Dose: Eight pills every one to three hours, dissolved in a little wa- ter, or dry on the tongue. Mercurius. Abdomen swollen hard, and painful to contact. Cut- ting, stabbing pains in the boAvels, accompanied with chilliness and shud- dering ; green or bloody mucus stools, with violent griping; profuse perspiration affording no relief; pale, wretched complexion; foul smell from the mouth; vomiting of bitter mucus; restless sleep. Dose: A powder or six pills every two to four hours. Belladonna. Great heat and tenderness of the abdomen. Violent contraction or clutching pains in the bowels. Pains which appear sud- denly and disappear just as suddenly after continuing for a longer or shorter period. Congestion of blood to the head, with throbbing of the arteries of the neck (carotids). Face flushed, eyes red and sparkling. Great intolerance to noise and light. Starting and jumping during sleep. Sleepiness, but cannot sleep. Partial or general spasms. Almost con- stant groaning or moaning. Dose: As for Aconite. Arsenicum. Even if the previous treatment fails, there is still hope that this remedy will succeed, if the following symptoms are present :— Very rapid and weak pulse. Sudden failure or sinking of strength. Cold ,300 OUR FAMILY PHYSICIAN. clammy sweat, and great restlessness. Intense thirst, drinking often but little at a time. Burning in the abdomen, worse after eating or drinking, usually folloAved by vomiting. Symptoms all worse after midnight. Do.se: As for Mercurius. Arsenicum always gives the best satisfac- tion in potencies as high as 30 or upward. Bryonia and Cantharis are also good sometimes. See "Repertory." Make hot applications to the abdomen. Bathe with tepid or cold water. Drink Elm Bark water, etc. CATARRHAL DYSENTERIA. FLUX. Symptoms. The disease sets in without any definite precursory symp- toms, or suddenly with violent pinching, cutting pains, radiating from the umbilical region downwards, and which are speedily succeeded by a vio- lent urging to stool, with discharge of fecal, soft or watery masses. After the evacuation, the pains abate for a shorter or longer period, after which they return Avith renewed violence, and more particularly Avith increased urging, attended with tenesmus, (pain and difficulty with frequent desire) and severe pressing pain, during which a small quantity of white, and sub- sequently blood-stained, mucus is discharged, Avithout any admixture of fecal matter in most cases. At the same time the patients experience an acute burning pain in the anus, and with every new discharge the tenes- mus increases. In slighter cases the disease sometimes runs its course without any fever; the more acute cases may be attended with violent fever; the stomach is at times involved in the affection, at times not at all; there is loss of appetite, retching, nausea, vomiting; the tongue is usually quite clean. The duration of the disease usually depends upon its extent, Avhich is pretty accurately measured by the extent of the pain. The slighter cases sometimes do not last more than a day, the severe cases last weeks, and then are disposed to pass into the chronic form. In the case of children the non-admixture of fecal matter in the stools is an ex- ception to the rule; blood, pus, and scrapings of intestinal membrane, shreds of mucus membrane, and false membrane, are met with the more frequently, of a mixed green color. The dysentery of children assumes more easily a chronic form than in the case of adults, and almost always leaves a peculiar disposition to relapses. The so-called teething dysentery is just such a catarrhal affection, and arises less frequently in consequence of the process of dentition than of other influences acting upon the little patient, especially an erroneous system of preparing and administering nourishment. In the case of children, even if there is no sign of fever, convulsive symptoms are apt to follow, imparting a higher degree of im- portance to the otherAvise not very important disease. A fatal termination of catarrhal dysentery, in a person of an other- wise good constitution, is a rare occurrence. Even where the disease sets in as a complication of other diseases, the danger incident to its course is only of moderate importance. DYSENTERY—FLUX. 301 The treatment will be shown when we come to speak of dysentery proper. DYSENTERIA EPIDEMIC A, DYSENTERY PROPER-FLUX. However trifling catarrhal dysentery may seem, dysentery proper is an important and dangerous disease. History.—Dysentery usually breaks out in an epidemic form; the few cases of sporadic dysentery that come to us for treatment, are either not dysentery, properly speaking, or else they are very rare occurrences. Dysentery is more particularly a disease of young persons and those of middle age, and very seldom attacks either the very young or very old. Epidemic dysentery almost always breaks out late in the summer, or in the beginning of fall, in very hot and dry seasons; it seldom lasts until winter is someAvhat advanced; it seems to occur more frequently among the lower than the higher classes; its spread is promoted by the living in crowded rooms; nothing shows this clearer than the devastations which dysentery causes in the ranks of armies. Neither city nor country people are spared; it even seems as though the latter Avere more fearfully visited by this plague. If a disposition to dysentery prevails, errors in diet and catarrhal exposures excite the attack; the statement, however, that the use of fruit favors the breaking out of dysentery, is not yet proven. This assertion, at most, only applies to unripe fruit, or to such kinds as are apt to cause cholera morbus, diarrhoea, etc., such as the early cherries, plums, etc. There are, undoubtedly, individuals whose bowels are irritated by the use of any kind of fruit, and in whom it may cause an attack of dysentery. These detached and well established historical data, cannot well be harmonized in one series, except by the supposition that there exists a pe- culiar virus, Avhich has a special relation to the colon and rectum; for it is only in these parts that the phenomena of dysentery become localized. In this respect, dysentery is very near to Asiatic cholera, and likewise to other infectious epidemics. What the quality of the dysenteric virus, is has not yet been decided with any degree of certainty. That the virus is of a vegetable nature might be accepted as true, where dysentery spreads over extensive districts: but this theory does not apply where dysentery attacks whole armies. A discussion of this point is not as useless as it might seem, since its proper solution is intimately connected with the pre- ventive treatment of dysentery. This question may perhaps be better elucidated by subsequent epidemics. It is certain that the virus is engen- dered in the patient, and is transmitted by him like the poison of cholera. Contagion does not take place by contact, but the infection is propagated by water-closets, close-stools, etc. This theory, which is now received as explanatory of the spread of cholera, explains the fact, why the disease de- creases and disappears with the appearance of frost; the cold destroys the poison. This may be the reason also why dysentery sometimes continues as long as mid-winter, provided the warm weather lasts, and there is no frost. The circumstance that during an epidemic all the inhabitants of one house, but not all the houses in the neighborhood, are attacked, and that epidemics spread more extensively, and more frequently in the coun- try where the exhalations from excrementitious matter are more freely 302 OUR FAMILY PHYSICIAN. diffused through the air, speaks likewise in favor of the theory, that infec- tion is communicated in the manner above described. Among armies in the field, the epidemic is propagated in a like manner, whereas the soldiers lying in the banacks are protected much more efficaciously, and the cases of dysentery occurring among them are less numerous. Even if the views which Ave have here expressed, are not absolutely accepted as true, yet no reasonable physician will neglect to arrest the spread of the disease, by effecting the removal of the A-arious circumstances, which we have pointed out as exciting causes of the epidemic. Another impor- tant question regarding the history of dysentery is, whether an al- teration in the functions of the liver does not constitute the chief exciting cause of the disease. The origin of the epidemic, at a time when the action of the liver is knoAvn to be altered, and the affections of the liver which so often prevail, during and after epidemic dys entery, seem to confirm this opinion. Hence, individuals in Avhom unhealthy changes in the functions of the liver, have developed a disposition to be attacked with dysentery, are most likely to be assailed by this plague; this circumstance again shows why middle-aged persons should be most liable. Where the ulcers are not too extensh-e, they heal without much cica- trization. If the loss of mucous lining is considerable, contracting cicatrizes are the result, so that the bowel looks as if twisted around by cords, or presenting valve-shaped contractions. It is upon the duration of this process that the length of the period of convalescence depends. Symptoms.—The breaking out of the disease is almost always preced- ed by precursory symptoms. The patient feels languid, prostrate, and out of humor; the appetite is, more or less, wanting; there is oppression of the stomach, deranged digestion, and an increased accumulation of flatulence. These symptoms soon increase to nausea and desire to vomit, Avith coated tongue and foul taste; sleep is disturbed ; there is drawing in the extremities, sensitiA'eness to external cold, shiverings, and an accel- erated pulse. These symptoms show that the disease has invaded the organism. AboA'e all, it is the diarrhoea which denotes the local sphere of the disease. Even if all the other precursory symptoms are wanting, diarrhoea generally precedes the attack, in company with slight colicky pains, and Avithout any further characteristic peculiarities. As these pains increase, the diarrhoeic discharges occur more frequently, but are, at the same time more scanty, in the same proportion the tenes- mus, which precedes eA'ery .discharge, begins to distress the patient. At times, after a feAV fecal eA'acuations, and at others after a some- what longer duration of the simple diarrhoea, fecal matter ceases to be discharged ; this is the commencement of the real disease. The colicky pains, which are seldom Avanting, in rease in intensity, be- come more continuous, and are attended with a painful urging to stool; a sensation as if the bowels would press out of the abdomen, or as though a heavy weight Avere suspended from the anus, or as if the sphincter ani (muscle that closes the anus, " puckering string") Avould tear. When these pains reach their bight, there occurs a scanty discharge, attended Avith an intense burning at the anus. At first a remission of the distress takes place after this discharge, but the more frequently it occurs, the BYSENTERY—FLUX. 303 more the tensmus increases in violence, and the less it intermits after the evacuation has taken place. The evacuated substance, which, for some time, continues to show a little tinge, soon becomes a mere mucus, with a grayish admixture, or a more or less copious admixture of blood (red and white dysentery), and of a peculiar insipid odor. In more violent cases, pure blood is evacuated. According as the disease is more or less intense the discharges occur every hour, sometimes every few minutes, so that the patient scarcely dares leave the chamber, however difficult it may be for him, owing to the continued violent and colicky pains, to sit up. The pains now become more tearing, cutting, radiating from the umbilicus (navel) downwards. The constitutional equilibrium is not much dis- turbed at the outset. In mild cases, the fever is scarcely perceptible, but there are frequent chilly creepings. The pulse is but a little accelerated, the temperature of the skin is not much increased. In proportion as the discharges increase in frequency, the pulse becomes correspondingly ac- celerated, hard and small, the skin hot and dry, the thirst distressing; the desire to \'omit increases to real A'omiting, although not regularly; the appetite is entirely gone. The patient soon loses his strength, and feels unable to sit up. The affection may continue, at this stage, for a week, after which it may gradually terminate in recovery. If the local changes are more considerable, the disease increases in intensity. The pulse grows frequent, small, and feeble, the thirst becomes agonizing, the temperature unequal, the extremities feel cool to the touch, the tongue can hardly be kept moist, the face has a cadaverous expression, and the prostration is complete. Usually the abdomen is much distended and sensitive. The discharges follow each other more rapidly, and the tenes- mus continues uninterruptedly. The discharges, together with the blood, contain shreds of mucous membrane, and a number of membranous frag- ments. When the disease reaches this hight, delirium is not an unu- sual occurrence. If the disease approaches a fatal termination, the discharges either become fetid, or else they cease entirely, or take place involuntarily, as a sign that the boAvel is paralyzed. It is always a bad symptom, if the discharges diminish in frequency without any corres- ponding improvement. Death supervenes amid symptoms of general prostration, meteorism (distention with gas) delirium, coma. The termi- nation in recovery may be considered certain, if a general improvement is accompanied by a decreasing frequency of the stools, and the colic abates, although the tenesmus still continues. As soon as the discharges contain faeces, and the fecal odor is restored, recovery may be considered under full headway. The pulse generally continues somewhat more rapid, yet becomes fuller and stronger, and the symptoms of fever disappear. After a severe attack of dysentery, recov- ery scarcely ever takes place very rapidly ; which, as we said before, is owing to the slowness with which the ulcerated surfaces heal; it may, also, be OAving to the fact, that the condition of the digestive organs does not admit of a rapid reparation of the waste, by a copious supply of food In armies, especially, the transition of acute into chronic dysentery is not a rare occurrence. The symptoms of chronic dysentery correspond with those of ulceration of the bowels, which indeed constitutes the basis of (be chronic form. In such a case the feA'er disappears entirely, but 304 OUR FAMILY PHYSICIAN. the diarrhoea continues, consisting at one time of fecal masses, lined with pus and blood, and at other times of a sanguineo-purulent mucus, or changing about with obstinate constipation. At the same time the appe- tite does not return, and the patients continue to lose flesh. Death is apt to terminate such sufferings, though, frequently, not until they have last- ed a long time. The severest forms of dysentery, the septic, putrid or typhoid form, are of very rare occurrence in our latitude; they are more frequently met with in hot climates. Such forms arise either because the milder form assumes a malignant type, Avith all the signs of gangrenous destruction of the bowel, or else they break out at once with an extraordinary degree of intensity, characterized by the signs of a most acute typhus, and rapidly terminating in death. Strictly speaking,'there is no transition into other affections; the abscesses of the liver, Avhich do not occur unfrequently, even among us, after a violent attack of dysentery, are most probably due to the absorp- tion of pus into the A'essels; or possibly to a disease of the lh'er, running its course simultaneously with dysentery. The prognosis, in the dysenteries of our climate, is emphatically fa- vorable. ALLOPATHIC TREATMENT. Treatment of Acute Sporadic Dysentery or Flux (occurring independ- ently of epidemic influences.) In this disease nature points unerringly toAvard a thorough emptying of the intestinal canal of its contents. This sIioavs by the copious diarrhoea which precedes the dysentery. The first object of treatment, therefore, is to effect this object as quickly and thoroughly as possible, assisting nature's efforts by an effi- cient cathartic. By far the most effective cathartic for this purpose is Sulphate of Magnesia (Epsom Salts.) Take a sufficient quantity of Sul- phate of Magnesia to saturate seven ounces of water ; add one ounce of Aromatic Sulphuric Acid. The dose of this mixture is a tablespoonful every hour or tAvo until it operates freely; or the Epsom Salts may be given in doses of a heaping tablespoonful steeped Avith one-third of its bulk of roasted coffee and repeated in four hours, if a free Avatery stool has not been before produced. Rochelle Salts in doses of a tablespoonful in solution Avith water and lemon juice or Citrate of Magnesia, may be em- ployed, but the acid solution of Epsom Salts is to be preferred. Castor Oil is only of less value as a purge in this disease than the cathartics before mentioned. If used it should be gh'en in doses of a tablespoonful or more, mixed with an equal quantity of Glycerine and flavored with a couple of drops of Oil of Cinnamon. This should also be repeated in four hours, if it has not operated. After thorough purgation has been produced the cathartic is to be discontinued. This effect is folloAved by a period of rest and sometimes recovery im- mediately takes place. This rest of nature should be aided and prolonged by a full dose of Opium. The Opium benefits also by its direct effect on the inflammation (called antiphlogestic) as well as aiding recovery by prolonging the quiet of the intestine. It is preferable to give the Opium by injection into the rectum. For this purpose a teaspoonful to a tea- DYSENTERY—FLUX. 305 spoonful and a half of Laudanum should be mixed with one or two tablespoonsful of thin starch or milk, and injected into the rectum Avith a hard rubber syringe. If it is thrown off it should be immediately repeated and caused to be retained by firm pressure upon the anus (opening of the bowel) Avith a towel under the hand until the efforts to expel it cease. Generally speaking, once in twelve hours is often enough to repeat the injection of Laudanum, but it should be often enough to afford complete relief, and the dose increased until this effect is produced. Suppositories of Opium or Morphine can be purchased which will answer the purpose. In some instances neither the injections nor suppositories can be retained in the rectum. In such cases it must be given by the mouth. Then the powder or pills of Laudanum or Morphine may be used. The usual dose is one grain of the powder or one pill, or twenty-five drops of Laudanum, or a quarter of a grain of Morphine, but the dose must be increased until relief follows its administration, and repeated often enough to continue the relief. The patient should be quiet in bed, a large flax-seed poultice contain- ing two or three tablespoonsful of mustard placed over the stomach. About half an hour after the Opium or the Laudanum injection is given, thirty grins of Ipecacuanha scraped in a medicine wafer, should be given, or it may be gh'en in milk. The Ipecacuanha causes the stools to become natural, the griping and straining cease, the hot, dry, skin becomes moist and the patient becomes refreshingly calm. In a simple acute case this may complete the cure. The Ipecacuanha may be repeated in from six to eight hours, if required, and will be taken if a disgusting sickness at the stomach is not caused. With every dose the hot poultice or a mus- tard plaster should be placed over the stomach. If a dose is vomited it should be immediately repeated. Some patients find it impossible to continue the use of the remedy. In such instances, its use must be dispensed Avith. The treatment, then, Avill rest upon free cathartics and Opium. Whenever stools, with mucus or slime and blood, begin to pass the cathartic should be at once resorted to, as in the first place, to be folloAved as before, with the Opium and the Ipecacuanha, if it is tolerated. It is well to state here, that the treatment of dysentery with Ipecacuanha has reduced the fatality in acute dysentery to one-third of the mortality pre- vious to its introduction, as shown by reports from the East Indies. Persons who cannot take Opium and Morphine, can*usually take the Watery Solution, or the Alkaloid of Opium, calledtCodia, in doses Lof a grain. The benefit from Opium is so great that it is fbest for patients to suffer some inconvenience from the Opium. Its unpleasant effects may sometimes be obviated by giving with it a full dose of Hyoscyamus or Belladonna—one or two grains of the Extract of Hyoscyamus, or one- fourth of a grain of Extract of Belladonna. Remedies which may sometimes (.^'associated with the internal use of Opium, in this disease, are: Bismuth in doses of twenty to Pthirty grains (half a teaspoonfulj. Acetate of Lead (Sugar "of Lead) in doses of three to five grains. Sulphate of ('opper in doses of a twelfth to a four! b of a grain. Tannin in doses of ten to twenty grains, and the various veg- etable astringents, among which are: Rhatany, Kino, Catechu Log- 20 306 OUR FAMILY PHYSICIAN. Avood, White Oak Bark, Witch Hazel, White Pond Billy Root, etc. Very seldom Avill it be necessary to resort to any of them, if the foregoing di- rections, regarding the use of Cathartics, Opium and Ipecacuanha, are strictly followed. When the disease is prolonged, and the stools become of a bloody, watery character, these astringents occupy quite an important place in the treatment. Ipecacuanha should be given, if tolerated, together with Opium, in some of its forms, to the extent of relieving pain, some of the foregoing astringents, which may be tried in succession, and tonics. Then cathartics, as a rule, should not be given. Particular attention should be given to the diet, and nothing of a coarse character, which will make stools, should be allowed, but the food should be rich in nourishment. Milk, meat-essences and broths, raAV eggs beaten up with a little sugar and milk, or water, ansAver this purpose the best. Moderate quantities of arroAV-root, sago, tapioca, and rice, may be given. The patient may drink, at will, of thin mucilage of slippery elm, or Gum Arabic, or flaxseed tea, barley or rice-water. One of the best forms of tonic for prostrated cases, and when recovery is sIoav, is: Elixir or Syrup of Quinine, or Cinchonidia, Strychnine and Iron. The dose is, usually, a teaspoonful three times a day, though a des- sertspoonful may be given. Whatever the form of tonic given, the dose of Quinine is one or two grains, Iron one grain, and of Strychnine not to exceed a thirtieth of a grain. In severe epidemics of dysentery, the treatment does not materially differ from the above, except, perhaps, in the quantities of medicines re- quired to control the disease. The principles of treatment are the same. Cathartics are to be given more cautiously, and are to be omitted alto- gether, if the discharges become watery instead of mucus, or if the patient be notably prostrated. The rules for giving Opium and Ipecacuanha are to be observed. Much larger doses of Opium may be required to procure relief from the pain and griping, and to arrest the frequency of the discharges from the bowels. It should be given frequently enough, and in increasing quanti- ties, until that result is reached. After a dose of Ipecacuanha has been retained, as a rule, less Opium Avill be required. While the Ipecacuanha should be repeated as before directed, no intermission must be permitted in giving the Opium, and should ahvays be carried to the extent of check- ing the watery-bloody discharges in increased doses till this effect is pro- duced. In increasing the doses ill this Avay, the patient must be carefully watched that Opium poisoning (narcotism) is not produced. Contraction of the pupils (" sight of the eye " decreasing), frequency of breathing and profound sleep, indicate this condition. If, however, the patient breathes tAvelve times in a minute, the danger from narcotism is not great. In cases of great danger from exhaustion and prostration, stimulants are to be given Avith the nourishment. For this purpose, I believe Bran- dy to be the best. It should be given to a point short of excitement of the circulation, or nen'ous system. Its beneficial effect Avill be shoAvn by a general calm, and the pulse will become softer, fuller, more regular, and DYSENTERY—FLUX. 307 slower, and the tongue moistens. The dose should be begun at a table- spoonful for an adult, repeated at intervals of four hours, preferably with food, and may if necessary be increased in frequency and quantity to meet the requirements of the case. It does harm, if the frequency of the pulse is increased and the tongue becomes dry. Symptoms of malarial trouble will call for Quinine, the same as is di- rected in (bilious) remittent feA'er. In all cases of dysentery, patients should refrain as much as possible from efforts to stool, for the sensation is delusory, depending on the in- flamed state of the boAvel. Cold to the anus, as ice Avrapped in a cloth, is useful. The Opium injections relieve this painful sensation the best of anything. Fhe grains of Sugar of Lead may be added to the injection Avith benefit, though for this combination a half a grain of the Acetate of Morphine, dissoh'ed in a teaspoonful of Glycerine, is better than the Lau- danum. Tannin, in quantities of a scruple, may be used in this way, instead of Sugar of Lead. In cases which, after thorough trial, cannot take Opium in any form, I Avould recommend an injection of one of the astringents named, dis- solved in a tablespoonful of Glycerine, with fifteen drops of the Fluid Ex- tract of Belladonna or a teaspoonful of the Tincture. A teaspoonful or tAvo of Fluid Extract of Hyoscyamus, or two or three grains of the Solid Extract, may be rubbed up with Glycerine, and used instead of the Bel- ladonna. In case none of these are procurable, a strong tea made Avith Jim- son Weed, Stramonium, may be used Avith benefit. During com'alescence, the amount of doses and frequency of giving them, should be gradually diminished. Tonics, as recommended in sim- ple acute dysentery, are applicable here. So dangerous a disease as epidemic dysentery, requiring such positive treatment, ought to be under the direction of a competent physician. HOMOEOPATHIC TREATMENT. According to our remarks on the causes of dysentery, it is evident that there must be a preA'entive treatment of dysentery, and that it must result in great good. From Avhat we haA'e said on the subject, the single points of this prophylactic treatment can easily be inferred. In this place we desire to call attention to the absolute necessity of keeping the evacuations of dysenteric patients separate. It is, moreover, of the ut- most importance to treat every diarrhoea that may occur during epidemic dysentery, Avith great care, and to arrest it as soon as possible, since it is an established fact, that a diarrlnca produces an increased sensitiveness to the dysenteric virus. Mercurius occupies the first rank among the remedies for dysentery, and among the mercurial preparations it is the Corrosive. Sublimate (Merc. Corr.) This remedy corresponds to the symptoms of ordinary dys- entery so perfectly, that it may safely be regarded as a specific remedy for the whole process. The leading symptoms of dysentery, the bloody mu- cus evacuations Avithout any fecal matter, attended Avith the most violent tenesmus and cutting colic, is a characteristic and constant 308 OUR FAMILY PHYSICIAN. symptom of Merc. Corr. All physicians agree that the lower attenuations of this remedy are preferable, and that it should not be gh'en higher than the sixth ; they likewise agree, that the dose should be frequently repeat- ed. The best plan is to give a dose of the remedy after every discharge; as the discharges diminish in frequency, the medicine will likewise baA'e to be repeated less frequently. The effect of the remedy is perceived very soon, in most cases within thirty-six hours. Of course we cannot expect to perceive a striking improvement in tAventy-four hours; nor Avould it be advisable to select another medicine, if no improvement takes place in that space of time. The Merc. Corr. almost ahvays deseiwes a preference in epidemic dys- entery ; Mercurius sol. is preferable in the so-called Avhite dysentery. In epidemic dysentery, the so-called Avhite dysentery is of rare occurrence, and then only a very transitory condition. On the contrary, catarrhal dysentery, is, in even' respect, adapted to Mercurius sol., and it is only in exceptional cases that this remedy will pro\-e unavailing. As long as the evacuations contain feces, although in small quantity, it is well to giA'e the solubilis the preference, no matter Avhether blood is dis- charged Avith the stools or not. On this account, this remedy is especially appropriate in the dysentery of children, especially during the period of dentition. The triturations of solubilis are preferable, whereas the Sub- limate acts better in solution. The Mercurius vims is preferred in this disease by many physicians. Next to Mercurius Belladonna is, without doubt, the most important remedy in dysentery, both the catarrhal and epidemic. As far as local symptoms are concerned, Belladonna is indicated by the violent urging to stool, with or without scanty discharge; violent pains in the distended abdomen; they are aggravated by pressure or else evidently of an inflam- matory character; liability of the rectum to protrude. Other prominent indications for Belladonna are: considerable urinary difficulties, even retention of urine ; violent feA-er, also Avith delirium, severe gastric de- rangement, nausea, vomiting. Belladonna is most frequently suitable for children ; less so for adults. The catarrhal form of dysentery being exceedingly varied, a number of other remedies might be recommended for this disease. Chamomilla, for instance, is a main remedy in the dysentery of teething children, if the local symptoms are accompanied by acute fever, restlessness, sleepless- ness, constant cries, vomiting of bile, nightly aggra\'ation of the symp- toms, or the symptoms only show themselves during night-time. Ano- ther remedy is Ipecacuanha, Avhen the tenesmus only sets in after the discharge, and there is frequent and distressing vomiting of bile, Avhilethe fever is not very considerable; Dulcamara and Pulsatilla, when the discharges consist of mere mucus; they mostly take place at night. Bary- ta, for the dysentery of children, when it threatens to become chronic, provided there are no striking symptoms of ulceration of the intestines. Calcarea carbonica, is adapted to the same form of dysentery as Baryta, likewise applicable to ulceration of the bowel, here it is even a chief remedy for children. A Dose of any of the preceding remedies should be given after each evacuation, provided they do not occur more frequently than every hour. COLK —KN'PERAGIA. 309 We have already stated, that the abovementioned remedies are suffi- cient in epidemic dysentery, unless it should pursue an entirely excep- tional, abnormal course, or be complicated Avith various accessory symp- toms. This statement likewise, only applies to cases that have been treated homceopathically, from the commencement. But we arc also called upon to treat d\y< ntery in its more advanced stages, or after the system has been saturated Avitb powerful medicines. For such abnormal forms of dysentery, the above-mentioned remedies are not sufficient, and one or more of the following list Avill have to be selected. Arsenicum album is never indicated at the commencement of dys- entery, only when evident signs of putrid decomposition become appar- ent, together with paralysis of the boAvels and anus, in a slight degree. The evacuations have no longer a peculiarly insipid smell, but are fetid, of a blackish-brown color, mixed with numerous shreds of mucous membrane. The pains are uniformly se\-ere, the fever is intense, attend- ed Avith sings of rapid prostration and great thirst. Rhus toxicodkndron, Hartmann says : " It is particularly applica- ble in protracted cases, where the violence of the symptoms has been diminished by the previous treatment, but Avhere all the symptoms that characterized the attack from the commencement, are still present; it is prominently indicated by excessive prostration, the blood is greatly deficient in plasticity, the organic activity threatens to become extinct; typhoid symptoms supervene." In other words, Rhus is suitable in typhoid dysentery. A noteAvorthy symptom is the circumstance that the evacuations appear at night; there are also involuntary discbarges. COLIC—ENTER ALGI A. A disease which appears under a great variety of aspects, and Avhichis associated with various derangements, either casual, or permanent and or- ganic. It should therefore especially be considered Avith due regard to the general review of disorders affecting the stomach and intestines, as afford- ed in the article on "Indigestion." Colic may be spasmodic, particularly as associated with hysterical com- plaints; or may be associated with local determination (congestion) of blood as occurring in conjunction with menstruation or piles; or again it may be developed as a transition of disease from other organs: as, for in- stance, when some previous disease has been suddenly suppressed; or again it may be associated with Avorms, or may appear as a manifestation of flatulency; or again, purely from foulness or surfeit of the stomach, or result from indigestible food; in other instances again, colic is associated with gravel, or other organic derangements of the kidneys, etc.; or it may be come developed in consequence of the suppression of chronic eruption on the skin, or again from excessive or acrid discharge of bile from the liver into the stomach and intestines. Symptoms. Griping, tearing, gnawing, or shooting pain in the bowels, chiefly confined to the region of the navel, generally attended with a pain- ful distention of the belly, with spasmodic contraction, and sometimes 310 OUR FAMILY PHYSICIAN. accompanied with vomiting and costiveness, or looseness of the bowels. One of the characteristic distinctions betAveen this disorder and inflam- mation of the bowels consists in the degree of alleviation to which the pain is subject upon pressure. The long continuance and intense severity of colic may however result in inflammation, for Avhich reason it is ever ad- visable to arrest its progress in any severe cases. Causes. The general exciting causes of this complaint are acid fruits and indigestible substances, cold from wet feet, drinking cold beverages when heated, constipation, worms, etc. It is frequently also a concomitant symptom of some other derangement, but occurs equally often as a pri- mary disease. This disease is so well understood, that we are justified in proceeding at once to the treatment, giving in its course various symptoms as devel- oped by different causes. ALLOPATHIC TREATMENT. Colic. In the treatment of colic, the first indication is to relieve pain, whatever may be the cause. This is done best by an injection of a teaspoonful of Laudanum with fifteen drops of Tincture of Belladonna. If there is flatulence, a couple of ounces of mixture of Assafcetida may be used with the Laudanum, as a vehicle. The injection should be made Avith a hard-rubber syringe. If no flatulence exists, the injection of Laudanum, with or without the Tincture of Belladonna, may be given with a couple of tablespoons- ful of Starch Water. The Assafcetida mixture (or Milk) is made by rub- bing two drams of the gum in a pint of water. A couple of teaspoonsful, or a tablespoonful, of the mixture (Milk) of Assafcetida given by injection, is an efficient remedy for the flatu- lent colic of infants. Three to Ave drops of Laudanum may be added if the first injection does not relieve. A cathartic ought not to be given in colic until after the pain is relieved, and then, if no inconvenience is experienced, twenty-four hours or a couple of days may pass before one is given. In the mean time, the bowels will generally move spontaneously. If they do not move, a large injection of warm water may be given. If this prove ineffectual, three Compound Cathartic Pills should be taken. If cathartics are given before relief from pain, the spasm of the in- testine interferes with its action, and it aggravates the malady. Much relief is obtained by hot applications over the abdomen. In mild cases, some hot aromatic tea, as Ginger, Anise, Cloves, or Mint, may giA'e relief. In severe cases, recourse should be had at once to the injection of Laudanum, or to a dose of twenty-five drops, and a tea- spoonful of Spirits of Camphor, by the mouth. Morphine, in doses of a quarter of a grain, or an Opium and Cam- phor, may be given. If complete relief does not obtain in an hour, the "dose should be repeated, either by injection or by the mouth. Hysterical colic is almost always relieved by an injection of a pint of the Mixture of Assafcetida, but if this does not succeed, the same remedy may be given by the mouth, in doses of a tablespoonful—Opi- umor Laudanum may be added, in extreme cases, as directed above. COLIC—ENTERAGIA. 311 The carminath'e teas, before mentioned, and hot applications, are useful. The treatment is given in considering the disease, Hysteria, to which the reader is referred, if anything additional is needed. In rheumatic colic, immediate relief from pain is to be procured as before directed for "colic." The rheumatic trouble may generally be overcome by the continued use of Salycilic Acid in doses of ten to tAventy grains, four times a day, ghTen in capsules or medicine wafers. For further consideration of the rheumatic condition, the reader is re- ferred to the article on Rheumatism. The treatment of neuralgic colic is identical Avith that of neuralgia, to which, and to the treatment of neuralgia, the reader is referred. In Printers' and Painters' Colic (Saturnine or Lead Colic) the treat- ment consists in the first place, in the relief of the extreme pain. This is accomplished precisely as is directed for simple colic. The use of opiates must be persisted in until relief is obtained. The obstinacy of the colic will require their continued administration at Aarying intervals of from one to six hours, for a much longer period than is required in simple colic. Together with the use of Opium a liniment of one part each of Chloro- form, Tincture of Aconite, Laudanum, and three parts Soap Liniment may be freely applied over the abdomen. Hot bathing is also useful. As a means of relieving the pain of lead colic, used continuously Avith the use of Opium and hot bathing, Alum may be ghreii by the mouth, in doses of fifteen grains eA'ery tAvo hours. A good formula is this : Take of Alum tAvo drams, Aromatic Sulphuric Acid one dram, Syrup of Lemon one ounce, Water three ounces. Mix. Dose: A tablespoonful every tAvo hours. A teaspoonful and a half of Alum may be added to a pint of boiling milk, separate the acrid acid of the Avhey (Alum Avhey.) The patient may take a wineglassful eA'ery hour or two. After the pain is relieAed the elimination of the lead from the system may be greatly hastened by free purgation Avitb the saline cathartics. The best one for this purpose is the Sulphate of Magnesia (Epsom Salts.) Take an ounce of Epsom Salts, Aromatic Sulphuric Acid a dram, Water four ounces. Mix. Dose: One-fourth part eA'ery three hours until free purgation takes place. After first gh'ing relief Avith Opium the bowels should be briskly moved every day during the treatment, by the use of Epsom Salts. The Iodide of Potassium is one of the best remedies to facilitate the elimination of lead from the system. Take of a saturated solution of Io- dide of Potassium fifteen drops, three times a day and gradually increase the dose until the characteristic effects of Iodide are produced. Vary the symptoms of an acute catarrh, with the presence of Iodine in the secretion from the nose. A drink of one drain (teaspoonful) of Aromatic Acid to the pint of Avater SAveetened as desired is1 protecth'e against Lead poisoning. Thor- ough cleanliness, washing out the mouth and nose (with a douche), warm bathing each evening, and the occasional use of Epsom Salts as a purga- tive, should be practiced. 312 OUR FAMILY PHYSICIAN In Colic from Copper, the relief of pain as directed for lead colic, with the use of Sulphate of Magnesia for a purgation, are the principal points in treatment, Iodide of Potassium given as directed for lead colic, assists in throAving the poison off from the system. The same precautions as to cleanliness are required as against lead. Milk is said to be a preventive. HOMOEOPATH 10 TREA TMENT. Nux-vomica is a valuable remedy in colic, either associated with fla- tulency or piles, or in colic arising from a chill, and is particularly indica- ted when there is a sensation of fullness and tightness at the upper part of the waist; deep-seated or cutting pains in the belly, Avith acute andhard, pressive, and forcing-down sensations, compelling the sufferer to bend double; confused headache, with occasional loss of conciousness; flatul- ence, aggravation of the pains on the slightest motion, generally disappear- ing Avhen at rest; e-onstipation, coldness and numbness in the hands and feet during the paroxysm; at the monthly period in females, Avhen we find weight, or violent, deep-seated, aching pain in the belly, dragging pains ex- tending to the thigh; aching and creeping sensation in the same part when sitting; painful pressure towards the terminal bowel. ■ Dose: Of a solution of six globules to six teaspoonsful of Avater, give a teaspoonful every half hour (in very acute cases), or every hour when the pain is not continuous or insupportable, until distinct amelioration or change. Pulsatilla is more useful in the affection occurring in females, either during the menstrual discharge or at other times, when coming on periodically in the evening during cold, damp weather; also when there are present a disagreeable tightness and distention of the belly and the upper part of the waist, pulsation in the pit of the stomach, aggravation of the suf- fering when at rest or in the evening, attendedwith shivering, which increases with the pains, and is mitigated by motion, when it has arisen from over- loading the stomach, or from rich, greasy food, with inclination to vomit, flatulence, looseness of the bowels, paleness of the face, livid circle round the eyes, and headache; also hsemorrhoidal colic, with fullness of the veins of the hands and forehead, restlessness, anxiety, and sleeplessness. Dose: A soluti m of six globules, or otherwise, in all respects as direc- ted for Nux-vomica. Chamomilla is chiefly useful for bilious colic (with looseness of the bowels and bilious vomiting); or for colic in females during the menstrual discharge. The following are the principal indications; sensation as if the intestines were gathered into a ball, and as if the belly were empty, with tearing and drawing pains, attended Avith excessive anxiety and restlessness ; distention under the lower ribs, and in the pit of the stomach; incarcerated flatulency, sometimes nausea, bitter vomiting, followed by desire to relieve the bowels, and bilious diarrhoea; livid circles round the eyes, alternate paleness and redness of the face; the pains come on parti- cularly at night, at times early in the morning, or after a meal. This remedy, particularly adapted for children of irritable temperaments, and is extremely serviceable in all cases in which a fit of passion has been the exciting cause of the sufferings. It is also useful when colic has arisen from cold in the feet, or checked perspiration. Dose: As for Nux. C( )L1C—ENT KRALGI A. 313 Oolocynth.—In the majority of violent and obstinate cases, we find this a most valuable remedy ; it is indicated Avhen the pains are excessive- ly violent, and of a constrictive or spasmodic character, or resemble stabbing and cutting, as if from knives; sometimes there is a sensation of clawing and pinching, and tenderness of the belly, with a pain as from a bloAV, or distention ; at other times a sense of emptiness is experienced, Avith cramps and shivering, or tearing pains in the legs; during the continu- ance of the attack, Ave find excessiA'c restlessness, agitation, aud tossing about, from the A'iolence of the pain ; when the pains come on, they con- tinue Avithout any apparent intermission ; after their disappearance, a sensation of bruising remains, and the sufferer feels as if the intestines Avere held together by thin threads, likely to break from the slightest mo- tion. This remedy, like Chamomil/a, is particularly efficacious in the so-called bilious colic, being indicated by the loose discharge from the boAvels, and bilious vomiting attending it; and also in cases where passion has been the exciting cause. Colocyn.th is more particularly useful in the case of adults. Dose: As for Nux. Belladonna is useful against flatulent colic, when there is protrusion of the transverse section of the great intestine, which becomes distended like a pad above the navel, attended Avith colic-like pain, doubling up of the body, which is relieved by pressure on the part; also severe bearing-down of the whole intestines ; also in menstrual colic, Avith spasmodic constric- tion in the belly, and a burning pain lower doAvn, or in the small of the back; pain in the lower part of the bowels, as if a number of nails were. holding the intestines. The symptoms are also attended Avith a liquid or matter-like discharge from the bowels, and SAvelling of the veins of the head ; and the pains are sometimes so violent as almost to deprh'e the pa- tient of reason. i Dose: Of a solution of six globules to two tablespoonsful of Avater, give a teaspoonful every half hour (in very acute cases), or every hour (when the sufferings are not continuous or intolerable), until distinct amelioration or change. Cocculus is indicated (especially in menstrual or flatulent colic) when there are severe constrictive or spasmodic pains and distention of the en- tire stomach, with nausea and fullness of the lower part of the belly, great flatulence, and difficulty of breathing ; also when there is a sensation of emptiness, and tearing and burning pains in the intestines, sometimes with squeezing, tearing and pulling pains, excessive anguish and nervous excitement; constipation. Dose: As for Bell. Arsenicum is often appropriate in cases of colic (bilious), arising from disordered stomach, \vith nausea, A'omiting, great relaxation of the bow- els, Avith green or yellow evacuations, violent gripings, headache, pale- ness of the face, and blue marks round the eyes. Again, in cases of bilious colic, which is prone to be preceded, followed or alternated with sick headache, Arsenicum is of great service. Dose: As for Nux-vomica. 314 OUR FAMILY PHYSICIAN. Coffea is valuable when we have to prescribe for colic Avith excessive pains, attended Avith great agitation, anxiety, and tossing about, grinding of the teeth, convulsions, suffocative attacks, oppressive despair, acidity, and coldness of the body and extremities. It is also useful in some kinds of menstrual colic, denoted by a sensation as if the belly were being rent asunder; or by fullness and pressure in the stomach, and violent spasms, which extend to the chest. It is also indicated by cutting pains in the in- testines as if divided by a knife, and also by the pains present being so vio- lent as almost to drive the patient to distraction, causing him to bend double, and draw up his limbs. Dose: As for Bell. Ignatia is a most valuable remedy for colic, particularly as affecting female patients of delicate constitution, and is indicated by the following symptoms amongst others: Fullness, tightness and pressive sensation across the region Avhich extends along the lower ribs; accumulation of wind in the bowels which is expelled with much difficulty, a relief, how- ever, being obtained upon /the expulsion of wind: stitching pains in the region of the spleen, etc.,—more especially however, if the colic occurs, or is worse at night. Dose: Of a solution of eight globules to three tablespoonsful of water, give a teaspoonful every hour, (or in very mild cases, every three hours), until distinct amelioration or change. Iris-versicolor {Blue Flag). Involuntary escape of fluid of an offen- sive, putrid and copperyodor. In cholera morbus it arrests the violent pain. Mercurius is a medicine of great value in cases of colic, character- ized by the following assemblage of symptoms:—nausea with profuse flow of saliva; voracious appetite with repugnance to SAveet things; frequent and troublesome hiccough; constant and painful urging to evacuate; se- vere pinching, drawing, nipping pains, with tightness and hardness of the belly particularly about the navel: or tensive, stinging, cutting, or burning pains; aggravation of these sufferings at night, and more particularly in the latter part of the night; extreme tenderness of the belly upon contact or pressure (the clothes or bed-clothes appear to cause pain); sometimes looseness of the bowels with slimy evacuations; considerable prostration of strength and chill (or even shuddering), accompanied with flushing of the cheeks. Mercurius is also a most important medicine in cases of colic associated with worms. Dose: Of a solution of six globules to three tablespoonsful of water, give a teaspoonful every half hour until three doses have been given, and then every hour until distinct amelioration or change. Secale-cornutum is indicated for male patients affected with colic attended with pain in the small of the back, eructations and vomiting, or dragging, tearing pain in the thighs:—or amongst female patients for colic occurring at the menstrual periods, when tearing pains in the bowels, pale- ness of the face, small, weak pulse, coldness of the extremities, and cold sweats are predominant symptoms; or when constipation with cramp-like pains in the bowels, and burning pains on the right side of the belly prevail. COLIC— ENTER ALGT A. 315 Dose: Of a solution of eight globules to three tablespoonsful of water, give a teaspoonful every hour until the suffering abates, and then every three hours until distinct amelioration or change. Carbo-veg. occurs, in many cases of somewhat serious aspect, as a medicine of great importance, and is particularly indicated by the follow- ing symptoms:—violent pains in the bowels, provoked even by the light- est and most Avholesome meal: sensation of heat in the head and in the bowels; determination of blood to the head, attended with heavy, aching pains; fullness and tightness of the belly so severe, as to convey the sen- sation that it would burst, and accompanied with flatulent risings, or ac- cumulation of wind with difficulty and oppression of breathing, nipping pains and rumbling, and sluggish action of the bowels. Carbo-veg. may often be administered Avith striking success in cases of colic associated with piles or Avith flatulency. Dose: As for Bell. PREDISPOSITION TO COLIC. Sulphur is amongst the most valuable remedies in the generality of cases in Avhich a constitutional predisposition to affections of this nature is evinced by the failure of other medicines to afford permanent relief. Wherefore, in particular, if Nux-vomica, or Carbo-veg., or if both have been employed as above directed, in cases of colic associated with piles, but have failed in obviating the repeated recurrence of the attacks, the perse- vering administration of Sulphur becomes necessary. The same may also be said of bilious colic, in Avhich Chamomilla or Colocynth, or both have been employed with similar results. The same remark is equally applica- ble to cases of flatulent colic, in which Nux-vomica, Carbo-veg., Chamomilla or Cocculus, or two or more of these medicines, have been previously em- ployed in like manner. Dose: During the continuance of an acute attack, of a solution of six globules to two tablespoonsful of water, give a teaspoonful every hour until relief is obtained. Subsequently, however, give six glo- bules in a wineglassful of water every morning the first thing {fast- ing), for ten days, (unless collateral symptoms should appear in the meanwhile)—after which, pause four days, and resume the course as before (if necessary), and so on until the symptoms are perman- ently subdued or undergo a distinct change. worm colic. As this is in point of fact, a mere symptom dependent upon the pres- ence of Worms in the intestinal canal, or upon the cases which promote the generation of these parasites, the subject will be more accurately con- sidered in the article devoted especially to that subject,—to which there- fore the reader is referred. HOME MEASURES IN CASUAL ATTACKS. In cases of colic, arising suddenly from indigestible food, a cup of black coffee, without milk or sugar, will frequently afford relief, by causing the stomach to free itself from the caus of annoyance:—that is, in patients who have not used that article as an ordinary beverage. Diet and Regimen. In this, as in all other complaints arising out of derangements affecting the functions or organs of digestion, the diet and 31(1 Oil! KAAIILY THYSICIAN. general habits, or the particular precautions in individual cases, should be regulated in conformity with Ihe directions afforded under the head of "Indigestion." If particular food or drink, such as raw fruit, milk or cold things, be apt to provoke an attack of colic, the particular food or drink in question, in every particular case, should be carefully avoided. CONSTIPATION AVITH DETERMINATION OF BLOOD TO THE HEAD. ALLOPATHIC TREATMENT. Constipation is to be treated, ahvays, with reference to the producing cause. In temporary constipation, as that of pregnancy, and in recovery from acute disease, is to be met, chiefly, by attention to the diet; but, if this fail, recourse should be had to laxatives or, possibly, in the first place, to an active purge. If there is complete obstruction, the disease is too serious to be tampered with by any but the most skillful man. In habitual constipation, there should be a regular effort at stool, at a regular time, Avhether the desire exists or not. The preferable time for this is soon after breakfast. As a preventive of constipation never should the natural desire to go to stool be voluntarily restrained. The constipation should be remedied as far as possible Avithout medi- cines, but by laxith'e food. Vegetable diet tends toward a looseness of the bowels, and animal food, by being almost Avholly absorbed, to consti- pation. The articles of diet to be preferred for this end are, cracked Avheat, Graham flour, Indian meal or hominy, and oat meal prepared ac- cording to the art of the kitchen, eaten with cream and sugar, or with butter and molasses. Almost all kinds of fruit, taken quite freely, are advantageous in OA'ercoming constipation. Molasses and broAvn sugar aid to make the bowels more lax. Milk is constipating, but only, I believe, because it is almost wholly absorbed. None of these articles of diet are to be used if they disorder digestion or occasion other disturbance. Sometimes more harm is done by burden- ing the stomach and bowels with articles difficult of digestion, or loading the intestines with unbolted flour, than could be done by the consti- pation. In the use of medicines, the patient should not, as a rule, be phys- iced, but the least active medicines which will accomplish the result, are to be used. If, however, constipation has for a long time been present, and the bowels filled with fecal accumulations, a cathartic which will thoroughly empty them is a necessity. For this purpose, a tablespoonful of Epsom Salts is a most efficient remedy. If boiled with a teaspoonful and a half of roasted coffee, for a couple of minutes in an earthen A'essel, and after it is allowed to draw for a few minutes and strained, the taste will be covered. A tablespoonful of Castor Oil, mixed with an equal quantity of Gly- cerine, flavored with a couple of drops of Oil of Cinnamon is appropri- CONSTIPATION. 317 ate under the same conditions. From three to five Compound Cathartic Pills, are also suitable for an immediate cathartic. Cathartics must not be frequently repeated, as this secondary effect is to render the bowels torpid; therefore, the smallest dose and the mildest means which will accomplish the result, should be resorted to, and pref- erably those which lmve the peculiarity of not causing constipation after their action. One of the best of this class is Aloes. As a cathartic, the dose is from two to ten grains, but a fraction of a grain with tonics suf- fices, generally. The remedy is Avell suited to all causes of debility in this disease, and to cases of hypochondria as Avith constipation. With sedentary persons Avho cannot change their occupation to an acth-e life, and Avomen who suffer from a torpor of the intestines, and consequent constipation, the following pill Avill be found, in most cases, to overcome the trouble: Take of Extract of Nux-vomica, Extract of Bel- ladonna, each ten grains, PoAvdered Aloes fifteen grains, Extract of Dan- delion thirty grains. Mix well, and divide into thirty pills. Take one pill at night. If the bowels do not move the next morning, another pill should be taken, but usually one day Avill be sufficient. If this proves too acth'e, the Aloes should be omitted from the formula. The directions for taking will be the same. After the bowels have been moving regularly for a long time, the pill should be omitted, and only taken again if the regular opening of the boAvel does not continue. For those Avho cannot take a pill, the same remedy may be given in fluid. Take of Tincture of Nux-vomica and Tincture of Belladonna each two and a half drams, and of Tincture of Aloes and Fluid Extract of Dandelion each fhre and a half drams. Mix. Dose: A teaspoonful, un- der the same conditions. The Dandelion is not necessary to the efficiency of the prescription. The Belladonna and Nux Vomica restore the tone and healthy action of the intestine and seem, in my judgment, essential, particularly the lat- ter, for the cure of many cases of constipation. There are many pills in the market for the relief of constipation, Avhich have merit, as the Ecco- protic pill of Win. Warner & Co., and the Aperient pills of other leading pharmaceutists. Before purchasing any of them, it should be ascertained that they contain Extracts of Nux Vomica and Belladonna or Hyos- cyamus. From ten to twenty drops of the Tincture of Colcbicum after each meal will often overcome constipation. Podophyllum is an appropriate laxative for constipation, a quarter of a grain is an appropriate dose. It is often used Avith benefit Avith Belladonna, and Nux Vomica, as may also be the Compound Extract of Colocynth, the dose of Avhich for this pur- pose being tA\'o grains. One or two Compound Cathartic pills at night relieA-e constipation, but do not produce a cure as a rule Avithout the use of Nux Vomica or Strychnine. Senna is not inappropriate as a laxative. The Confection of Senna may be eaten, one or two teaspoonsful at a time, or a tea of ten ounces of Senna leaA'es to a pint of water may be made, and one to four ounces taken at a time. Co-existing dyspepsia will require treatment as directed in that diss- 318 OUR FAMILY PHYSICIAN. ease. A general debility will require tonics of Quinine and Iron. The Citrate of Iron and Quinine two drams and a half, dissolved in four ounces of Syrup of Orange Flowers, is one of the best tonics. Dose: A teaspoonful three times a day. The Syrup or Elixir of Iron, Quinine, and Strychnine, in doses of a teaspoonful three times a day are appropriate. Many other tonics might be given, and particularly suitable to cases afflicted Avith constipation. If a person is of a full habit, a teaspoonful of Epsom Salts daily, is an effectual remedy for his habitual constipation. The regular use of an injection of cold Avater is a simple and often effectual temporary measure for relieving constipation. A piece of hard soap, about the size and shape of a pigeon's egg, will sometimes excite a movement of the bowels. These are only temporarily useful. An effect- ual cure almost always depends upon the will, establishing the habit of a regular motion, with the tone restored to the intestine by the use of Nux Vomica and Belladonna. If these are given for a time with Aloes or Podophyllum the cathartic should then be omitted and the Bella- donna and Nux Vomica given alone. If the plan before suggested of having a regular time for stool and alloAving nothing to interfere with it were rigidly carried out, and taught by parents to their children, constipation Avould be a disease as seldom met Avith as it is frequent now. HOMOEOPATHIC TREATMENT. Aconitum, Belladonna. One or both of these medicines may be advantageously administered, singly, in alternation, or in succession, and in addition to such as have been mentioned \vith detailed indications (such as Opium, Nux-v. etc.), Avhen the constipation is associated Avith predominant fullness of the acsscIs of the head. Dose: Of either medicine, as selected, give three globules in a tea- spoonful of Avater, every six hours, until the predominant head- symptoms are modified, and then every tAvelve hours, until positive amelioration or change. HOME MEASURES. In all cases of an inveterate or chronic nature, recourse may, occa- sionally, be had to an enema, or lavement of tepid or of cold Avater, as a temporary mode of relief, until the medicine has effected the desired re- sult. The drinking of a tumblerful, or more, of cold Avater, thrice a day, Avhen fasting,—dashing cold water against the belly, and then applying brisk friction, by means of a coarse towel,—combined Avith early rising, and daily exercise, (not violent or beyond the strength of the patient, so as to cause suffering,) will be found useful auxiliaries in promoting a reg- ular action of the boAvels. Electro-magnetism is another, and most useful, auxiliary, either in cases arising from culpable neglect, or indolence, or from inability, or im- practicability, to relieve nature Avhilst traveling. In chronic cases aris- ing from inertness of tlie boAvels, or a sort of intestinal paralytic debility, the application of electro-magnetism is often superior to any other aux- iliary. HAEMORRHOIDS—PILES. 319 Diet. The diet ought to be regulated according to the state of the primary digestive organs, and highly seasoned food, or that which con- tains much fibrous or ligneous matter, such as radishes, cabbages, turnips, green fruits, etc., should be avoided. HAEMORRHOIDS. PILES. Symptoms. Enlargement of the veins, or effusion of blood in the cel- lular tissue of the terminal bowel, either Avithin or Avithout the funda- ment (internal or external piles); or protrusion and distention of one or more of the inner foldings of the same intestine, with or Avithout bleeding (open or blind piles), preceded or accompanied by pains in the back, the base of the spinal colum, and belly; sensation of itching, prickling, tick- ling, burning, or pressing at the terminal bowel, sometimes extending to the adjacent parts, with, in general, constipation, and not unfrequently derangements of the urinary organs. Predisposing causes. The predisposing causes of the disease are: 1. A constitutional taint. 2. Local debilitation of the vessels by contin- ued excesses, by abuse of warm drinks, purgings, or injections, etc. Exciting causes. Among the exciting causes are, habitual costive- ness, severe exertion on horse-back, use of drastic medicines, of warm, stimulating diet, or of A'inous, alcoholic, and fermented drinks, tea or cof- fee, the excessive use of seasoned food and spices, the suppression of long- continued discharges, sedentary habits, sitting on a cold seat or on damp ground, the pressure of the gravid womb, tight-lacing, or any other cause of local pressure, morbid accumulation of blood in the liver, mental emo- tions, etc. The painful practice among surgeons of removing the hemorrhoidal excrescences by means of the knife or ligature, is much to be deprecated ; for, independently of the danger not unfrequently attending the opera- tion, it may occasion serious consequences by a sudden transfer of the congestion to some of the noble organs; in a great number of cases, more- over, it wholly fails, and the disease returns, sometimes even in an aggra- vated form. ALLOPATHIC TRREATMENT. Treatment of Haemorrhoids (Piles) will consist in the first place in the avoidance of those causes which predispose to congestion of the veins of the rectum (lower boAvels.) Active out door life must take the place of sedentary occupation. Constipation must be completely remedied by the means directed for that disease. Attention to diet and the regular habit of emptying the boAvels being all-important. Cathartics nor injections Avill not answer this purpose, though, as directed for constipation, a free cathartic will be necessary, Avhen the bowels have been for a long time inactive and the bowels filled Avitb fecal accumulations. When this con- dition of the bowels is attended with recurring attacks of bleeding the cathartic is especially useful. 320 OUR FAMILY PHYSICIAN. Straining at stool must be avoided, neither must the patient remain long setting at stool. The inflammation which causes futile efforts at straining, must be restrained by anodyne remedies. These efforts increase the congestion and contribute towards the formation of tumors. Diar- rhoea must be treated as directed in that disease. The lax condition of the tissues in diarrhoea aids in the development of piles. Immediately after the evacuation of the boAvels has occurred the anus (opening of the bowel) and the protruding piles should be bathed with cold Avater. The parts should be carefully dried and annointed with an ointment made by the folIoAving formula: Take of Tannin a dram (sixty grains), Puh'erized Opium a scruple (twenty grains), and Stramonium Ointment an ounce. Mix. Fhe grains of Morphine may be used instead of the Opium. In the absence of this ointment before the piles are re- turned they should be washed and dried as before, and lubricated with Cold Cream, Sweet (Olh'e) Oil, or Glycerine, before they are returned. When the piles are protruding, they can be more readily pressed back Avhen the patient is in a stooping position with the hips raised, or sup- ported on his knees, while the chest and head rest on the bed. If the piles become swollen and inflamed and cannot be returned, the patient should remain in bed and cold applications, as cold Avater, or a cloth wet in a solution of Sugar of Lead thirty grains. Acetate of Morphine ten grains, in a pint of soft water, or poultices, may be used. The aboA'e ointment may be made more curative by thoroughly mix- ing Avitb it half a dram of Iodine. At night the ointment should be ap- plied again, and if the piles have not protruded, it should be introduced into the rectum Avith a suppository tube. Much suffering may be avoided by establishing the habit of haA'ing the regular movement of the bowels occur just before bedtime, after Avhich if the piles are returned, as before directed, the sphincter muscle recovers its tone duriug the night, and the tumor of piles does not escape during the next day. My removing this much irritation, so much has been done toward a cure. The stools may be rendered soft and imirritating by taking one or two teaspoonsful a day of the folIoAving mixture in water : Take of each Magnesia, Sulphate of Magnesia, Precipitated Sulphur, and Sugar of Milk, an ounce, and Pulverized Anise Seed half an ounce. Mix Avell. The use of Ergot and Nux-vomica Avill often overcome the laxity of the tissues about the rectum, Avhich predispose to piles, as : Take of Er- gotine iSquibb's Extract) a dram, Extract of Nux-A-omica fifteen grains ; make into thirty pills and give one night and morning; or take of Fluid Extract of Ergot one and a half ounces. Tincture of Nux-vomica half an ounce. Mix. Take a teaspoonful morning and cA'ening. It is claimed a cure can be effected by the faithful application of :i lotion of Iodine, Tannin and Stramonium, every night, to the part. Take of Iodine thirty grains, Iodide of Potassium six grains. Water eight drops is sufficient, (ilyrerine an ounce. Mix, and add to the mixture two drams of Tannin, and afterward mix with it, in a mortar, a dram of Extract of Stramonium moistened with sufficient water. Label Pile Lotion. This solution, to be beneficial, should be applied every night. HAEMORRHOIDS—PILES. 321 A suppository of talloAV may be formed, with the fingers dipped in this mixture, and inserted into the rectum at night, and allowed to remain until morning. If a greater anodyne effect is desired, five grains of morphine may be added to the solution. The farther treatment, if required, belongs to the practical surgeon. The most approved and most efficient treatment for the cure of pile is the old and well-tested operation of tieing them off. The cure, by this means, is the most invariably complete of any method known. The plan is to thoroughly empty the boAvel with Epsom Salts or Castor Oil the evening before the operation. In the morning the patient should, a couple of hours before the operation, take a large injection of a quart or more of warm water, and then take a half a grain of Opium. Then the anaesthetic can be given the tumors exposed Avith a Thebault's anal Speculum, and the tumors brought within reach with a Vulsellum. A large needle Avith a stout silk thread is passed through the base of the tumor, the needle removed and the thread tied tight on each side of the tumor, but not tight enough to sever the tumor. Two tumors oper- ated on in this Avay on each side of the gut, is sufficient to cause the cure of the others, if any exist. The patient will remain in bed, the pain relieved by Opium in doses of a grain. The boAvels should not be moved until the fourth day, when Castor Oil may be given, folloAved by an injection of Avarm water. After the operation, the urine (water) Avill gen- erally require removing Avith a catheter. If the operation is to be done Avithout an anaesthetic the cathartic should be given only about five hours before the expected operation, and, after they move, the Avarm Avater in- jection is given and the patient brings down the tumors by straining over a vessel of warm Avater. When the tumors are down they are tied as be- fore directed. Small folds of membrane may protrude from the anus; when inflamed they are troublesome and frequently bleed. They should be removed Avith the scissors, if not inflamed, and if bleeding follow, Sub-Sulphate of Iron ought to be immediately applied to stop it. Other plans of treatment are by excision, the hot iron, Nitric Acid, the galvanic cautery or the ecraseur; but the plan of tieing them off is to be preferred. The object is to obliterate the tumors. The plan of causing the obliteration of the tumors by injecting Car- bolic Acid into each tumor, with a hypodermic syringe has come quite generally into vogue. A mixture of one part Carbolic Acid to three parts of Glycerine. Four to six drops may be injected into each tumor. A coagulation is immediately formed in the tumor, which results in its ob- literation. Carbolic Acid, applied to the tissues, is an anaesthetic, so this operation is not painful, but the inflammation which sometimes results, causes so much suffering as to call for anodynes. For this purpose, Opi- um and Belladonna maybe given by injection into the rectum—a tea- spoonful of Laudanum and ten to fifteen drops of the Fluid Extract of Belladonna, in a little Glycerine, Avill be quite effectual in controlling the inflammation and pain. The injection may be repeated in twelve hours, if necessary. Further means for relieving pain should be by Opium giv- en by the mouth. For this plan of treatment, the same preparation is 21 322 OUR FAMILY PHYSICIAN. required as for the operation by the ligature (tieing off), and the after- treatment will be the same. To prevent the return of piles, after a cure, attention to the general habit is necessary. The regular evacuation of the bowels, and keeping the fecal discharges in a soft state by diet and laxatives, as is directed for constipation. HOMOEOPATHIC TREATMENT. Nux-vomica is a most valuable remedy in this affection, and is very efficacious against both descriptions of piles, but especially against bleed- ing piles, particularly for individuals who lead a sedentary life, or who indulge in the use of coffee or stimulating liquids, and also for females during pregnancy—when the haemorrhoids are attended with shooting, burning, or itching pains, colic, shooting and jerking pain, or pain as if from a bruise in the loins, rendering it difficult to rise or walk in an erect position ; and when they are accompanied by constipation and sometimes painful and difficult passing of water, and the other symptoms described, as indicating this medicine, under the head of " Indigestion." Dose:' Eight pills in a teaspoonful of water, night and morning, until amelioration or change. Sulphur may follow the administration of Nux-vomica; and an alternation of these remedies, at intervals of a week or ten days, frequent- ly effects a cure in cases of long standing. Dose: If to follow Nux-vomica, to complete the cure, give six globules in a wineglassful of water, every morning the first thing {fasting) for ten days. Pulsatilla.—Discharge of blood and mucus during stool, and at other times, with painful smarting and sensation of excoriation in the piles, pains in the back, pallid countenance and disposition to fainting; difficulty in passing water. Dose: Of a solution of eight globules to six teaspoonsful of water (to which add ten drops of alcohol), give a teaspoonful morning and evening, until the whole is consumed. If further treatment then be requisite, pause four days, and recontinue the course in like manner. Ignatia is indicated by itching and creeping, and also sensation of constriction and excoriation in the posterior passage, and prickings ex- tending deep into the lower intestine; discharge of blood or of bloody mucus, rumbling noise in the belly, and protrusion of the lower intestine, accompanied with acute pain. Dose: Three globules in a teaspoonful of water, every twelve hours, until amelioration or change. Antimonium-crudum.—Discharge of mucus and of blood at every stool, followed by severe colic and pains in the piles, with throbbing, itching and burning at the fundament, and discharge of glutinous, acrid moisture, particularly at night; frequent determination of blood to the head, with bleeding at the nose ; stiffness in the back, shooting pains in the loins, burning and rheumatic pains in the limbs, flatulency and constipation Dose: Of a solution of six globules to two tablespoonsful of water, give a teaspoonful every six hours, until four doses have been'given, and then every twelve hours, until positive change. WORMS. 323 HOME REMEDIES. Take four or five ripe buckeyes just after they come from the tree, re- move the outer brownish shell from them ; slice them up fine. Put them in a tin cup with enough melted lard to cover them ; let them simmer or steep near a fire for an hour or tA\o. Then strain and press out the lard, and when cool, it (the lard) is fit for use. A little of this ointment must be applied to the tumors and within the bowel twice a day. Take the leaves of Mullen, a large handful. Put in a quart of cold soft Avater and place over the fire ; let it simmer until reduced to a pint; then take out all the leaves, pressing them as dry as possible. Now put all the remaining liquor back over the fire and let it remain until reduced to one-fourth pintor less ; put in three tablespoonsful of good, clean lard, and a lump of beeswax as large as a hulled black walnut; let it simmer until all the water has passed off in steam, then take off the fire and stir until almost cold, when you will have a nice smooth salve. To use.—Apply a little of the salve to all the affected parts two or three times a day, rubbing it in well A\'ith the finger, reaching well up the bowel. This is reliable and gives permanent relief. The surgical operation for the radical cure of Piles, which has been of very late years introduced among physicians, and also used to a great ex- tent by specialists who have uniformly charged from fifty to five hundred dollars and eA'en more for the operation, is only this simple thing : Take of Carbolic Acid fifteen grains, of pure Glycerine seventy-five grains. Mix. Of this inject with a hypodermic syringe one to three drops (owing to the size of the tumor) into each tumor. This causes the formation of pus or matter and the absolute destruction of the piles, but the pain after the operation is very great and also needless. One hour before the operation an injection of one dram of Tincture of Nux Vomica, one dram Tincture of Stramonium and one dram Laudanum to a quart of water should be used. After the operation, a salve made by adding one dram Arnica Flower, one dram Stramonium (Jimstown Weed) leaves dry, one dram Tincture of Aconite, to a quart of water; let it simmer slowly until it is reduced to one half pint, then add half a pound of good lard and an ounce of beeswax. Let this evaporate on the back of the stove, or near the fire until all the Avater is gone, Avhich will be when there is no more steam from it. It will burn \Tery easy. Then pour off and press out all you can from the leaves, etc., and use to rub well on all the affected parts two or three times a day, being careful to reach as far up the bowel as you can. With these precautions you will make a sure, safe, and almost painless cure. It will be best to go to some good, careful doctor who knows his busi- ness, to get the hypodermic injections made. The rest you can do just as well. WORMS. HELM 1NTHIASIS. INA'ERMINATION. The number of worms that are found more or less frequently in the human bowels is very large. Here Ave will name and speak of three 324 OUR FAMILY PHYSICIAN. A'arieties as being the ones likely to produce any of the symptoms of dis- ease. First: Pin worms or thread worms. Second : Long round worm or Luin'n h-oid. Third : Tape worm or Tornia. First: The pin avorm is the smallest of the three; it is one-third to one-half an inch long and as thick as common size thread. It has a very small swelling Avhich it uses for, and out of courtesy we call it, its head. Usually it is found only in the very last part of the intestine and some- times in the vagina, into which it crawls from the anus. At times, only a few are seen together; sometimes, however, they occur crowded together in largfe masses, most generally among children. The symptoms occasioned by this worm, A'ary a great deal. One of the most common, is a A'iolent, distressing itching of the anus, especially in the evening and at night, and disturbing sleep a great deal. Some children are driven almost frantic by this itching, and are tormented by an almost unaccountable nervousness in consequence of it. Among adults, this itching is scarcely ever so painful and severe. The irritation caused by the worms, sometimes occasions a catarrhal affection of the mucous membrane of the rectum, or a spasmodic contraction of the sphincter, Avith a constant urging to stool, Avhich is not less distressing than the itching. If a large number of them penetrate into the vagina they cause severe itching, Avbites, and the constant rubbing is apt to give rise to self-abuse. Beside these less important results, Ave sometimes meet without any otherwise assignable cause, Avitb more important disturban- ces, principally of the central nervous system, sometimes resulting in indefinite spasmodic movements, and at other times in eclampsia, epilep- sy, chorea, etc. We cannot prove that these affections are caused by worms, but this seems the more probable, as a removal of the worms is sometimes succeeded by an entire disappearance of the nervous dis- ease. ALLOPATHIC TREATMENT. Worms. For practical purposes, it is sufficient to dh'ide the treat- ment for worms into that for seat worms (ascarides), also called " pin- worms" and thread-worms. Hound worms (lumbrici), and tape worms (taeniae). Scat worms inhabit the loAver boAvel (rectum) and large intestine. Tn females, they sometimes invade the vagina. They deposit their eggs iu the folds of the anus and vagina. Remedies, to be effecfh'e, must be ap- plied to these parts. One of the best and simplest is a large injection of a solution of common Salt, repeated every third or fourth day until three or four injections are given. Some of the same solution should be applied to the folds of the anus, and, with female children, to the folds of the ex- ternal genitals. In cases of females, an injection may be required into the vagina. One injection will kill all the Avorms that it touches, but the eggs hatch in three or four days, so that the injection needs repeating. Tea (infusion) of Quassia is, also, effective as an injection. The strength of this tea is tAvo ounces of Qassia chips to a quart of Avater. AVORMS. 325 A weak decoction (tea) of Aloes may, also, be used for the same pur- pose. In case the last two remedies are used, a solution of Carbolic Acid should be applied with a sponge to the folds of the anus and external genitals of female children. Should the Avorms continue to appear, it indicates that they lodge high up in the intestine, and a feAV doses of Santonine of two to fiA-e grains to an adult, and half a grain to a grain to a child, should be given two or three times a day, for two or three days, followed by a purge of twenty grains of Calomel for an adult, or five to ten grains for a child, or of Cas- tor Oil. The Santonine may be given poAvdered with a little sugar. After the purge, the injections will complete the cure. HOMOEOPATHIC TREATMENT. Of all three kinds of AA'orms the expulsion of the pm worm is by all odds the most difficult. Internal remedies can do very little good, as these little pests haA'e their home in the Arery lowest part of the boAvels, Avhere medicine taken by the mouth cannot reach them to do any good. But a solution of salt in Aval or about Iavo teaspoonsful to the pint will reach them, if used as an injection, and repeated a feAV times. Or a decoction (tea) of common garlic {Allium Satirum) used in full injections fer a month; at intervals of three or four days, will make them seek a more pleasant place. A few doses of Cina. or Sul ph. will remove any unpleasant constitu- tional symptoms remaining after the removal of the worms. Dose: Of either, six pills dissolved in a teaspoonful of water every morning before eating. long worm (lumbricoides). The intestinal long worm is the most common of all. It is from six to twelve inches long, has a cylindrical body of the size of a goose-quill, tapering at both ends. Its common abode is the small intestine ; exceptionally the worm Avanders into thestomach. Very seldom only one worm is present in the intestine, generally there are seA'eral together, sometimes as many as twenty or thirty, and even many more. The symptoms caused by the presence of these worms, vary greatly. In the majority of cases there are no very prominent symptoms present; it is only by accident that the presence of worms is generally discovered; the only symptom is perhaps an increased longing for bread, and pota- toes ; and perhaps a less fresh and healthy complexion. More deep-seated and more general derangements, may be caused by a number of worms together, or by the agglomeration of the worms into large balls, or by their entrance into some other organ ; or else the boAvels may be exceed- ingly irritable, in consequence of which a small number of worms may cause intestinal catarrh or enteritis, together Avith their consequences. Among these latter, Ave number the nervous phenomena caused by worms, which have already been mentioned in the paragraph onpin- Avorms. The ailments caused by lumbrici, often resemble greatly other more or less important processes, such as gastric fevers, typhus, dysentery, and 326 OUR FAMILY PHYSICIAN. likewise the above-mentioned nervous derangements; it is of no small importance to ascertain their origin at an early period. These nervous derangements manifest themselves by various phenomena, of more or less constant occurrence. The appetite becomes fitful, or the patient has a more or less exclusive, or, at any rate, decided hankering for farinaceous food; the nose and anus itch violently; the pupils are considerably di- lated ; the eyes are surrounded with dark margins; the patients are of a changeable and irritable mood ; bowels act irregularly, at times consti- pated, at other times alternately constipated and loose, with frequent changes of this character. It sometimes happens, that their irritation occasions a real gastric fever, Avhich does not always disappear immedi- ately after the removal of the worms; large balls of these worms, may even cause the same functional or structural changes as hard masses of fecal mat- ter. Properly speaking, it is only in children, that lumbrici cause nervous derangements, and it is well, Avhen these derangements manifest them- selves, that you should direct your attention to the presence of worms. In giving medicines for worms, the bowels should be as empty as they conveniently can, so that the remedy may act on the worms as en- ergetically as possible. For this reason, it is best to give remedies for worms in the morning before breakfast, and if cases are rebellious, the patient should abstain from eating till noon, or through the day. Medicines ought not to be given to children, for worms, merely on suspicion, but only when there is positive evidence of their presence. For round worms, one of the most efficient remedies is the Fluid Ex- tract of Pink Root and Senna. The dose for an adult is a tablespoonful, and half a teaspoonful to a teaspoonful for children, every four hours un- til it purges. This will probably end the round worm. Wormseed Oil, in doses of five to fifteen drops on sugar, three times a day for two or three days, followed by a purge of Castor Oil, is successful treatment. It may also be given with the Fluid Extract of Pink Root and Senna. Santonine is an efficient remedy against the round worm. It is tasteless, and may be given Avith sugar, or sprinkled on bread and but- ter. The dose is from half a grain to five grains, according to the age of the patient. It should be given three times a day for a couple of days, followed by a purge of Calomel or Castor Oil. After the purge, it should be given for a couple of days, to destroy any worm which may recently hatch. Another effectual plan is to take a purge in the morning, fast during the day, and take at night five grains of Santonine with twenty grains of Calomel, for an adult, or one or two grains of Santonine and five grains of Calomel for a child. The next morning a purge of Senna should be ta- ken. An infusion (tea) of Senna for this purpose may be made by steep- ing an ounce of Senna leaves in a pint of water. One.fourth of this is a dose for an adult, and one or two tablespoonsful for a child. It can be flavored and sweetened to suit the taste. The common remedy, Turpentine, ought not to be given, unless ne- cessity compels it. It is not reliable against worms unless given in doses of a tablespoonful, and then unpleasant effects may follow. If used, it should be given with twice the amount of Castor Oil. WORM3. 327 HOMOEOPATHIC TREATMENT. The long worm is most surely removed by Cina. (worm seed) and the form in which it is best is the Santonine (an alkaloid of worm seed as Quinine is of Peruvian Bark.) This can be given in doses of one or two grains, twice each evening for two days; then omit for one week and repeat until twelve doses are taken. This remedy can usually be obtain- ed in the shape of candy called Santonine Lozenges containing one grain each, and are to be given as directed above. After the child has taken this remedy, the clothing or bedding Avhich conies in contact with the urine is almost always stained yellow or straw- color, which is no cause for any alarm. It is best to keep the child from eating farinaceous food the day previous to taking the medicine. For conditions or symptoms remaining after the worms are removed, see Cina, Nux Vomica, Spigelia, Mercurius, Pulsatilla, at the close of this chapter. The T^nia or tape-worm is from three feet to twenty or more yards long, is smooth the best part of its length, and about a quarter to a half of an inch wide; towards the extremity representing the head, its shape is more rounded and thin, and the head itself is thin as a thread. The color is of a faintish white, with a yellowish tint. The worm consists of the very small head, which is sucked fast in the intestinal mucous membrane, and to Avhich a neck of the thinness of a thread, and half an inch in length, is attached, from which neck, the single links of the worm afterwards proceed. At first these links are nar- row, but rather short than broad, so that the worm exhibits a series of closely-crowded transverse lines; the further removed from the head the more the length of these links increases in proportion to their breadth, until the last links acquire a length of half an inch to one inch and more. The worm grows in length from the head outward, until the last full- grown links become, sooner or later, detached, and are expelled with the stool. The taenia has its principal abode in the small intestines, and is only exceptionally met with in the large. Generally, there is only one taenia found in the same individual, although we are acquainted with one case where twenty-one worms were discharged by the same person. Such cases are, of course, very rare. As in the case of other worms, so are the disturbances caused by the taenia exceedingly various, both in kind and degree of intensity. It may be safely asserted that, in the majority of cases, the taenia causes very lit- tle trouble, and that the patients do not become aware of its existence until a few links have been expelled with the stools, when a variety of ailments and distresses are forthwith traced to the taenia, which, in real- ity, are the work of the imagination, rather than of the taenia. The mildest disturbances which the taenia occasions, are winding, twisting, colicky pains around the navel, not very intense, setting in paroxysm- ally, more particularly after eating certain kinds of food, and in the morning when the stomach is yet empty. Generally, these pains are as- sociated with a little nausea, or even with a sensation of canine hunger, but these symptoms are so trifling that they are only complained of when the patient has become perfectly certain that a taenia is growing in his bowels. Under circumstances which it is difficult to analyze, more in- 328 OUR FAMILY PHYSICIAN. tense disturbances may shoAV themselves, a disconnected enumeration of which we here subjoin : violent colicky pains in the bowels, or a creep- ing or crawling sensation as from a worm, around the umbilicus, Avith increased secretion of saliva, nausea, even vomiting, especially after eat- ing fermented food, herring, sharp condiments, sour fruit. Increased appetite, canine hunger, in spite of which the patient emaciates; itching of the nose and anus ; sickly complexion; low spirits and irritable mood; irregular stool, alternately normal and diarrhoea; headache, disturbed sleep, A'ivid dreams ; palpitation of the heart; changes in the sound of the voice. Finally, the above-mentioned more striking affections of the general nervous system, which can be traced Avith more certainty to the presence of taenia. The presence of taenia can only be diagnosed, with perfect certaintj', if the patient has actually passed links of the worm. Many lay-persons are too anxious to attribute their ailments, gastric derangements, such as heart-burn, water-brash, etc., to the presence of taenia; especially if they experience a sensation as if a worm were crawling about in the stomach, or up the oesophagus; if, in such a case, no links are passed Avithin a few weeks, it is pretty certain that there is no taenia. Most links are passed spontaneously at the time of the new moon. In the treatment of tape-worm the patient should fast for a day, tak- ing a little milk or beef tea only. In the evening a purge should be taken of a tablespoonful of Castor Oil, a tablespoonful of Epsom Salts or three drops of Croton Oil. After this purge operates, the worm is exposed to the full effect of the medicine, which should then be taken. One of the most efficient remedies we have against tape-worm is Pumpkin Seed. Two ounces of fresh seeds are to be pounded in a mortar with half a pint of water until the husks are separated and the meats thoroughly incorporated with the water. The mixture is strained and taken, the fasting in the meantime continuing. The dose may be repeat- ed in three hours, and in three hours more a purge of Castor Oil should be taken. If the worm is not removed, head and all, the treatment is to be repeated the next day. The pressed Oil of Pumpkin Seed may be given instead of the above emulsion in doses of a tablespoonful two or three times and followed by the Castor Oil purge. After the preparatory treatment by fasting and a purge, a dram tea- spoonful of the Oleo-Resin of Male Fern (Felix Mas), gi\re a fourth part thirty minutes apart, on two successive days, followed by a purge of Cas- tor Oil (a tablespoonful), or three drops of Croton Oil is an effectual remedy against tape or round worms in persons of any age. It can be given in syrup or mucilage. Should necessity compel the use of turpentine, one or two tablespoons- ful, with an equal quantity of Castor Oil, should be given after the prepar- atory treatment. As a preventive of intestinal worms of all kinds only Altered water should be drunk. Meat should be thoroughly cooked, but it is not neces- sary to cook it until dry. Fruit and vegetables should be made clean before eating. Tonics following the treatment are useful. PROLAPSUS ANI. 329 HOMOEOPATHIC TREATMENT. Tape-worai is easily expelled by the use of either of the folIoAving : Take Kousso three to four drams, place in a common goblet or tum- bler, and pour cold water upon it until the glass is Avell tilled, being care- ful that none of the powder is left floating on the surface; let it stand over night, and in the morning after taking nothing more than a small cup of black coffee, drink the medicine in tAvo portions, half an hour apart. If there is a disposition to vomit, a little lemon juice may be swal- lowed. In from tAvo to Ave hours after taking the medicine, the worm is expelled. No need of a cathartic. Pumpkin seeds two ounces, peel off the outer covering, bruise well, mix in a little Avater, and use as directed above for Kousso, except if the worm does not come away in six hours, use a cathartic or an injection of Oil. PROLAPSUS ANI. FALLING DOAA'N OF THE LOWER PART OF THE INTESTINES. A protrusion of a portion of the rectum or of its internal coat from the anus, is denominated a prolapsus or pirwndentia, ani. In some cases a considerable portion of the rectum comes out to the extent of three or four inches, in others only a little, it presents a circular dark red, pad-like lump, from the size of a small hulled black walnut to that of a goose-egg. Causes. Any thing Avhich tends to weaken the muscles which sup- port the intestine. Among these are the frequent use of cathartics (physic), especially those containing Aloes, Epsom Salts, etc. The presence of pin worms, (ascarides) in the lower portion of the intestinal canal, habitual costiveness, piles, straining at stool during diarrhoea, or dysen- tery (flux), or when straining to pass water. This is much more frequent among children than grown people. In some cases the intestine remains out a considerable time without any ill consequences, but more commonly it swells and inflames very speedily. TREATMENT. Treatment. When this accident occurs, some person of strong and steady nerve, should at once attempt to replace the protruding parts, by first oiling the parts well with fresh lard, Sweet Oil, Tallow, fresh butter not salted, or sweet cream; then second, make steady not very hard pressure in the center of the protruding parts, with the Avell oiled thumb or thumb and fore finger; occasionally, if necessary, making light pressure on the outside of the tumor with the thumb and finger of the other hand, near the anus; when it will slowly, or in some cases, quickly return to its proper place. If, after carefully and perseveringly trying for a reasonable time, ten or fifteen minutes, (which will appear to be a long time) the parts do not return, send at once for a good and careful physician. 330 OUR FAMILY PHYSICIAN. This trouble having once occurred, is liable to occur again. The best means of preventing this, is a quiet position and careful attention to the diet, Avhich should consist of the plainest aliment; rye mush and sugar is very good food in such cases. The Homoeopathic remedies, which Avill usually permanently relieve the tendency to return and, also help in the moment of the accident, are in the order of their names, Nux-vomica, Ignatia, Mer curius, Sulphur, Podo. Hydropathic in connection with careful diet, take a cold sitz bath every evening. This bath is also generally used by the homoeopathic. Gently push the protruding part back into the body and inject into the bowels the following: Take of Crowfoot or Alum Root, White Oak bark( each in coarse powder, a tablespoonful; make half a pi nt of strong decoc- tion (tea) to which add half a tablespoonful of powdered Alum. This should be injected cold two or three times a day; when very severe a ban- dage will have to be worn to keep the bowel from falling. Internally let the child drink freely of a tea of equal parts of Golden Seal and Solomon's Seal. The child should be taught not to strain during stool, and its diet must be similar to that recommended for costiveness. If while the bowel be firmly held in place by a tight bandage, the child be made to lift several times every day, a weight proportioned to its strength it will aid materi- ally in overcoming the difficulty. INFLAMMATION OF THE LIVER. 331 Part Sixth. CHAPTER XIV DISEASES OF THE LIVER AND SPLEEN. INFLAMMATION OF THE LIVER. This disease is divided into the Acute and Chronic: the latter generally goes by the name of Liver Complaint, although a careful consideration of symptoms will frequently discover that the real disease is in the stomach and intestines; however, in many cases, the liver itself becomes much affected from this cause, and in itself deserves considerable attention. When the disease has been for a long time unchecked, and the inflam- mation becomes deeply seated in the substance of the liver, an abscess frequently forms, bursting either externally or internally; in the latter case often proving critical, inducing hectic fever. ACUTE INFLAMMATION OF THE LIVER. This disease is much more common in tropical climates than with us. There, a high mode of living, exposure to heavy dews or damps in the evening, and the powerful rays of the sun by day, are amongst its principal exciting causes; but it may also arise from violent mental emotions, the use of stimulating or alcoholic drinks, suddenly suppressed evacuations, strong emetics or purgatives, the abuse of mercury, gall-stones, external injuries, or injury of the brain. Symptoms. These differ according to the seat of the inflammation. When it occurs on the outer surface or convex side, the symptoms closely resemble those of pleurisy; there is generally a violent pain under the false ribs on the right side, sometimes resembling stitches, at others burning- shooting to the breast-bone, the right shoulder-blade, and point of the shoulder, and even affecting the right foot,—sensation of numbness or tingling in the arm of the same side, the pain increased by inspiration; a short, dry cough, and the symptoms of inflammatory fever; bowels irregu- lar, generally constipated, and stools, in the majority of cases, of an un- natural color. In this form the patient can only lie on the left side. When the seat of inflammation is on the inner or concave side of the liver, the pain is much less, and the patient complains rather of a sensa- tion of pressure than actual pain, but the whole biliary system is much affected. The eyes and countenance become yellow, and sometimes com- plete jaundice declares itself; the urine is orange-colored the evacuations mostly hard, and generally of a whitish or gray color. We also find bitter taste in the mouth, vomiting, and considerable distress. The patient can only lie on the right side. Inflammatory fever is present in this form like- 332 OUR FAMILY PHYSICIAN wise. In both forms, on examination, the region of the loAver ribs, on the right side, will usually be found hot, tumerfied and painful on pressure. Inflammation of the liver, unless properly treated, is apt to assume the chronic form; it may also end in suppuration externally, or internally by a communication either with the lungs or intestinal canal, or by an abs cess in the substance of the organ itself, or may terminate in indurations or other alteiations of structure, in gangrene, or in the formation of adhesions. The disease may terminate by resolution, critical transitions to other organs, piles, diarrlnca, bleeding at the nose, or eruptions on the skin gen- erally, erysipelas. ALLOPATHIC TREATMENT. The treatment of congestion of the liver, will consist as far as possible in the removal of the causes of the disease. In some instances there are sedentary life, and too generous living. Great benefit will be derived in some of these cases from horseback riding, hunting, Avalking, etc., Avhile saline laxatives, as Seidlitz Powders, directly diminish the congestion. The use of beer, and spirits should be discontinued, and the diet made more simple and plain. If the congestion is of 1 -ng continuance, benefit Avill result from the use of Dilute Nitro-Muriatic Acid. It may be given in doses of ten or fifteen drops. It should be given before meals, largely diluted in sweetened water, or preferably in a couple of ounces some bitter infusion, or infusion of Columbo (one ounce of simmred in a pint of water). Bathing the right side Avith a solution of Nitro-Mtiratic Acid- three ounce to a gallon of water, is of advantage. Drinking the Avater from some of the sulphur springs, is sometimes useful. If the patient is debilitated, the use of the Nitro-Muriatic Acid should be associated Avith the use of Citrate of Iron and Quinine, a dram and a half dissolved in four ounces of Lemon Syrup, or of Syrup of Orange Flowers of which a tea- spoonful may be taken after each meal. If the congestion of the liver depend on disease of the lungs or heart, treatment, will of course, have reference to those affections, and reme- dies addressed directly to the congestion of the liver, Avill be only pallia- tive. In inflammation of the liver, there is great danger to life. The in- tense pain should be relieved by the use of Opium, in doses of a grain, at such intervals as may be necessary to relieve the pain—one or tAvo hours, or longer, apart. The pain must be relieved. Laudanum may be given by injection in doses of a teaspoonful in a tablespoonful of thin Starch, and repeated once a day. The anodyne effects of this may be increased, if necessary, by giving Opium in doses of a grain, or Morphine in doses of a quarter of a grain, by the mouth. A liniment of equal parts of Laudanum, Tincture of Aconite, Chloro- form and Soap Liniment, may be continuously applied to the right side over the liver, by means of a flannel saturated in the linament, and cov- ered with oiled silk. The boAvels may need acting on mildly, preferably by an injection of warm Avater. In this disease there is especial danger from suppuration. ACUTE INFLAMMATION OF THE LIVER. 333 Tonics and nutritious food are early called for. The best tonic reme- dy is Quinine and Nitro-Muriatic Acid. Two or three grains of Quinine every four hours, Avill be appropriate. The Nitro-Muriatic Acid should be given in doses of ten to twenty drops, largely diluted in sweetened water, at about such intervals as food is given, as an aid to digestion. Such food as milk, eggs beaten up Avith sugar and water or milk, giv- en raAV, strong beef-tea, and animal essences, are appropriate. Should the inflammation, Avhether embracing the Avhole organ or limited to a portion, result in abscess Avhich can be distinguished through the abdominal wall by feeling with the band (palpation), t is proper to open it. If the surface of the liver is adherent to the inner surface of the wall of the abdomen, the opening may be made directly into the abscess. But if the adhesion has not plainly taken place, an incision should be made doAvn to the peritonium (lining membrane of the cavity of the ab- domen) and the Avound filled with Lint or Oakum. In three days the membrane will be adhered so the opening can be made with safety, which may be done either with the knife or trocar. Generous diet, Avith the Quinine will probably enable the patient to survive. Should the abscess open into the intestine or bronchial tubes, it may be necessary to giA'e anodynes (as Opium) in small doses to relieve the ir- ritation of those parts. HOMOEOPATHIC TREATMENT. Aconitum, Belladonna, Mercurius, Lachesis. Aconite is especi- ally indicated in the commencement of the attack, and may ahvays precede the other remedies, when there is violent inflammatory fever, attended Avith insupportable shooting pains in the region of the liver, with tossing, restlessness, and great anxiety and anguish. Dose: Of a solution of eight globules to Lavo tablespoonsful of water, give a teaspoonful every three hours, until improvement or change. Belladonna may be advantageously administered, after Aconite has subdued the preceding symptoms, or from the commencement, when the following indications present themselves; oppresive pains in the region of the liver, Avhich extend to the chest and shoulders, distention of the pit of the stomach, sometimes extending across the region of the stomach, producing a sensation of tension, with difficult and anxious respiration; determination of blood to the head, with cloudiness and giddiness, some- times causing faintness; great thirst, tossing about at night, and sleepless- ness. Belladonna may be advantageously alternated with Nux-vomica in such cases as coincide with the joint indications afforded for both of these medicines, especially if the patient has been addicted to excessive use of fermented liquors. Belladonna is, moreover, especially appropriate when the temperament of the patient exhibits a combination of the sanguine and lymphatic. Dose: If singly, dissolve eight globules in two tablespoonsful of water, and give a teaspoonful of the solution every two hours, until amelioration or change. If no positive and permanent improvement should ensue within four hours after the third dose, pause two hours more, and proceed Avith the next medicine. If in alternation with Nux-v., the like solution of each administered in rotation, by tea- spoonsful, at intervals of two hours. 334 OUR FAMILY PHYSICIAN. Mercurius will, in the majority of cases, prove effectual when Bella- donna has failed to produce a favorable impression on the disease, and should accordingly be administered six hours after the third dose of the foregoing remedy in such instances. The particular indication for Mer- curius are as follow: Considerable fullness or tumefaction in the region of the liver, Avith pricking, burning, or oppressive pains, not allowing the patient to lie long on the right side, and sometimes augmented by movement of the body or part affected; pain in the shoulders; bitter taste in the mouth, want of appetite, thirst, and continual shivering, sometimes folloAved by sweat- ing, but without relief, Avith pale yellow color of the skin and eyes; also, in more advanced stages of the complaint, when there is indura- tion of the liver. This medicine may moreover, like Belladonna, be administered in alternation with Nux-vomica, under similiar conditions. If the patient is of a lymphatic temperament, or is distinguished by softness of the muscular system, there Avill be additional reason for select- ing Mercurius. Dose: A solution of eight pills, in all respects, singly, or in alterna- tion, as. directed for Belladonna. Bryonia, Chamomilla. Bryonia, Avhen the pains in the region of the liA'er are mostly shooting, or consist of an obtuse pressure, with tension and burning, increased by touch, coughing or respiration, and especially during inspiration, or much exacerbated by moA-ement; also when the symptoms are attended with violent spasmodic oppression of the chest; rapid and anxious respiration; bitter taste in the mouth, tongue coated yellow, and constipation. Bryonia, like Chamomilla, is particularly useful in cases which have been excited by mental emotions, such as a violent paroxysm of anger, and is Avell adapted to persons of nervous or bilious temperament, and of choleric disposition. Dose: Of a solution of eight pills to tAvo tablespoonsful of water, give a teaspoonful eA'ery three hours, until distinct amelioration or change. In cases in which the pain is very severe, the doses should be repeated every tAvo, three and four hours, progressively, accord- ing as improA'ement ensues, and, subsequently, every six hours. Chamomilla is more particularly required in the milder forms of the complaint, or, more correctly speaking, in simple irritation of the liver, when there are pressive pains, pressure in the stomach, oppression of the chest, and a sensation of tightness under the ribs ; yellow color of the skin, pains not aggravated by motion, etc.; tongue foul and yellow, bitter taste in the mouth; paroxysms of great anxiety. Chamomilla is also almost a specific, Avhen the above symptoms have been brought on by a fit of passion. Dose: In all respects as directed for Bryonia. Nux-vomica is particularly indicated when the pains are shooting and pulsative, and attended Avith excessive tenderness in the region of the liver, to the touch, pressure in the region of the stomach and under the ribs, with shortness of breath and constipation ; also when enlarge- ment and induration occur; and, in the chronic form, when there are marked symptoms of derangement of the stomach. This medicine is es- liver complaint. 335 pecially appropriate for the treatment of patients of a sanguine or bilious temperament or choleric disposition. Dose: In acute attacks, four globules in a teaspoonful of water every two hours, until a degree of effect is apparent, and then every six hours, until positive improvement results. In chronic cases, six globules in a tablespoonful of water, every night at bed-time, for a week, after which, a pause of four days should ensue, the adminis- tration being similarly resumed, if necessary, and so on. Pulsatilla. Sensation of tension in the region of the liver, and pressure or dull pain in the region of the stomach; oppression at the chest, bitter taste, yellow tongue, nausea; loose, greenish, and slimy stools; excessive anxiety, especially towards evening or during the night. (Temperament lymphatic; disposition mild.) Dose: Of a solution of six globules to two tablespoonsfuls of water, give a teaspoonful every six hour, untils amelioration or change. Sulphur is valuable to follow any one of the preceding medicines, which, although apparently indicated, does not speedily produce a decided action; or when the disease continues, although in a diminished degree ; it is particularly efficacious, after Nux-vomica, to combat the bad conse- quences of the disease. In many instances in Avhich the distinct analogy between the symptoms of the disease and those which characterize one or more of the other medicines enumerated herein, has led to the adminis- tration of such other medicine or medicines, and when such treatment has failed to be folloAved by adequate benefit, the intermediate adminis- tration of a single dose of Sulphur, from time to time, has served to awaken the susceptibility of the system to the action of such other medi- cine (when evidently appropriate), and the repetition of its administra- tion after such dose of Sulphur has been followed by admirable results. Dose: To assist the action of the other medicines, give four globules in a teaspoonful of water, following up the treatment with the rem- edy judged most appropriate to the case, after an interval of twelve hours. SUPPURATIVE INFLAMMATION OR ABSCESS OF THE LIVER. Sulphur, Silicea, Kali-c, Lycopodium. These four medicines may be numbered amongst those which have proved most useful in cases of suppuration of the liver. The selection from amongst them must, of course, depend upon the particular features of each indh-idual case, and must be regulated by instituting a comparison between the symptoms of the disease and those which are recorded as characteristic of each of these medicines in the article on that subject. Dose: As for Nux. Diet.—The regulations for diet which are prescribed for the treat- ment of Fevers in general, and such other regulations as are detailed in the article on " Indigestion," are equally applicable to cases of Inflam- mation of the Liver. 336 OUR FAMILY PHYSICIAN. LIVER COMPLAINT OR CHRONIC INFLAMMATION OF THE LIVER. In this form of the disease Ave find many of the foregoing symptoms, but in a modified degree ; and in addition, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh and loses strength ; and there is, not unfrequently, present an occasional cough with expectoration ; sometimes considerable perceptible enlarge- ment of the liver, either continual or returning periodically, with a num- ber of dyspeptic symptoms; high-colored or red urine, yellow tinge of the skin and eyes, occasional febrile symptoms: the pulse, except during these attacks, generally quick but regular. ALLOPATHIC TRE ATM EN T. Chronic Inflammation (Cirrhosis) of the Liver is generally caused by the use of alcoholic drinks. The patient generally pays no attention to this trouble until it causes dropsy of the abdomen. It is then safely regarded as incurable. In the early stages of the disease, by the abandoning of the use of spirituous liquors, and the use of Arsenious Acid, and the Iodides, as in the following formula, recovery can doubtless be made. Take of the Io- dide of Ammonium a dram, FoAvler's Solution half a dram, Tincture of Calumbo an ounce, Water four ounces. Mix. Do.se: A teaspoonful three times a day, before meals. The use of Dilute Nitro-Muriatic Acid in doses of ten or fifteen drops in sAveetened Avater three or four times a day is beneficial. In the later stages the treatment is the same as for Dropsy of the Peritonium (Ascites ) HOMOEOPATHIC TREATMENT. With proper modifications as to the frequency of doses, the regula- tions prescribed in the foregoing article (pp. 332 to 334) are equally applicable to this variety of the disease. The medicines enumerated should accordingly be selected in conformity Avith the indication therein set forth. The folIoAving, however, are especially appropriate, in the ma- jority of cases of Chronic Inflammation of the Liver, and the under- mentioned rule for the dose is generally, reliable, as regards other medi- cines. Nux-vomica, Bryonia, sulphur, sepia.—There are comparatively few cases (if any) of Chronic Inflammation of the Lh'er, in Avhich one or more of these medicines, either singly, successively, or alternately, will not be required ; for indications see pages 332 to 33-1. Dose: Of the medicine selected giA'e four globules in a teaspoonful of water, morning and evening, for a week (or until an earlier subsi- dence or change in the symptoms); after which, pause four days, resuming the course, as before, if necessary, and so on. JAUNDICE. Symptoms.—Yellow color, varying in shade from a pale saffron to a dark-brown yelloAV, appearing first in the eyes, then extending over the JAUNDICE. 337 surface of the whole body; hard, whitish evacuations; orange-colored urine; symptoms of deranged digestion, and sometimes, tensive pain or pressure in the region of the liver. In severe cases, eA'en, the perspiration will impart a yellow hue to the patient's linen. Exciting Causes.—The disease frequently declares itself Avithout being plainly referable to any exciting cause; the principal causes, how- ever, are affections of the liver, indigestion, poisonous substances, taking cold, poAverful mental emotions, emetics, drastic purgatives, or internal obstructions, such as gall-stones, or even worms obstructing the biliary duct. Predisposing Causes.—Amongst the predisposing causes may be enumerated a too sedentary or irregular mode of life, indulgence in spirit- uous liquors, and the frequent use of aperients. It may be also remarked, that this disease frequently assumes the in- termittent type. Jaundice is not, of itself, to be considered as a dangerous disorder, but rather as an indication of some internal derangement, which, if neglected, may entail serious consequences ; for example, dropsy, hectic feA'er, or general wasting aAvay. ALLOPATHIC TREATMENT. Jaundice is a symptom which accompanies other diseases of the liver, and in such instances its treatment is that of those affections. Generally there is a catarrhal inflammation of the upper part of the intestine (duodenum) requiring that the food should be light and unirritating to this part of the digestive tube. Milk, eggs, animal broths, broiled beef steak, oysters, fresh fish, are suitable. Bread, arroAV-root, rice, potatoes, beans, pies, etc., may, by calling upon the functions of that part of the intestine, continue the disease. Laxatives may be called for, but must be mild. Injections are to be preferred, if there is constipation. A Seidlitz powder may be taken. In this, as in other affections of the liver, the Nitro-Muriatic Acid is useful in doses of ten drops in sweetened water three times a day. Manganese has appeared useful, in catarrhal jaundice. Take of dried Sulphate of Manganese forty grains, Purified Ox Gall sixty grains, Resin of Podophyllum two and a half grains. Mix well, make a mass and divide into twenty pills. Dose: One three times a day. In Malarial Jaundice, after from ten to twenty grains of Quinine has been given, Manganese is also useful. Take of Dried Sulphate of Man- ganese forty grains, Chenoidine sixty grains. Mix and make into twenty pills. Dose: One three times a day. A small blister over the stomach has appeared useful Pain should be relieved with half grain doses of Opium or ten drops of Laudanum, or a grain of the Extract, or one or two teaspoonsful of the Tincture of Hyoscyamus. When jaundice has continued for Aveeks or months, an irremediable 22 338 our family physician. obstruction to the flow of bile. If it cannot be removed, remedies are directed to aid in the elimination of bile by the kidneys, and skin and to Bupport the powers of life. To increase the flow from the kidneys the diuretic pill, composed of one grain each of Extracts of Squill and Digitalis and Calomel, may be given, one pill every three hours until it acts freely on the kidneys. Or the Fluid Extract of Broom may be given in doses of half a teaspoonful. Watermelon or Pumpkin Seed tea may be useful. The skin may be sufficiently acted on by hot bathing. If not, by the hot wet pack. Bile may be supplied to the aid of digestion by giving one or two cap- sules filled with ox gall after each meal. It should be remembered that the yellowness will exist in the skin for some time after the bile duct is open, so that the bile flows naturally into the intestine. HOMOEOPATHIC TREATMENT. Mercurius, china. These are two of the best remedies in the treat- ment of the disorder. Mercurius may be denominated a specific remedy for jaundice in a great number of cases, when indeed the patient has not been subjected to drenching courses of Mercury or Calomel. Dose: Six globules in a teaspoonful of Avater, every six hours, until four doses have been given, and then every twelve hours, until per- manent and positive amelioration or change. China is, however, to be preferred to Mercurius in cases in which Mercury has been too copiously administered. China is also particularly appropriate when the attack has come on after violent corporeal exertion, or when it can be distinctly traced to indigestible substances ; also, when the disease assumes an intermittent character. In a great number of cases, indeed, in which jaundice recurs periodically, or in which patients, al- ready predisposed to its attacks, haA'e been unavoidably or inadvertently exposed to some directly exciting cause (such as oA-er-exertion, cold, etc.) China will operate as a preventive resource, and will commonly ward off the development of an incipient attack. Dose: For the treatment of jaundice, in an advanced stage, give four globules in a tablespoonful of water, three times at intervals of four hours and at intervals of eight hours, until amelioration or change. As a preA'entive resource, give six globules in a wineglass- ful of water, night and morning, for three days, then pause tAvo days, suspending treatment, or resuming the course, similarly, ac- cording to the state of the patient. Nux-vomica is preferable in the generality of cases, even in such as have been directly occasioned by violent emotion, when the bowels are confined, or alternately confined and relaxed. Nux-vomica is also especially appropriate when sedentary habits, or study, or indulgence in spirituous liquors, appear to have been the predisposing, or, partly, the exciting causes of the attack. Dose: Three globules in a teaspoonful of water, every four to eight hours. Digitalis. A most important remedy in many cases of this disease: JAUNDICE—GALL-STONE—SPLEEN. 339 the following are the principal indications for its employment: nausea, retching, or vomiting, and purging of greenish fluid; or sluggish state of the bowels, with white, gray, or clay-colored evacuations; tongue clean, or coated white; pressure at the pit of the stomach and region of the liver; al- ternate heats and chills. Dose: Of a solution of six globules to three tablespoonsful of water, give a teaspoonful every two hours, until the violence of the symp- toms become modified; and then every four hours, until positive amelioration or change. INFLAMMATORY JAUNDICE. Cases in which jaundice is associated with symptoms of inflammation and pain on pressure in the region of the liver, are so closely analogous to inflammation of the liver, that the reader is referred, on this subject to the foregoing articles, treating especially of that disease. GALL-STONE.—ALLOPATHIC TREATMENT. In the treatment of the passage of gall stones, is in the first place to relieve the pain, and for this purpose the best remedies are Opium and Belladonna. If a physician is at hand, he will give a hypodermic injection of a quarter of a grain of Morphine with a sixtieth of a grain of Atropine. The effects of the anodyne should be maintained until the pain, caused by the passage of the stone, ceases. An injection of a teaspoonful of Laud- anum with half a teaspoonful of Tincture of Belladonna, in a couple of tablespoonsful of thin starch may be made, or the same remedies given by the mouth in half the quantities. The pain may be intense enough to in- duce the physician to resort to the inhalation of Chloroform or Ether. Belladonna Ointment may be applied over the seat of pain, and cov- ered Avith a hot flaxseed meal poultice. A hot bath is sometimes successful in mitigating pain. No rule can be given for giving Opium in this disease, but when larger doses have been given for a few days, Opium poisonng may occur unexpectedly. ' Expulsion of the calculus (stone) may be aided by cathartics, for this purpose salines are to be preferred, as Epsom Salts and Seidlitz Powders. No remedies are known which can be given in sufficient quantity to dis- solve the stones. As a preventive measure the Phosphate of Soda should be gh'en in doses of from twenty to thirty grains, two or three times a day. The rem- edy should be persevered in for months. It has the property of rendering the bile more liquid, and so prevents the formation of new gall stones. A change from a sedentary life is desirable. A. simple, wholesome diet, and attention to the general health are called for. CHAPTER XV. INFLAMMATION OF THE SPLEEN. Symptoms. Sharp, pressing, or shooting pains in the region of the spleen, beneath the lower ribs on the left side, with, in most cases, a high 340 OUR FAMILY PHYSICIAN. degree of fever with general derangement; and sometimes enlargement and tumefaction; when very severe, vomiting of blood. From our very imperfect knowledge, hoAvever, of the physiology of this organ and its relation 10 the others, this disease, except when it presents itself in the tangible form above mentioned, is extremely diffi- cult to discover. Its best characteristics are tenderness or sensibility on pressure in the region about the spleen, Avith general debility; paleness of the complexion, bloodless appearance of the conjunctiva (the superficial membrane lining the eyelids, and extending over the fore part of the eye- balls), languid circulation, and tendency of the extremities to become cold. It is a rare disease in this country, but sometimes declares itself in hot seasons, when it is not unfrequently mistaken for other affections. It may, hoAvever, arise in individuals of delicate constitutions,or in children, when exposed to the influence of marshy miasms, particularly when to that cause has been added insufficient clothing, Avant of exercise or proper nutriment, and long-continued mental disquietude. ALLOPATHIC TREATMENT. Acute inflammation of the spleen is to be treated on the same general principles as inflammation of the liver. The same anodynes will be re- quired, and they are to be administered in the same way. The constant application of cold by means of a bladder of pounded ice over the region of the spleen is particularly appropriate. Benefit Avill also result from the use of Ergot in large doses. A teaspoonful of the Fluid Extract of Ergot may be given three times a day. By far the most common affection of the spleen is a chronic inflam- mation knows as enlargement of the spleen, which occurs in malarial dis- tricts, or Avhere intermittent fever prevails. It is also known as ague cake. This affection, occurring periodically, requires the use of Quinine in full doses—five or ten grains given six hours apart, until a slight ringing of the ears is produced. For continued use for enlarged spleen, it should be continued with Sulphate of Iron. Take of Sulphate of Quinine sixty grains, Dried Sulphate of Iron ninety grains. Make into thirty pills, ac- cording to the art of the apothecary. Take one pill three, four or five times a day. Bromide of Potassium, given in doses of from ten to fifteen grains three times a day, sometimes reduces the enlargement of the spleen with wonderful rapidity. The Iodide of Ammonium and Arsenious Acid, in small doses, fre- quently repeated, see particularly efficacious in chronic enlargement of the spleen {ague --------- SUPPRESSION OR DELAY OF THE MENSES—AMENORRHEA. " This suppression either takes place during the flow, or in conse- quence of causes acting previous to the actual appearance. In the former case a cold may have operated ; or cold washing may be the cause; or the feet may have got chilled ; or the patient may not have been sufficiently protected by her clothes; mental or moral emotions, vexations, chagrin, anger, fright, or dancing, sexual intercourse, dietetic transgressions may have led to the suppression. Most of these causes, if operating shortly before the time when the menses were to come on, may cause their reten- tion. A gradual suppression of the catamenia may take place in conse- quence of deficient nutrition, as well as of the abuse of warm beverages, and the continued influence of depressing emotions. We have already shown that a change in the mode of living may superinduce a suspension of the menses, in the case of young women, without leading to derange- ments of the general health. " The more sudden the suppression of the menses, the more violent the changes arising from such an occurrence. Some of the most promi- nent symptoms are: Violent headache, great anxiety and oppression of breathing, nose-bleed, spitting of blood, congestions of the head, heart, SUPPRESSION OF THE MENSES. 377 and lungs, and the like. In some cases a suppression of this kind gives rise to acute uterine catarrh. If a physician is called in time, he will, of course, inquire Avhat gave rise to the trouble, and will seek to remoA'e the consequences of fright, mortification, anger, etc., by appropriately-spe- cific remedies. If the physician is not called until some time after the morbid symptoms have existed, the aforesaid remedies will no longer be applicable, and the constitutional condition generally Avill have to be acted upon by corresponding remedies, and you should follow the same course as a physician. ALLOPATHIC TREATMENT. Amenorrhea. If the menstrual flow (menses) never has appeared and the patient is strong and healthy, and there is no menstrual molimen (symptoms or sensations) it is not prudent to resort to any interference. Every means should be employed to strengthen and invigorate the system. The body, rather than the mental faculties, should be exercised. Life in the open air and tonics containing iron, should be given if the patient is anaemic (having thin blood.) Constipation should be corrected as directed in the treatment of that disease. The preparations containing Aloes are especially appropriate. « Scarcely ever is menstruation (and menstrual sensations) absent after nineteen or tAventy years, unless there is lack of development in some of the organs of generation. This is to be inferred, if invigorating measures after employment for some time, have proved ineffectual. The advice of a skillful physician should be always procured. Development of the womb to a proper size, has in some cases been induced. Retention of the menses is probable when regular symptoms of men- struation occur without the flow, and the abdomen of the patient gradu- ally enlarges. The cause of retention may be absence of the vagina, an imperforate hymen or colosure of the mouth of the womb. These may be overcome by the skill of the surgeon. If the general health is good andthe generative organs, vagina, uter- us, and ovaries are well or reasonably developed, Iron may be effica- cious in establishing the menstrual flow. Persons who have Amenorrhcea (suppression of menstruation) are generally suffering from an indisposition of some kind with which the amenorrhcea is associated or dependent on. In some cases the patient has fallen into ill-health before the menses have ever appeared, and as a con- sequence there is no attempt at menstruation. It is, therefore, perfect nonsense to attempt to bring on the monthly flow or cure the amenorrhcea, while the general health remains impaired. In a patient suffering from consumption, treatment ought not to be directed to menstruation at all, until the patient can be brought up to a good degree of general health, and then nature will establish the menses if the system is able to sustain the discharge. It is a popular error that stoppage of the monthly courses is the cause of the ill-health which accompanies it, whereas exactly the opposite is the truth ; the general indisposition has caused the suppression of the menses. In the treatment of these cases the return of the monthly sickness is the final result to be attained. Improvement in other respects must be first attained and al- 378 OUR FAMILY PHYSICIAN. most always the rest will follow as a necessity under nature's order alone. If the patient is not surrounded by good hygiene, this is the first point to attain. She should have pure air, and exercise out of doors should be taken. This exercise, if taken for exercise, is apt to be neglect- ed and not be of a character which will make her of cheerful spirits; recreations, such as buggy riding, and walking with cheerful companions, or rambles in the fields or woods will accomplish this, if not carried to a point which is too fatiguiging. When the patient becomes exhausted at her exercise she is going a little too far. A sedentary occupation may sometimes need to be changed for a more active one. With persons who are unaccustomed to physical exercise, this habit must be cautiously and gradually begun. With shop and factory girls poor hygiene is most likely to be the cause of such a poor state of health as will produce amenorrhcea. In these cases, while the use of medicines follow the same rules as in other debili- tated patients, it is quite secondary to the improvement of their hygienic circumstances. In schools too little time is given to unrestrained life (exercise) in the open air and too much time to quiet mental work, and the anxiety of pa- rents as to the intellectual development of their children, leading them to send them to school at too early an age, and to crowd them too rapidly, is a prolific source of ill-health and consequent amenorrhcea. If parents would not send their children to school until they were eight years old, and then if a large portion of the day was appropriated to every student to take such recreations as her inclinations lead her to, the breaking down and ill-health in schools for girls, would be as rare as it is now common, provided eight full hours were regularly spent in sleep. The importance of exercise is admitted in theory in these schools, but the amount is not regulated to the wants of each particular case. The long walk may be beneficial to the strong and well-nourished, if they are ac- customed to such exercise. The girls not so strong and well-fed, may, in these very walks, lay the foundation for a serious disease. To make exercise most useful it must be pleasurable, and for that end restraint must be thrown off. Again, exercise ought not to be violent. The gym- nasium is productive of good if not carried to an extreme. It may do much harm. Such exercises as jumping are not to be indulged; occa- sional and moderate horseback riding is good, but carried to an extreme it may do harm. Early hours, good nourishing food, of which animal food form a large part, plenty of fresh air, and warm clothing are necessary to ensure good health, both before and after menstruation. The constipation and derangement of the digestive organs is generally an effect of the state of ill-health, which is to be corrected in the first place, before the patient can take such an amount of nourishment as will bring her body to a vigorous state and maintain it there. Two or three Compound Rhubarb pills at night, followed by a Seidlitz Powder, or a dessertspoonful of Rochelle Salts in Lemonade in the morning, may be given once or twice a week for a time; or after the bowels have moved freely from the use of three or four Compound Cathartic Pills. Remedies SUPPRESSION OF THE MENSES. 379 may be used as are directed for constipation. The pills containing Aloes and Extract of Nux Vomica are to be preferred. The circulation should be maintained by free, pleasurable exercise in the open air, sponging the skin Avith tepid or cool water and rubbing briskly with a coarse or rough towel, until the skin is aglow, and warm clothing. It is very important to keep the feet, legs, and arms so well clothed that they will keep warm. The two remedies which are especially serviceable in building up the health to a point at which menstruation will occur in obedience to nature alone, are, Iron and Quinine. One of the best forms for its efficacious administration is the Citrate of Iron and Quinine in doses of from three to five grains three times a day. It may be dissolved in Syrup of Ginger or Orange Flower Avater. Take of Citrate of Iron and Quinine two and a half drams, Syrup of Ginger six ounces. Take a teaspoonful or a tea- spoonful and a half three times a day. If the bitter taste is seriously objected to, one or two grain pills of the Sulphate of Quinine may be given two or three times a day, and the same quantity of the Soluble Ci- trate of Iron may be given in solution with Cinnamon or Orange Flower Water in the same proportions as directed for the Citrate of Iron and Quinine. The Pyrophosphate of Iron answers the purpose very well. It can be given as follows: Take of Pyrophosphate of Iron two and a half drams, water sufficient to dissolve, Syrup of Orange sufficient to make six ounces, mix. Dose a teaspoonful three times a day. The Tincture Muriate of Iron has long deservedly enjoved a reputation in the cure of amenorrhcea, and is one of the most effectual. The dose is fifteen or twenty drops three times a day, largely diluted in sweetened water. Before buying the sugar or Gelatine coated pills of Quinine one of these should be cut open with a knife, if they are good they will be soft under the coating. After the use of Iron and Quinine for a time, if health is not restored it is well to change to the use of Iron with Strychnine. Take of the Cit- rate of Iron and Strychnine seven Scruples, water sufficient to dissolve, Syrup of Ginger or Orange a sufficient quantity to make six ounces. Dose, a teaspoonful three times a day. Each teaspoonful contains a fraction less than a thirtieth of a grain of Strychnine. If the patient does not suffer from impoverishment of the blood, or if they have recovered from the anaemia, from three to five drops of Fowler's Solution three times a day may be given with benefit. It seems to restore the activity of the ovaries. The Choloride of Gold and Soda in pill, one twentieth of a grain each, three times a day is also thought to be beneficial, in the same way. Dyspepsia must be treated as is directed in that disease. It may some- times be advisable to keep the patient for a time on a milk diet. Only such food should be given as is found by experiment to be readily diges- ted. Milk, beef tea, eggs beat up with sugar and water or milk, are some of the easiest digested, and nutritious food. The object in treatment is first to put the body in good health as the amenorrhcea is only a symptom of the state of ill health. If menstruation have been suddenly suppressed, it is best to give a hot 3S0 OUR FAMILY PHYSICIAN. sitz (hip) bath, a copious drink of Ginger tea, place her in bed and give her a full dose of Dover's PoAvders (tenor fifteen) grains, especially if she has had a child. A mustard plaster may be put over the lower part of her ab- domen, and bottles of hot Avater about her hips and loins. The use of elec- tricity has in some instances caused a return of the flow. A hot water injection into the rectum may be made. When the time for menstruation has past, we must wait until just be- fore the next period, when for three or four days a Avarm hip bath should be given night and morning. If there is no pregnancy some of those reme- dies called emenagogue (calculated to promote the Aoav of menses), may be given, if the physician desires, but as so much harm may be done with these, it is deemed proper not to give directions for their use in a popular book. When the mental emotions have been the cause of the sudden sup- pression, Opium to the extent of produceing quiet in doses of half a grain to a grain is the best remedy. Laudanum in doses of ten to tAventy drops, or Paregoric in doses of two teaspoonsful may be given. Chronic suppression should be treated on the principles before given, viz: correction of the general health, and from month to month encour- age the menstrual flow by the gentle measures just enumerated. HOMOEOPATHIC TREATMENT. Pulsatilla should be employed when a suppression takes place from the sudden effects of a chill, when the symptoms generally correspond with those described under the head of that remedy, in the article on Chlorosis. Dose: Six pills in a teaspoonful of water, night and morning, for a week (unless a change should sooner occur); then pause eight days, after which the course may, if necessary, be repeated as before, and so on. Cocculus in cases in which there are habitually attacks of colic-like pains in the bowels at the periods at which the menstrual discharge should occur if it were regular, more especially if the patient complains of great weakness of the lower extremities, languor and lassitude, precar- ious appetite, and generally also nausea, with much oppression at the chest and in the region of the stomach, etc.; especially when this func- tional derangement occurs in full-habited and apparently healthy persons, particularly if the suppression be traced to mental emotions. Do.se: As for Pulsatilla. Nux-moschata when the suppression is accompanied by spasms and other hysteric affections; disposition to sleep and faint away; great ner- vousness ; complete exhaustion after slight exertion; pains in the loins, etc., Dose: As directed for Pulsatilla. Caulophyllum should be given when there are spasmodic, bearing- down pains; and sympathetic, crampy, spasmodic pains in the bladder, rectum, or bowels. Dose: As directed for Pulsatilla. Veratrum should be administered in cases in which the convulsive profuse menses. 381 and other symptoms incidental to the suppression, when caused by fright, have failed to yield to the last-named medicine; and when there are pale, livid face; frequent nausea and vomiting; cold hands, feet, and nose ; great weakness, Avith fainting turns. Dose: As directed for Pulsatilla. Lycopodium has proA'ed of service in cases in which the patient com- plains of headache and giddiness; flatulent distention of the bowels before each period at which the secretion ought to have returned ; and habitual costiveness. Dose: As directed for Pulsatilla. Belladonna should be employed in cases which are associated with fullness of blood, determination of blood to the head, violent throbbing of the arteries of the head and neck, and nose-bleed. Pose: As directed for Pulsatilla. Sulphur is one of the most important remedies for the treatment of cases which assume a chronic and obstinate character, more particularly if such cases occur in persons of a feeble or exhausted constitution, or who bear about them, in a marked degree, the traces of a scrofulous habit of body, or Avho are affected Avith the piles; or, again, when the prevailing symptoms are such as have been described in detail under the head of this medicine, in the article " Chlorosis or Green-Sickness." Dose: Six pills in a teaspoonful of water, the first thing in the morn- ing, fasting, for six days (unless change should sooner occur); then pause ten days, after which the course may, if necessary, be repeated as before, and so on. Sepia is also of great value, whether at the onset or after the previous administration of Sulphur, for the treatment of chronic and difficult cases, and for such as are complicated with scrofulous taint of constitu- tion, or which occur in otherAvise feeble and exhausted subjects. Sepia is more especially appropriate when the prevailing symptoms are such as have been described in detail under the head of this medicine, in the article on " Green-Sickness." Dose: Four pills, in other respects as directed for Sulphur. MENORRHAGIA. PROFUSE MENSTRUATION. The quantity of the menstrual discharge varies a great deal in differ- ent individuals. The climate, constitution and manner of living have considerable influence. The duration of the discharge, and the periods of return, are also varied. In some women it continues from four to ten days, while in others it lasts only a feAV hours ; from three to six days is, however, the most usual period. The regularity is, in many cases, exact to a day, or even an hour; while in others a variation of several days is a usual occurrence without the slightest disturbance in the usual health re- sulting therefrom. An excess of loss of menstrual blood, a true monorrhagia, does not 382 OUR FAMILY PHYSICIAN. occur as often as it may seem to those who complain of it. To constitute menorrhagia, seA'eral circumstances have to occur that require to be care- fully discriminated. The generality of discharged blood has to exceed the ordinary loss quite considerably; and then, again, we have to inquire whether the scantiness of the ordinary menstrual flow is not an abnor- mal diminution in the present case. The menstrual flow is likewise con- sidered too copious if it continues beyond the ordinary period, although this need not necessarily imply that the menses are profuse. It is, there- fore, the morbid character of the menses that is necessary to determine the disorder, for a copious flow of the menses cannot be considered ab- normal as long as the constitutional harmony is in no respect disturbed by it. The causes of menorrhagia are quite numerous, of which it may be best to make mention of a few : Excess is occasioned by onanism, novel- reading, a constant dwelling of the fancy upon sexual things, and the ha- bitual use of heating beverages. A few other important points have to be added : Under certain circumstances, a profuse flow of the menstrual blood becomes a real physiological necessity to the body ; for instance, if a larger supply of nourishment than the body requires for its normal support, causes a real plethora. This can hardly be regarded as a morbid condition. A profuse flow is sometimes occasioned by changes in the uterus, such as acute or chronic inflammation of the womb, or some for- eign growth in the uterine cavity. Nursing exerts a very particular in- fluence. As a rule, nursing women do not menstruate ; yet it may hap- pen, even in the case of quite healthy mothers, that the menses reappear again permanently, in which case the Aoav is often very profuse. This is not a normal condition, although it does not inconvenience all women. Menorrhagias that set in when the process of nursing is continued too long, are of an exceedingly threatening character. Accident occurs quite often where the women nurse their children for several years for the purpose of preventing conception, not thinking that by so doing they inflict permanant injury upon their health. We must not forget to record the fact that diseases of other organs, or of the general constitution, ex- ert an influence upon the menses. Diseases such as typhus or scurvey, etc., the influence of heart disease or consumption, and all such diseases which, alter the quality of the blood must be considered. It is more especially heart disease that causes menorrhagia, so that the heart had better be carefully examined in every case of menorrhagia. Finally, the cessation of the menses, at the critical age, is almost always ushered in by profuse loss of blood. HOMOEOPATHIC TREATMENT. Ipecacuanha is one of the more generally useful medicines in severe cases of this derangement, as well as in flooding after labor, and may, in most instances, be administered first, unless there are strong indications for a preference being given to any of the others. Dose: Six globules in a teaspoonful of Avater, repeated at intervals of six hours, until amelioration or change. Sabina is indicated when the discharge is excessive, of a bright color PROFUSE MENSES. 383 and occurs in full-habited females who are prone to miscarry; or when the subjoined symptoms prevail ; rheumatic pains in the head and limbs, great weakness; pains in the loins similar to those of labor. Dose: Six globules, as directed for Ipecacuanha. China is of considerable utility Avhere there is great debility in con- sequence of a more copious menstrual discharge than is natural. Dose: Six globules in a teaspoonful of water, repeated at intervals of six hours, if necessary. Nux-vomica is especially appropriate for the following symptoms :— The discharge being of too frequent occurrence, too profuse, and of too long duration ; and when it commonly stops for a day or so and then re- turns, attended with spasms in the belly ; sometimes nausea and fainting, especially in the morning; pains in the limbs; restlessness; irascibility. Nux-vomica is especially serviceable Avhen the above symptoms occur in females who are addicted to the daily or frequent use of coffee, liquors and other stimulants, or have been extensively drugged by old-school practitioners. Dose: Six globules in a teaspoonful of water, repeated at intervals of four hours. Chamomilla is frequently useful when there is a discharge of dark, clotted blood, with severe colic, or pains like those of labor; great thirst; paleness of the face, and coldness of the limbs. Dose: Six globules in a teaspoonful of water, repeated at intervals of six hours, until improvement or change. Ignatia is of considerable service in cases resembling the aboA'e, when the derangement happens in hysterical or sensitive females, of mild and uncomplaining disposition; or who have had a great deal of trouble. Dose: As for Chamomilla. Veratrum is more particularly required for too early or too copious menstrual discharge, always attended with diarrhoea. Dose: Three globules, as directed for Chamomilla. Gelseminum is indicated in cases in which there is scarcely an inter- val between the periods; which are not, however, attended with much suffering; or, the flow having ceased, is brought on again by fright or other mental emotion. Dose Three globules, as for Chamomilla. Kreosote will be found useful when the menstrual blood has a de- cidedly offensive odor, is too profuse, and lasts too long; the abdomen becomes distended before the periods; leucorrhcea, which excoriates the parts, between the periods. Dose: Three globules, as directed for Chamomilla. Diet and Regimen.—Patients who are habitually affected with ex- cessive menstrual discharge should live with great regularity, keeping early hours, taking regular, but moderate daily exercise in the open air (during the intervals) in favorable weather, and partaking of nothing but the most digestible, simple, and unstimulating diet, which, at the same 384 OUR FAMILY PHYSICIAN. time, should be of a nourishing and strengthening description. Emo- tions of all kinds should be avoided, as much as possible ; and during the continuance of the discharge the semi-recumbent posture should be retained, and the body kept cool. Neither food nor drink should be taken hot; the food should be as cool as it can be relished, or chiefly cold, and the beverage quite cold. In addition to these directions more explicit particulars may be derived from the article on " Eradicative Treatment," at pp. 100—105 MASTITIS. inflammation of the breasts. The mammae constituting exclusively a part of the female organism, we prefer treating of inflammation of the mamma? in this place instead of ranging this disease among the diseases of the thoracic organs. Mastitis proper only occurs during or immediately after nursing. The painful, sometimes rather extensive, hardened SAvellings of single por- tions of the breasts, which sometimes occur among unmarried females or married women who are not nursing, especially about the time of the menses, are evidently transitory states of congestion which never termin- ate in suppuration. The cause of mastitis is always traceable to the impeded discharge of milk. By some cause or other, soreness or a bad shape of the nipples, too feeble drawing by the child, one or more milk ducts become closed, the milk in the corresponding mammary lobule becomes stagnant, and an inflammatory process is the result. Another cause of obstruction of the milk-ducts is the improper manner in which some women wear their clothes, owing to Avhich the the breasts either hang too loosely, or a direct pressure is exerted upon them. The doctrine that mastitis can originate in dietetic transgressions or a cold, is a conven- ient supposition rather than a scientific fact. What happens Avith other abscesses, is likewise true in regard to abscesses of the mamnue ; in some cases they heal rapidly, in other cases they cause vast destructions of tissue. Mastitis is most apt to occur soon after confinement or shortly after weaning the child; mastitis occurring at the latter period is less apt to lead to the formation of abscesses. Symptoms.—The disease never breaks out all at once Generally Avomen experience some time previous, a gradually increasing pain both spontaneously or Avhile the child is nursing; and a swelling soon develops itself soon after. As a rule the lower or lateral lobes are inflamed, very seldom the upper ones, and still less frequently both breasts. Sooner or later, sometimes in a few days, and at other times in some Avceks, the painful spot becomes red and more sensitive, and the inflammation is intense, the Avhole organism feels the effect of the inflammatory process, and shows its sympathy by febrile phenomena. Soon the infiltrated tissue shows the signs of suppuration, the pus being discharged through a small opening. As soon as the discharge, Avhich is never complete, commences, the pain suddenly ceases and the febrile symptoms abate. The course of the inflammation depends upon a variety of circum- stances. If the inflammation is confined to one lobe, the abscess most Inflammation of the breasts. 385 commonly discharges close to the nipple, empties itself very rapidly and heals. If several lobes are inflamed, or the inflamed lobe is situated near the base, the suppuration, swelling and pain continue for a long time; months and even years may elapse before the abscess heals, which dis- charges through several openings near the nipple. This disorder never lasts less than two weeks, and, under corresponding circumstances, may continue for months even, in its acute form. The treatment of mastitis includes above everything else a prophy- lactic treatment which has to be commenced long before confinement, especially in the case of primiparse (a woman with her first child.) The preservation and proper management of the nipples and of the mamma? generally should be a constant subject of our attention. After confine- ment, if women do not intend to nurse their children, they will have to dispense with liquids as much as possible. Nursing women have to keep the folknving points constantly in view: the breasts must not be kept too warm, must not be enclosed in tight clothing, and must, oy some suitable support, be prevented from dragging down; e\Tery time after the baby has nursed, the nipple must be washed, but not be kept moist betAveen the acts of nursing; the excessive use of liquids which women fancy favor the secretion of milk, must be avoided; the child should be put to the breast as seldom as possible, for the more hungry it is the more vigorously it will draw and the more complete- ly the breast vail be emptied. At the same time the nipples will not be held so long in the child's mouth, and they will not be exposed so much to the risk of being made sore by the constant nursing. By following these instructions, and more particularly by putting the child to the breast every two hours in the early period after confinement, mastitis will generally be prevented. You must do it. If the breasts have become hard and painful, the best remedy in the case of lying-in women is Bryonia, less frequently Belladonna, whereas the latter medicine is better adapted to women who are weaning their in- fants. We sometimes succeed in dispersing the stagnation of the milk by gently rubbing the indurated portion while the child is nursing. The same good effect is sometimes obtained by causing the milk to be drawn by an older, more vigorous child. In no event should the infant be all at once kept from the breast, even if nursing causes pain. It is only if the pain is very acute, and the hardness considerable that the infant should no longer be put to the diseased breast. Belladonna will now have to be ad- ministered. As soon as redness has set in, the chances of scattering the inflammation are very slim; in some exceptional cases we may sometimes succeed in effecting this result by a few doses of Mercurius. Warm poul- tices should never be omitted; they sometimes favor the dispersion of the abscess as much as in other cases they hasten the process of suppuration. Hepar sulphuris will promote the discharge of the pus. A great many authorities teach to open the abscess at an early period in order to prevent the further spread of the inflammation. We doubt whether such a pro- ceeding is justified by corresponding results; after opening the abscess we have often seen the inflammation spread much more rapidly; in the most tedious cases of mastitis, the abscess had been opened in accordance with 25 386 our family physician. his suggestion. In a fortnight at latest the discharge of pus ceases under he use of a few doses of Mercurius, and the sore heal HOMOEOPATHIC TREATMENT. Bryonia is the principal remedy in this affection, before the inflam- mation becomes fully developed, especially when the breasts are hard, red, tense, and tumefied, and feel heavy; and when there is some degree of fever. Dose: Of a solution of six globules to four teaspoonsful of water, give a teaspoonful every four hours. Belladonna is, however, required when the inflammation is more in- tense, and the erysipelatous appearance of the skin is clearly defined usually running in radi; and is, in such instances, usually sufficient to subdue all inflammatory symptoms. Dose: As directed for Bryonia. Sulphur may be required, more especially for the treatment of scro- fulous subjects, and when the previous administration of Belladonna has been productive of partial or limited improvement, an evident suscepti- bility remaining, even if the active inflammatory symptoms have been allayed. It is also useful when, after the bursting of an abscess in the breast, the cavity is slow in healing up, and the discharge excessive. Dose: As for Bryonia. Graphites should be employed, particularly in scrofulous subjects where the breasts are in such bad condition from previous inflammations and abscesses, that the milk cannot flow, and its retention threatens in- flammation and abscess. Graphites will in most cases, ward off the diffi- culty. Should Graphites fail, Phytolacca should be tried, no other remedy being more prominently indicated. Dose: As directed for Sulphur. Phytolacca decandria will be found to be a most valuable remedy in may cases; more particularly where the breasts are hard from the com- mencement of the disorder, sensitive to touch, and more or less painful. It will also prove useful for "lumps " in the breasts. Dose: As directed for Bryonia, use also as an external application. Mercurius may be be required after any of the foregoing medicines, when, notwithstanding the previous treatment, and the reduction of the inflammatory symptoms, a degree of induration still remains. Dose: As directed for Sulphur. Phosphorus is indicated when symptoms of threatening formation of matter (abscess), such as increase of pain, with transitory chills, and throbbing in the breast ensue. Its immediate employment, under such ircumstances, will often succeed in speedily relieving pain, and prevent- ing the ripening and bursting of the abscess. It is also indicated in severe cases where there are already fistulous ulcers formed, of blue appearance, and having callous edges; and the patient has hectic fever and night sweats. Dose: Three globules every six hours, until relief is obtained. CANCER OF THE WOMB. 387 CARCINOMA UTERI. CANCER OF THE UTERUS. In, by far, the majority of cases, this disease occurs beyond the age of forty, and is very seldom met with in women of a less advanced age. Feeble as well as robust, married as well as unmarried women are at- tacked by this terrible destroyer. Cancer of the uterus is one of the most frequently occurring forms of carcinoma, and not unfrequently runs its course as a solitary cancer. It is only in rare cases that it breaks out in addition to cancerous degenerations of other organs. Cancer of the uterus is frequently mistaken, at the commencement, for menstrual disorder, leucorrhcea or chronic inflammation of the womb. The first symptoms usually are menstrual derangements, cessation or a more frequent return of the menses, or in the place of the menses we have irregular hemorrhages and leucorrhcea. The mistake is made the more easily, if the patient has not yet reached the critical period, so that these changes may be set down as results of a natural cessation of the monthly secretion. If the patient has passed through the critical period, a sudden flow of blood takes place, at first resembling the menstrual flow, but soon increasing to a true hemorrhage. In the beginning the patient often complains only of a feeling of weight, drawing in the pelvis, a pressing toAvards the sexual organs, or the pains are excited by bodily motion, a concussion, sexual intercourse, touch. An examination shows the vaginal portion harder than in the normal condition, of unusual re sistance, swollen, misshapen, rugged and knotty, sensitive to pressure and readily bleeding. In the course of the disease, pains set in which are, at first, only vague, and occur only now and then, but afterwards become more severe, and finally, especially at night, exceedingly violent, pressing, stinging, lancinating, burning, not confined to the region of the uterus, but spreading to the small of the back and thighs. Characteristic are the more or less violent, burning and stinging-boring pains over the pubic bones and in the small of the back, along the hips and thighs, in- terfering with walking, and even sitting; very often a burning pain is continually felt deep in the pelvis, accompanied by fugitive stitches dart- ing through the uterus. The neighboring lymphatic glands are generally larger and painful. At the beginning of the trouble, a serous or slimy secretion flows from the vagina, having but little smell; more usually the discharge is copious, of* a brownish-red, suspicious-looking color, having a horrid smell and excoriating the skin. The bleeding becomes more and more frequent and copious, the blood being mixed with detached portions of tissue. These hemorrhages consume the strength of the pa- tient in a very short time. At this stage of the disease, the ichorous dis- solution of the cancer progresses very rapidly. The disease generally lasts for years, calculating from the first manifestation of distinct symptoms, and without allowing for the influence of special circumstances, such as confinement, which is one of the most pernicious occurrences that can happen to a woman afflicted with cancer of the womb. It is inconceiv- able how it is possible for the organism to bear up for so long a time un- der a destructive malady, like cancer, without perishing. 388 OUR FAMILY PHYSICIAN. TREATMENT. No more than we reject the possibility of a cure of cancer gener- ally, do we believe that cancer of the uterus is an incurable disease, al- though it is difficult to obtain certainty in this respect. Kreosotum. When the following symptoms are present : Obsti- nate leucorrhcea during frequently recurring losses of blood, with aching or pressing pains, and a gradually appearing fetid discharge of a serous fluid or a bloody ichor. This is attended with burning or lancinating pains in the small of the back and loins. When standing she experi- ences a sensation as of a weight in the pelvis ; coition is painful; all the symptoms are worse at the time of the menses. Electrical stitches in the vagina, as if proceeding from the abdomen, causing the patient to start; voluptuous itching in the vagina, with burning and SAvelling of the external and internal labia; ulcerative pain during coition ; the men- ses appear from four to ten days too soon, and continue for days, with discharge of a dark, coagulated blood, pains in the small of the back, and subsequent discharge of a pungent and bloody ichor ; gnawing, itching and smarting in the parts; the menses stop for hours and days, but after- wards return again in a more fluid form and attended with violent colicky pains. The pressing downwards and the abdominal spasms continue after the menses, more especially in the groin and pelvic region ; bleeding from the uterus and a continual corrosive leucorrhcea are not wanting. The pains are worse at night. Sensation of fainting on rising, with a peevish and desponding mood, and livid complexion. Arsenicum album has been given with excellent success in carcino- ma uteri. Arsenic can only be resorted to after the whole organism re- flects the picture of a cancerous disease. However, it only palliates the severe pains and the sleeplessness, and perhaps modifies the profuse met- rorrhagia, which occurs every now and then in the course of the disease. Nitri acidum is indicated in carcinoma uteri, as it is in many other nveterate dyscrasic conditions of the organism. The most important symptoms are : Irregular menses, they sometimes remain suspended for weeks and then appear again at short intervals; between the menses co- pious leucorrhcea of a badly-colored, brownish appearance and offensive odor. The patient looks worn, feels nervous and is depressed in spirits. Obstructions in the portal circulation, such as hemorrhoids, indicate this drug. Acidum nitricum can, however, only be used as an intercurrent remedy at the commencement of the disease; if ichorous dissolution has commenced, this drug is no longer of any use. CARCINOMIA MAMMiE. CANCER OF THE BREAST. Next to the uterus (womb) the breasts are the most frequently attack- ed by cancer. The causes of this disease can scarcely ever be determined with certainty. The influence of depressing emotions which are so easily and so commonly succeeded by cancerous degenerations, or diseases, is a much more evident source of the difficulty than the belief of some that it is the result of a bruise, from a blow or contusion. Cancer of the breast most commonly occurs between the ages of forty and fifty, about the period which is generally designated as a change of cancer or the breasts. 389 life. Unmarried women or women who have not had children seem to be more liable to it than married women with children. Before and after this period, it is proportionally a rare occurrence. The commencement of the disease is scarcely ever marked by peculiar morbid phenomena; the patients generally do not notice anything out of the way until a tolerably large tumor is perceived in the breast. It is at first round, smooth, movable, grows with more or less rapidity, and loses its mobility in proportion as it increases in size, and its surface becomes more uneven. At first it is most commonly deep-seated and gradually grows toAvards the surface, is sometimes entirely painless or becomes, pain- ful only at the time of the menses and when receiving some mechanical injury. If the cancer reaches the skin, it coalesces with it, after which the pains are almost constantly felt. At the same time the disorginizing pro- cess extends to the deeper tissues, and at an early stage the axillary (arm pit) and other neighboring glands become involved. The patients now commence to feel constantly or at intervals, and particularly at night, lan- cinating, boring pains in the affected part which very soon become un- bearable. The assimilative functions begin to suffer; the patients have a pale yellowish-gray appearance, the spirits are very much depressed. A characteristic sign is the gradual effacement and finally the complete re- traction of the nipple which discharges either spontaneously or on pressure a turbid, serous fluid. At the place where the cancerous growth first be- came interwoven Avith the skin, the latter by slow degrees loses its healthy color, and 'finally breaks. An irregularly-shaped ulcer forms, showing a disposition to penetrate to the subjacent tissues; the edges of the ulcer are infiltrated, have a sickly color and an uneaven base, and secrete at first a thin, serous and afterAvards an ichorus, purulent, bloody, and most com- monly very fetid fluid. If the disease runs a slow course, the incipient ulcer often heals for a time, but again breaks open at a later period; if the disease runs a rapid course, spongy and readily-bleeding excrescences are apt to shoot up from the bottom of the sore. If larger vessels become necrosed, hemorrhages take place which are sometimes very profuse, at other times trifling. The further course of the disease which, having ar- rh'ed at this stage, always terminates fatally, depends upon the extension of the cancer, upon the invasion, by the carcinomatous process, of internal organs, upon the importance of the hemorrhage and upon the loss of fluids in consequence of the ichorus discharge. The duration of the whole disease varies considerably, ranging from two to twelve and even more years. The younger the patient, the sooner she will succumb to the disease, and the more sudden the cancerous growth, the sooner it Avill destroy life. The prognosis is very bad with scarcely an exception. In many respects the diagnosis is liable to difficulties, because various kinds of benign tumors may recur in the breast. An incipient cancer cannot always be recognized as such, though it may grow rapidly and be painful; these two conditions neA'er occur in the case of benign tumors. At a later period the diagnosis is determined by the retraction of the ' nipple, the fluid which it discharges, the rugged unevenness and immo- bility of the swelling, the participation of the neighboring glands in the 390 OUR FAMILY PHYSICIAN. disease, the failing of the whole organism without any increase of the secretory products. Nevertheless there occur many cases of cancer, the true nature of which remains for a long time undetermined and is clearly revealed only after the disease has run a long course. Cancer of the breast is generally considered a surgical disease; it is supposed by most authors that internal treatment cannot reach it. The disease, at least in its incipiency, is considered purely local, and an opera- tion the only cure. For these and other reasons, having given you the means of selecting an intelligent and honest physician and surgeon, we unhesitatingly commend you to his care and here offer no treatment. HOME REMEDIES. Take the juice of Sheep Sorrel, let it evaporate on a pewter plate to the consistence of a thick extract; apply this over the cancer. It is very pain- ful but good. Another. Take equal parts of Sheep Sorrel, Poke Leaves and Yel- low Dock Root, beat them up in a mortar with a little water; squeeze out all the fluid; place it on a lead or pewter plate, and let it evaporate until it forms a thick extract. Apply to the cancer. This is a noted cancer cure. Again: Make a ley of the ashes of Red Oak Bark; boil down until it is as thick as molasses, and cover the cancer with it. In about an hour afterward, cover it with a coat of Tar. Remove this in a few days, and if any protuberances remain in the wound, apply more of the Oak Bark Potash and the Tar plaster, and so on until the cancer is cured. Heal the ulcer with some common salve. t COMMON cold. 391 F»ai-t TXinth. DISEASES OF THE RESPIRATORY ORGANS. CHAPTER XX. DISEASES OF THE LARYNX AND TRACHEA. (windpipe.) CATARRH, OR COMMON COLD. CATARRHAL FEVER. This term is given to an affection, which consists of a mild degree of inflammation of the lining membrane of the nostrils and windpipe, and occasionally also of the ramifications of the latter, induced by exposure to sudden changes of temperature, or to a damp or chilly atmosphere with insufficient clothing, particularly as regards children. Symptoms. This complaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head, or in the back and extremities, and subsequently hoarseness or cough, generally preceded by transitory chills or shiverings; there is also a slight degree of wheezing and difficulty of breathing. When the disease is confined to the nose and sinuses, it is termed A cold in the head. PREMONITORY STAGE. HOMCEOPATHIC TREATMENT. Camphor {concentrated tincture) is frequently effective in arresting the development of incipient cold or influenza, particularly if the exciting cause, to which it is immediately traced, has been wet feet. The symp- toms Avhich usually identify the propriety of resorting to Camphor under these circumstances are as follow: unusual weariness, heaviness, and general uneasiness, attended with shivering and dryness or coldness of the skin, and symptoms of approaching fever. Dose: One drop of the concentrated tincture on a small lump of pure loaf sugar every three hours, until three doses have been given. Nux-vomica is the most generally useful, particularly when the symptoms have accrued after exposure to a draught, or prolonged expo- sure, in Avinter, to a cold, dry, frosty atmosphere. Dose: Six pills in a teaspoonful of water at night, repeated, if neces- sary, after an interval of six hours. Chamomilla is preferable when a copious outbreak of perspiration has been suddenly checked by a current of dry, cold air, or by a sudden transition from heat to cold. In the case of children, and highly sensi- tive females, this remedy is more especially useful. 392 OUR FAMILY PHYSICIAN. Dose: Six globules in a teaspoonful of water, as directed for Nux- Vomica. Bryonia should be employed Avhen the symptoms of incipient catarrh have been excited by prolonged exposure to a cold easterly Avind; or when in adults, who are subject to lh'er complaints or to rheumatism, the natural SAveat has been suddenly suppressed, whilst they Avere someAvhat heated. Dose: Six pills in a teaspoonful of water, repeated, if requisite, after the lapse of twelve hours. Dulcamara is the most appropriate remedy to be taken by those who are subject to severe coughs, or to sore throat, whenever they are ex- posed to a close, damp atmosphere (either during the day or late in the evening), or after getting the feet wet. Its alternate administration with Mercurius is sometimes of great advantage. In other cases when Dulca- mara fails to arrest the symptoms it should be promptly followed by Mer- curius. Dose: As for Nux. If in alternation with Mercurius, six pills, first of the one then of the other, in a teaspoonful of Avater, at inter- vals of four hours betAveen them. Arsenicum is especially appropriate for the treatment of ill-effects resulting from a chill whilst bathing, or from long-continued immersion in the water, either voluntary or otherwise. Chills in the stomach, pro- duced by partaking of raw. cold fruits, or by eating ices, or drinking very cold water when heated, are also most readily counteracted by this medicine. Dose: Four globules in a teaspoonful of water, repeated, if necessary, every three hours. Pulsatilla should, hoAvever, be preferred under similar antecedent circumstances, if drinking whilst heated, or eating cold fruit, ices, etc., has caused the indisposition. Dose: Six pills as directed for Nux. FEVER STAGE. Aconitum is one of the principal remedies in feverish attacks pro- voked by cold, and particularly from exposure to a dry, cold wind, or to a draught, when hot, dry skin is present, or general shivering chills, al- ternating with burning heat of the surface; great thirst, especially towards evening, with a sensation of dryness, and roughness or scraping, slight burning, and sensation of excoriation in the upper part of the windpipe, or even throughout the whole of the chest, which gives rise to an incessant short, dry, IioIIoav cough (more of a hoarse or rough descrip- tion at night); restless sleep. Dose: Six pills every two hours in a teaspoonful of water. Bryonia when there is an excessively dry, hollow cough accompanied by tenderness of the upper part of the windpipe on pressure, inclination to vomit, and pain in the chest, as if it would be torn asunder; severe headache, aching pains in the limbs, increased by the slightest move- ment, violent cold in the head. Dose: Four piils in a teaspoonful of water, every two hours. COMMON COLD. 393 Nux-vomica.—Dry cough, particularly in the morning, and some- times during the day, rarely during the night; occasionally a small quantity of adhesive phlegm is with difficulty expectorated after a fit of coughing; and the paroxysms are frequently attended with a painful sensation in the region about the navel, as if arising from the effects of a bruise or blow. This remedy is further of great utility in catarrhal fever, with disposition to chilliness or wandering fever-chills, worse during movement, coming on and gradually increasing in the after part of the day, and alternating with flushes of heat. Warmth and absolute rest mitigate these symptoms. Dose: As for Bryonia. Chamomilla.—In the treatment of children, this medicine is gene- rally preferable to Nux-Vomica in arresting the attack. It is extremely valuable in restoring the suppressed perspiration, and removing the fol- lowing symptoms: colic, with pains in the head, ears, and teeth, thirst, and ill humor, and impatience; dry heat of the skin, or chilliness in any part of the body which may happen to be uncovered for a short time, or on lifting up the bed-clothes ; burning heat in one part (as for instance one cheek) and chilliness in another; severe, dry cough, especially at night, excited by tickling in the upper part of the windpipe. Dose: As for Aconite. Belladonna is indicated when there is a throbbing, bursting head- ache, attended with tendency of blood to the head, and increase of the pain from movement or exposure to cold air, pain and heat in the head, eyes, and nose; cough at night. Dose: As for Bryonia. Mercurius, when the lining membrane of the eyelids, nostrils and air-tubes is highly irritated, and gives rise to copious shedding of tears, cold in the head, and cough Avith profuse expectoration; headache, or feel- ing of tightness and fullness in the head, with pulsation extending to the nose; pains in the limbs and joints, accompanied with profuse sweating, which affords no relief. Dose: As for Bryonia. Sepia is indicated in cases of catarrhal fever, with shivering chills on every movement in a warm room, rarely alternating with heat; nocturnal spasmodic cough, with shortness of breath and inclination to vomit; cold in the head, pain at the back of the head. PREDISPOSITION TO COLD. PRECAUTIONARY MANAGEMENT. Some individuals, particularly among those of the fair sex, are tor- mented with an extreme degree of susceptibility to cold, the best correc- tive of which is, to rub the throat, chest, and indeed the whole body, every morning with a wet toAvel, until a glow of heat is produced,—drying one part before another is commenced;—also to acquire a habit of going out every day , provided there is no inherent predisposition to pulmonary consumption; extremes, either of heat or cold, should at the same time be avoided, and care taken, when the body is heated, to let it cool gradually. 394 OUR FAMILY PHYSICIAN. The shower-bath is another useful means of overcoming an unusual sus- ceptibility to cold. It should, generally speaking, be begun in summer and used tepid at first. ACCESSORY MEASURES. In many instances catarrh is carried off, or runs to a salutary termina- tion, in a day or two; and this desirable result is frequently obtained by having timely recourse to the simple expedient of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm demulcent fluid, such as gruel; bathing the feet and legs in warm water, at the tem- ature of about 98 to 100 degrees Fahrenheit, is also a useful auxiliary mode of restoring prespiration, but the patient should go to bed immediately afterwards. Very robust persons who are accustomed to be in the open air in all weathers, but who have caught cold after having overheated themselves, will frequently prevent any bad effects by drinking one or two glasses of cold water on going to bed. Others again, recover quickly, especially when the cold is confined to the head, by totally abstaining from all fluids for forty-eight hours, or by taking a tablespoonful of fluid, thrice a day only (at breakfast, dinner, and tea), for seventy-two hours. INFLAMMATION OF THE LARYNX. OR UPPER PART OF THE WINDPIPE. The disease consists in a suppurative inflammation, haA'ing its seat in the lining membrane of the upper part of the windpipe, or the connecting cellular tissue between it and the subjacent parts. The disease bears a considerable resemblance to croup, of which it very generally forms a part; but occasionally the inflammation is exclusively restricted to the upper part of the windpipe; and it is a frequent cause of a fatal termination in scarlet fever and smallpox. It is distinguished from croup by a constant hawking (which the patient voluntarily exercises in order to clear the air- passage) rather than a violent and involuntary cough,—and by the charac- ter of the expectoration, which consist of a thick, tenacious phlegm rather than of a coagulable and membranaceous looking exudation. Symptoms. The invasion of the disorder is announced by the usual signs of inflammatory fever; the voice soon becomes hoarse and inarticul- ate, whilst a painful sense of constriction is experienced in the throat; the breathing is laborious and shrill during inspiration; the upper part of the windpipe is extremely sensitive to the touch, so that the slightest pressure against it, either externally, by the hand, or internally, from the perform- ance of the act of deglutition, is productive of the most distressing spasms, which threaten death from suffocation. The heat of skin is great, the pulse rapid and hard, the thirst considerable, but incapable, of being satis- fied from the suffering that is occasioned by the attempt. On examining the throat, it is often found to present a red, inflammed, and turgid ap- pearance; in some cases the epiglottis (the small, oblong body, attached to the root of the tongue, which protects the opening of the windpipe) is in volved, and the motions of the tongue are thereby rendered painful and difficult. As the disease gains ground, the face becomes swollen, and sometimes livid, the eyes protruded as in threatened strangulation, and life is speedily cut short by suffocation. HOARSENESS. 395 Results. The disease, if not arrested, occasionally terminates fatally within a few hours, or in a day or two at the farthest. It ought not to be treated by the non-professional reader. HOMOEOPATHIC TREATMENT. Aconitum must immediately be exhibited when the signs of in- flammatory fever declare themselves, and continued until it gives evidence of having effected an abatement of the fever. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every half hour. Spongia should in the generality of cases, be administered with Acon- ite every two hours after the last dose of Aconite, or as soon as the breath- ^ ing becomes shrill, and the pain and sensibility in the upper part of the windpipe are more decided, with increase of hoarseness and difficulty of articulation. Hepar-sulphuris should be given six hours, or sooner if needful, after the last dose of Spongia, when the latter remedy appears to have done all that it is capable of effecting; in which case, this medicine will either be adequate to complele the cure, or at all events to bear the patient out of danger, and thus to leave more leisure for appropriate selection in treating the remaining symptoms. Hepar-s. may, however, be selected to follow Aconitum in preference to Spongia, if the fever and burning heat of the skin continue notwithstanding the previous administration of Aconitum. Belladonna has likewise rendered very appreciable service, espe- cially when there were considerable heat of the skin, much thirst, but complete inability to swallow liquids, owing to the spasms which the attempt occasioned; further, when, on looking into the throat, it was found to present an inflamed and swollen appearance. Belladonna is, however, not to be administered in cases in which it has previously been employed ; as, for instance, if the affection of the windpipe occurred im- mediately after an attack of pure Scarlet-Fever. HOARSENESS. Hoarseness, or roughness of the voice, arises from some morbid con- dition of the upper part of the windpipe. In the majority of cases the seat of the affection is in the mucous membrane which lines that part, which is extremely liable to be affected by the common causes of Catarrh; hence it is a frequent accompaniment of the latter disorder. HOMOEOPATHIC TREATMENT. Pulsatilla is indicated by almost complete loss of voice, particular- ly when accompanied with loose cough, or thick, yellow discharge from the nostrils. Dose: Six pills in a teaspoonful of water night and morning, but if, after the course of a week's treatment, although much improved, the case be not cured but appears to have become stationary, proceed with one or other of the following medicines, according to symp- toms. Mercurius.—This remedy will be found useful in removing any 3)3 OUR FAMILY PHYSICIAN. symptoms remaining after the above, but it is to be preferred should the hoarseness, from the commencement, be attended with thin discharge from the nose; and also when a sensation of burning or tickling is com- plained of in the upper part of the windpipe, with the characteristic indication of Mercurius, namely, a disposition to profuse sweating, espe- cially at night. Dose: Six pills in a teaspoonful of water, repeated at intervals of twelve hours, until amelioration or change. Nux-vomica.—Hoarseness, accompanied with a dry, fatiguing cough, worse in the early hours of the morning, with dry obstruction of the nose. Dose: As for Pulsatilla. Rhus-toxicodendron.—Hoarseness, accompanied with sensation of excoriation in the chest; oppressed breathing, with frequent and violent sneezing, unaccompanied by cold in the head, but occasionally by a great discharge of phlegm from the nose. Dose: As for Mercurius. Stannum is more particularly required Avhen symptoms such as the following are present: cough, with copious expectoration of a greenish- yellow color, and of a sweetish or saltish taste, attended with great weakness and disposition to sweats ; soreness at the chest as from internal excoriation; feeling of weakness or sinking in the chest, as if it were empty, particularly after expectorating, or even after speaking; or dry, shaking cough, Avorse at night or towards morning, excited or aggravated by speaking or laughing, and occasionally followed by vomiting of food. Dose: Four pills as directed for Sepia. Lycopodium is very efficacious in obstinate coughs which are worse at night, and are attended with expectoration of tenacious phlegm, and sometimes vomiting; paleness of the face, emaciation, pains and oppres- sion in the fore part of the chest, flatulence, ill-humor, etc. Dose: Six pills in a teaspoonful of water, morning and evening, until change. Phosphorus is appropriate to the following symptoms: dry cough excited by tickling irritation in the throat or chest, or by laughing, talking or drinking, or by cold air, and accompanied with pricking in the wind- pipe ; hoarseness, or pains in the chest as if from excoration; cough with hoarseness, fever and depression of spirits, sometimes with apprehensions of death; dry-sounding cough, followed by expectoration of viscid or bloody phlegm, and attended with oppressed breathing and livid hue of lips and face; cough occurring in consumptive habits. Dose: Six pills in a teaspoonful of water, night and morning, until change. Arnica is of great value in coughs attended with bleeding from the nose and mouth; headache, pricking in the chest, rheumatic pains in the loins and extremities, and soreness or pain, as from a bruise, in the chest and belly. Dose: As for Phosphorus. common cold. 397 Spongia. In acute inflammation of the lining membrane of the air- tubes, this remedy is often of essential service; but it is of equal utility in the chronic variety, when the chronic symptoms prevail: cough with muco- purulent expectoration, emaciation, redness and deformity of the points of the fingers, lividity and incurvation of the nails, hectic fever. Dose: Four pills as directed for Lycopodium. ALLOPATHIC TREATMENT. The treatment of Catarrah or common cold is given in chapter X under the head of Catarrah, and in chapter XXI under the head of Acute Bronchitis. Sub-Acute Laryngitis often occurs in colds either alone or with Coryza (acute catarrh of the nose), or with Acute Bronchitis, but may occur alone. The inflammation is of a low grade. There is either hoarseness or loss of voice (aphonia), and a hoarse cough. In children spasm of the larynx is apt to be excited, known as false croup, but this is rarely the case in the adult. Besides the treatment as recommended for Acute Bronchitis, strong irritations over the larynx (Adams apple) is use- ful. This is best made by the frequent application of Tincture of Iodine. When the coloring of the skin is an objection the Decolorized Tincture of Iodine may be used, or a blister can be applied over the larynx. The inhalations of warm vapor is especially useful in all inflamma- tions of the laryux. The steam from a solution of Chloride of Ammonium from a croup kettle, or a spray producer may be inhaled with benefit. Glycerine may be applied freely to the epiglotis, and orifice of the larynx with benefit in some cases. It should run into the larynx. A large cam- el's-hair brush should be used. Should the fever run high, and the pulse rapid, great benefit Avill be derived in this as in other catarrhal inflamma- tions, by giving Tincture of Aconite in doses of half a drop to a drop every half hour until an impression is made on the fever, and then given one or two hours apart. It may be used without interfering with other treat- ment. A couple of drops of Tincture of Belladonna may be advantage- ously given with each dose of Tincture of Aconite, especially when the secretion of phlegm is profuse. Tincture of Iodine droped in hot water will yield a vapor which may be inhaled frequently during the day. The vapor may be made to ascend through a funnel made of stiff paper, and so conveyed to the mouth. Chronic hoarseness of the throat occurs most frequently in persons of sedentary habits in a somewhat debilitated state of health. The indica- tions are in the first place for life in the open air, and less at the desk. These persons also need tonics, and possibly an alterative. Such a medi- cine we have in the Syrup of the Iodide of Iron, which may be given in doses of thirty drops in water three times a day. An equally servicable, and more elegant preparation is the following: Take of Iodine of Potas- sium five drams, ryrophosphite of Iron one dram, water one ounce, Sim- ple Syrup three ounces, Spirits Pepermint half a dram. Dissolve the Iron in half the water and add the Syrup; dissolve the Iodide of Potassium in the remainder of the water, mix and add the Spirits of Pepermint. Dose a teaspoonful three' times a day. In robust persons the Iron may be om- mitted. Other tonics which may be useful are Citrate of Iron and Quin- 398 OUR family physician. ine, in doses of from three to five grains three times a day; dissolved in water or Syrup of Orange. Two or three grain doses of Citrate of Iron and Strychnine given in the same way may be found useful in restoring the general health. Three to five drops of Fowler's Solution may be given often, with advantage, with the above remedies. A dram and a half to two and a half is proper for a four ounce mixture. Pills of the Phosphide of Zinc, and Extract of Nux-vomica will often prove servicable. The following mixture of Iron may be given in connection, if Iron seems required: Take of Pyro-phosphate of Iron a dram, Water sufficient to dissolve, Syrup of Ginger sufficient to make four ounces. Mix. Dose a teaspoonful three times day. Nervous hoarseness is often relieved by from five to ten grains each of the Bromide of Ammonia and Bromide of Potassium, in water, three times a day. Atropine, in doses of a hundred and twentieth to an eightieth of a grain twice a day, will often prove effectual in relieving this form of hoarseness. Counter-irritation, by means of Tincture of Iodine, or Decolorized Tincture of Iodine, applied by a camel's hair brush ; or a liniment of equal parts of Croton Oil, Turpentine and Sweet Oil; or by the use of Ointment of Tartar Emetic (made by mixing two drams of Tartar Emetic with an ounce of Lard) rubbing it well into the skin twice a day. Applications to the diseased surface, the vocal cords and interior of the larynx can best be made by inhalation. Iodine may be inhaled by dropping the Tincture into hot water. Carbolic Acid may be combined with Tincture of Iodine in the proportion of half a dram to a dram to half an ounce; a sufficient quantity of Iodide of Potassium should be added, to prevent the Iodine from precipitating. Iodoform vapor may be inhaled with benefit often. The vapor may be generated by heating a plate or saucer with some of the powder upon it, and may be conducted to the mouth by a stiff paper funnel. Bromine vapor may be inhaled by warming a vial having a few drops of the liquid, and holding to the mouth. A solution of Nitrate of Silver containing ten to twenty grains to the ounce, is, perhaps, the most useful of all the local applications. It should be applied with a brush or probang with the aid of a laryngoscopic mirror. Various substances, besides the above, may be used by means of the steam atomizer or the air spray producer, but they have no special advan- tage over the methods given. Persistent cases of excessive hoarseness (chronic laryngitis) depend, generally, upon tuberculosis or syphilis. If ulceration has gone on to any extent, the hoarseness or loss of voice is incurable. The former dis- ease is treated of in chapter XXI, in the article on Consumption. The latter disease does not come within the scope of this work. This trouble must not be confounded with the hoarseness which ex- ists in Chronic Pharyngitis (inflammation of throat) frequently called clergyman's sore throat, which is treated of in Chapter XL The treatment of this form of Catarrh (sub-acute Laryngitis) in chil- dren does not differ materially from its treatment in adults. The child in the majority of cases, should be kept within doors until the inflammation COUGH. 399 —cough and hoarseness—disappear. Then he may be gradually accus- tomed to his out door play, by beginning first at mid-day. In fact some children may be permitted to go out for a little while in the middle of the day, during the course of the attack. The clothing should be warm en- ough to keep the skin warm and moist. Flannel should be next to the skin. A stimulating application should be made to the neck, as rubbing the skin thoroughly and often with Turpentine, or Turpentine and Spirits of Camphor, and a flannel saturated with Camphorated Oil, (Camphor one scruple, Olive Oil one ounce), may be worn around the neck. Cough should be relieved by the use of Paregoric, in doses suited to the age of the child, with an equal quantity of Tincture of Hyoscyamus, from ten to thirty drops of each can be given to children two to six years old in Syrup, or Syrup of Squills or Ipecacuanha. A hot foot bath at night will be useful. The cough mixture, or ten to thirty drops of Paregoric, or three grains of Dover's Powders (to a child three to five years old), should be given upon going to bed. If the disease becomes chronic, as in the adu t, it probably depends upon tuberculosis or syphilis, and is amenable to treatment proper for these diseases. Should the chronic affection be of scrofulous origin, benefit will re- sult from the internal use of the following mixture: Take of Iodine of Potassium a dram and a half, Pyrophosphite of Iron half a dram, Simple Syrup four ounces, Spirits Peppermint half a dram. Of this Syrup a tea- spoonful may be given three times a day. Cod Liver Oil will be useful. The diet should be good, the clothing flannel and warm. The Tincture of Iodine should be applied upon the neck over the larynx every day, or if the neck becomes very sore every other day. COUGH. Symptoms. Forced and audible expiration, with or without fever: either dry or acccompanied with expectoration. Cough, although not dangerous of itself, may become so, or form an important feature of other diseases. As a precursor of consumption it is too often neglected. Causes. It may arise from an irritation of the air-passages or lungs, from disease of these organs, or from cold or other causes, or be merely sypathetic — or the consequence of derangements of other important organs. We purpose here to treat more particularly of simple mucus or moist and dry cough. NERVOUS COUGHS. Obstinate nervous coughs occurring in highly-irritable, nervous, and hysterical subjects, and which are generally dry, or attended with scanty and difficult expectoration, consisting of a little clear phlegm, are often re- lieved by change of air and scene, or even by exhilarating or active occu- pation, when medicinal resources fail to ensure a permanent cure. 400 OUR FAMILY PHYSICIAN COUGH.—TREATMENT. Aconitum is indicated by violent short cough, with quick hard pulse and feverish heat; pricking in the chest when coughing, or during in- spiration. Dose: Six pills in a teaspoonful of water. Dulcamara. The following are indications for the selection of this remedy: moist or loose cough, with copious expectoration after exposure to a cold, damp atmosphere; or cough with hoarseness and copious secre- tion of phlegm in the ramifications of the windpipe, sometimes accom- panied by expectoration of bright-colored blood during the night; bark- ing, shaking, cough, increased or excited by taking a deep breath. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every three hours. Belladonna. Short, dry, barking {spasmodic, catarrhal, or nervous), cough at night, in bed, and also during sleep, renewed by the slightest movement; dry cough day and night, with irritation or tickling in the pit of the throat, or sensation as if a foreign body Avere in the windpipe, or as if dust has been inhailed; spasmodic; cough, which scarcely allows time for respiration. This medicine is also sometimes useful in cough with rattling of phlegm on the chest, pricking in the front or sides of the chest, and ex- pectoration of thick, white phlegm, coming on especially after meals; lan- cinating pain in the belly; hoarseness, redness of the face, headache, sneez- ing after coughing, and pain in the nape of the neck. Dose: Dissolve six pills in four tablespoonsful of water, and give a teaspoonful of the solution every three hours; but if only partial relief has resulted, within three hours after the fourth dose, pause three hours longer, and proceed with the next medicine. Hyoscyamus frequently answers when Belladonna has only afforded partial relief, and may be preferred to that remedy when the dry, tickling, nocturnal cough is mitigated for the time by sitting up in bed; also when there is mucus rattling in the throat. Dose: A solution of four globules, as directed for Belladonna. Ignati-amara is preferable to Belladonna and Hyoscyamus in very tickling coughs, which continue day and night with equal severity, and are accompanied by a running cold in the head. Ignatia is, moreover, especi- ally indicated by the subjoined symptoms,—shaking spasmodic cough, or short, hacking cough, as if arising from the presence of dust of feather- down in the throat, which becomes aggravated the longer the paroxysm of coughing continues; dry, tickling cough with cold in the head, occurring both day and night. This remedy is, further, particularly efficacious, when the attacks of coughing become aggravated after eating, or on lying down at night, or on rising in the morning, and when the patient is of a mild and placid temper, or subject to alternations of high and low spirits. Dose: As for Belladonna. Nux-vomica.—This is a valuable remedy in many cases either of a catarrhal or nervous character, and is particularly efficacious where there is a dry, hoarse, fatiguing, and sometimes spasmodic cough which occurs in an aggravated form in the morning, and occasionally, also towards evening; or which recurs more or less during the day, but relaxes again COUGH. 401 at night, and is then occasionally supplanted by oppression at the chest on lying down or on awaking during the night, accompanied with a feel- ing of heat, and dryness in the mouth; if there be any expectoration, it consists merely of a little phlegm, which is detached with great difficulty. The cough is generally excited by a disagreeable tickling or scraping, with a feeling of roughness or raAvness in the throat, sometimes attended with hoarseness and feeling of roughness in the chest, but more frequently Avith severe headache, or pain as if from a blow or bruise in the pit of the stomach under tlie false ribs : it is frequently aggravated after meals or by movement, not unfrequently, also, by reading or meditation, and is occa- sionally folloAved by vomiting. Dose: Six pills in a teaspoonful of water, every three hours. Pulsatilla.—Severe shaking, catarrhal or nervous spasmodic cough, worse towards evening and at night, frequently followed by vomiting; sensation of suffocation, as if from the vapor of sulphur; increase of cough when in a recumbent posture; cough which is at first dry, then followed by copious expectoration of yellowish or whitish phlegm, sometimes of a salt or bitter taste; or expectoration of mucus streaked Avith blood; wheezing, or rattling of mucus in the chest; the paroxysms of coughing are frequently accompanied with soreness in the belly, as if from a bruise or blow, or painful shocks in the arms, shoulders, or back, and sometimes followed by a sensation as if the stomach became inverted from the vio- lence of the cough; involuntary emission of urine when coughing; loose cough, with aching in the chest, hoarseness, cold in the head ; excited by a sensation of scraping or of erosion in the throat; shivering. Dose: Six pills in a teaspoonful of water, every four hours. Chamomilla is indicated by dry cough, excited by continual tickling or irritation in the upper part of the windpipe and chest, and increased by talking; the cough is most troublesome during the night, but also occurs during the day, particularly in the morning and towards evening ; accumulation of tenacious phlegm in the throat; wheezing in the chest, cough during sleep, sometimes accompanied with paroxysms, as of threat- ening suffocation ; cough with scanty expectoration of tenacious, bitter phlegm. This medicine is well adapted to the treatment of coughs in children, accompanied with more or less of the symptoms above described or with hoarseness, cold in the head, dryness in the throat and thirst; great fretfulness; fever towards evening; paroxysms of coughing after crying, or after a fit of passion. Dose: Of a solution of eight pills to three tablespoonsful of water, give a teaspoonful every four hours. Bryonia is indicated by catarrhal cough occurring in winter during the prevalence of frost and cold easterly winds, with aggravation of the fits of coughing on coming from the the open air into a warm room. The following are the general indications for its employment: dry cough, with or without hoarseness, and excited by constant irritation in the throat, or as if caused by A'apor in the windpipe, with greatly accelerated respira- tion, as if it were impossible to obtain sufficient air; spasmodic, suffocat- ing cough, after partaking of food or drinks, and also after midnight; cough with prickings or shootings in the chest and violent bursting head- 26 402 OUR FAMILY PHYSICIAN. ache, especially at the temples—also with prickings in the pit of the stomach, or in the side; further, in loose cough, day and night, Avith scanty expectoration of whitish or yellowish viscid phlegm, or slight spitting of blood, the paroxysms being sometimes followed by A'omitings and accompanied by pain as from a bruise under the collar-bones, and pain and fullness in the forehead, as if the contents of the head were forced out, this remedy will frequently be found of great service;—and likewise in dry, nervous cough. Dose: Of a solution of twelve pills to three tablespoonsful of water, give a teaspoonful every three hours. Rhus-toxicodendron is indicated by short, dry cough, worse towards evening and before midnight, excited by tickling in the chest, attended by hoarseness, or a feeling of roughness or rawness in the throat, congestion in the chest, a sensation of suffocating constriction, anxiety, and short- ness of breath; cough on waking in the morning, or short cough, with bitter taste in the mouth, on lying down at night and on waking in the morning, with expectoration of viscid phlegm, sometimes followed by vomiting, pains in the stomach, and darlings or pricking in the thigh. Cough with expectoration of bright blood, with sensation of sinking or exhaustion of the chest, or shooting pains in the chest and sides. Dose: Eight pills in a teaspoonful of water night and morning. Ipecacuanha is more particularly required when the following symptoms occur; catarrhal, nervous, or spasmodic cough, particularly at night, attended with painful shocks in the head and stomach, and followed by nausea, retching, and vomiting; or dry cough, arising from tickling in the throat; or severe, shaking, spasmodic cough, with oppressed breathing, almost amounting to suffocation. In the case of children, this remedy is frequently valuable, when they appear to be threatened with suffocation from the accumulation of phlegm, or where the paroxysm is so severe as scarcely to afford time for respir- ation, causing the face to assume a livid hue, and the frame to become quite rigid. Dose: Of a solution of twelve pills to three tablespoonsful of water, give a teaspoonful every hour, until positive change. Mercurius is indicated by catarrhal cough with hoarseness or watery discharge from the nose, or accompanied toith diarrhan; or dry cough, ex- cited by irritation in the throat, or the upper part of the chest, which be- comes particularly troublesome towards evening, and at night; sometimes with slight prickings in the chest Avhen coughing or sneezing; excited or increased by talking; cough in children with discharge of blood from the nose, vomiting, and headache: dry, spasmodic cough, with pain in the head and chest as if they would burst, retching after the paroxysms, and oc- casional expectoration of blood. Dose: Four pills in a teaspoonful of Avater, night and morning, until distinct change; or, if retching be present, the like dose, every two hours, after fits of coughing. Carbo-vegetabilis is particularly indicated by h How cough, excited by irritation, or a troublesome sensation of crawling in the throat, and at- tended with burning pain and sensation, as if from excoriation in the COUGH. 403 chest; catarrhal or nervous spasmodic cough, frequently followed by in- clination to vomit or vomiting, occurring in paroxysms throughout the day; cough Avith hoarseness, especially toAvards evening, or morning and evening, increased by speaking. Obstinate cough with expectoration of greenish phlegm, or eA'en of yellowish matter, or with expectoration of blood and burning sensation in the chest (a characteristic indication for this remedy as well as for Arsenicum). Dose: Four pills in a teaspoonful of water, night and morning, for four days. Arsenicum is required for cough with oppression at the chest, and tenacious phlegm in the upper part of the Avindpipe and chest; cough ex- cited by a sensation of dryness and burning in the windpipe. Dry cough, chiefly in the evening after lying down, often Avith difficult respiration and fear of suffocation {suffocative catarrh, catarrhal, asthma), as if arising from inhaling the vapor of sulphur : dry cough, excited by eating or drinking, or by ascending stairs, or cough which arises as soon as the open air is en- countered; thin, acrid discharge from the nose; sneezing; periodic dry cough, —nocturnal cough with general burning heat, cough Avith expectoration of bloody phlegm; catarrh in the lungs of old people, attended with ten- acious mucus expectoration, which is extremely difficult to eject and causes rattling in the chest, oppressed respiration, and, frequently, symptoms of impending suffocation, or paralysis of the lungs. Dose. Three pills in a teaspoonful of Avater. every two hours. Ammonium-carijonicum is indicated by dry. Inkling, suffocative cough, especially in the morning, sometimes Avith fever, occurring during the prevalence of a cold, stormy, bleak state of the atmosphere, and attended with a sensation of heat or burning behind the breast-bone, resembling that which is occasioned by drinking spirits; hoarseness; cold in the head, with copious discharge of acrid, watery fluid. Dose: As for Arsenicum. Causticum, which may sometimes be of service in cases analogous to that which has been named as suggesting Ammonium c, either before, after, or in the place of that medicine, is especially indicated by dry, hollow cough, Avhich even wakes the patient from sleep; short cough, excited by tickling, crawling, or a feeling as if the throat were excoriated, or by talk- ing; and cold, attended at times with burning, or a sensation of soreness in the chest, and rattling of phlegm; pain in the hip, and, occasionally, invol- untary emission of urine when coughing; pain in the chest, as if it were raw and sore (the patient comparing his feelings to those which he could conceive to arise from the application of a blister to the exterior of his chest). Dose: Three pills as directed for Arsenicum. Silicea is indicated by cough with oppressed breathing on lying on the back, or cough attended with tightness and oppression at the chest, as if something stopped the respiration while speaking or coughing. Fa- tiguing, or deep hollow cough, day and night, aggravated by movement or by speaking, and sometimes attended with aching and pain, as if from a bruise, in the chest; cough with copious expectoration of transparent hlegm or purulent matter, sometimes streaked with blood; cough which 404 OUR FAMILY PHYSICIAN. asthmatic breathing and emaciation, and with dread of suffocation at night; cough irritated or excited by a sensation as if a hair were on the tongue. Dose: Six pills in a teaspoonful of water, night and morning, for four days. Sulphur is of paramount importance in some cases of obstinate coughs, and particularly in dry cough which disturbs the patient at night as Avell as during the day; the cough is frequently excited after partaking of food, or during a deep inspiration, and is generally attended with a sensation of spasmodic constriction in the chest, sometimes folloAved by inclination to vomit, or the involuntary escape of urine, or pain as if from excoriation, or pricking pains in the chest; headache, pains in the chest, belly, loins, and hips; also cough, with expectoration of thick, avhitish or yellowish phlegm, or of a greenish-yellow, fetid mucus, or purulent matter, of a saltish or sweetish taste; fe\rerish cough with spitting of blood. Dose: Three pills in a teaspoonful of Avater, morning and evening, for four days. Calcarea-carbonica is particularly indicated when the folIoAving symptoms occur: dry cbugh, aggravated towards evening, or at night, excited by tickling in the throat, or by a sensation as if there vf ere feather- down in the throat; also loose cough, with rattling of mucus in the chest, and expectoration of offensive, thick, yellow phlegm; anxiety. Dose: Six pills in every respect as directed for Sulphur. Sanguinaria-canadensis.—Dry cough ; pain and stitch in the right side of the chest; diseases of the lungs ; it has a certain reputation in the cure of coughs. Dose: The same as Calc. carb. Sepia.—The symptoms which indicate this medicine are as follows: cough, with copious expectoration of phlegm of a saltish taste, and of a yellow or greenish color ; also dry, spasmodic cough, particularly at night, or on first lying down, attended, in children, with crying, fits of chok- ing, nausea, retching, and bilious vomiting. This remedy is especially adapted to individuals having a constitutional taint, such as the scrofu- lous, scorbutic, etc., and, in chronic coughs, with thick, yellowish, greenish, or even puriform expectoration, with a putrid taste, it is also a valuable remedy. Dose: Four pills in a tablespoonful of water, night and morning, until change. CROUP. In an attack of Croup it is of the utmost importance to afford help before the dangerous stage sets in. The mother who has the best oppor- tunity of watching her child may avert the danger by the care and treat- ment recommended here. If the family physician is in reach he should be sent for at once. If no physician is near, this treatment may be used in perfect confidence of CROUP. 405 its ultimate favorable effects. Persons who have once heard the croup cough will never forget it; those who have not heard it may know it by the following signs: It is very much like the hoarse barking of the com- mon cur dog; sometimes shrill (crowing), sometimes deep and hollow, but rough ; it is an anxious sound. The cough occurs in paroxysms. The inspirations are long and labored ; the expirations interrupted and jerking. The little patients frequently toss about the bed in great agony, stretch the neck, and bend the head backwards, boring it into the pillow, which last should not be prevented, as, if forced to raise the head too high suffocation may take place in consequence. The pulse is feverish and the urine deep red. True membranous croup is not near so frequent as most persons imagine ; most cases of croup would remain without any danger if the proper treatment was at once pursued. ALLOPATHIC TREATMENT. Laryngitis with spasms of the larynx, (Spasmodic, Catarrhal or False Croup) is the form of Croup Avhich is most common with children who are said to be "subject to croup." As the attack generally occurs suddenly, and is quite alarming in its symptoms, it is very important that the parent should know Avhat is to be done. If the little patient is put into a warm bath at the temperature of 100° the great probability is that the spasm of the larynx, and the difficulty of breathing will soon cease. The bath should continue from ten to twenty minutes, or until the full relaxing effect is produced. The patient, if four or five years old should then have a dose of twenty drops to three fourths of a teaspoonful of Paregoric with half a teaspoonful of Syrup of Ipecacuauha, and placed in a warm bed. The throat should be then well rubbed with Turpentine, or a Liniment composed of Aqua Ammonia one part, Olive Oil tAvo parts, mix and add one part of Turpentine. The severe smarting (counter irritation), of the application will prove most servicable. if the spasm is not relieved by the warm bath an emetic should be given. The Syrup of Ipecacuauha is very suitable in doses of a teaspoon- ful from ten to twenty minutes apart until vomiting occurs, or the par- oxysm ceases. In very robust children the Hive Syrup is admissible for this purpose in doses of fifteen to thirty drops every fifteen minutes, but on account of the extreme and continual depressing effect of the Tartar Emetic it contains should be given only to the strongest children. Twenty grains of Powder of Ipecacaunha may be put in two or three ta- blespoonsful of warm water and a teaspoonful given ata dose. Blood- root given with Ipecacuanha has proved serviceable with both catarrhal and true croup, in the hands of Dr. Ransom of Burlington, Iowa. The following is a suitable formula: Take of Powdered Ipecacuanha a dram, Powdered Bloodroot a scruple; mix, and divide into three powders. Put one powder in a wineglass of warm water and give one or two teaspoons- ful, or one dram each of the Fluid Extract of Ipecacuanha and Tincture of Bloodroot, may be given in doses of five or six drops every ten or twen- ty minutes in Syrup or sweetened water. The dose of the emetic should be repeated until vomiting occurs or the paroxysm ceases. If neither result can be produced by these means, a teaspoonful of Powdered Alum may be given, mixed with syrup or honey, to produce vomiting, which 106 OUR FAMILY PHYSICIAN. will relieve the difficult breathing. The use of Ether by the mouth and inhalations Avould be prudent at the hands of a physician, and is useful; the same may be said of Chloroform. As soon as the sickness of the stomach has subsided, unless the boAV- els are well open, a saline cathartic should be giA'en. as, a teaspoonful or two of Rochelle Salts in Lemonade or from five to ten grains of Calomel. If the emetic has been given at night the cathartic can generally be given the next morning. A poultice, a flannel wet Avith a saturated solution of Gum Camphor in Olive Oil or Belladonna Ointment, may be applied to the neck after thorough rubbing Avith the Turpentine Irritating Liniment. During the day the patient should have an anodyne sufficiently often to relieve the cough, as two parts of Paregoric and one part Tincture of Hyoscyamus may be giA'en in doses of twenty to forty drops to children old enough to run out of doors. The Tincture of Belladonna may be giA'en instead of Hyoscyamus in doses of two to ten drops. The anodyne and a hot foot bath should be given at night. The folIoAving is a suitable mixture for an anodyne to be administered through the day: Take of Paregoric half an ounce, Syrup of Ipecacuanha half an ounce, Tincture of Hyoscyamus tAvo drams, water and simple syrup each three drams ; to this may be added a dram of Citrate of Pot- ash previously dissolved in the water. Half a teaspoonful may be given from two to four hours apart to a child two or three years old, a teaspoon- ful to older children. If the fever and pulse should run high, a quarter or a half of a drop of Tincture of Aconite may be given without reference to other remedies every half hour until an impression is made on the fever; then at in- tervals of two or three hours, as, take of Tincture of Aconite a dram, Syrup three drams; mix. Dose: One or two drops. If the child is weakly a grain of Quinine (in pill or powder) should be given three or four times a day and a teaspoonful of a solution of half a dram of Pyrophosphate of Iron in four ounces of simple syrup. The child should be confined to the bed during the acute stage, and after this passes, should be kept in the room for a few days and then gradually accustomed to the open air by going out for a short time only in the middle of the day. As a preventh-e of this annoying trouble, children of all ages should be clothed in flannel during the later autumn, winter and spring. The dress should be high in the neck, the sleeves long and warm. The legs and feet should also be warmly dressed Avith woolen stockings and drawers. Then, if warmly clad and the feet kept dry and warm, out of door life will be beneficial. In weakly children tonics of Quinine and Iron will prove serviceable. The sugar-coated pill and Pyrophosphate of Iron recommended above will be found appropriate given three times a day. It is needless to say that a recurrence of the paroxysms of difficult breathing occurring at any time in the course of the disease, demands the repetition of the hot bath or emetics, or both. croup. 407 True Croup—inflammation of the larynx with exudation (false mem- brane),—the most dangerous of all the forms of Laryngitis—is not as a rule, marked in the beginning of the disease with such alarming symptoms as accompanies the various forms of false croup, yet upon its early recog- nition, and prompt measures of treatment, depends the degree of success which will follow our efforts. In order, if possible, to render the distinction between false and true croup, the following table is inserted, which is compiled from various authorities. Simple laryngitis with spasm or false croup. Begins with nasel catarrh, or cold and hoarse cough, or Avith a sudden attack at night with suffocation. The throat is natural or slightly reddened. After the paroxysm the child seems well or nearly so, the fever disappears or diminishes greatly. Voice is nearly natural, never whis- pering. If a paroxysm returns, it is during the following night, but not as se- vere ; the hoarseness disappears and the cough becomes loose. Seldom lasts more than three days. Seldom destroys life. Laryngitis Avith Exudation or true croup. When epidemic, begins as an in- flammation with exudation of false membrane. When not occurring epidemic the invasion is more grad- ual, Avith a slight hoarseness one or tAvo days. There is fever, hoarse- ness increases, the cough is hoarse, muffled, crammed. Generally there is exudation in the throat, and later paroxysms of suffocation. Fever continues; breathing is dif- ficult, labored and each act greatly prolonged; cough hoarse and smoth- ered; A'oice hoarse and whispering. The difficulty of breathing and suffocation increases; the cough and voice are smothered or gone alto- gether: the stridulous (harsh sound) of breathing continues. Seldom lasts less than five or six days. The hoarseness lasts several weeks. Proves fatal in the majority of cases. So that if a case recovers, ana no false membrane has been discovered in the expectorated matter the case was almost positively not one of *true croup. The child should be confined in bed. The food should be digestible and nutritious, such as milk, strong beef tea (made by putting a pound of finely minced, lean beef into a pint of cold water, and slowly raising the temperature to 160° F., and maintaining it there for four hours—a little water may be supplied from time to time, to supply loss by evaporation) or essence, raw eggs beaten with sugar and water or milk. Starchy food may be allowed in limited amount. In this disease the writer believes that local applications hold^the first rank, and the best of all local means is the constant inhalation of steam. This end is accomplished the best by maintaining the room at a temperature 408 OUR FAMILY PHYSICIAN of 85° or 90°, and fill the air with steam from kettles of boiling Avater. The breathing of this warm, moist air has the best effect upon the local inflam- mation, relieves the spasm of the larynx, and facilitates the ease of breath- ing and also contributes to the separation of the false membrane by allaying inflammation and hastening separation. A kettle may be made of tin with a spout so fixed that sitting on a stand at the side of the bed a jet of steam can be thrown across the patient's face. By this means the moisture inhaled can be greatly increased. This kettle can be heated by a spirit lamp. A simply constructed kettle for this purpose Avas inven- ted and sold in New York at $3,00. It is cailed Rouchette's croup kettle, but any tinner can make one Avhich will answer the same purpose. The inhalation of steam should be continued through the Avhole course of the disease. The freedom from spasm and other difficulty of breathing while this warm, moist air is inhaled, greatly decreases the need of emetics which will be spoken of hereafter. Counter irritation to the neck over the larynx should be thoroughly made with Turpentine, or the Liniment of Amonia ana Turpentine direc- ted for false croup, or Tincture of Iodine applied twice a day, after which Belladonna Ointment containing a scruple or half a dram of Camphor to the ounce, should be freely applied to the neck, and then cover Avith a flax- seed poultice. The Camphor can be more easily incorporated in the Oint- ment by dissolving it with a little Ether. In the case of some very strong children, cold applied to the neck over the larynx and windpipe is more effective in the earliest part of the disease. A piece of pork should be applied to the sides of the neck to keep it from getting cold, and a napkin rung out of ice water or containing a lump of ice, should be laid over the neck, and then covered with a dry towel to prevent Avetting the patient's clothes and bed. The best known solvent for the false membrane is Lime Water. It is best applied from time to time by means of an atomizer or spray appar- atus, and should be used warm. The air of the room may be purified every hour or two, slacking a lump of quick lime in the room. The other most useful applications which may be applied to the inflam- ed surface, are: Lactic Acid, Nitrate of Silver, Tincture Muriate of Iron, Tannin and Alum. Three and a half drains of Lactic Acid to ten drams of Distilled Water, may be used with spray apparatus. Bromine may be used as directed in Diphtheria. Half a dram of Carbolic Acid to four ounces of water may be applied with an atomizer. It is, doubtless, especially useful after suppuration, and separation of the false membrane has begun. Nitrate of Silver, if used, should be applied to the patches of false membrane only, but in strong solution by a physician. Tannin, in Glycerine (one or two drams to the ounce), may be ap- plied, with a large camel's hair brush, to the orifice of the larynx, with the aid of a laryngial mirror. Tincture of Iron, one or two drams to the ounce of Distilled Water, and Alum; in saturated solution, may be applied by a spray apparatus. Of these, the writer considers them all inferior to Lime Water. In the treatment of croup, emetics hold an important place. They aid in expelling the false membrane when it becomes detached. They CROUP. 409 should be given at once, when the labored, smothered breathing indicate the presence of false membrane in the larynx. Many physicians pre- scribe an emetic in the beginning of the disease, believing its tendency is to prevent the deA'elopment of false membrane, and hasten its separation If the patient is strong, an emetic of Ipecacuanha may be giA'en at once Mix a teaspoonful of Ipecac in a half a glass of water, and give from a dessertspoonful to a tablespoonful eA'ery fifteen minutes, until vomiting takes place. Bloodroot, to one-third the amount of the Ipecacuanha, may be given in the same mixture. The efficiency of the Ipecac emetic is in- creased by gh'ing, at the same time, a teaspoonful of powdered Alum. In cases of feeble children, the Sub-Sulphate (Yellow Sulphate) of Mercury is the best emetic, and after the disease has progressed for a time, as it causes the least exhaustion of any of the emetics. Three to Ave grains, rubbed up with sugar, may be placed on the base of the tongue and swallowed with a little Avater. If vomiting does not occur, the dose should be repeated at the end of fifteen minutes. Professor Barker, of New York, prescribes this remedy immediately when called to a case of croup, and claims not to haA'e lost a case since he began this treatment. Alum, powdered, given in doses of a teaspoonful in syrup or honey, with or without a teaspoonful of Syrup of Ipecacuanha, repeated every fifteen minutes until vomiting occurs, is a serviceable emetic. One or two grains of Sulphate of Copper, given in powder, with two or three grains of Ipecacuanha, given every ten minutes, until vomiting occurs, is, after the Yellow Sulphate of Mercury, probably the best emetic in true croup. After vomiting has been produced by Sulphate of Cop- per, many German physicians claim it has a specific effect upon croup, which may be obtained by giving it in doses of a quarter of a grain every two hours. While it is true that in the majority of cases which have recovered, emetics have formed a prominent part of the treatment, the Avriter be- lieves they have been beneficial only by removing, during the act of vom- iting, the false membrane that was already detached or separable, and not by any specific effect. Hence, in his opinion, the indication for their use is the difficult breathing. They should be given from time to time, to accomplish this purpose, three or four times in the twenty-four hours. In extreme cases, every three or four hours. In order to sustain the strength of the patient, some nourishing and quickly-digestible food should be given immediately after the action of an emetic. Mercury is thought, by many physicians, to diminish the inflamma- tion and exudation of false membrane. This opinion is held by Prof. H. C. Wood, in his work on therapeutics, second edition, when the patient is robust and the general symptoms active, and no time should be lost in bringing the patient under its influence. From half a grain to a grain, may be given every two or three hours, or three grains Avith three grains of Dover's Powder may be given two or three times a day, until the pa- tient is mercurialized (salivated). The writer is skeptical as to the bene- fit from this practice, but in so dangerous a disease, if the good which may come from it is ever so small, the voice of any one ought not to be 410 OUR FAMILY PHYSICIAN. raised against it. It is not used in the writer's practice. Alkalies are more serviceable. In the use of alkalies the following formula may be used : Take of Chlorate of Potash two drams, Citrate of Potash two drams, Tincture Muriate of Iron a dram, Simple Syrup two ounces, water sufficient to make four ounces. Mix. Dose: One or two teaspoonsful every four hours. A dram and a half of the Muriate of Ammonia may be used instead of the Citrate of Potash, or two or three grains may be given separately in water. This treatment should be continued night and day until the cough becomes loose or treatment is abandoned on account of the helpless- ness of the case. Anodynes are generally required in this disease. The most useful is Opium, but on account of the tendency of the disease to destroy life by suffocation, much caution should be used in its employment. It is best to give it alone, or add it to other medicines as they are given, that it may be discontinued at any time, which should be done on the appearance of asphyxia (symptoms of suffocation). The Deodorized Laudanum in doses of four or five drops, or three grains of Dover's PoAvder, sufficient to maintain such an impression as will relieve excitement and spasm. Paregoric may be used for this pur- pose. In some cases the Bromide of Potassium with a little Hydrate of Chloral acts better. Take of Bromide of Potassium two drams, Hy- drate of Chloral half a dram, Syrup of Tolu half an ounce, Water an ounce and a half. Dose: A teaspoonful three or four hours apart until spasmodic symp- toms cease. If spasmodic action is marked, it can be given every half hour until relieved. To those who have never resorted to it the little call for ano- dynes when the patient is kept in a Avarm room, filled with vapor, will be surprising. When ,all remedies are proving unavailing and the difficult breathing increases and marches on to suffocation, the operation of tracheotomy (opening into the windpipe) should be resorted to by the medical attend- ant as offering the only hope for recovery. The friends ought not to object. After this operation the treatment is simply to keep the patient in the warm moist atmosphere. Keep the tracheotomy tube clean and support the powers of life by nourishing food. The other danger is from the disease traveling down the windpipe and causing death from suffoca- tion or from the development of bronchitis or pneumonia. The steady continuance of the moist air at 90° of temperature is the best preventive. Should they occur (broncho-pneumonia) the chest should be wrapped in an oiled silk jacket and the skin of the chest frequently rubbed with tur- pentine or the ammonia and turpentine liniment before recommended for the throat. Should the patient recover, the tracheotomy tube may have to be worn for months or until the larynx is clear of obstruc- tion. At any time during the disease, if the patient becomes enfeebled, stimulants may have to be given in addition to nourishment, as, a tea or CONGESTION OF THE LUNGS. 411 dessertspoonful of brandy in milk, beef tea or egg. Wine whey may be given if preferred. In the paragraph on emetics Tartar Emetic (and Hive Syrup), were not mentioned because deemed unnecessary, as having no special benefit on the disease and frequently doing harm, and sometimes even causing death by its prostrating effect, when given at a time when danger was ap parently not immediate. HOMOEOPATHIC TREATMENT. Aconite is the remedy in the first stage Avhen there is high fever, dry hot skin, and great restlessness. On attempting to swallow, the child cries as if from soreness and pain in the throat. Loud breathing during expir- ation but not during inspiration. Hepar sul.—Croup with loose, rattliny, choking cough; the air pas- sages appear clogged with mucus. The child cannot bear to be uncovered and coughs wheneA'er any part of the body is uncovered enough to get cold. Great drowsiness and profuse sweat. Iodine.—Soreness and pain in the throat and chest, which the child manifests by grasping the parts Avith its hand. Dry, short, hacking cough with difficulty of breathing. Membraneous croup with wheezing, sawing respiration. Face pale and cold, voice deep, rough, and hoarse. Kali bichronicum in true membraneous croup. The disease ap- proaches gradually; at first there is slight dyspnoea (short breathing) with hoarse, croupy cough ; as it progresses the difficulty of breathing increases and the air, as it passes in, sounds as if it were passing through a metallic tube. Hoarse, dry, barking cough; tonsils and throat red, swollen, and covered with a membrane; head inclined backwards; violent wheezing and rattling in the windpipe, heard at a distance. This is one of the very best remedies known, in true eroup ; use crude, finely powdered. Spongia in non-membraneous croup, where there is a rough, crowing sound to the cough. Slow, loud, wheezing and sawing respiration, or suffocative fits with inability to breathe, except with the head thrown backwards. Discharge from the nose or sneezing, or dribbling of saliva from the mouth. Dose: Any of these remedies need to be repeated rapidly during the most critical part of the attack, say a dose every thirty minutes to two hours. CHAPTER XXI. DISEASES OF THE LUNGS. CONGESTION OF THE LUNGS. Symptoms. The symptoms of congestion of the lungs vary greatly, according to the condition of the lungs and the degree of congestion. The lower grades of acute congestion only cause a sensation of oppression 412 our family physician. Avith shorter and more hurried breathing, at times passing away rapidly, at other times more slowly, or having remissions, but being otherwise painless. In the higher grades the breathing suddenly becomes oppress- ed to an extraordinary degree, so that the patient seems on the point of suffocation. The respiration is hurried, superficial, noisy; the pulse in- creases in frequency and fullness, the face looks flushed. Most commonly these symptoms are associated with a desire to cough, and the frothy sputa are tinged with blood. There is no pain if the lungs are otherwise sound, whereas consumptive persons experience a great deal of pain. In the highest grades of congestion the dyspnoea (difficult breathing) increas- es so rapidly and the congestion becomes so great that the patients die of asphyxia, sometimes so suddenly that an accident of this kind has been termed apoplexy of the lungs. The lesser grades of the affection generally terminate sooner or later in complete recovery. Passive congestion has almost the same symptoms as the active form, great oppression of breathing, red face, accelerated action of the heart. The prognosis in acute congestion is almost always favorable; con- gestions caused by violent emotions are the least promising. A frequent repetition of the attacks is always a very bad sign; they show that either the heart is intensely diseased, or else that consumption is their exciting cause. ALLOPATHIC VIEWS. The treatment of Acute Congestion of the lungs does not differ in the first place, if it be general, from that ghTen further on in this chapter for the invasion of Acute Bronchitis; or if the Congestion be limited to one (or more) lobes of the lung, the treatment will be the same as that of Pneumonia during the stage of invasion. Should the disease not end at once the subsequent treatment will be that for Bronchitis or Pneumonia, whichever the affection proA'es to be. If the congestion produces hemor- rhage, the treatment given for hemorrhage from the lungs should be used. Cold may be apjflied for the relief of acute congestion ia the same way as is hereafter directed in hemorrhage from the lungs. A passh'e congestion of the lungs may arise from any cause which obstructs the return of blood through the pulmonary veins to the heart. In Asthma or Emphysema of the lung (dilation of the air cells of the lung) imperfect oxygination of the lung causes passive congestion in the pulmonary circulation. A diseased condition of the mitral orifice of the heart, which obstructs the flow of blood or allows the blood to regurgitate from the left auricle into the right ventricle, is another cause. Tumors pressing on the pulmonary veins may be another cause. In other instan- ces the Avhole veinous system will become congested and the skin livid. Dropsy Avill occur in the case of heart disease or an obstructive tumor. The treatment will ha\-e reference to the relief of the disease causing the obstruction. It should be born in mind that the congestion is in an entirely differ- ent part of the circulation in acute congestion of the lungs which is in the nutrient circulation from the bronchial arteries and in passive con- CONGESTION OF THE LUNGS 413 gestion which is from obstruction to the return flow of blood which passes through the lungs for the purpose of being purified. HOMOEOPATHIC TREATMENT. The main remedy for all active congestions of the lungs is undoubt- edly Aconite. Aconite is particularly appropriate in congestion de- pending upon heart affections, or indicating and accompanying con- sumption ; such individuals have a delicate skin, bright complexion and sanguine temperaments. If the disease Avas caused by a fit of anger, or vehement chagrin, or mortification, Aconite is indicated so much more fully. Dose: Six pills in a teaspoonful of water, every hour to three hours. Belladonna has likewise many symptoms pointing to pulmonary congestion, but it is not so easy to determine the conditions for which Belladonna is indicated ; they likewise occur less frequently. Belladon- na is preferable, if not only the lungs, but likewise the brain is im'olved in the congestion, and it is less depending upon disease of the heart than upon some other affection. Leading symptoms distinguished from those of Aconite are: dark redness of the face, bluish redness of the lips, glist- ening eye; anguish and restlessness ; a constant, dry, hacking cough, or else a spasmodic and dry cough. Dose: As for Ac. Nux-vomica is an excellent remedy for certain kinds of pulmonary congestion, if the following conditions pre\rail: The attack is occasioned by sedentary habits, excessh'e mental efforts, the use of coffee, ardent spirits, in the case of sanguine, robust individuals who are free from dis- ease of the heart; after a copious meal, in the night. The symptoms re- semble those of Belladonna more than they do those of Aconite. Dose: As for Ac. Digitalis purpurea is, inappropriate in an isolated attack, but is, on the other hand, indicated if the congestions occur very frequently or evidently point to tuberculosis. In such affections, however, there is every reason why the medicine should be given very cautiously. It is not absolutely necessary for the heart to be the starting-point of the dis- ease, for uncomplicated, tubercular congestions of the lungs are likewise most easily relieved by Digitalis. Dose: As for Ac. Bryonia is the next best remedy to this latter drug. In very acute cases which may become dangerous to life by the premature supervention of an acute oedema of the lungs, no time should be lost unnecessarily by awaiting the effect of the first named three remedies; if they act at all, they will show their curative influence after the very first dose. If they do not afford speedy relief, Phosphorus should at once be used; or, in case of heart affections, Arsenicum. Dose: Six pills every two hours. 414 OUR FAMILY PHYSICIAN. SPITTING OF BLOOD. DISCHARGE OF BLOOD FROM THE LUNGS. RUPTURE OF A BLOOD-A'ESSEL. Symptoms.—Expectoration of blood, in greater or less quantity, in- duced by coughing, attended by symptoms more or less severe. Various Forms.—This disease discovers itself in three varieties: first, by an effusion of blood from the mucous lining of the air-tubes; secondly, by congestion of the lungs; and, thirdly, by the rupture of a blood-vessel in the tubular caA'ity of the lungs, during the course of Con- sumption. It is, however, proposed to deal generally with the subject, and to point out the different remedies found useful in the treatment, according to the symptoms present. Distinctive Characteristics.—We must be careful not to confound this disease with affections of the mouth or gums, or the occurrence of discharge of blood from the nose escaping through the posterior opening of the nostrils, and being returned by the mouth. When the blood pro- ceeds from the chest, it is almost invariably attended with a sensation as if it came from a deep-seated source, is warm, generally tastes sweet, and there is, frequently, a simultaneous burning and painful sensation in the chest. Precautions to be observed.—When the attack is imminent and is preceded by well-known premonitory symptoms, the patient should refrain from loud or prolonged speaking, calling, singing, blowing wind instruments, violent exercise of the arm, running, ascending stairs, or, in short, from anything calculated to increase the respiratory action, or otherwise to fatigue the chest. Issue and Results.—When spitting of blood occurs in a robust and healthy person of sound constitution, it is not very dangerous; but when it attacks slender and delicate persons, it is more serious and diffi- cult of removal. It is, however, chiefly Avhen the patient has had a succession of severe attacks, and the blood is discharged in a large quan- tity, that the case may be considered dangerous. Symptoms.—The disease may present itself without any marked pains or difficulty of breathing, and pass offAvith no return of the attack; or be preceded by dry cough, oppression, or tightness at the chest, shivering coldness of the extremities, great lassitude, and high pulse—and be ac- companied by hacking or husky and distressing cough, anxiety, quick pulse, pale and livid countenance—cease, and then return in a few hours, and be followed by difficulty of respiration and cough: in still more severe cases, when a marked tendency to Consumption exists, the anxiety, oppression at the chest, and febrile symptoms are more severe, pure blood, if coughed up, and the paroxysms frequently return. RUPTURE OF A BLOOD-VESSEL. [The rupture of a blood-vessel is a rare occurrence, although it some- times occurs in consumption. When, however, a blood-vessel of any consequence, included in a tuberculous excavation, does give way, the result is generally fatal.] Causes.—Indulgence in spirituous beverages, overheating the body SPITTING OF BLOOD. 415 by immoderate exertion, or too great external heat; blowing wind-instru- ments; contusion of the chest or back; falls; injury of the lungs; breathing a vitiated atmosphere, or vapors charged with acrid substances ; colds or coughs; violent mental emotions; diseased state of the lungs, whether as the immediate result of inflammation or during the progress of actual consumption; a general scrofulous habit; suppressed menstrual, haemorrhoidal, or other discharges; or repelled cutaneous eruptions. ALLOPATHIC TREATMENT. In hemorrhage from the lungs quiet in bed is to be insisted on, the head and shoulders should be raised, the -food cool, drinks should be cold, and small pieces of ice may be frequently taken into the mouth, the voice is not to be used. Food should be simple and nutritious. Liquids are preferable to solids, as milk, raw eggs beaten up with sugar and Avater, and beef tea. Regarding treatment by medicines the remedies which are constantly on hand, and are appropriate are Turpentine, Alum, Sugar of Lead and Ice. Ten to twenty drops of Turpentine may be given every hour. One or two teaspoonsful of Glycerine flavored with three or four drops of Oil of Gaultheria will almost completely cover the taste of Turpentine—it may be given on sugar, Sugar of Lead may be given in doses of two to five grains tAvo to four hours apart. Two grains of Alum may be given with an equal quantity of sugar every two hours. In case there is pain small doses of Opium should be given at the same intervals as long as re- quired; as half a grain of Opium, five grains of Dovers Powders, or ten drops of Laudanum. In applying cold to the chest, large linen clothes may be wrung out of ice Avater, an! wrapped around the chest, or what is better, cold may be applied to the chest and back by means of ice-bags. It is unnecessary to resort to this, unless the bleeding is severe, especially, if the patient is in good strength. Tight bandaging of a limb at its junction with the body, will be serviceable by preventing the return circulation. Other remedies which a;e most important are Ergot, Ipecacuanha, Digitalis, Gallic Acid, Subsulphate of Iron. Ergot may be given in connection with other remedies in doses of one or two teaspoonsful of the powder or Fluid Extract as often as every half hour if required. The following is a good mixture: Take of Fluid Ex- tract of Ergot three ounces, Fluid Fxtract of Ipecacuauha, and Deoderized Tincture of Opium each half an ounce, mix, and give a teaspoonful every half hour or hour, or take of Fluid Extract of Ergot an ounce, Fluid Ex- tract of Ipecacuauha, Fluid Extract of Digitalis each half an ounce, mix and give from thirty drops to a teaspoonful as is required. It will be observed in the use of Ipecacuanha, in frequently repeated doses, for hemorrhage, that when vomiting occurs the bleeding ceases. Digitalis is especially serviceable when a little bleeding occurs constantly with the expectoration, with an occasional mouthful of blood. Gallic Acid, in doses often grains with ten drops of Aromatic Sulphuric Acid in a wineglass of water, is a valuable internal astringent in cases of hem- orrhage. This dose may be repeated every two hours. The Solution of 416 OUR FAMILY PHYSICIAN. Sub-Sulphate of Iron, in doses of twenty drops in Glycerine, have proved effectual. Astringent inhalations are a Aery useful form of medication, given from an atomizer or spray apparatus. The following solutions may be used for atomizing : Tannin twenty grains to the ounce of Distilled Wa- ter ; Alum in saturated solution ; and the solution of the Sub-Sulphate of Iron from ten drops to half a dram, in an ounce of Distilled Water. Persons Avho haA'e hemorrhage from the lungs may be saved a great deal of unnecessary alarm by a knowledge of the fact chat the trouble, of itself, very seldom leads to serious results. Aside from the fact that it is a symptom of tuberculous or some serious disease, no uneasiness need be felt. HOMOEOPATHIC TREATMENT. In by far the greater number of cases the discharge or spitting of blood soon ceases of its OAvn accord; the most important object, therefore, is to seek to cure the complaint Avhen the hemorrhage has ceased, and thereby to prevent its return, or to check the development of organic dis- ease of the lungs (that is, disease attended with alteration of structure.) Pulsatilla, Cocculus, sf.pia, Sulphur.—One or more of the last three of these remedies Avill sometimes be required, successively, after the previous employment of Pulsatilla, Avhen this remedy is insufficient to restore the regularity of the periodical discharges, and the spitting of blood is associated with suppression of the menses. Pulsatilla is, hoAvever, the medicine Avhich is most appropriate wherewithal to commence treatment, in the majority of cases arising from suppression of the monthly discharge in females or of a haemorrhoidal flux in either sex (particularly Avhen the indh'idual is of leuco-phlegmatic temperament), and also in other instances characterized by the folIoAving symptoms: expectoration of dark, clotted blood, attended with shivering, especially toAvards evening, or at night, and great anxiety; pain in the loAver part of tlie chest; feeling of flaccidity in the region of the stomach, and weakness. Dose: Six pills in a teaspoonful of Avater night, morning and noon, for a week ; then pause four days, after Avhich the course may be resumed as before, if necessary, and so on, until change. Refer also to the articles on "Green Sickness" and "Suppression of the Menses." Bryonia is a good remedy in doses where the expectoration of blood, which is often in a coagulated state, is excited by a tickling cough; and where there is oppression at the chest, with frequent necessity to take a deep inspiration ; anxiety and irascibility. Dose: In every respect as directed for Pulsatilla. Nux-vomica is adapted to individuals of an irritable temper, in whom this affection owes its origin to a hemorrhoidal suppression, a fit of passion, or exposure to cold. It is further indicated by dry cough, which causes headache, Avith excessh-e tickling in the chest, and exacer- bation of the symptoms towards morning. Dose: Four pills in a teaspoonful of Avater, night and morning, for a week, then pause four days, after which repeat the same course if yet requisite, and so on until permanent relief or change ensues. SPITTING OF BLOOD. 417 Rhus.- When the blood expectorated is of a bright-red, the mind much agitated, and the patient irritable and rendered worse after the slightest A'exation or contradiction. Dose: In all respects as directed for Nux-Aomica. Arnica-.aioni ana is principally useful in cases arising from external injury, such as a seA'ere bloAV on the chest, or from lifting a heavy weight, or any other exertion, even blowing wind instruments; but also in almost all cases Avhere the stethoscope detects effusion of blood into the air-cells, attended with a sensation of constriction and burning in the chest, pain as from contusion in the back and shoulder-blades, and difficulty of breathing. Moreover, profuse expectoration of dark-colored blood or clots, brought up without much exertion, or bright, frothy blood, mixed with mucus and clots ; sensation of tickling behind the breast-bone; general heat, great weakness, and fainting. Dose: Of a solution of eight globules to three tablespoonsful of Avater, give a, teaspoonful eA'ery hour, until six doses have been giA-en, and then every six hours until manifest improvement or change. TREATMENT OF VERV SEVERE CASES. Aconitum is often found most serviceable in Avarding off'an attack, by the great poAver Avhich it possesses in controlling the circulation, and is indicated, previous to the paroxysm, by the premonitory symptoms of shivering, Avith accelerated pulse, palpitation of the heart, a sensation of ebullition of blood in the chest, with burning and fullness in the same region; paleness and expression of anxiety in the free; great anguish and anxiety, aggraA'ated by lying down; or during the attack, when the expectoration is profuse, coming on in gushes, and excited by a slight, dry cough. Dose: Four pills in a teaspoonful of water, repeated at intervals of two hours, until manifest change. Ipecacuanha is required Avhen a taste of blood remains in the mouth a feAV hours after the employment of Aconite has been com- menced, and there is frequent cough, with nausea, weakness, and expect- oration streaked Avith blood. In some instances in Avhich neither this remedy nor Arsenicum a\'ails singly to subdue the symptoms, the altern- ate administration of both has been resorted to Avith admirable results. Dose: If singly, six pills in a teaspoonful of water, repeated at inter- vals of an hour, until change. If in alternation with Arsenicum, a solution of eight pills of each, separately, to four teaspoonsful of water, administered by teaspoonsful eA'ery half hour in rotation, until manifest improA'ement or change. Arsenicum becomes necessary when the anxiety, anguish, and palpi- tation of the heart increase, notAvithstanding the previous administra- tion bf Aconite or Ipecacuanha (or both); and when, in addition, Ave find extreme restlessness, and general, dry, burning heat. Dose: If singly, four pills in a teaspoonful of water every hour. If in alternation with Ipecacuanha, as directed for that medicine, above. Sulphur, followed by the subsequent administration of Arnica, is of essential service in cases in which the Spitting of Blood recurs, after hav- 27 418 OUR FAMILY PHYSICIAN. ing previously yielded (with the associated symptoms) to the action of the foregoing medicines. Do.se: Three pills of Sulphur in a teaspoonful of Avater, repeated in three hours, and followed by a pause of six hours, and then by the consecuth'e administration "of similar doses of Arnica every three hours, until manifest improvement or change results. China is one of our best remedies in restoring the vital energies of the patient, after considerable loss of fluids, whether blood or other secre- tions; it is, therefore, particularly efficacious after a se\'ere attack of this affection ; but it is also indicated during its course, Avhen the spitting of blood takes place after violent cough, or Avhen there is a continual taste of blood in the mouth, or when we find shivering alternately Avitb access of heat, frequent and short-lived perspirations, tremor, and confusion of vis- ion, with a sensation of vacuity or lightness in the head, Aveakness, and desire to remain constantly recumbent. Dose: If against actual discharge of blood, give six pills in a tea- spoonful of Avater, eA'ery hour, until change. If as a restorative agent after an acute .attack, give four pills in a tablespoonful of water, night and morning, until manifest improvement or change. Ferrum-metallicum may be exhibited Avith advantage after China, in severe cases, and when the fourth dose of the last named medicine has been productive only of partial effect; or may be preferred if the expec- toration follow a slight cough, and is scanty, but consists of pure bright- red blood, attended with pain between the shoulder-blades, with inability to remain long in a sitting posture; the patient feels the concomitant symptoms relieved by movement, but is speedily fatigued, especially by conversation. Dose: If against actual discharge of blood, six pills ; if as a restora- thTe remedy, four globules, as directed for China. ACUTE BRONCHITIS. INFLAMMATION OF THE MUCOUS MEMBRANE OF THE BRONCHIAL TUBES. History. Acute bronchitis is one of the most frequent diseases of the human kind generally. It is not generally a dangerous disease when attacking middle-aged persons; it is on the contrary very dangerous to chil- dren and old people, and therefore constitutes one of the most important diseases of these two periods of human existence. It is undeniable that the first years of childhood are peculiarly predisposed to this disease. A predisposition of this kind likewise exists among persons of a more ad- vanced age, and may almost always be attributed to the following circum- stances : An effeminate mode of living, without adequate exercise in the open air, and not admitting of a free and easy respiration; constitutional diseases, even such as do not emaciate and debilitate the system, more es- pecially scrofula and consumptive, irritability of the mucus membrane in consequence of frequent attacks of bronchitis; acute and chronic diseases of the lungs. The exciting causes cannot well be traced with positive certainty. A Acute bronchitis. 419 cold and consequent suppression of the perspiration is undoubtedly one of the most ordinary causes, but not quite as common as is generally sup- posed. The atmosphere doubtless exerts a powerful influence not only in consequence of rapid changes in the temperature, but principally through the changes in atmospheric electricity, and, as modern investigations seem to have confirmed, through consequent changes in the amount of ozone in the atmosphere. This becomes so much more probable, if we observe that a large number of cases of bronchitis are not so much caused by a damp and cold, as by a dry and cold wind, such as prevails in our region of country when the Avind blows from the nortliAvest and north. If the temperature of the wind Avere the main cause of the trouble, an east wind Avould cause bronchitis most easily, which is certainly not the case. An epidemic bronchitis spreading over a large tract of country and being even consid- ered contagious, the so-called influenza or grippe, depends upon conditions which we designate as miasmatic, but of the true nature of which we are as yet ignorant. Secondary bronchitis develops itself secondarily in per- sons afflicted Avith heart disease, congestion of the lungs or during the presence of acute exanthems (measles, scarlet fever, etc), or various in- tensely acute constitutional diseases. The lighter form of bronchitis, generally designated as bronchi- al catarrh, frequently sets in without any fever; at any rate generally it is scarcely perceptible; sometimes no fever at all is present or the fever is at most indicated by a succession of creeping chills. This form of bron- chitis scarcely ever exists isolatedly, but is almost always attended with catarrh of the nose and larynx. After experiencing a feeling of malaise for several hours, and a marked sensation of languor, the patients are at- tacked with a dry and spasmodic cough attended with a raw or sore feeling in the chest; at the same time the breathing is somewhat oppressed and there is no expectoration at the outset of the disease. The appetite is less, but not gone, the tongue is not always coated; the patients are able to re- main up, but feel drowsy and often complain of violent headache. Very often the cough remains dry for a long time, but more frequently a ten- acious, greenish-yellow scanty expectoration commences on the second day. which it is very difficult to hawk up. At the end of three to nine days, very rarely at a later period, and then only if the patients neglect themsehes, the expectoration becomes more copious, whiter, lumpy, and isjraised more easily, the normal feeling of health is restored, and, while the cough is gradually decreasing, the disease passes off. The attack seems so slight, that many patients go about as usual, but, by pursuing this course, expose themselves to relapses which are very apt to take place and beget a tendency towards the inflammatory form of bronchitis, or else orig- inate the consequences that will be more fully described in a subsequent paragraph. INFLAMMATORY OR ACUTE BRONCHITIS. This form of bronchitis which is marked by much more violent phe- nomena, is not by any means a purely simple form of bronchitis of a higher degree of intensity. It does not. ordinarily, result from an exist- ing catarrh of the upper respiratory organs, unless the catarrh is sudden- ly and violently increased by severe neglect; but most generally it occurs 420 OUR FAMILY PHYSICIAN as a primary disease. It generally commences with a violent chill, Avhich is distinguished from the chill that initiates acute inflammations, by the circumstance that it is not followed by as high an increase of tempera- ture, and that there is a frequent recurrence of the chill, especially on motion. The patient feels A'ery weary and languid, complains most gen- erally of a violent headache, exhibits frequent changes of complexion, experiences a rheumatic drawing in the limbs and great restlessness, and is scarcely eA-er capable of remaining out of bed. Very soon these gen- eral symptoms, which do not point out more particularly the locality of the disease, are followed by a burning, sore pain in the chest under the sternum at every deep inspiration, which is felt more severely when coughing. The cough sets in at the same time as the pain is felt; it is more or less violent, sometimes spasmodic, at first dry but not hoarse, but very soon accompanied by the above-described expectoration. There is no dyspnoea, properly speaking, but the breathing is more labored, less full, and hence somewhat more hurried.- The pulse is accelerated, but if is only in the severe grades of the disease that it exceeds one hundred pulsations. In this form of bronchitis, the digestive organs are always inA'olved, the appetite is entirely gone, the boAvels are constipated, there is seldom any A-omiting. Even in simple bronchitis, when not complicated with tubercles, the expectoration is easily tinged Avith blood, Avbereas raising a quantity of pure blood is a rare occurrence and ahvays points to a more dangerous and more deep-seated constitutional disease. All the phenomena, espe- cially the cough, exacerbated in the evening and about midnight. The further course of the disease is governed by a variety of circumstances. The importance of bronchitis of any degree in the case of tuberculous consumptive patients; will be more fully inquired into when we come to treat of consumption. In favorable cases, uncomplicated forms of bronchitis terminate in four or fiA'e days, or exceptionally at an earlier period, in simple bronchi- al catarrh. The general symptoms moderate in intensity, the fever abates almost entirely, the expectoration becomes more profuse, more fluid, of a whitish-gray color, and is more easily raised by the cough which is noAv much less painful. The patients do not often feel well again before the tenth day. If the course of the disease is less faA'orable, its different phases are either more protracted, or else other morbid conditions become associated Avith it. In the former case, the dry, spasmodic, distressing cough may last beyond the seventh or even to the fourteenth day, after which the period of a more profuse secretion of mucus lasts equally long. Although this longer duration of the disease shows, as a rule, that it is of a secondary nature, yet a purely primary form of bronchitis may run an equally long course, an occurrence peculiar to old age. The patient's age exerts a greatly modifying influence over the course of the disease, as well as over its danger to life. Among old people, or only somewhat advanced in age, the danger is quite considerable, and seems to depend more particularly upon the increased liability of the bronchial mucous lining to swell, upon the profuse quantity of the secre- tion at the same time as the respiratory process becomes feebler, and upon the consequently increased danger of oedema of the lungs. ACUTE BRONCHITIS. 421 Hence the bronchitis of old people differs greatly from that which we have described in the preceding paragraphs. The disease originates in the same manner, only the fever symptoms seem to be less violent. The pulse soon becomes smaller and Aveaker, the skin becomes moist and cool, the tongue dry and broAvn, and the senses are poAverfully affected by the disease : sopor, delirim and grasping at flocks, setting in. In this man- ner the patient may succumb to the disease in a few days, the increase of the mucous rales (rattle) and the decrease and final and total cessation of the expectoration constituting the most ominous signs of approaching dissolution. One of the most common terminations of bronchitis is chronic bron- chial catarrh Avhich succeeds the acute form the more rarely, the younger and healthier the individual. Having described the other forms of bronchitis, Ave here devote a feAV lines to a description of infantile bronchitis , which, as regards its course and importance, differs most essentially from the corresponding bronchitis of adults. An inflammation of the larger bronchial tubes, be it slight or severe, has almost the same phenomena in the case of children as in that of adults, except that the fever is much more violent and the breathing is in almost every case interfered Avith very considerably, at an early period. The importance of this process, in the case of children, is much greater than in that of adults, for the reason that in the former it is apt to spread to the smaller bronchial tubes, after which the children who at first gave no cause for alarm, suddenly appear attacked by a dangerous disease. The symptomatic development generally takes place as follows: Af- ter the children have had for some days a simple catarrh, attended with severe fever, the breathing becomes more hurried and, progressively, more oppressed, and the children become more and more restless and anx- ious. The respiration, during inspirations as well as expirations, now becomes wheezing, more especially during an inspiration. The cough continues to increase in vehemence, without anything being expectorated; or, if anything is raised, it is only Avith great difficulty a small quanti- ty of mucus which is swallowed again as soon as raised. The general or- ganism, in such a severe disease, is of course correspondingly affected. The difficulty of breathing noAV increases from hour to hour, and soon reaches a degree of intensity that is in no respect inferior to the worst attack of croup, and becomes still more distressing in consequence of the unceasing efforts on the part of the children to obtain relief by coughing. The pulse becomes frequent and small, the skin on the extremities and head is covered with perspiration, the face is pallid or livid, becomes blu- ish during an attack of cough, the anxiety and restlessness reach the highest degree of intensity. If, at this stage of the disease, there is no improvement by an increase of the expectoration and a relief from the difficulty of breathing, the disease presents the same picture as in the last stage of croup, only the hissing sound caused by the stricture of the glottis is Avanting. The children become calmer, pallid and cool, they are lying in a state of unconsciousness or sopor, the respiration becomes very superficial, the paroxysms of cough abate more and mote, and the 422 OUR FAMILY PHYSICIAN. children die comatose. This fatal termination sometimes takes place in the first week of the disease, less frequently after] the fourteenth day. Recovery always takes place sloAvly, the liability to relapses is very great; the strength does not easily return, and the cough sometimes con- tinues for many weeks. The diagnosis is only difficult in the case of very small children ; here the characteristic cough is almost always entirely absent, in general the reaction against the disease is either slight or non- apparent. The prognosis is the more doubtful the younger the patient. That dentition complicates the prognosis, cannot be taken for granted. The greater liability to the disease, at this period, is proba- bly owing to the increased susceptibilities of the infantile organism. ALLOPATHIC TREATMENT. A common catarrh or cold affecting the bronchial tubes, is known to physicians as Acute Bronchitis. It frequently begins as a coryza (catarrh or cold in the head) and may often be cut short by a full opiate and a dia- phoretic (medicines Avhich produce sweating). A remedy which fulfills these indications the best is the Dover's Powder (Compound Powder of Ipecacuanha.) It may be given in doses of ten to fifteen grains at bed- time. Twenty or thirty drops of Laudanum, a quarter of a grain of mor- phine, or half a grain of Codia may be given instead. The proper time to take this remedy is before going to bed. It should be accompanied with a hot foot bath, and a copious drink of ginger tea. The next morn- ing a free cathartic should be given as a Seidlitz Powder, or a tablespoon- ful of Rochelle Salts in lemonade, or a tablespoonful of Citrate of Mag- nesia, or a tablespoonful of Epsom Salts. (The disagreeable taste of Epsom Salts is removed by boiling with one-third of its bulk of roasted coffee in an earthen vessel for a couple of minutes, then let it draw a few minutes and strain.) This plan of treatment is effectual in stopping or lessening the effects of a cold. If the disease becomes established, it will yield more readily if the pa- tient remains in bed to secure uniform warmth and moisture of the skin. In severe cases the room should be charged Avith steam in the manner described for croup. If there is much pain or soreness of the chest, a mustard plaster or a liniment of one part of Aqua Ammonia, tAvo parts Olive Oil and one part Spirits Turpentine, will be found useful. Spirits Turpentine alone or with an equal part Spirits Camphor may be used for this purpose with equal benefit. Three to ten drops of the Fluid Extract, or teaspoonful doses of the Syrup of Ipecacuanha, or ten drops to half a teaspoonful of Hive Syrup, can be given at such intervals through the day, as Avill keep the skin slightly moist. Morphine in doses of a tAvelfth to an eighth of a grain, or Paregoric in doses of a teaspoonful, may be ghTen three or four times or oftener during the day to relieve cough. I find a mixture of equal parts of Paregoric, Tincture of Hyoscyamus and Fluid Extract of Wild Cherry Bark, in doses of one or two teaspoons- ful, an exceedingly efficacious remedy for the relief of cough in all forms ACUTE BKONCHITIS. 423 of Bronchitis; if the Fluid Extract of Wild Cherry Bark has been de- prived of astringency as is done by Chapman, Green & Co., of Chicago, the remedy is an agreeable one to take. In case there is fever with the attack, or much secretion of mucus, Aconite may be used Avitb the best effect and is not incompatible with other treatment Avhich may be needed. The Tincture of Aconite may be giA'en in doses of half a drop or a drop every half hour, until an impres- sion is made on the fever movement and then continue in doses of a drop every hour or two or three hours. In the continued use of the Aconite, if the bronchial secretion is very profuse, the Tincture of Belladonna may be given Avith it as folloAvs : Take of Tincture of Aconite a dram, Tincture of Belladonna two drains ; mix. Dose: Three or four drops from one to three hours apart. If the inflammation linger and appear disposed to become chronic, Quinine should be gh-en in doses of 1a\'o or three grains three times a day. If the patient is pale and feeble, fifteen or tAventy drops of the Tincture Muriate of Iron should be given with a dessertspoonful of a saturated solution of Chlorate of Potash in syrup enough to make a pleasant mix- ture, after each meal. The diet should be nutritious. Warm clothing, hearty food, and life in the open air are the best preventives against " taking cold." Some points in the treatment of Acute Bronchitis in young children require special consideration. Young children do not expectorate (throw the phlegm off from the bronchial tubes) and suffocation may be caused from its accumulation. This may be supplied in the act of vomiting. An occasional emetic should therefore be gh-en. Teaspoonful doses of the syrup of Ipecacuanha, The emetic should be repeated every day or oftener, or when the breathing becomes impeded by the accumulation of phlegm. After vom- iting is produced no nauseant medicines should be ghren until vomiting is again required. A Avarm bath should be given at the commencement of the disease. This, with an emetic in the first twelve hours, may cut the attack short. The chest should be wrapped Avith a flannel saturated with Camphor Oil (Olive Oil containing twenty or thirty grains of Gum Camphor to the ounce) and this covered with muslin. If this oil does not redden the skin, a little Turpentine may be added until it does; or a thin poultice made of flax-seed meal, containing one-sixteenth part of pulverized mus- tard may be applied to the chest and covered with oiled muslin. Or one or two grains of powdered Tpccac may be given in water and repeated every fifteen minutes until vomiting occurs; Alum may be given with the Ipecac in doses of a teaspoonful if A'omiting does not soon produce an emesis. The boAvels should be moA'ed regularly, and if this does not occur naturally a laxatiA'e should be giA'en. Castor Oil with an equal quantity of Glycerine flavored with a couple of drops Oil of Gaultheria or Cinna- mon to each dose may be used for this purpose in doses of one or twTo teaspoonsful. 421 OUR FAMILY PHYSICIAN. For constitutional treatment the following formula may be used: Take of Syrup of Squills two drams, Acetate of Potash half a dram, Syrup of Tolu, and Anisa water, each seven drams. Mix, and give a child of six months or a year, a teaspoonful eA-ery three or four hours. Twenty or thirty drops of Tincture of Bloodroot may be added to this formula. If the kidneys or skin are not acting freely twenty or thirty drops of Spirits Mendireces may be giA'en at the same time or separ- ately. Opiates ought not to be given with any freedom, but if there is much cough or restlessness it should be relieved with from fifteen to thirty drops of the mixture of Paregoric, Hyoscyamus and Wild Cherry Bark, as spoken of in the treatment of adults, at such interA'als as is required; it may be given in the syrup above written. If there is much fever and the child is two years old or over, eight to tweh'e drops of Tincture of Aconite root may be also added to the above syrup mixture. The patient should be allowed the breast freely and have in addition, if that is insufficient, creamy milk, juice of lean meat, or strong beef tea. The object of treatment is to supply the lack of expectoration by the proper use of emetics, to support the poAvers of life by nutritious food, and diminish the congestion of the bronchial mucous membrane by Avarm and mildly irritating applications and by diaphoretics, laxatives, and last and least anodynes. The treatment of Capillary Bronchitis, i e. in the small bronchial tubes. does not differ essentially from the treatment of ordinary Bronchitis, except that as the disease is infinitely more grave, much more attention must be given to supporting the strength of the patient, and, in children, relieA'ing the lungs of mucus, by the use of emetics. When the fever runs high Aconite should be given as before directed. In capillary bronchitis Snakeroot, Carbonate of Ammonia and Iodide of Potassium seems especially useful. Take of Fluid Extract of Snakeroot an ounce, Carbonate of Ammo- nia a dram, Iodide of Potassium a dram and a half, Syrup of Tolu and Water each an ounce and a half. Mix. Dose: A teaspoonful for a child and a tablespoonful for an adult three or four hours apart. HOMCKOPATHIC TREATMENT. Aconitum. Marked indications are, hot, dry skin, with strong, hard, and accelerated pulse; roughness of the voice; short, dry, and frequent cough, excited by tickling in the throat and chest; obstructed respired ion. wheezing or sonorous noise in the chest; anxiety; restlessness, headache, and thirst, with occasional, scanty expectoration of a sticky phlegm. Dose: Of a solution of six pills to two tablespoonsful of Avater, give a teaspoonful, repeated at intervals of an hour, until the indicative symptoms are allayed. Bryonia is of great service, in a large number of cases of bronchitis, at the commencement of the attack, and should be administered two hours ACUTE BRONCHITIS. 425 after the third dose of Aconitum, in the event of the unmodified continu- ance of the fever-symptoms,—the following indications being present: laborious, rapid, and anxious breathing, with constant inclinations to make a deep inspiration: hoarseness; headache; dry cough, attended with a burning, pricking pain, extending from the throat to the middle of the breast-bone; or cough, day and night, with scanty and difficult expectora- tion of viscid, Avhite or yellow-colored phlegm, in some instances tinged Avith blood; wheezing; dryness of the mouth and lips; hot, dry skin, or dry- ness of the skin during the day, and copious perspiration at night; exces- sive thirst. When a pain as if arising from the effects of a bruise, is ex- perienced under the breast-bone, with aching and sensation as if t,he con- tents of the cranium would be forced through the forehead, after each fit of coughing, or when the breathing is impeded by shootings in the chest, and the affection threatens to become complicated with pleurisy, this rem- edy is still more particularly called for. Dose: A solution of six pills, as directed for Aconitum. Spongia is often of great service after the previous administration of Aconite, Avhen there still remains a considerable degree of inflammation in the air-tubes, especially the larger, with wheezing or sonorous noise in the chest; and also at a more advanced stage of the disease, Avhen rattling of mucus is distinctly audible; hollow, dry cough day and night, but worse toAvards evening; or cough with scanty, viscid, ropy expectoration; heat in the chest; burning, tickling irritation in the top of the Avindpipe; quick, anxious, laborious respiration; inability to breathe unless the head is thrown backwards; hoarseness. Dose: Of a solution of six pills to two table spoonsful of water, give a teaspoonful every two hours. Belladonna. This remedy is useful when there is severe headache, materially aggravated by coughing; flushed face; oppression of the chest, and constriction, as if bound, with loud wheezing and rattling of mucus in the air-tubes; short, anxious, and rapid breathing, dry, fatiguing cough, es- pecially at night, which is endeavored to be suppressed on account of the pains which it creates; heat of the skin, and thirst; soreness of the throat. Belladonna is often exceedingly efficacious in children, particularly in those insidious cases Avhich commence with a slight wheezing, and then suddenly become aggravated to such a degree as to threaten suffocation; the heat of the skin being at the same time considerable, and the pulse ex- cessively rapid, and sometimes even intermittent. Dose: Of a solution of six pills to two tablespoonsful of water, ghre a teasponful every three hours. Mercurius. This remedy may occasionally be found useful in the second or secretive stage, when the symptoms of bronchitis are accom- panied by excessive perspiration; Avhen the cough is fatiguing, worse in the evening and at night, and excited by a tickling irritation, or sensation of dryness in the chest, with quick, short, oppressed breathing, and louder breathing than ordinary; hoarseness; cold in the head, with watery, acrid discharge; swelling of the nose. Dose: As for Belladonna. Phosphorus. This important remedy is frequently of great utility in 126 our family physician bronchitis, when the more inflammatory symptoms haA-e been subdued by Aconite, but the breathing continues much oppressed, accompanied with great anxiety, and heat in the chest; dry cough, excited by tickling in the throat or chest, aggraA'ated by talking or laughing, and followed by expectoration of stringy phlegm of a saltish taste. Further. Avhen the disease has been neglected, or when, from the symptoms which present tbemseh'es at the commencement, Ave lurve reason to dread complication, or an extension of the inflammation to the substance of the lungs, there will be additional reason for administering Phosphorus. Dose: Four pills in a teaspoonful of Avater eA'ery four hours, until distinct change. Pulsatilla. This remedy is often required in the second or secre- tive stage to complete the cure, after the previous exhibition of Aconi- tum, Avhen the acute inflammatory symptoms haA'c been subdued, and the expectoration has become thicker and more copious. It may, howev- er, be prescribed before or after any of the medicines Ave have named, especially Avhen the disease occurs in persons of mild disposition, or lym- phatic constitution, and the symptoms are as folloAv: breathing short, accelerated, and impeded, attended Avitb rattling of phlegm, heat in the chest, and anxiety ; hoarseness; shaking cough, Avorse toAvards evening, at night, or in the morning, accompanied Avith considerable expectora- tion of tenacious, or thick, yellowish phlegm, sometimes mixed Avitb blood ; cold in the head, with copious discharge of thick, discolored phlegm. Dose: Of a solution of six pills to tAvo tablespoonsful of Avater.ghe a teaspoonful every two hours, until improvement, or change. If im- provement occur, the intervals should be extended to six hours, and the administration thus continued, until the subsidence of the symp- toms. bronchitis in children. Chamomilla is often a most useful remedy after the previous exhi- bition of Aconitum in cases occurring amongst children, when a slight de- gree of whistling or sonorous noise in the chest still remains; dry cough, Avorse at night, occurring even during sleep. (See also Belladonna.) Dose: Four pills in a teaspoonful of water, given every three hours. Ipecacuanha is also a very serviceable remedy for children, when there is Avheezing or rattling in the chest, and when on coughing they are almost suffocated by the excessive secretion of phlegm, and become livid in the face ; shortness of breath and perspiration on the forehead after each (it of coughing. Dose: Same as Chamomilla. Arsenicum should be given two hours after the third dose of Ipe- cacuanha, if the latter remedy has only been productive of partial benefit, and is indeed to be selected in preference to Ipecac, if the folIoAving indications occur; the pulse very quick, feeble, and irregular, and the patient reduced to a state of extreme debility and collapse, the breathing obstructed almost to suffocation and attended Avith a wheezing and ichistliny noise in the chest, cough and hoarseness. Dose: Of a solution of eight globules, to four teaspoonsful of water, give a teaspoonful (or tAvo globules dry on the tongue), at intervals of five, ten, fifteen, and twenty minutes, and so on, adding five min- utes to the length of each succeeding interval. CHRONIC BRONCHITIS. 427 CHRONIC BRONCHITIS. CHRONIC PULMONARY OR BRONCHIAL CATARRH. In the majority of cases chronic bronchitis owes its existence to one or more attacks of acute bronchitis out of which it arises by gradual de- velopment. Even as thus arising as a secondary disease, the affection is* exceedingly frequent, but this frequency is still more increased by the cir- cumstance that it accompanies most of the material changes of structure in the lungs, particularly consumption, and that it likewise occurs as a complication of diseases of other organs. The latter occurs more particu- larly in diseases of organs that obstruct the return of the blood from the lungs, such as heart disease and affection of the liver. As a primary dis- ease, chronic bronchitis is more particularly met with among persons who are upwards of forty-five years old ; every chronic pulmonary catarrh of young people excites a Avell-founded suspicion that it emanates from some other pulmonary disease as its source. Men are much more frequently afflicted Avith chronic bronchitis than women; children are seldom at- tacked. In northern climates, chronic pulmonary catarrh becomes much more frequent; in the countries with a damp and cold climate it is almost endemic; it likewise prevails among individuals whose business confines them to damp and cold places. Persons who have to inhale a good deal of dust during their work, such as stone-cutters, millers, and sculptors, are likewise exposed to frequent attacks of chronic bronchitis. Smoking is likewise a frequent cause of this disease. The use of tobacco causes chronic catarrh of the bronchial lining membrane much more frequently than one imagines, without any acute attack having preceded the chronic form. Considering our mode of living, and when affecting persons beyond the age of fifty, the milder cases of chronic bronchial catarrh do not pre- sent any marked symptoms. The parties cough a little, most generally in the morning, and after that they expectorate some, but assimulation is not affected by the disease, nor is the respiratory process interfered with, and the condition sometimes remains unchanged for years. The more violent cases, on the contrary, cause constant and most commonly increasing trouble. After the termination of an acute bronchial cartarrh,—for chronic catarrh seldom sets in gradually Avithout any preliminary acute stage,— cough and expectoration remain and continue with slight variations until made worse again by another accute attack. The cough is marked by tAvo essentially distinct features. If the bronchial secretion is scanty, tena- cious and firmly adhering, the paroxysms of cough occur less frequeutly, but in such a case the cough is most severely spasmodic and not unfre- quently leads to gagging and vomiting. The paroxysms occur most fre- quently at night, less commonly in the day-time. After violent exertions, some of the above-described mucus is expelled; sometimes a little mucus is now hawked up till some time after the cough. If the secretion is more copious, the cough sets in chiefly in the morning-hours or after the use of warm food; it may continue for a long time, but is not spasmodic, for af- ter a few energetic spells of cough, the mucus is detatched and expector- ated. I 428 OUR FAMILY PHYSICIAN. Sooner or later the cough becomes associated with more or less violent oppression of breathing, Avhich may even creep along without being per- ceived, and corresponds with the increasing thickening of the bronchial mucous membrane, a diminuation of its elasticity and the copious quantity of the secretion. At first this oppression is only perceived by the patients Avhen making an effort, during a rapid walk, going up hill; soon, however, it is felt even during an ordinary walk, even during rest, and causes a great deal of annoyance. In the higher grades of the disease, the patients are threatened during the paroxysm of cough with danger of suffocation; even between the paroxysms the nature of the existing affection is re- vealed at first sight by the elevated thorax and consequent shortening of the neck. The most intense pain, however, is endured by the patients if an accute aggravation of the disease takes place. Under such circumstan. ces they exhibit such a picture of distress, that it seems as though they could not possibly live longer than twenty-four hours. These acute ex- acerbations occur almost certainly once at least every spring ana fall, even if the patients have not knowingly been exposed or have not even left their room. In the beginning the general organism is not affected by the complaint, even tolerably severe forms of this disease are borne for a long time with- out any perceptible detriment. Very seldom, and only if the secretion is Arery profuse, emanciation gradually supervenes, in spite of which the pa- tients may live, however, for many years. The greatest danger is occa- sioned by the influence exerted by the impended respiration over the cir- culation. The functions of the heart become abnormal; the deficiency of blood in the lungs and its imperfect aeration either cause passive conges- tion of the liver, and a corresponding chronic intestinal catarrh, or disturb- ances in the functions of the spleen or kidneys, or passive congestion of the brain with its inherent dangers, so that it is not without reason that a raised thorax and short neck are designated as an apoplectic habit. If the catarrh has become an inveterate disease, it is apt to last to the end of life; but that such a noble organ as the lungs should be capable of bearing for so long a time, even a severe degree of an apparently danger- ous disease, is indeed remarkable. It is not marasmus, Avasting of flesh; the patient need dread, but the constant succession of acute attacks Avhich indeed are rarely immediately fatal; most patients die of this dis- ease amid symptoms of general dropsy. If an acute attack assumes the form of capillary bronchitis or pneumonia, the lives of such patients are indeed in extreme peril. In recent cases, the prognosis is not altogether unfavorable so far as a cure is concerned; life is very seldom endangered by such ,i disease- The chances, of course, depend upon Avhat structural changes have taken place, and to what extent. The worst omen is heart-disease, Avhich almost always terminates in dropsy in a very short time. ALLOPATHIC TREATMENT. In Chronic Bronchitis the general health demands attention in the first place. To this end the diet should be good and nutritious but plain; meat, milk, eggs, fowl, fish, and farinacious food will be required. As a rule alcoholic stimulants are not to be used. In case of feeble persons Quin- CHRONIC BRONCHITIS. 429 ine and Iron should be giA'en. The Quinine may be given in pills, and the Muriate Tincture of Iron (the preparation which I prefer) in doses of fifteen or twenty drops, largely diluted in SAveetened water three times a day. Cod Liver Oil may be called for, and Avhen there is much secretion the Hypophosphites or Phosphates are seiwiceable in supporting the pa- tient. If the Compound Syrups are used which contain Iron, the Muriate Tincture of Iron need not be given. Take of the Compound Syrup of Hypophosphites (containing Iron) three and a half ounces, Di- lute Phosphoric Acid half and ounce ; mix, Dose: A teaspoonful three times a day. Out of door life is often to be insisted on and sometimes a change of climate is not only beneficial, but necessary, to effect a cure. The surface of the body is to be kept warm and the skin active. Frequent Avarm baths should be taken, though cool baths are not to be prohibited, if the reaction after them is good and they proA'e beneficial. Special attention should be giA'en to the clothing. In cold climates woolen or silk under- clothing should be worn and the other clothing sufficiently heavy to aAroid chilliness. A A-est and drawers of chamois or buckskin, worn im- mediately over the underclothing, affords the required protection and avoids the necessity of an inconvenient weight of clothes in cold weather. This simple deA'ice secures a uniform temperature and activity of the skin, which will to a degree relieve the bronchial mucous membrane. Counter irritation is many times a successful means of securing the same result. For this purpose the use of Croton Oil, or a liniment of equal parts of Croton Oil, Turpentine, and Olive Oil, to maintain a slight eruption over the chest, is often very appropriate. Tartar Emetic Ointment (one part of Tartar Emetic to five of Lard) is a suitable preparation. A " warming plaster " is often worn with benefit. Some medicines often exert a curative influence. The Iodide of Po- tassium or Ammonium with Fowler's Solution of the Arsenite of Potash as in the following: Take of Iodide of Ammonia or Potassium five drams, Fowler's Solution a dram and a half, Simple Syrup four ounces, Spirits Peppermint half a dram. Mix. Dose: One or two teaspoonsful in water three times a day after eating. If the patient needs Iron a dram of the Pyrophosphate may be added to the mixture. Muriate of Ammonia is considered by many physicians a valuable remedy in this disease. Licquorice disguises the taste. It may be given as follows: Take of Muriate of Ammonia two drams, Extract of Liquor- ice two drams, Syrup of Tolu four ounces. Mix. Dose: A teaspoonful in water four to six times a day. Copaiba often exerts a wonderfully curative effect. It may be given in doses of fifteen or twenty drops three or four times a day. It may be yiven on sugar or in Aromatic Mucilage, as : Take of Copaiba, Balsam Tolu and Powdered Acacia each an ounce, Aromatic Sulphuric Acid half a dram, Peppermint Water six ounces. Mix. Dose: A tablespoonful three or four times a day. The remedy is so unpleasant that few take it willingly. Gelatine Cap- 430 OUR FAMILY PHYSICIAN. sules of Copaiba, as sold in the drug stores is the most convenient form for many to take the remedy. Chlorate of Potash in saturated solution given in doses of a teaspoon- ful to a tablespoonful three or four times a day is often curative. The taste is pleasant if mixed Avith Syrup. When Iron is required the Mur- iate Tincture can be given in this solution. A form of medication which is often useful in cases with profuse secretion, and is adopted largely by quacks, is inhalation. Steam is the simplest and often one of the best. A solution of Morphine one-half to one grain to the ounce of water, Extract of Belladonna in the same pro- portions. Extract of Hyoscyamus four to five grains to theounceand inhaled from an atomizer or spray producer, Avonderfully relieve the cough and irritation of the bronchial tubes. Astringent solutions may be used in this way. Tannin from one to twenty grains to the ounce, Alum from five grains to the ounce, to a saturated solution. Morphine can be added to the solution in the strength of one-quarter to one grain, to the ounce if local anodyne effect is desired. Sugar of Lead in solution three to ten grains to the ounce are among the indications appropriate to inhale from the atomizer or spray apparatus. Should the expectoration be fetid Carbolic Acid—the spray of a solu- tion of Carbolic Acid one to four grains to the ounce, Sulphurous Acid one to four drams to the ounce—may be used. The A'apor of Carbolate of Iodine (half an ounce of Tincture of Iodine, Iodide of Potassium fifteen grains, Carbolic Acid one dram) produced by Avarming the bottle with the band may be inhaled Avith advantage. The solution should be weak to begin with and its strength gradually increased as is required. For anodyne remedies to relieve the cough, if anything is necessary, the preference should be given to Hyoscyamus and Belladonna to the exclusion of Opium, because of the latter deranging the digestion, and the danger from the indefinitely continued use of the drug establishing the opium habit. Tincture of Hyoscyamus in doses of a teaspoonful or Tincture of Belladonna in doses of ten or fifteen drops may be given as often as is required to relieve cough. The mixture of Paregoric, Hyoscy- amus and Wild Cherry recommended for Acute Bronchitis may be appropriately used. The use of Bromide of Potassium, or Ammonium and Chloral Hy- drate, is frequently very serviceable in relieving the cough, either alone or given in connection with other anodyne medicines, but most benefit will IoIIoav its use when the cough is of a spasmodic character. Take of Bro- mide of Potassium half an ounce, Chloral Hydrate two drams, Syrup of Tolu two ounces, Water to make the mixture six ounces. Dose: A tablespoonful three or four hours apart. HOMOEOPATHIC TREATMENT. Sulphur is, in the majority of cases, one of the principal remedies for the treatment of Chronic Bronchitis. The particular symptoms which serve to indicate its employment, are as follows: dry, racking cough, with spasmodic tightness of the chest, sometimes aggravated by the recumbent CHRONIC BRONCHITIS. 431 position, and not unfrequently attended Avith nausea or even vomiting; accumulation of phlegm in the air-tubes, and scraping sensation in the throat; sensation of soreness at the chest; chronic hoarseness, and even loss of voice; aggravation of the generality of the symptoms in raw, damp. cold weather; dry cough at night; or cough with considerable expectora- tion of thick, whitish or yellowish phlegm, chiefly in the day time; attacks of suffocative sensation and oppression of breath; rattling of phlegm on the chest, and occasional or even frequent palpitation of the heart; pains in the head and chest during fits of coughing; mistiness of sight, and sen- sation of darting; fullness in the head. Dose: Six pills in a tablespoonful of water, every morning the first thing (fasting), for a week then pause four days, after which the course may, if necessary, be resumed as before, and so on. Calcarea-carb. is more distinctly indicated Avhen the patient is sub- ject, from time to time, to depression of spirits, characterized by exceeding- anxiety respecting his or her health, and attended with great languor (often to a distressing degree); stitches, and occasional pains in the chest and in the sides; tickling sensation in the throat, accompanied or followed by dry, violent cough; the last-named symptoms occur especially at night, when in a recumbent position, or even during sleep, or in the eA'ening; prolonged and obstinate hoarseness, to which the patient is much subject, and Avhich is constantly induced by changes of weather; accumulation of adhesive phlegm in the air-tubes, and rattling of phlegm on the chest; sometimes moist cough, Avith expectoration of offensive phlegm (thick and yellowish). Dose: Six pills, as directed for Sulphur. Carbo-veg. is more particularly indicated by repeated fits of spasmo- dic cough during the day, and in the evening; pains as of soreness in the upper part of the windpipe, or sensation of tickling and roughness in the same part; iirolonged and intractable hoarseness and roughness of voice, aggravated by talking, or by raw, cold, damp weather, and occurring more particularly in the morning or toAvards night; rheumatic pains in the chest and limbs; cough Avith considerable expectoration of greenish phlegm. Dose: Six pills in a teaspoonful of water, morning and evening. Pulsatilla. This medicine is more particularly appropriate when the following symptoms and conditions occur: dry cough, which subse- quently becomes moist, and is then characterized by very considerable ex- pectoration of saltish or bitterish phlegm, or of phlegm tinged with blood, or of a yelloAvish or whitish appearance; soreness of the palate and throat; frequent attacks of chilliness Avithout thirst; yellowish, greenish, or offen- sive discharge from the nose; hoarseness, or even loss of voice; cough with much expectoration, and with pain on the chest; racking cough ex- acerbated at night and in a recumbent position, and accompanied with rattling of phlegm, nausea (or even vomiting), and sensation of being stifled, feeling of soreness or contusion about the belly in the act of coughing. Dose: Six pills in a teaspoonful of water, night and morning. Sepia is usually of eminent service in such inveterate cases of chronic bronchitis as are characterized by—cough attended with or followed by abundant expectoration of greenish-yellow, matter-like, or even bloody 432 OUR FAMILY PHYSICIAN. phlegm of putrid or saltish taste, occurring chiefly in the morning and towards night, and accompanied with a sensation of weakness and sore- ness about the chest; or sometimes dry. spasmodic cough, attended with nausea and resulting in the vomiting of bilious matters,—the cough occur- ring particularly at night, and being further characterized by difficulty of breathing or shortness of breath. Dose: Four pills in a teaspoonful of Avater, night and morning, for a Aveek, then pause four days, resuming the course after this interval, if necessary, as before, and so on. Causticum is also a medicine of much importance in the treatment of this disease, and is more particularly indicated by: aching pains in the limbs, bones in the face and jaws, and in the.throat and heaa, associated with a violent, racking cough, of Avhich the fits occur particularly at night; feebleness of voice ; hoarseness, or eAen loss of voice; lacerated and pain- ful sensations in the chest and throat; faltering or feebleness of the lower extremities; rattling of phlegm; watery discharge from the nostrils ac- companied with headache; flushing of heat at night, attended with palpi tation of the heart; chill during every motion; sometimes nausea, and even vomiting of food with dainty or deficient appetite. The open air pro- vokes or aggravates the symptoms. Dose: Three pills in a teaspoonful of water, morning and evening. Arsenicum is a valuable remedy in severe cases, characterized by great debility and languor, particularly if the subjoined symptoms occur: violent, dry cough, accompanied with shortness of breath, or even with at- tacks of apparent suffocation in the evening or at night, and provoked by cold drinks, or by the least exposure to cold air; or moist cough, with ac- cumulation of very adhesive phlegm in the ramifications of the Avindpipe, Avhich is haAvked or coughed up with great difficulty; and general aggra- vation of the symptoms at night or after eating. Dose: Four pills in a teaspoonful of water, three times a day, until the symptoms become less violent; and then at night and morning. INFLUENZA. EPIDEMIC catarrh. We apply the name influenza to every bronchitis invading a large sur- face of country, and involving with marked symptoms of illness the whole organism, more especially the nervous system, attacking a number of individuals in the same epidemic with very similar symptons, although these may differ ever so much in different epidemics. Influenza is generally preceded by a preliminary stage where the local symptoms of catarrh of the respiratory organs are still wanting, or are but imperfectly developed, whereas the patient complains very much of an extreme langour, with nervous excitement, sleeplessness and loss of appetite, without or with only slight fever. As the fever increases, the local symptoms become generally more marked and more intense. At times, a coryza is the only prominent symptom, at other times the mucous lining, from the nose to the finest bronchial divisions, is inflamed. At the INFLUENZA. 433 same time a violent and constant headache is complained of, which is com- monly located in the forehead, and is marked by all the peculiarties that so commonly characterize the headache in an incipient typhus. This head- ache is accompanied by rheumatic pains in many parts of the muscular system, accompanied by a degree of debility that almost amounts to pa- ralysis. After a gradual, very seldom sudden increase, the disease reaches its full height. The catarrh is at times violent, at other times very slight. The fever is intense, but so plainly remittent that the remissions some- times appear like intermissions. Tlie debility is excessive. The head- ache is agonizing, and is either complicated with sopor, or with violent de- lirium. The digestion is entirely prostrated; the tongue is thickly coated white or yellow, at times it exhibits a sickly redness with disposition to dryness; nausea and even diarrhoea are often present; the bowels are con- fined, diarrhoea is less frequent. The symptoms exacerbate in the even- ing and at night, the patient being very much disturbed by the cough which aggravates the headache a great deal. Thus the more violent at- tacks of influenza simulate an acute typhus, milder cases a so-called ner- vous gastric fever. Death may take place in the second week amid symp- toms of general exhaustion ; sometimes it takes place at a later period in consequence of the peculiar secondary diseases which frequently break out as sequelae of influenza. In the case of sound, robust individuals, the disease mostly terminates its course in a fortnight, but always leaving an extreme weakness which may last for Aveeks. In the case of old people the danger is always great, and recovery takes place very slowly. An abatement of the fever is al- ways the surest sign of an improvement. The disease very often leaves very threatening results, such as diseases of the lungs, stomach and liver. Thus we see that the prognosis in influenza is uncertain, even if the disease sets in favorably at first, and the patient had been in the habitual enjoyment of good health. If the individual had pulmonary disease, or in the case of old persons, a fatal termination is not uncommon. The pe- culiar nature of the actually existing epidemic may likewise exert a great influence; whereas, one epidemic scarcely destroys a single life, another epidemic, on the contrary, claims a great many victims. ALLOPATHIC TREATMENT. In Epidemic Bronchitis or Influenza, in addition to the treatment given for ordinary Bronchitis, tonic doses of Quinine, two or three grains three times a day, should be given. If the patient is feeble, Tincture Muriate of Iron is needed, in doses of ten to twenty drops in sweetened water, after each meal. The writer is of the opinion that Fowler's Solu- tion, in doses of five to ten drops, and the Iodide of Potassium in doses of fifteen or twenty grains, three times a day, is beneficial; they can be given in syrup and water with sarsaparilla and peppermint. HOMOEOPATHIC TREATMENT. INCIPIENT STAGE. Camphor (saturated tincture). This medicine, when employed upon . the earliest manifestation of symptoms of Influenza (or of Common Cold 28 434 OUR FAMILY PHYSICIAN. during the prevalence of Influenza), characterized by chilliness, shiver- ing, and general sensation of uneasiness, will frequently prove effectual in arresting the further development of the disease. In a more advanced stage, moreover, Camphor is equally indicated, and is often of great ser- vice, when laborious, asthmatic breathing, accumulation of phlegm in the air-tubes, and cold, dry skin occur as predominant symptoms. Dose: One drop of the saturated tincture on a small lump of fine loaf-sugar, repeated at intervals of one hour. Nux-vomica. This remedy has also repeatedly proven of great effi- cacy in the first stage of influenza; and, frequently, when timely admin- istered, in the cases in which it is indicated, prevents the development of the disease. The symptoms Avhich point out the fitness of Nux-v. are chiefly as folloAV : obstruction of the nose ; hoarse hollow cough, excited by tickling in the throat, and attended with severe headache; confusion in the head, giddiness ; want of appetite, disgust at food, acid taste, or vomiting of bitter or acid matter ; thirst; pain as from a bruise under the short ribs ; aching pain in the lower part of the back ; constipation ; pain in the chest as if from excoriation; alternate heats and chills ; gen- eral aching and prostration; sleeplessness, nocturnal excitement, and restlessness; pains in the face and teeth. Dose: Six pills in a teaspoonful of water, three times a day. INFLAMMATORY STAGE. Aconitum is indicated for children when the disorder assumes an inflammatory character, with quickness, hardness, and fullness of pulse, dry, hot skin, and short, harsh, shaking cough. Do.se; Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every three hours, until feA'er symptoms abate. Arsenicum. The following are the characteristic indications for the employment of this important remedy: heaviness and rheumatic pain in the head; profuse, watery and corrosive discharge from the nose, causing a disagreeable burning sensation in the nostrils; violent sneezing; shivering and shudderings, with severe pains in the limbs; oppression of the chest; difficulty of breathing; thirst; anxiety; rest- lessness; great prostration of strength, with aggravation of suf- ferings at night, or after a meal; inflammation of the eyes, with sensibil- ity to light. These symptoms may be attended with a deep, dry, fatiguing cough, worse in the evening, at night, or after drinking; or with sensations of dryness and burning, with mucus in the throat, which is difficult to detach. Dose: Two pills in a teaspoonful of water, every two hours, until the symptoms are moderated, and then every six hours. Mercurius.—This remedy is indicated by the following symptoms: chilliness, folloAved by profuse perspiration, unattended by mitigation of suffering; severe cold in the head, Avith copious, acrid, watery discharge; fever, with general heat; great weakness, relaxed bowels, headache ; pains in the head, face, teeth, and chest; sore throat; swelling of the glands beneath the ear ; violent, shaking cough, at first dry, but subse- quently moist, with copious secretion of phlegm—the paroxysms of WHOOPING-COUGH. 435 coughing being commonly excited by irritation in the throat and cheat; aching in the bones, and slimy, bilious diarrhoea, attended with strain- ing. Dose: As for Aconite. Phosphorus has been found exceedingly useful when there was excessive irritation in the windpipe and its ramifications, bordering on inflammation, with alteration of the voice, and pain during speech. Dose: Six pills in a teaspoonful of water, every three hours. Bryonia has proved of great service in relieving the violent, pressive aching, bursting, frontal headache, dry, hot skin, with or without fever, and cough, both day and night, with scanty or copious, easily loosened, white or yellow-colored phlegm; or when the cough produced pain in the upper part of the belly, and caused a pain, as if arising from the effects of a blow, beneath the breast-bone or under the short ribs. It has further been found of great efficacy when the liver was tumefied, painful to the touch, or on coughing, or taking a full inspiration ; also when vom- iting was liable to take place after coughing. Dose: Of a solution of eight pills to four teaspoonsful of water, give a teaspoonful every four hours. Opium has, in some cases, been successfully employed, when other remedies had failed, against distressing, dry cough, or cough Avith diffi- culty in expectorating the phlegm which has been detached, the parox- ysms of which were always followed by yawning. Dose: Six pills in a teaspoonful of water, every four hours. WHOOPING-COUGH. TUSSIS CONVULSIVA, PERTUSSIS. Whooping-cough is an epidemic disease which sometimes occurs in the form of very extensive, and sometimes circumscribed epidemics, in which latter case the few cases of whooping-cough might be called local. So far the real cause of the epidemic has not yet been determined. A con nection with other epidemic affections, especially measles, and likewise with smallpox and scarlatina cannot well be denied. Whooping-cough fre- quently precedes or succeedes epidemics of the last-named diseases, and in rare cases accompanies them. In the majority of cases whooping-cough commences as an ordinary catarrh of the nose or of the larynx, trachea and bronchial tubes. This introductory catarrh which does not, properly speaking, form a component part of whooping-cough, may break out in all degrees of severity and ex- tent without this circumstance justifying a conclusion regarding the ap- proaching attack. Hence the most proper course Avould be to regard this preliminary catarrh as connected with the epidemic only in so far as it furnishes a soil or a susceptible spot upon which the whooping-cough miasm can be grafted, and in which it can germinate. This is shown by the cases where the whooping-cough breaks out without being ushered in 436 OUR FAMILY PHYSICIAN. by a simply catarrhal stage, or where a simple catarrh exists for weeks before it is converted into whooping-cough. At any one period of this first stage, in a few days or even after the lapse of weeks either a harmlessly-sounding cough sets in or else an actually-existing cough becomes more severe, and sooner or later assumes a paroxysmal character which constitutes it whooping-cough. After this form of cough has reached its full development, the simple cough ceases entirely ; only in a feAV instances violent paroxysms and simple turns of cough occur mingled together. A single paroxysm has the following characteristic symptoms: The children who had hitherto been bright and cheerful, shortly before the setting in of the paroxysm, become restless and anx- ious, or, if old enough, they complain of titillation in the larynx or un- der the breast bone, or of oppression of breathing ; it is very seldom the case that a violent cough sets in without any preliminary symptoms, which, after a short lapse of time, is succeeded by a wheezing and labored inspiration taking turns with the single paroxysms without admitting of a full respiration, for the reason that all the respiratory muscles and par- ticularly the glottis are affected by the spasm. While the exertion to cough is constantly increasing and the spasm of the glottis is gradually abating, the children finally succeed in raising or vomiting up a more or less considerable quantity of a tenacious, Avhite mucus, which terminates the attack. During the attack the children express great anguish and restlessness; in consequence of the impeded breathing, the face and tongue become blue-red, the eyes weep, a watery mucus is discharged from the nose, eA'en blood is spit up sometimes and flows from the nose to the terror of the parents. The vomiting either brings up mere mucus or the contents of the stomach. Involuntary discharge of stool and urine is a rare occurrence if the children are otherwise robust. After the ter- mination of the paroxysm the children continue for some time in a state of confusion and languor, after which they play again as if nothing had happened. Only in the case of feeble or very small children the parox- ysms are succeeded by real attacks of eclampsia, or else by a state of sopor or even complete catalepsy. Under such circumstances the intermissions are not free from morbid symptoms, whereas vigorous children seem per- fectly sound between the paroxysms. These paroxysms sometimes set in quite frequently, and at other times at more protracted intervals. Generally their frequency increases up to a certain point where the affection remains stationary for sometime, after which it gradually decreases in violence. In the space of twenty- four hours the children may have upwards of thirty paroxysms of cough; they occur more frequently in the night, and at this time likewise last longer and are more intense. A paroxysm lasts seldom longer than three minutes ; if the parents assert that the paroxysms last longer, they are deceived by the anxiety Avhich the mother particularly experiences, to whom a minute may possibly seem a quarter of an hour. The paroxysm is excited by talking, eating, screaming, or by violent exercise, likewise by a violent fit of passion ; the cough may likewise occur Avithout any ap- parent cause, for instance, during sleep. The constitutional state of the little patients is variously affected by the cough, eAren if there are no complications. Strong children bear this whooping-cough* 437" COugb for months, without losing flesh, or without their general well- being being interfered with . It may, hoAvever, be accepted as a rule that if whooping-cough lasts longer than four weeks, children begin to lose their strength and flesh, and that this loss goes on increasingly in propor- tion as the cough lasts longer. Sickly and very small children are speed- ily and threateningly affected by the cough, even if none of the foregoing complications are present. The children grow pale and languid, they loose their appetite, but are not often attacked with diarrhoea. The course of the disease is generally for several months; but when we come to speak of the treatment, we shall show that this period is con- siderably abbreviated in homoeopathic hands. Of particular importance are the complications and sequelae of whooping-cough, Avhich alone constitute the dangerous features of this disease. The most frequent of these complications are inflammatory affections of the lungs. The catarrh of the respiratory passages, which was incon- siderable at first, invades the more delicate ramifications of the air-pass- ages more and more until a more or less intense bronchitis sets in, Avhich easily assumes the capillary form, and becomes readily associated with pneumonia. The presence of such a pneumonia is suspected if the bron- chitis steadily increases in intensity, and the intervals betAveen the parox- ysms are no longer free from hacking cough and a constantly increasing shortness of breath,--but the signs of this untoward change do not set in until the cough has lasted for days, and even weeks. In such a case, the little patient does not entirely recover from the attacks, he groAvs languid and feA'erish, has a short and dry cough, he does not Avish to rise from bed, the pulse is hurried, the respiration becomes more and more incom- plete, more hurried; he feels drowsy and tosses about. If these symp- toms manifest themselves in the later course of the disease, they always augur danger, and very commonly lead to a fatal termination. Brain diseases are scarcely ever caused by the direct action of whoop- ing cough; existing diseases of this kind may beccme fatally aggravated by the cough. The convulsions which often attack little children during the course of whooping-cough, are more correctly attributed to the influ- ence of Avhooping-cough over the whole nervous system, and, on this ac- count, may become lasting. The apperantly violent congestions of the head during the paroxysms are of very little importance to the brain of a perfectly healthy child, but they prognosticate trouble, if the brain was diseased before the cough set in. Acute heart disease is seldom one of the complications of whooping- cough. On the other hand, the development of consumptive pulmonary affections is a very common thing. Usually, however, these affections ex- isted before the cough set in, although many cases occur where the cough occasions the disposition of the tubercular matter in individuals predis- posed to this disease. Beside the complications, the frequently occurring sequelae may prove very dangerous to the patients. Among them we distinguish chronic bronchial catarrh, deterioration of single parts of the lungs, with conse- quent malformation of the thorax, pulmonary consumption, heart-disease, although the last-named rarely,'and then involving mostly the right side of 438 OUR FAMILY PHYSICIAN. the heart; spasms, occasionally mental derangement, and lastly hernia, which is of comparatively frequent occurrence. If the disease lasts a long time, complete marasmus is not an unfrequent occurrence; it is not attend- ed with other morbid conditions, and seems to resultf rom the exhausted con- dition of the nervous system caused by the excessive paroxysms of cough. The prognosis is always uncertain. Although the cough does not en- danger the lives of healthy children, nevertheless, the supervention of one of the above mentioned complications at any period during the course of the disease may occasion death, or a life-long infirmity; thus it happens th^t we often see vigorous and healthy children come out of an attack of epidemic whooping-cough like wretched invalids. ALLOPATHIC TREATMENT. In the treatment of Whooping-cough, it is to be borne in mind that the most careful attention to the hygienic management of the case, will save from the complicati ms which constitute the chief danger from the dis- ease. But with this attention, many cases require no further treatment. The clothing should be warm, and flannel should be worn next to the skin at all seasons except summer. The child must be kept indoors during wet weather. The food should be plain and digestible, but nutritious. In the beginning of the disease, the treatment should be the same as that given for an essential catarrh in the same situation. The same direc- tions are appropriate for the continuing catarrh. Of the remedies especially appropriate in this disease, is Bella- donna. It is markedly serviceable in the spasmodic stage, and if there is much bronchial secretion, but can be given at any time. The rule I have followed is the one given by Trousseau, viz: to begin with a single dose at night, much smaller than will probably be required the next night, two doses were given the third night, three and so on regularly increasing in arithmetical progression until the cough and spasm is markedly re- lieved (or excssive dryness of the throat, and dilitation of the pupils from Belladonna, become so severe as to be impossible to continue), The dose which is found to relieve the cough should be given each night for aweek. Then the dose may be lessened in the same manner as it was increased back to the first dose, but if the cough increases, the size of the dose is to be increased. The medicine should be given about a week after the spas- modic cough has ceased. Trousseau began by giving to young children a pill of one tenth of a grain of Extract of Belladonna, or one fifth of a grain for a child four years old, increased as above directed. As Atropine is the only form which is of uniform strength, it is doubtless the best form for this use. Take of Sulphate of Atropine one fifth of a grain dissolved in an ounce of Distilled water. The dose is two to four drops taken at bedtime,and gradu- ally increase the dose as is here directed. The Tincture is a suitable prepara- tion, beginning with three drops for a child of two years. The Mono Brom. ate of Camphor, the Bromide of Ammonium probably rank next in value. Of the Mono Bromated Camphor may be given in doses of three to five grains in Syrup of Tolu, and Mucilage four times a day. Three to ten grains of the Bromide of Ammonium, or Potassium may be given in Syrup of Tolu and Mucilage three or four times a day. When the Bromides are given, a dose of Chloral five to ten grains in WHOOPING-COUGH. 439 Syrup and water at night will generally give a prolonged, and quiet sleep. The two may be prescribed in one mixture. Take of Bromide of Amoni- um two arams, Chloral Hydrate half a dram, Syrup of Tolu half an ounce> water an ounce and a half. Mix and give a teaspoonful four times a day. In case spasm of the glottis occurs (upper opening of windpipe), the mix- ture may be given every half hour. It is claimed that the local effect upon the throat, of a solution of Quinine in Avater acidulated (with Hydrochloric Acid) sufficiently to effect a complete solution. It is used by inhalations of the solution in spray or atmozing, and taken internally in the usual full doses, one to five grains> given every three or four hours. The writer has seen tie disease yield with wonderful rapidity to this treatment in conjunction with the Bella- donna treatment. The inhalation of steam Avill often be beneficial. The vapor of Carbolate of Iodine (Tinct. Iodine, four drams Iodide of Potas- sium fifteen drams, Carbolic Acid a dram), or Bromium inhaled by drop- ping upon hot Avater is often beneficial in severe cases. The medicated steam may be conducted to the mouth by an inverted glass funnel or one made out of stiff paper. The inhalation of Oliphiant Gas (burning gas) has proved beneficial. In case of excessive long-continued bronchial secretion the above inhala- tions will prove of value. The inhalation recommended for chronic bronchitis may also be used. Some of the other internal remedies deserve mention as proving serviceable in domestic practice and in the hands of physicians. Carbon- ate of Potash (Saleratus) of one or two grains three times a day to a child a year old. It may be given with Cochineal as follows: Take of Carbon- ate of Potash half a dram, Cochineal ten grains, White Sugar two drams, soft water four ounces. Mix. Dose : One or two teaspoonsful three times a day. Alum is often serviceable in doses of one to six grains according to age. Take of Alum a dram, Syrup of Ginger, Syrup of Acacia, and soft water each an ounce. Mix. Dose: One or two teaspoonsful three times a day or oftener. Sulphur is often useful in doses of from two to five grains in milk or molasses tAvo or three times a day. Lung Fever (Pneumonia) is the most dangerous complication. Its management requires especial care. Stimulant applications to the chest, a thin poultice of sixteen parts flaxseed and one part fine mustard covered with an oiled muslin jacket should be used, or the chest wrapped in flan- nel thoroughly wet with a saturated solution of Camphor Gum in Olive Oil. Anodyne and tonic remedies will be required as in pneumonia occurring under other circumstances. Especial attention should be given to the latter, and to supporting the system with nourishment. Spasms will be best met by warm baths and the Bromide and Chloral mixture before given. HOMCEOPATHIC TREATMENT. FIRST OR FEBRILE STAGE. In the incipient, fevery, irritative, or catarrhal stage of the cough, the most appropriate remedies are to be found amongst those which we have 440 OUR FAMILY PHYSICIAN already pointed out in the treatment of common Cough, and must be se- lected according to the indications there giA'en and administered in the same manner, unless otherwise specified. By a careful selection of these reme- dies, it is frequently possible to check the disorder in the first stage. The folIoAving, hoAveA'er, according to the special indications mentioned, are particularly appropriate. Aconitum is appropriate in many instances for initiatory treatment, inasmuch as there is generally a considerable degree of fever present. As soon, howeA'er, as the febrile symptoms have somewhat subsided under the employment of Aconite, which in the generality of cases will occur within a few hours after the first dose or two, and appropriate selection should be made from amongst the following medicines. It should not be omitted, that Aconite will frequently be required from time to time, as an intermediary remedy, AvheneA'er marked febrile or inflammatory symp- toms are present, always returning to such other medicines as are most prominently indicated, as soon as the symptoms Avhich especially indicate Aconite have been moderated. Dose: Six pills in a teaspoonful of water, repeated, Avhen requisite, at intervals of three hours. Pulsatilla is appropriate when the symptoms are as follow: cough loose, and accompanied with a flow of tears, weakness of the eyes, sneez- ing, thick, discolored discharge from the nostrils, slight hoarseness, and inclination to vomit after coughing; occasional diarrhoea, especially at night. Dose: Six pills as for Aconite. Mercurius is indicated by hoarseness, Avatery discharge from the nose, with soreness of the nostrils; dry fatiguing cough, generally occur- ing in two successive fits. Dose: Four pills in a teaspoonful of water, immediately after the fits of coughing (but not more frequently than eA'ery hour.) Belladonna is one of the most important remedies in the catarrhal stage of whooping-cough, Avhen there is dry, hollow, or harsh and bark- ing nocturnal cough which becomes materially aggravated at night. This medicine is also particularly well adapted to the sore throat, Avhich is not an unfrequent concomitant, at the commencement of the affection. Dose: Three pills as for Mercurius. Nux-vomica is of great service when the cough approaches the sec- ond stage. It is indicated by the following symptoms: dry, fatiguing cough, attended with vomiting, and occurring particularly from about midnight until morning ;—the paroxysms so protracted and violent as to produce apparent danger of suffocation, with blueness of the face, and, oc- casionally, bleeding from the mouth and nose. Dose: As for Mercurius. Ipecacuanha is, like Nux-vomica, of great value when the cough is attended with danger of suffocation, and each inspiration appears to ex- cite a fresh fit of coughing. It is further indicated when the fits are attended with spasmodic stiffness of the body and blueness of the face, great anxiety and accumulation of phlegm in the chest. Dose: Of a solution of ten pills to three tablespoonsful of water, give a teaspoonful every three hours. pneumonia. 441 second or convulsive stage. Drosera is one of the principal remedies in the treatment of the disease, when it has reached this stage; and in cases where the constitu- tion has not been enfeebled by the transmission of hereditary weakness or other causes, it will speedily declare its beneficial effects, and materi- ally shorten this trying and painful period of the disorder. The particu- lar indications for the use of this medicine are: violent paroxysms of cough, occurring in such rapid succession, as to threaten suffocation, and attended Avith the characteristic shrill sound during inspiration, and sometimes fever; after each fit of coughing, vomiting of food, or of stringy mucus; relief on moving about; no fever; or, if there be fever, it con- sists of regular paroxysms of chilliness and heat; thirst after the cold fit; warm perspiration, sometimes only at night. „ Pose: Of a solution of eight pills to two tablespoonsful of Avater. give a teaspoonful after eA'ery severe fit of coughing. Veratrum-album is indicated Avhen the child has become reduced in strength and emaciated; or Avhen it suffers from cold sweats, particu- larly on the forehead, with excessive thirst, involuntary emission of urine, vomiting, and other symptoms common to this stage ; also pain in the chest and towards the groin ; low fever, with small, Aveak, and accelera- ted pulse; much thirst; aA'ersion to conversation. Dose: As for Drosera. Carbo-vegetabilis (Charcoal) is frequently useful in bringing this stage of the affection to an early and successful termination, after the pre- vious use of Veratrum or Drosera, or both of these important remedies par- ticularly Avhen, notwithstanding the decrease of cough, the tendency to vomit still remains. Cuprum-aceticum.—This remedy is found most useful in the nervous stage, particularly when convulsions with loss of consciousness ensue after each paroxysm. Also when we find vomiting after the attacks, rattling of mucus in the chest, and wheezing at all times. In almost all cases a marked benefit has followed the employment of this remedy ; sometimes it has been found sufficient of itself to cut short the disease, and, in others, has so far modified it, that other remedies, which had before seemed to fail, have, after its exhibition, acted with the most marked effect and completed the cure. Dose: Of a solution of twelve pills to three tablespoonsful of water give a teaspoonful every half hour. PNEUMONIA. INFLAMMATION of the lungs. On account of its frequency and the importance of the affected organ, Pneumonia is one of the most important diseases. Pneumonia may occur at any age, but attacks more especially individuals between the ages of twenty and forty years, very rarely children in the first years of infancy. No constitution is exempt from the liability to an attack; if a robust and 442 OUR FAMILY PHYSICIAN. plethoric constitution is generally regarded as more susceptible, it is, most probably, because robust men are more frequently exposed to the exciting causes of pneumonia. This circumstance is most likely the reason why men are so much more frequently attacked than women; the occupations pursued by men expose them more fully and more frequently than women to the deleterious influences productive of pneumonia. Infants at the breast, and children who have not yet passed through the first period of dentition, are seldom attacked with croupous pneumonia. The nature of the country does not seem to exert any palpable influence; for pneumo- nias occur in a level country as well as on mountains, in sunny districts as well as in exposed places. The seasons, on the contrary, exert a deeiaed influence. Our statistical tables show to a demonstration that the transi- tion from cold to warm seasons is the most fruitful source of pneumonia; the transition from warm to cold seasons is less productive of this disease, winter still less and summer least of any. Mechanical injuries, more es- pecially a violent blow or kick, may likewise give rise to pneumonia; nox- ious agents acting directly upon the lungs, such as irritating gases, excess- ive cold or heat, may likewise excite the disease. Symptoms. As yet we are not acquainted with any disease which, in the absence of any particular complications, runs its course in such fixed and stable forms as pneumonia, and adheres as fixedly as this disease to definite critical days. Pneumonia begins almost without an exception with a chill Avhich is usually very severe and is in many respects of great importance. It is from this chill that we date the comencment of the disease and by it we determine the critical days. The chill which is sometimes of very long duration and is immediately succeeded by, but never alternates with fever, is in no other disease of such a peculiar nature. As soon as the chill sets in, the muscular strength vanishes so that the patient finds it almost impos- sible to stand erect. As soon as the chill, which almost always lasts several hours, and scarcely ever only a few minutes, is over, a violent, dry fever-heat sets in, and the pulse becomes more or less accelerated, fuller and more tense, but very seldom exceeds the number of 100 beats. The temperature is always raised a few degrees. The face, which, during the chill, has an almost cadaverous appearance, now becomes flushed, sometimes only on one side; the cheeks are bright-red, the eyes injected, and very commonly some headache is felt, and the patient generally feels thirsty, but is very seldom disposed to vomit. The appetite is at once gone, and owing to the intense fever, all the secretions are suspended. The patient feels more exhausted than he really is. This condition which is as yet free from all local symptoms, may last longer than twenty-four hours, but in such a case the local symptoms appear at an earlier period; in rare cases they precede the chill. The patient complains of unceasing stitching pains which he generally points out with tolerable accuracy as existing at the affected spot, very seldom far removed from it; they are aggravated by every unusual exertion of the respiratory organs, especially by coughing and they sometimes increase to a high degree of intensity. The pain usually sets in associated with a short and at first dry cough, the respira- tory movements are much less full and more frequent in number. The pneumonia. 443 breathing is not only painful and accelerated on this account, but the violent fever likewise occasions an increased desire for breath which can- not be gratified, and causes great restlessness and anxiety and a marked activity of all the other respiratory movements. These exertions are generally so striking that pneumonia can be recognized from this very fact, more especially from the flapping of the alae nosi during an inspira- tion. Vocalization is of course altered, feebler and shorter, and frequent- ly interrupted. Soon after the cough has begun to set in, the patient begins to expect- orate ; this expectoration is important as a diagnostic sign. It is scanty, very tenacious, and usually intimately mixed with blood from the com- mencement, which imparts to it the color of rust, or brick-dust; this color is scarcely ever absent in the case of young, robust individuals. At this stage the physical symptoms have so far advanced that they render the diagnosis perfectly certain. During the first days the fever gradually increases, showing but slight morning remissions. Considering the high degree of temperature, the pulse is not so very frequent, scarcely ever exceeding 120 beats ; gradually the fullness of the pulse decreases consider- ably. The end of the inflammatory stage generally designates the period when a change takes place in the symptoms. The infiltration is seldom completed on the third day, sometimes not till the seventh, even still later. After this, the pains almost cease, the breathing becomes more tranquil, the fever is apparently less, the pulse remains unchanged, the constitutional symptoms do not mend very perceptibly. The local as well as the general symptoms may remain unchanged in intensity, until a change takes place in the disease. Such a change seldom takes place before the fifth day. This critical change is very often preceded by the breaking out of hepes labialis (cold blisters) which almost always author- izes the expectation of a favorable turn. Previous to the critical change, the intensity of the symptoms either rises to a great height by a gradual increase, or else it is often the case that after two to four quiet days a violent fever again rages for twelve to eighteen hours, after which the disease decreases very suddenly. Convalescence takes place so rapidly that on the fourteenth day every trace of the disease has generally dis- appeared. As we shall see presently, the mode of treatment exerts a great influence in this respect. Pneumonia does not alter the shape of the throax, or so little that no stress need be laid upon this symptom; nor are the intercostal spaces al tered any more than the general capacity of the throax. Very com- monly, however, a more distinct vibration of the thoracic wall, corres- ponding to the diseased portion of the lungs, is perceived when the pa- tien t is talking. The most important positive signs are yielded by percussion which informs us with tolerable certainty whether a larger portion of the lungs is infiltrated or not. We speak, of course, of croup- ous pneumonia, for it is this alone that causes the infiltration of a consid- erable portion of the lungs, most commonly of a whole lobe. In the incipient stage of pneumonia, the sound either remains unchanged, or is only changed very slightly ; hence, immediately after the occurrence of the chill, no changes can be discovered. But in proportion as the hyper- 444 OUR FAMILY PHYSICIAN. semia increases, the percussion-sound becomes more tympanitic, some- times to such an extent that one might be led to believe, a piece of intes- tine bad been struck. Hence the tympanitic sound is really characteristic in pneumonia, and is only less marked, if the thoracic walls are very thick, or if the diseased portion of the lungs is separated from the thoracic wall by a normal layer of pulmonary parenchyma. In croupous pneu- monia, this is very seldom the case. The more complete the infiltration, the more completely the air escapes from the lungs, and the more empty the sound becomes unless a layer, from which the air has not yet escaped, lies OA'er the diseased portion of lungs. On the sides of this normal layer the dullness often first changes to the tympanitic and further on to the normal sound, the tympanitic sound is sometimes heard even in the non- affected portion of the lungs, most likely owing to the accompanying hyperaemia. A change in the infiltration is revealed by percussion if res- olution takes place, in which case the tympanitic sound most commonly returns for a short time, and soon after gives way to the full sound. The results of ausculation are equally valuable as diagnostic signs. At the commencement of pneumonia, the normal respiratory murmur is very often quite feeble, much less frequently increased. As soon as the infil- tration begins to set in, and the air is still able to circulate in the inflamed portion of the lungs, we perceive, especially during an expiration, the crepitation that is so rarely absent that it can almost be regarded as char- acteristic in pneumonia. In the case of children, the invasion of the disease is often marked by convulsions, such as may occur in other acute affections ; in the case of adults, spasmodic symptoms are seldom witnessed. A very severe in- testinal catarrah sometimes constitutes the stage of invasion. In such a case the A'omiting only lasts until the infiltration is completed, whereas the diarrhoea often continues throughout the whole course of the disease. In the case of children, as well as of old people, very seldom in the case of adults, pneumonia throughout its whole course is sometimes accompa- nied by such prominent cerebral symptoms that a physical exploration alone is capable of establishing the diagnosis upon a perfectly reliable basis, for even the cough in such cases is often wanting. The patients sometimes remain unconscious during the whole course of the disease, which need not run a prolonged course on this account. Cerebral derangements of a lighter grade, a light delirium, mostly of a merry nature, sleeplessness or sopor, are very common occurrences. These happen most frequently in the case of drunkards. The tongue does not exhibit any regularly-occurring changes;—at times it is quite clean,— sometimes very much coated, at times humid, at other times quite dry. The last-mentioned appearance is not very promising, it is especially ominous if the balance of the symptoms impart to the affection a dubious character. The appearance of a slight icterus (jaundice) after the comple- tion of the infiltration is very common, nor is it of any particular impor- tance ; but if icterus sets in together with symptoms of catarrh of the stomach and bowels, it always indicates an unwelcome complication which threatens to delay the course of the disease. As a rule the skin remains pretty dry during the whole course of the disease; profuse or exhausting sweats occur much less frequently. PNEUMONIA. 445 The symptoms specially appertaining to the lungs, vary considerably. The cough, which is usually not very violent and occurs in single short turns, may assume a spasmodic character when, on account of the increase of pain, it becomes a source of great distress to the patient. It rarely is entirely wanting, or is quite dry. It is particularly old people who some- times do not cough at all. The frequency of the respirations is sometimes but inconsiderably increased, and it is the insufficient depth of the inspir- ations that reveals the character of the disease. The pain varies more than any other symptom; in the case of old people it is generally very slight; in their case the admixture of blood in the sputa is generally mis- sing. In the case of young and vigorous individuals the resolution of the in- filtration generally takes the place very rapidly, sometimes in a single day. Thus Ave find that the fever decreases on the ninth day, and that the pa- tient generally feels a little better; but there is no sudden decrease of all the abnormal phenomena, no immediate, but a scarcely perceptible, drag- ging commencement of convalescence. We seldom notice this condition of things in the case of robust men; it occurs quite easily among weakly persons and after an exhausting method of treatment. Sometimes, after convalescence has begun, an exacerbation Avith progressing infiltration sets in, in which case the fever is very apt to assume an asthenic character and the appearance of typhus, yet the course of the disease need not neces- sarily be very much protracted or unfavorable. But almost without an exception, important complications exist in such cases; such a form of pneumonia is very seldom the result of epidemic influences, but most gen- erally of an exhausting treatment. Experience has shown that the seat of pneumonia is of great impor- tance as regards the probability of a normal termination. As a rule pneu- monia of the right side is much more favorable than that of the left, pneumonia of a lower lobe lighter than that of an upper one, which is apt not to terminate in resolution and to assume a tubercular form. Inflam- mations of the left upper lobe are especially obstinate and deviating from the normal course; they occur the least frequently. ALLOPATHIC TREATMENT. In the beginning of a case of Pneumonia, a saline purge, as one or two teaspoonsful of Epsom Salts, (boiled for a couple of minutes with one- thira its bulk of roasted coffee in an earthen dish, and allowed to draw a few minutes to disguise the taste,) the same quantity of Citrate of Mag- nesia, or Rochelle Salts, or a couple Seidlitz Powders, and its operation followed by a full dose of Opium in some form as the quarter grain sugar coated pills of Morphine, the grain pills of Opium or Cordia, ten grains of Dover's Powder, or twenty-five or thirty drops of Laudanum : the opiate continued at such intervals as will relieve the pain, restlessness or vigi- lance of the patient, with hot fomentations, hot poultices, or hot Turpen- tine stupes applied to the chest, will meet the requirements of the case. The patient should be kept in a warm room of 05° to 70° F. The air should be moistened Avith steam. There is no better treatment for the control of deep seated inflamma- tions than the use of Opium in the doses above indicated. The writer 446 OUR FAMILY PHYSICIAN. has frequently seen a marked decline in the frequency of the pulse and breathings (resperations) with comfort and refreshing sleep follow the use of full doses of Opium, not only in the early stage of the disease; but to accompany its continued use to the extent of relieving pain or restless- ness throughout the course of the disease. The Avriter very seldom sees the need of any further sedative treatment. This treatment has the ad- vantage of not being harmful. It in no way delays resolution. If the patient does not expectorate thoroughly, and mucus accumulates in the bronchial tubes, opium ought not be given in full doses. Doses about half the size of those named above, are appropriate under such circumstances. From the beginning, to the end of the disease, great benefit will be de- rived from hot fomentation. The hot, wet pack is one of the most service- able. A large towel, wrung out of hot water, is folded and laid on the affected side: the whole chest is then wrapped in a large towel or bandage. The covering should be thick, to retain the heat. Previous to applying the hot pack, it is doubtless, advantageous to apply a hot Turpentine stupe. A flannel is wrung out of hot water, dipped in hot turpentine, ap- plied to the chest, and thickly covered to retain the heat. When consider- able smarting has been produced, the stupe may be replaced by a hot, wet pack, or a hot poultice. Lay hot poultices, covering the affected side and front part of the chest, or the whole chest. They should be frequently re- peated. Linseed meal is the best substance from which to make a poul- tice. The stupe may be used twice a day. In case a poultice is used, suf- ficient mustard may be mixed with the flaxseed meal, (one or two ounces to the pound,) to make the poultice sufficiently irritating, without the use of the stupes. The amount of blood drawn to the surface from the internal organs, by these hot dressings, is simply immense. One of the best, and most easily managed dressings for the chest is a flannel jacket, covered with an oiled muslin one. This is the dressing used in Bellevue Hospital, N. Y. This protects against cold, and secures all the benefits of a poultice. The repeated application of the Tincture of Iodine, is an effectual application. Blisters are harmful in the first stage, and after the fever subsides, when absorbtion has begun, they have no advantage over the application of the Tincture of Iodine. If the fever and pulse continue to run high, either the Tincture of Aconite or Veratrum Viride may be given, according to the following di- rections : Many physicians place great esteem upon the use of Veratrum Viride in the treatment of pneumonia. This opinion was extravagantly expressed by the gentleman with whom the writer first read medicine, Dr. A. K. Fifield, of Canneaut, Ohio : "Veratrum Viride is the sheet anchor in the treatment of pneumonia." There is no doubt of its poAver to so re- duce the force of the current of blood that in the early (beginning) stage of the disease, in strong subjects in full health, and so lessening the amount of blood circulating in the lung, that important service may be rendered. But as soon as the lobe of the lung affected becomes solidified its usefulness must cease. It is too powerful a remedy to be given with- out the guidance of a physician. The dose of the Fluid Extract is one to three drops, and of the Tincture (U. S. P.) is from two to six drops. If PNEUMONIA. 447 used, the dose should be small at first, and frequently repeated, one to two hours apart. The dose can be increased until the rapidity of the pulse and highth of fever are materially lessened. The Tincture of Aconite is serviceable in the same way and is pre- ferred by many practitioners. It is more especially useful in the incipi- ency of the disease, but can be continued with greater advantage until the fever ceases to rise when the remedy is omitted. It may be given in doses of a half drop to a drop, every half hour, until an impression is made on the fever movement, and then continued in doses of a drop every hour or two. This in itself is very effectual treatment. Some physicians are so confident in its efficacy as to assert that no other treatment is re- quired up to the period of crisis, but other measures of treatment are not incompatible with it. There is no doubt, in some cases of very strong, vigorous patients, Avhen the constitutional symptoms are very violent, of the benefit of bleeding, if practiced during the stage of congestion ; this is within the first twenty-four hours, generally. Many circumstances prevent its prac- tice then, as a rule. Only the most robust can be benefited even then. After the disease is fairly established in any case, bleeding can only weaken. All the sedative and revulsive effect required, can be secured by the cathartic, Opium and hot applications, with, perhaps, the use of Aconite, or Veratrum Viride. The use of Mercury or Tartar Emetic, according to the plan of some, is not called for, as they have no special influence over the disease. One of the principal objects in treatment, after exudation has taken place, is to support the strength of the patient, by means of nourishment, tonic remedies, and stimulants. The majority of cases which prove fatal do so from failure of the powers of life before resolution can take place. It is, therefore, important that supporting measures should not be delayed beyond the time when it is evident that the patient has pneumonia. In patients who are feeble to begin with, this supporting treatment is all the more necessary early in the disease. It is just as important to sup- port the strength of the patient in this disease as it is with continued fever or any other disease. In warm climates, this part of the treatment is even more important than in cold or temperate climates, as in them patients are less able to sustain the disease. Animal essences (consisting of the juice of finely-chopped lean meat extracted by heating in a loosly- corked bottle set in a kettle of waterj, strong beef tea (made by taking a pound of finely-minced lean beef in a pint of cold water, gradually raised to a temperature of 160° and maintained at that point for four hours, when it is to be strained and seasoned for use. During the steeping, a little Avater can be added from time to time to supply the loss by evapo- ration). Milk, egg beaten with a teaspoonful of sugar and mixed with a little water, or milk, and starchy articles of food, as bread, rice, gruel, etc., will form a suitable variety. The taste of the patient can be, generally, followed Avith safety. Tender beefsteak, broiled rare, is not inadmissible in many instances; tender fowl and game may often be allowed. Nour- ishment should be given four times in the twenty-four hours in all cases. The patient ought to have nourishment in the night, and, if very ill, it shoqld be given from two to four hours apart, night and day. 446 OUR FAMILY PHYSICIAN Of tonic remedies, Quinine is to be preferred. It is not needed in mild cases, but should be given in doses of one to three grains three or four times in the twenty-four hours, when prostration of the vital pow- ers is likely to occur. It may be given throughout the course of the dis- ease. In cases occurring with intermittent feA'er, Quinine should be given in large doses, as directed for intermittent or remittent fever, until the periodical paroxysms are arrested. The high feA'er is not an objection to its immediate use. In malarious localities, it is possible to prevent the deA'elopment of these malarial complications by the use of tonic doses of Quinine. Alcoholic stimulants are often a necessary of the supporting treat- ment of this disease as an aid to digestion. Two or three teaspoonsful of Brandy or Whisky, may be given with the milk, beef tea or essence, or gruel, every time it is given. Their use should be resorted to whenever any degree of prostration occurs, or insufficient nourishment is taken. The late Prof. Hughes Bennett, of Edinburg, directed the use of stim- ulants, as soon as the pulse became soft, to the amount of from four to eight ounces of wine a day. Out of one hundred and twenty-nine cases treated in the Royal Infirmary, of Edinburg, treated by Prof. Bennett, one hundred and twenty-five recovered, and of these, eighty-five took wine or spirits in quantities varying from three ounces upward to, in one case, twelve ounces. Sometimes very large quantities of spirits are re- quired. After convalescence is well established, their use should be dis- continued. | In chronic pneumonia, tonics of Quinine and Iron, as three grains of the Citrate in syrup, three times a day. Cream or Cod Liver Oil may be required. Anodynes should be given to palliate the cough and distress. The cough mixture of Paregoric, Hyoscyamus and Wild Cherry Bark, direcied in the treatment of acute bronchitis, is often sufficient, but stronger preparations may be used if necessary. Counter-irritation, by applying Tincture of Iodine over the affected side, is useful. Suppura- ting measures comprise all that can be done to prolong life. In the treatment of pneumonia in young children, the same princi- ples prevail as are gh'en for adults. A teaspoonful of Rochelle Salts/or Citrate of Magnesia, should be given to move the bowels. They should be kept open by the occasional use of the same remedy. For the relief of pain, cough and restlessness, Opium should be given in just sufficient amount to relieve these symptoms. The most eligible are : Paregoric, Laudanum, particularly the Deodorized Laudanum and Dover's Powders, in doses suitable to the age. Under six months, five to ten drops of Paregoric; half a drop to a drop of Laudanum; one-fourth to half a grain of Dover's PoAvder, given from two to four times in the twenty-four hours. Over the age of six months, up to tAvo years, these doses may be doubled. A somewhat larger dose may be given to a child of three or four, and for one five or six years old, the dose may be three times as large as for six months. The opiate is often more serviceable if Tincture of Hyoscyamus in doses the same as of Paregoric or Tincture of Belladonna in the same doses as of Laudanum, is given with it. In older children, Avith excessive fever and a bounding pulse, the PNEUMONIA. 449 Tincture of Aconite may be given in doses of half a drop to a drop two or three hours apart. Its continued use will depend on the amount of im- pression on the fever and pulse. It should not be continued after the fever is down or the pulse doAvn to one hundred per minute, or if given in only half the former doses. Then if the fever rises again it can be given more frequently. The following is a suitable mixture: Take of Tincture of Aconite Root sixteen drops, Syrup of Ipecac two drams, Syr- up of Tolu to make four ounces. Mix. Half a teaspoonful can be given every two or three hours, to a child five years old. From one to three grains of Citrate of Potash may be given about four hours apart, in syrup or in other mixtures, to stimulate the kidneys and skin. Spirits Mendiresus in doses of half a teaspoonful to a tea- spoonful and a half, giA'en in the same way, is suitable for the same purpose. The supporting treatment should be the same as for adults and should be begun early. Strict attention to nourishment should be given from the beginning, from two to four hours apart. The dose of Quinine for a tonic is from half a grain to a grain. The dose of Brandy or Whisky, given in the food, is from half a teaspoonful to a teaspoonful every two or three hours. Infants at the breast will be sufficiently nourished by the breast. With them the stimulant should be given in sweetened water. The same plan of counter-irritation as with adults should be followed —giving preference to a thin poultice made of flaxseed meal, with one- sixteenth part of mustard, kept constantly on the chest, covered with a jacket of oiled muslin. Flannel wet with Olive Oil, containing as much Camphor as it will dissolve, wrapped about the chest and covered with oiled muslin, is a convenient and suitable application. The Oil can be made more irritating, if it does not redden the skin, by the addition of a little Turpentine. Turpentine, Tincture of Iodine, or Mustard poultices, may be used if preferred, but the chest should be covered by oiled muslin what- ever plan of counter-irritation is followed. Complicated Cases. Symptoms. In severe cases, inflammation of the lungs is often found combined with pleurisy, in which case the pains of the chest are intense, and mostly of an acute, shoothing character. An- other and still more frequent complication is formed with bronchitis. Issue and Results. When the disease comes rapidly to a favorable termination, some striking evacuation generally attends it, such as a very free and abundant expectoration of thick, Avhite or yellow matter, often slightly streaked Avith blood; or a profuse and general sweat; diarrhoea; a profuse discharge of urine, Avith a copious sediment; or a flow of blood from the nose. If inflammation of the lungs be not checked in the earlier stages, the lung is altered in structure; and the face becomes patched with red, and sometimes livid, the vessels of the neck swollen and turgid, and the pulse weak and irregular. In the advanced or suppurative stage of the disorder, the expectoration becomes purulent or converted into a brown, serous fluid, and slight shiv- 29 450 our family physician. erings generally supervene; the pain or sense of fullness and tightness becomes abated, and the patient is commonly enabled to lie on the affected side without much inconvenience; but the pulse becomes weak and thready, and the strength commonly sinks rapidly: a fatal result is, however, some- times, even then, avoided by proper homoeopathic treatment. HOMOEOPATHIC TREATMENT. The great danger attendant upon this disease renders the assistance of professional experience, when that can be obtained, absolutely indispen- sible. But to provide, in some measure, for the contingencies in which such aid cannot be secured, the following directions are subjoined, to en • able even unprofessional persons to entertain some hope of insuring a suc- cessful issue. Aconite. In the stage of simple inflammatory congestion, with se- vere inflammatory fever, whether or not accompanied or followed by violent shooting pains in the chest, this remedy is unquestionably of great service. Dose: If singly, of a solution of six globules to two tablesoonsful of water, give a teaspoonful every hour, until the pulse becomes re- duced in volume and frequency, or the skin moist, or covered with profuse perspiration,—upon which the intervals may be extended to two hours, and the administration thus continued. Bryonia is frequently the best remedy to follow Aconite, when the more severe febrile symptoms have been lowered by the medicine, or, more especially, when such symptoms as the following predominate: cough with expectoration of stringy or tenacious phlegm of a brick-dust color, oppres- sion and acute shooting pains in the chest; orrhuematic pains in the chest and extremities, with aggravation on movement; foul, dry, tongue, con- stipation, and other indications of derangement of the stomach. When the pain in the chest is excessive, and of a shooting, cutting, or pricking character, the membrane which invests the lungs is generally involved, and the case thereby complicated with pleurisy. In such cases the alter- nate use of Bryonia, with such other medicine as may further embrace some of the symptoms, is sometimes necessary, or, at all events, conducive to more speedy recovery. Dose: In every respect as directed for Aconitum. Belladonna is, generally required before (or even after) Bryonia, when the fever returns after having been apparently subdued by Aconitum, and the difficulty of breathing, and pain, or feeling of uneasiness in the chest, continue: the expectoration tinged with blood, and difficult to bring up; the cheeks flushed, lips and tongue dry and parched, the skin hot, and the thirst incessant; the pulse hard, quick, and full; the sleep disturbed by frightful dreams and delirium. In young, robust subject, Aconitum and Belladonna may be exhibited in rapid alternation, with the most sat- isfactory results during the first stage. In such cases, indeed, the further progress of the disease is not unfre- quently arrested, or at all events, such a degree of improvement is effected that any remaining symptoms, such as some degree of oppression, and expectoration of viscid phlegm, readily yield to the administration of Bryonia. Dose: As for Aconite. t- ASTHMA. 451 Phosphorus. This remedy has been employed with striking success in almost every stage of the disease in question, under whatever form it presented itself, and even when the disease had already attained a some- what advanced stage. Much fever, with hard, full pulse, cough, and blood- stained expecoration, are the salient general indications for Phosphorus. It is also more or less necessary in all cases occurring in consumptive habits. Dose: If singly, of a solution of six pills to two tablespoonsful of water, give a teaspoonful every three hours. additional particulars.—serious cases. Antimonium-tartaricum is frequently of service when the oppres- sion at the chest and anxiety continue to increase, and the pulse becomes small, weak, and irregular ; or, moreover, either when there is no expect- oration, or when the expectoration is not tinged with blood, and occurs chiefly at night; or, again, when difficulty of breathing, anxiety, and other dependent symptoms are always temporarily relieved after expect- orating. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful, first at intervals of a quarter of an hour, and then of half an hour, and so on, extending the intervals to three hours, as improvement gradually ensues. When the urgent symptoms have subsided, consider the general aspect of the symptoms, and suspend or continue treatment accordingly. Sulphur is a medicine of great service when a relapse threatens to succeed the improvement previously effected by other treatment; and in repeated courses, upon the accession of convalescence, to restore the vigor and equilibrium of the system, and to neutralize the remaining suscepti- bility to affections of the same organs. Dose: If against ari impending relapse, three pills in a teaspoonful of water every three hours, until the progressive improvement, previ- ously manifested, becomes apparent. If as an after-remedy, against the remaining susceptibility of the lungs, give six pills in a table- spoonful of water, every morning, the first thing {fasting) for a week. ASTHMA. A disease characterized by an extreme difficulty of respiration (breath- ing) which is worse at certain seasons of the year and particular periods of the day, being generally worse at night. The difficulty of breathing is increased by violent emotions, damp atmosphere, excess of any kind, strong exercise, running, walking briskly, or ascending a flight of stairs. It is also more laborious in a horizontal position, and hence more distress is felt at night when in bed. The warmth of the bed also has a strong influence on the disease, by assisting in the causes that fill up the air- passages, and hence causing paroxysms to be more frequent during the night than the day. 452 OUR FAMILY PHYSICIAN. The patient seeks relief by sitting upright in bed, or bending the body forward and endeavoring to expand the chest mechanically by every possible means. Old persons are more liable to the disease than young. It is now believed thatjjspasmodic asthma is caused by a spasm of the muscular fibres encircling the bronchial tubes, especially the small branches. The existence of these fibres is placed beyond a doubt by mi- croscopic examinations. In common Asthma the lining membrane of the air passages is more or less affected, as in chronic bronchitis, but the affection of the mucous membrane extends further down into the lungs, the air cells are more obstructed, and the conformation of the chest itself is often somewhat contracted and defective. The action of the diaphragm is imperfect, as well as that of the walls of the chest, and hence it is that from want or enervation and free action in these parts, the disease is com- monly deemed nervous, as distinguished from chronic bronchitis which affects the bronchial mucous membrane chiefly. In Spasmodic Asthma the nerves are still more deeply implicated; their action seems defective in the respiratory organs, as stammering shows imperfect nervous action in the organs of speech; and in both cases the difficulty is increased by physical or moral excitement. Chronic Asthma seldom shortens life where patients carefully avoid all violent emotions, exer- cise, and excess, although spasmodic paroxysms may endanger life at any time, if these precautions are neglected. Attacks of Spasmodic Asth- ma generally occur during the first sleep, soon after midnight when sleep is most sound, or early in the morning. The patient suddenly awakes with a sense of suffocation, tightness of the chest and difficulty of breathing; the respiration is wheezing and laborious, the shoulders are raised and every effort made to enlarge the chest. The pulse is usually quick, weak, and irregular, the lower extrem- ities cold. When cough and expectoration come on or can be brought on the patient is relieved. The spasm may continue half an hour or more and even three or four hours. Asthma is often complicated with diseases of the heart, or Avith chronic bronchitis, acting as a source of permanent congestion, predisposing the parts to be more easily thrown into a state of spasm. The most common consequences or concomitants of the disease are chronic inflammation and dilation of the broncha. Emphysema (a swel- ling produced by air or gas) oedema (tumefaction) of the lungs, spitting of blood, tubercular deposits, larger girth and widening of the cavities of the heart, collection of liquid into the sack containing the heart, into the pleura, and sometimes congestions and effusions in the head causing apo- plexy. ALLOPATHIC TREATMENT. For the relief from a paroxysm of Asthma a great variety of remedies have been tried by the patient and frequently he knows what will suc- ceed most promptly, so that often his experience is the best guide. The narcotics which are best adapted for immediate relief are Mor- phine and Belladonna. A hypodermic injection of a quarter to a third of ASTHMA. 453 a grain of Morphine (always by a physician) is one of the surest known means for cutting short a paroxysm. Atropine may be injected in doses of a sixtieth of a grain and is prob- ably the next best method for procuring relief. These two remedies may be combined with advantage. A slower and unsatisfactory way is to give these remedies by the mouth. A third to half a grain of Morphine and twenty to thirty drops of the Tincture of Belladonna are the doses. Inhalations resorted to are Stramonium, Belladonna, Tobacco, Opium, Nitrate of Potash (Saltpetre), Arsenic and anaesthetics. Stramonium or Belladonna leaves are smoked from a common pipe with benefit, or dipped in a strong solution of Saltpetre and dried, they may be burned in a close room and the fumes breathed until relief is obtained. Cigarettes made by the folIoAving formula (of Trousseau) are excellent, the patient smoking them when the paroxysm occurs and breathing the fumes until relief follows : Take of Belladonna five grains, Stramonium and Hyoscy- amus each three grains, Extract of Opium one-third of a grain, Cherry- Laurel Water a sufficient quantity to moisten the leaves. Moisten the leaves of Belladonna Stramonium and Hyoscyamus in the Cherry-Laurel Water, having dissoh'ed in it the Extract of Opium, dry and make into a cigar ette. Tavo to four of these cigarettes may be smoked during the day. To persons Avho do not smoke the smoking of one or two cigars will frequent- ly bring relief. The following formula is a tried and useful one, and has been long and successfully employed in the Pennsylvania Hospital. Paper prepared as follows and rolled into cigarettes can be smoked two or three times a day until relief is afforded or giddiness follows : (It is called Compound Arsenical Paper.) Take of Belladonna leaves ninety-six grains, Hyoscy- amus and Stramonium leaves each forty-eight grains, Extract of Opium four grains, Tobacco eighty grains, "Water a pint. Mix, and make a solu- tion ; then add Nitrate of Potash (Saltpetre) one hundred and forty grains, Arsenite of Potash three hundred and twenty grains. Saturate white, thin, blotting paper with this solution and when dry it is ready for use. It can then be rolled into cigarettes and smoked. Either Chloroform and Nitrite of Amyl given by inhalation, by a physician, will frequently arrest a paroxysm. Burning nitre paper in the room and allowing the patient to inhale the fumes, is frequently successful in arresting the paroxysm or producing relief. The paper is made by dipping white blotting paper in a saturated solution of Saltpetre and drying. Certain remedies which produce nausea will arrest a paroxysm- One of the best of these is Lobelia, one or two teaspoonsful of the Tinc- ture may be given every half hour until nausea is produced. Other Eme- tics may be used; in this way the sickness of the stomach relaxes the spasm and the patient breathes freely. Anti-spasmodics, such as Assafcetida, Skunk Cabbage, and Skull Cap, will sometimes relieve the spasm causing the difficult breathing. Brom- ide of Potassium in doses of fifteen or twenty grains with half as much 454 OUR FAMILY PHYSICIAN. Iodide of Potassium, given every half hour or hour, will sometimes cut the attack short. In the interval between the attacks, attention should be given to the general health by the use of tonics, as may be required, regular habits of life, the regular use of sponge or shower bath, regulating the diet to over- come dyspepsia, relieving constipation. When digestion is poor, one or two teaspoonsful doses of Liquid Pepsin, prepared by Sheffer's formula, taken at meal times, will be beneficial. Sometimes five or ten drops of Dilute Hydrochloric Acid, may be added to each dose, with benefit. Nearly all cases of Asthma depend upon a co-existing bronchitis, and upon the cure of that depends the cure of the Asthma. The most effectual measure to produce this is a change of climate, (even changing the sleeping apartment from one room to another has been knoAvn to accomplish it). The most popular climate noAV for asthmatic patients to resort to is that of the Rocky Mountains—especially Colorado. This climate proves beneficial in a large number of instances. Commencing to change the residence, a locality chosen should in the first place be one which possessed just the opposite characters as the for- mer one, as from the city to country, or from country to the city. If the patient lived in a moist air, a locality Avith a dr,y one should be first tried —and vica verse; from a low region to a high one, or the opposite, etc. Sufficient has been said to guide in the selection of a change of residence. If the patient does not improve under the treatment resorted to, a change of climate should be insisted on. A remedy Avhich proves successful in a large number of instances is Iodide of Potassium. It should be continued for a long time, in doses of five, ten, fifteen or twenty grains, three times a day. The smallest dose should be commenced with. It can be given with tonic remedies, should they be needed. This is one of the remedies which is sometimes given to relieve an attack of asthma. For this purpose, it should be given in doses of fifteen, twenty or thirty grains, eA'ery tAvo, three or four hours, accord- ing to the severity of the seizure. It is one of the most reliable remedies. In the so-called " hay asthma," or summer catarrh, the Iodide of Potas- sium, combined Avith Arsenic, gives good results: Take of Iodide of Po- tassium an ounce, Fowler's Solution a dram, water four ounces. Mix, and give a teaspoonful every four hours. When Arsenical Cigarettes are not smoked, Arsenic may be given in doses of one to three drops, after eating. The two remedies, Iodide of Potassium and Arsenic, have accomplished the greatest number of cures. For the relief of bronchitis, the various means recommended for bronchitis may be resorted to. HOMOEOPATHIC TREAMENT. The treatment has to aim at the relief of the present paroxysm and at the curing of the disease. When the attack is accompanied by conges-. tion of the head in fleshy individuals, and in women and children of a peevish, illnatured tendency, where the attack usually occurs in the evening, sensation of dust in the lungs, better when binding the head HICCUP. 455 back and when holding the breath. Face and eyes red, head hot, sleepi- ness—but cannot sleep, Belladonna will prove itself a good remedy. If the attack was brought on by mental excitement: Aconite. If children are troubled with asthmatic breathing while teething, and at the same time are very peevish, nothing pleasing them, want to be carried all the time: Cham. If the breathing is anxious, short and oppressed, with much labor and greatly increased difficulty on ascending a flight of stairs, attacks of suffocation especially at night or in the evening in bed attended with great restlessness and fear of death, extreme thirst, drinking often but a little at a time; cannot lie for fear of suffocation and wants to be in a warm room, you will find Arsenicum the best remedy. Ipecac for Spasmodic Asthma with violent contractions in the throat and chest. Rattling noise in the bronchial tubes during an inspiration. Suffocation threatens from contraction in the throat and chest, worse from the least motion. Nausea with a feeling of empitness about the stomach. SINGULTUS, HICCUP. This is owing to a spasmodic contraction of the diaphragm, during which the air is draAvn in through the contracted glottis with a shrill and short sound. The hiccup either originates in the nervous centers, as during a gen- erally increased irritability or Neuralgia, especially in the case of hysteric and hypochondriac patients; or vvhen accompanying cerebral (brain) dis- eases, such as cerebral anaemia consequent upon long-lasting, exhausting diseases, or upon considerable losses of blood and other animal fluids, as well as upon violent psychical (mental) impressions, such as fright, an. ger, etc. Or else, it is simply a reflex-phenomenon, as during diseases of the pleura and pericardium. Consensual singultus may occur during diseases of the stomach, liver, pharynx, intestinal canal, etc. In the case of children it often occurs in consequence of a cold, or acid stomach. Singultus occurring during cerebral anaemia (bloodlessness of the brain) consequent upon chronic diseases, such as cancer, Bright's disease, tuber- culosis (consumption,) etc., or upon exhausting diseases, such as typhus, cholera, or upon pleuritis with profuse exudation; likewise upon exhaust- ing diarrhoea, is always a very dangerous symptom that may continue for days, and finally increase to convulsions. HOMOEOPATHIC TREATMENT. A passing hiccup is scarcely ever noticed; only if it lasts too long and becomes too severe, medical treatment may have to be resorted to. In cases of simple hiccup it may be arrested by stopping the breathing for some time, or by drinking a little cold water, by fixing one's attention 456 OUR FAMILY PHYSICIAN. upon a certain object, such as: holding a key in one's hand, by a syste- matic crossing of the fingers of both hands; by a sudden surprise, or such domestic remedies as eating a little sugar, magnesia, ice, etc. Infants who have taken cold, have to be Avarined, after which they should be put to the breast; if their stomachs are acid, we give them Cal- car 6, or Nux. vom. 6; if they are affected with intestinal catarrh, we give them Chamomilla 3, or Rheum 3. A domestic remedy that is frequently made use of, is calcined Magnesia, as much as will cover the point of a knife morning and evening. In one case, Avhere not one of these remedies would help, a teaspoonful of recently prepared lime-water removed the spasm. As external remedies practitioners recommend: laying grated horse- radish upon the epigastrium, dropping ether upon the pit of the stomach, painting this region Avith the oil of chloroform, one drachm to two drachms of almond-oil, and in desperate cases the inhalation of ether or chloroform. »♦ ♦ ♦» CHAPTER XXII. DISEASES OF THE PLEURA. PLEURITIS, PLEURISY. INFLAMMATION OF THE PLEURA. Inflammatory affections of the pleura are not by any means rare oc- currences ; yea, the frequent adhesions of the lungs to the thorax reveal- ed by post-mortem examinations, show that pleuritic affections are not only very frequent, but that they run their course unobserved. The more trifling inflammatory phenomena are without any practical value, nor do they ever constitute an object of treatment; for this reason we here treat only of the more acute forms of pleurisy with copious exudation. Pleurisies of this character are scarcely ever really primary diseases; in the majority of cases they are of a secondary nature. The history of primary pleuritis is somewhat obscure, unless the disease is caused by some direct and mechanically acting agency. A most frequent cause is said to be a violent cold ; but the case is here, as in pneumonia, the con- nection is taken for granted rather than proven. The more frequent oc- currence of pleuritis, during peculiar states of the weather, justifies the conclusion that atmospheric conditions exert a decided influence upon the origin of this disease. To designate such inflammations as rheumatic is in so far justifiable to some extent, at least, as acute rheumatisms occur epidemically at the same time. On the other hand, pleuritis as a complication or secondary affection, PLEURISY. 457 is exceedingly frequent. All inflammatory pulmonary affections, even hyperemia of more than ordinary extent, if occurring near the surface of the lungs, develop pleuritis which is generally confined to a very lim- ited space, but may likewise be very extensive and violent. Inflamma- tory affections of the heart may lead to pleuritis. Acute rheumatism and peritonitis, and likewise acute exanthemata, easily result in the develop- ment of pleuritis. Among chronic affections, the following may occasion the disease: Pulmonary consumption, pulmonary abscess, suppuration of the vertebra and ribs, Bright's disease. The occurrence of pleuritis during the stage of con\ralescence in severe acute affections, in pyaemia and generally in diseases characterized by marked signs of a septic con- dition of the blood, is a remarkable fact which does not admit of any further explanation. Like peritonitis, so pleuritis is superinduced in its Avorst and most extensive form by the intrusion of foreign substances into the pleural caA'ity, most commonly by the effusion of pus from a superfi- cial cavern, or from a suppurating bone. Symptoms. It is absolutely impossible to draw a permanently and universally true picture of pleuritis; the symptoms characterizing an at- tack of pleuritis, vary greatly in intensity as well as extent; many symp- toms are sometimes entirely wanting, whereas in other cases they are most prominently present. However, inasmuch as the symptomatic dif- ferences of pleuritis are mostly depending upon the quality of the exuda- tion, Ave subjoin a superficial sketch of these differences and shall discuss essential details in subsequent paragraphs. The plastic exudation exists seldom as an idiopathic affection; it gen- erally accompanies other diseases, more particularly pneumonia. Inas- much, however, as it is scarcely ever, even when existing as an idiopathic disease, accompanied by violent fever, we may suppose, that even where it exists as a complication, it does not contribute much to an increase of the fever. On the other hand it is precisely this form that causes the most violent pain which is very much increased by every somewhat more expansive movement of the thorax and of the body generally, more partic- ularly by coughing, and Avhich very frequently renders even percussion painful. After the lapse of at most a week the pain disappears again entirely; but the physicial signs, of which we shall treat by and by, some- times remain for some time after. Like all other more extensive inflammatory processes, it almost always sets in Avith a severe chill followed by considerable increase of the pulse and temperature, attended with headache, intense thirst, loss of appetite, and almost immediately an intense pain in the inflamed region of the pleura. The pain generally decreases in proportion as the effusion in- creases in quantity. As the exudation increases the breathing of course becomes shorter, and a distressing cough sometimes sets in, with a thin expectoration which is tinged with blood, but is not to be regarded as a sign that pneumonia or bronchitis has supervened, but most commonly depends upon no other cause than the congestion of the non-affected part, which congestion is a necessary consequence of the pressure caused by the exudation, and for this reason does not show itself at the outset of the disease, but only in its subsequent course. In favorable cases the termina- tion in recovery may commence with the second week, and may lead to a 458 OUR FAMILY PHYSICIAN. complete restoration of health; or else, the process of reabaorption takes place very slowly, imperfectly, and the patients remain for a long time in a sickly, lentescent condition, Avhere they are threatened with renewed attacks and exacerbations. The third form, empyema, often develops itself, as was stated above, from the second form. That pus is forming, may be inferred from the cir- cumstance that the fever does not abate; on the contrary, that in the sub- sequent course of the disease, and without any increase of the exudation, the fever increases in violence, mingled with chills, or assuming the char- acter of an hectic fever, with a constantly increasing prostration of strength. If the purulent exudation is a consequence of pyaemia, of a septic state or a general dissolution of the blood, the exudation may origin- ate and run its course without pain; it only aggravates the previously exciting morbid phenomena. The course of the disease depends essentially upon the fact whether the exudation is re-absorbed or enclosed within a sack, or finally, whether it escapes from the cavity, and in what direction. The fourth form, where the exudation is chiefly serous, usually im- parts to pleuritis a sub-acute or even chronic character. This form is very insidious, because itso often develops itself very gradually and without pain, and even commences without fever which does not generally supervene until at a later period. At first the patients only complain of lassitude, they lose their appetite, have a sickly appearance. Gradually the respir- ation becomes more oppressed and labored, but not by any means to a degree that might lead the patients to suspect the presence of a pulmonary disease. The quantity of the exudation occasions a displacement of the thoracic and abdominal organs. Recovery from such attacks always takes place slowly; it is only exceptionally that absorption takes place very rapidly amid a profuse flow of urine. Among the symptoms of pleuritis there is not one that could be pointed out as characteristic of the disease. It is true that in most cases of acute pleuritis we have the peculiar pain, but it varies exceedingly in character and intensity. At times the pain is simply a sensation of tenseness and constriction ; at other times the pain is a seated, localized stitching pain; at other times again the pain is spread over the whole side of the thorax, and is of a tearing or burning kind. Not unfrequent- ly there is no pain at all; this happens more particularly in most insidi- ous cases. In genuine pleurisy there is very seldom any cough, especially at the commencement of the disease ; if cough sets in at a later period, it may be occasioned by simple hyperemia, or by pneumonic infiltration. At all events it causes the patient a good deal of distress, increases his pain to an extraordinary degree and complicates the course of the disease, since every additional obstacle must necessarily, in view of the existing shortness of breath, imply an additional amount of danger. The symp- toms presented by other organs cannot be determined beforehand. Most generally it is the action of the heart, especially that of the right heart, which is altered; if any considerable amount of exudation is present, the beats of the heart become irregular, stronger and more rapid, the more so the more the heart is pushed out of its place by the effused fluid. A dis- placement of the liver is attended with pressure in the right side, and slight symptoms of jaundice. Neither the intestinal canal nor the kid- PLEURISY 459 neys are involved in all cases. The brain becomes slightly engorged, if the effusion is copious and the circulation is interfered with. The position of the patients deserves particular notice, more especially as contrasted with their position in pneumonia. Pleuritic patients almost always lie on the painless and unaffected side, whereas, if the effusion is not attended with pain, they prefer lying on the diseased side. Very seldom the patient wants to lie on his back; if he does, the trunk has to be ele- vated a good deal. All these objective as well as subjective symptoms, which we have described, are not sufficient to establish a reliable diagnosis. If a reliable diagnosis is at all possible, it will have to be based upon the results of a physical exploration, which is even more important in this disease than in pneumonia, for the reason that pleurisy often remains such a latent disease that the objective phenomena alone can shed light upon its exis- tence and true character. This examination can only be made by a phy- sician . ALLOPATHIC TREATMENT. The indications for treatment, in the first place, are to subdue the in- flammation and to relieve the pain. For this purpose, full doses of Opi- um is the most useful and effecth'e treatment, which not only relieves the pain completely, but lessens the congestion very materially. The hypodermic injection of Morphine in doses sufficient to produce its sedative influence, a third to half a grain, by the physician, is the best method for its administration. If given by the mouth, from a grain and a half to two grains of Opium, thirty to forty drops of Laudanum, fif- teen or twenty grains of Dover's Powder, may be given every two hours, until the pain is relieved, and repeated at intervals sufficiently often to relieve the pain. After the pain is relieved, doses half the size above named will probably be sufficient, but the pain must be relieved. Morphine may be given, by the mouth, in doses of a third to half a grain, and repeated every hour until the pain is relieved, after which the dose should not exceed a fourth of a grain, repeated often enough to relieve the pain. For continued use, if the preparations of Opium produce unpleasant symptoms, probably Atropine in doses of one-sixtieth of a grain, given with the Opium, will obviate the difficulty; or Codia may be used in- stead of Opium or Morphine in the same doses as that of Opium. A full dose of Quinine (fifteen or twenty grains) at the very begin- ning, is said to suppress the inflammation. It is more effectual if Opium be given with it as above directed. The cold wet pack, applied to the side, diminishes the inflammation and relieves the pain. A large towel is wrung out of cold water, folded and placed over the affected side. Then wrap the chest tightly with a long, broad bandage, or towel, which was previously had in readiness and fastened. Oftentimes the hot wet pack is more servicable and is to be preferred, the feelings of the patient being a safe and reliable guide. It is applied 460 OUR FAMILY" PHYSICIAN. in the same way, the towel being wrung out of water as hot as can be borne. Hot linseed-meal poultices applied to the affected side, will answer the same purpose. Some physicians prefer a large mustard plaster over the affected side; or Turpentine steepes, in the method described in the treatment of Pneu- monia. The application of Tincture of Iodine may be made to the af- fected side, and is a serviceable form of counter-irritation. A large blister, over the affected side, is always applied by some good practitioners, but they do not seem to possess any advantage over the use of heat either by the pack or poultices, and appear to be harmful by adding to the irritation from which the nervous and circulatory systems are suf- fering. When the disease has begun to decline, a blister is useful, by as- sisting in the remoA'al of the products of inflammation, but then has no advantage over the repeated applications of Tincture of Iodine. Like pneumonia, in cases of robust persons with high fever and a strong, incompressible pulse, and the pain is very severe, a blood-letting, in the very beginning of the disease, will prove serviceable and often be followed by quick relief. The amount of blood taken should be from twelve to sixteen ounces. A feeble, or only moderately strong person, ought not to be bled. After the pain has been relieved for several hours by the use of Opi- um, the revulsive effect of a free saline cathartic is required. For this purpose, one or tAvo tablespoonsful of Epsom Salts is the most efficient. If boiled with one-third its bulk of roasted coffee for a couple of minutes, in an earthen vessel, and then allowed to draw for a few minutes, the taste will be covered. Other salines may be given, but with less effect, as the Solution of the Citrate of Magnesia, Rochelle Salts or Seidlitz Powders. The bowels should be kept open by the use of moderate doses of the saline cathartics. For this purpose the latter ones are as appro- priate. If the fever and pulse continue to run high, after the influ- ence of the Opium is produced, a drop of the Tincture of Aconite should be given every half hour until an impression is made on the fever movement and then continued in one-drop doses of one hour to two hours apart, according to the degree of fever and the force of the pulse. The opium should be continued in doses of suffi- cient size and with such frequency as would relieve the pain. The use of Veratrum Viride is preferred by some practitioners as a sedative for the pulse and fever. While it is very powerful it seems to the writer that the Aconite is to be preferred. Neither of them should be prescribed except by a physician, and then they are only called for, as a rule, in persons of robust constitution. In giving Veratrum Viride, the Fluid Extract should be used in doses of one to three drops, or the Tinc- ture, in doses of two to six drops, repeated every hour until the pulse is slowed and then repeated two hours apart to continue the required impres- sion upon the pulse. This treatment should continue as long as there is pain and fever, and should be maintained just in proportion to the prominence of these PLEURISY. 461 symptoms, but should be discontinued when they disappear. Counter- irritation will be appropriate, as will be shown. Great reliance is placed upon the use of Mercury by some practition- ers, as having a specific effect upon this and other inflammations of serous membrane and by these is generally given with the opium in doses of from one-half to one grain. The writer believes it is powerless in the way claimed. The use of the remedy as a cathartic, in doses of ten grains, is admissible, if the patient is not especially susceptible to the in- fluence of the drug. If the bowels do not move it should be followed by a Seidlitz PoAvder, or one of the other saline cathartics mentioned above. The nutrition of the patient should be maintained by alloAving such food, from the very beginning of the disease, in patients not strong, as will be retained and is digestible ; as a rule milk, eggs, animal essences or strong beef tea, and bread, rice, and other farinaceous articles are to be chiefly used, but in the latter part of the disease the food should be more solid and meat may be allowed. In a very robust patient feeding is not required to be followed as persistently until a few days have elapsed, but with feeble patients the best results depend upon immediate and system- atic feeding. The principles for nourishment given on the treatment of Pneumonia will apply here Avith only little less force. Measures to promote the absorption of the liquid thrown out into the pleural cavity are hydrogogue cathartics (producing watery stools), diuret- ics (medicines increasing the flow of urine), counter-irritation and such remedies as may especially promote absorption. It is generally not well to resort to these cathartics until late in the disease, on account of their extreme depressing influence. The most powerful should be given only when the greatest urgency exists, as ex- treme difficulty of breathing, from the great amount of liquid in the pleural cavity, or Avhere other means have proved unaA'ailing. They are Elaterium, Croton Oil, and Gamboge. They ought, if used, to be pre- scribed by a physician. The dose of Elaterium is one-eighth to one-fourth of a grain; it should be combined with half a grain or a grain of Extract of Hyoscyamus. The dose of Croton Oil is one drop in mucilage or syrup. The dose of Gamboge is three to five grains in pill form, or rubbed up with sugar. Cathartics which are less severe, and very effective and can be relied on are the Saline Cathartics mentioned before in the Diuretics; may be given without reducing the system, and they act often with effiiciency. Mustard Whey is resorted to as a domestic remedy, and is often sufficient. It may be taken almost at will. Water Melon or Pumpkin seed tea can be given with the addition of fifteen or twenty grain doses of the Citrate Bitrartrate or Acitate of Potash. Squill, Digitalis and Broom are the most efficient remedies for this purpose. They may be combined in an Infus- ion of Digitalis (made from one dram of Digitalis to a half pint of water), four ounces, Vinegar of Squill half an ounce, Fluid Extract cf Broom half an ounce. Mix, and give a tablespoonful three times a day or oftener. The Potash Salts just mentioned may also be given with this mixture, or the Iodine of Potassium in doses of twenty grains, 462 OUR FAMILY PHYSICIAN. When giving cathartics or diuretics for removing the dropsy, the amount of drink should be limited as much as possible. Blisters no doubt hasten the absorption of the fluid, but it is probable that as much good will be done by the repeated applications of Tincture of Iodine to the side. If the strength of the patient should begin to fail, cathartics and diu- retics are out of place, especially the former, and Tonics and stimulants should be given as directed for Pneumonia. If the liquid accumulates in the chest to such a degree as to endanger life, the surgeon should remove it by tapping as will be described for Chronic Pleurisy and Dropsy of the Chest. The treatment of chronic pleurisy calls for the same treatment as the latter stage of acute pleurisy, consisting of the same cathartics and diu- retics, and for the same purpose. Small blisters may be repeatedly ap- plied over the side, or preferably the Tincture of Iodine may be applied from time to time. The strength of the system requires support by the use of Tonics, nourishment, and in extreme cases Alcoholic stimulants and out of door exercise. In many cases supporting measures are the chief means of cure. The Citrate of Iron and Quinine is as good a tonic as any, given in doses of three to five grains three times a day. It should be given in solution. The diet should be of the most nutritious possible, but simple and diges- tible. If Alcoholic stimulants are used at all it should be a glass of wine or tablespoonful of whisky or brandy at meal times, and is doing good if the patient eats and digests more food. If the fluid persists in the chest it can be effectually removed by tap- ping by means of a small trocar and canula attached to a Davidson's syr- inge. The liquid is removed in the same way as it is drawn from a vessel, during the process of an injection when the fluid returns after its re- moval a half ounce of the Compound Solution of Iodine (Iodine a dram, Iodine of Potassium two drams, water twenty-one drams), should be in- jected into the plural sac. This is especially serviceable if the sac con- tains pus. Then the sac may be washed out with an ounce of this solution to a pint of water. The use of Iodine of Potassium in doses of ten to twenty grains three times a day for a long time is useful in promoting absorption. The treat- ment of dropsy of the chest is the same as that for chronic pleurisy. The principles of treatment for pleurisy in young children are essen- tially the same as for the disease in the adult. The doses of Opium ad- missible are proportionately much smaller than are directed for an adult. It cannot, with safety be used so heroicly. For a child six months old or less, five to ten drops of Paregoric, and half a drop to a drop of Lauda- num. Above this age and under two years, ten to twenty drops of Pare- goric, two or three drops of Laudanum, or a grain of Dover's Powder; at the age of three or four, twenty to thirty drops of Paregoric, three to five drops of Laudanum or two grains of Dover's Powder, may be given. The effect should be watched with a great deal of care. The doses should be repeated only sufficiently often to relieve pain, Avhich will vary in fre- quency from two hours apart to two or three times a day. When the opi- ate is given every two hours until positive drowsiness is produced, it should be given at longer intervals. PLEURISY. 463 Hot applications, poultices or the hot wet pack, are the preferable means for local treatment. Hot Turpentine stupes, or the application of the Tincture of Iodine, or Mustard plaster, may be resorted to. These are fully described in the treatment of pneumonia of the adult. After the pain is relieved, the bowels ought to be moved by the use of a saline purgative, as directed for adults, in doses of half a teaspoonful to a teaspoonful; or Castor Oil may be given in doses an eighth to a fourth the size, mixed with an equal quantity of Glycerine, and a drop or two of Oil of Gauletina or Cinnamon, to disguise the taste. The bowels should be kept soluable by full or half doses of the same cathartics. If the pulse and fever continue high, after the pain is relieved and the warm applications to the side have been made, if the patient is over three years old, the Tincture of Aconite in small doses, frequently re- peated, until an impression is made on the fever, and the pulse reduced to ninety or a hundred. It can be given Avith syrup as follows: Take of Tincture of Aconite half a dram, of Syrup Tolu three and a half drams. Mix. Dose: From one to six drops every one or two hours. If the disease is secondary, or the patient feeble, Aconite or other de- pressing measures ought not to be used. Opiates to relieve pain, stimu- lant and warm applications as above directed, tonics and nourishment, will constitute the treatment. Except the child takes freely from the breast, nourishment consist- ing largely of milk, eggs, animal essences, and strong beef tea should be given through the length of the disease. To promote absorption, the use of Tincture of Iodine for a counter- irritant is preferable. Small blisters made with the Blistering Collodion is admissible. The diuretic effect of Iodide of Potassium is very useful. It should be given in doses of two to fh'e grains three or four hours apart: Take of Iodide of Potassium two scruples, Syrup of Peppermint and Water each an ounce. Mix. Dose: Twenty drops to a teaspoonful. If the child's blood is much impoverished, a scruple of the Pyro-Phosphate of Iron may be added to the above formula. This prescription is very useful in preventing the disease passing into the chronic state. Other diuretics may be given in connection with the Iodide of Potas- sium. The following is a suitable formula: Take of Vinegar of Squills two drams, Tincture of Digitalis thirty drops, Water four ounces. Mix. Dose: A teaspoonful for a child two years old, or a dessertspoonful for a child four or five years old, three or four times a day. Purgatives should be limited as above stated, to keep the bowels open. In case the treament failed to produce the absorption of the fluid the surgical procedures recommended for Chronic Pleurisy of the adult should be resorted to by the physician. HOMOEOPATHIC TREATMENT. Aconitum is an indispensable remedy in allaying the intense fever (with quick and full pulse) which is often attendant on Pleurisy; and is in 464 OUR FAMILY PHYSICIAN. many cases, indeed, when timely administered, alone sufficient to cure the disease. It completely supplies the place of the lancet in such cases, and rarely fails to effect improvement in from six to eight hours; should it not do so in that space of time, another remedy must be selected. Dose: Of a solution of ten pills to tAvo tablespoonsful of Avater, give a teaspoonful every hour, until the pulse becomes more healthy, the skin moist, and the breathing less painful and impeded. Bryonia-alba should, in general cases, follow Aconitum when the fever has been somewhat allayed by that remedy. It is more particularly indicated, either in simple or complicated pleurisy, Avhen the following symptoms are encountered, at an early stage of the disease: aching, burn- ing, but more especially acute shooting or cutting pains in the chest, much increased during inspiration or on movement; oppression and anxious res- piration; palpitation of the heart; dry, cracked, broAvn, or yellow-coated tongue; bitter taste, nausea, and occasionally vomiting of mucus, or of a bitter, bilious-looking fluid; aching or painful pressure at the pit of the stomach and under the false ribs; intense thirst, especially at night; con- stipation; head confused and giddy; giddiness on sitting-up in bed; ach- ing and shooting pains in the head, or pain as if the head Avould burst, particularly at the temples, with exacrebation on coughing, or moving; firey, or bluish redness, and puffiness of the face; restless, disturbed sleep, frequent star tings; nocturnal delirium, with alternations of lethargic sleep; burning heat of skin; occasionally, partial, clammy perspiration; pulse generally frequent, hard, and small, but sometimes full, unequal, in- termittent, and weak; aching in the limbs. Lastly, when, in connection with many of the above, the following symptons are met with : cough on lying on the side, or impossibility of lying otherwise than on tlie back; dry cough, or cough with expectoration of dirty yellow-colored phlegm, streaked or tinted with blood, and attended with great exacerbation of pain,—Bryonia will rarely fail to render much service, and can, indeed, Avith difficulty be dispensed with. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every four hours (or in very severe cases every two hours). Sulphur may with advantage follow Bryonia, when the pain men- tioned has been removed by that medicine, and often completes the cure, when Aconite or Bryonia, or both of these, have been insufficient. This remedy is, however, not uncommonly, of essential service as an interme- diary resource, administered from time to time, to awaken the suscepti- bility in the system to the action of others,—in such cases (associated with constitutional taint) as are not adequately influenced by either of the fore- going. Dose: If as an intermediary medicine, two globules in a teaspoonful of water, four hours after the last dose of any other medicine, fol- krwed, in six hours, by such treatment as may be particularly indi- cated. If as a conclusive resource to perfect' the cure (already ad- vanced) three globules in a teaspoonful of water, every six hours, until four doses have been given, and then six globules the first thing in the morning (fasting) for four days ; then pause two days, resuming the course as before, if necessary, and so on, until all traces of the disease have been removed. INFLAMMATION OF THE HEART. 465 Fart Tenth. DISEASES OF THE ORGANS OF CIRCULATION. CHAPTER XXIII. DISEASES OF THE HEART. INFLAMMATION OF THE HEART. Under this head, we Avill have reference to inflammation of the mus- cular structure of the heart, carditis,--inflammation of the lining mem- brane of the heart, endocarditis and inflammation of the membranous sac which envelopes the heart, pericarditis. These are generally treated upon as separate and distinct diseases, but as their symptoms are very similar, as well as the treatment recommended for them, we have judged it best to embrace them under one head. Symptoms.—Inflammation of the heart, or its membranes, usually commences A\rith the symptoms common to most inflammatory attacks, as chills, heat and dryness of the skin, thirst, flushed face, full pulse, etc. These are succeeded by rapid, imperfect and often unequal breathing and an acute lancinating pain about the region of the heart, which may ex- tend to the shoulder. This pain, especially in pericarditis, is aggravated by pressure over the heart, as well as by a full inspiration. There will, also, be a dry harrassing cough, Avhich augments the patient's sufferings, and generally a sense of suffocation will be experienced. Motion or exer- cise will increase the pain and difficulty of breathing to a greater or less extent. The features are haggard and expressive of much suffering, with a degree of anxiety, the heart beats violently and irregularly; a sensation of fainting is present, more or less constantly at first, the pulse is full, hard, and bounding, but speedily becomes small, frequent, and unequal, and frequently cannot be observed at the wrist; the appetite is deficient; the tongue coated white ; the bowels constipated; the urine insufficient and high-colored; the skin is often bathed in sweat, as in acute rheuma- tism ; and when the diaphragm or midriff is involved, there will be a distressing and painful hiccup. Causes.—These affections are, most commonly, owing to the pres- ence of acute rheumatism, the disease either attacking the heart prima- rily, or being translated to it from some other part of the system. They may, likewise occur from other causes, and are sometimes met with in combination with pleurisy, Bright's disease of the kidneys, etc. Prognosis.—These attacks are of a very serious character, and may terminate fatally in a very short time; though it is said that even when 30 466 OUR FAMILY PHYSICIAN. left entirely to themselves without any care or treatment not more than one in six cases is wont to proA'e fatal. The principal evils to fear are the secondary or chronic affections resulting from the acute attack. ALLOPATHIC TREATMENT. Inflammation of the substance of the heart is so rare and so com- pletely impossible to determine during life, that a discussion of means of treatment is not called for. The most frequent form of inflammation is that of the lining mem- brane of the heart (endocardium) and is called endocarditis. It produces the great majority of the diseases of the heart by causing permanent changes in its valves. This form of inflammation of the heart (endocarditis) most frequently occurs Avith inflammatory rheumatism (of the joints) and appears to depend on the same morbid cause. AVhen rheumatism exists, therefore, treatment required for it will have the most favorable influence on the endocarditis and should be employed. If promptly resorted to they prove protective againt this disease. Remedies addressed directly to this inflammation may be briefly summarized as follows: It is appropriate to use saline laxatives, pro- vided the patient is not weak or reduced. The articles most appropriate are a tablespoonful of Rochelle Salts, and Seidlitz Powders. Pain over the region of the heart should be met by hot poultices, the hot wet pack, as described for pleurisy, or Turpentine stupes. Opium in doses of half a grain to a grain, fifteen to twenty-five drops of Deodorized Laudanum or appropriate doses of other preparations of Opium, may be given to relieve the pain and sufficiently often to procure this effect. The subsequent ill-effects of the disease are due to the products of the inflammation, either the deposit of Gymple beneath or upon that portion of the membrane covering the valves. Remedies which will reduce the fibres in the blood or retain it in a fluid state, are called for. The alka- lies called for by the rheumatism are appropriate. Ammonia has a direct influence to this end; the Aromatic Spirits of Ammonia (Hartshorn) may be given through the course of the disease. The dose is a teaspoon half full to a teaspoonful in water or syrup and may be repeated from two to six hours apart, according to the severity of the disease. To promote the absorption of the lymph Iodide of Potassium may be given in doses of ten to fifteen grains three times a day and the Tincture of Iodine may be applied, daily or less often, over the region of the heart. The discrimination of this affection requires the skill of a physician. The more immediately and exceedinyfy dangerous inflammation to which the appendages of the heart is subject is pericarditis (inflammation of the serous membrane covering the heart.) When the disease occurs in the course of acute Articular Rheumatism the remedies appropriate to that affection are urgently called for. The use of the saline cathartics, Rochelle Salts in doses of one to two tablespoonsful or one or two Seidlitz Powders, are useful by way of revulsion. They should be repeated in four hours, if the bowels have not moved. Opium in some of its forms is invaluable given to the extent of reliev- INFLAMMATION OF THE HEART. 467 ing pain. The best manner of using it is the hypodermic injection of Morphine in doses of a quarter to a third of a grain by a physician. They may be repeated every half hour until pain is overcome. A third of a grain of Morphine, thirty drops of Laudanum or a grain and a half of Opium may be given every hour until pain is relieved. Afterwards repeated at such longer intervals as will maintain the effect. If, after the pain is relieved, the pulse continues strong and very rapid Tincture of Aconite may be given in doses of a drop every hour until an impression is made on the fever and pulse and then every two hours to maintain its effect. Tincture of Veratrum Viride is used instead by some practitioners for this purpose. The dose is two to five drops of the Tincture, or one to three drops of the Fluid Extract every two hours. Mercury is thought by some practioners to exercise a controlling power over this and other inflammations of serous membranes. If used it may be given in doses of a sixth to a third of a grain of Calomel every two hours to impress the system quickly. Its beneficial action is, to say the least, doubtful. Counter irritation, such as Mustard plasters, Turpentine stupes as di- rected for pneumonia, the applications of Tincture of Iodine, the hot wet pack may be useful. A warm poultice may be kept over the region of the heart. After the acute symptoms have subsided to promote the absorption of fluid from the pericordeal (upon the heart) sac, the region over the heart may be painted every day with Tincture of Iodine, and small blisters may be applied by using the Blistering Collodion with a camel's-hair brush. When a blister is made it should be allowed to immediately drp up. The use of Cathartics is admissible as far as the strength of the pa- tient permits to promote absorption. Epsom Salts, or Citrate of Magnesia* or Bitartrate of Potash may be made to produce one or more water stools a day. Diuretics as Squills and Digitalis maybe given in equal parts three or four times a day in doses of a teaspoonful. It is during this stage that the strength of the system needs support- ing with nutritious food, as strong beef tea or essence, milk, raw eggs beat up with sugar and water or milk, or poached, and such farinacious ar- ticles as the patient desires; steak broiled rare may be eaten if relished. Quinine in doses of one to three grains three times a day, may be given for a Tonic. If the circulation is weak, stimulants are called for, a table- spoonful of brandy or whisky may then be given in milk or with the raw egg as often as two hours apart, if required. Its beneficial effect will be shown by producing a fuller, softer, and more regular pulse. During convalesence the diet should be good and nutritious, but sim- ple. Much exercise should be avoided, though part of the time spent in the open air is beneficial. Treatment appropriate to other diseases when pericorditis occurs as a complication must be continued. Pericorditis from wounds can have little else done for it, except re- lieve the pain with Opium. Should the disease become chronic, the treatment given for the acute disease after the early symptoms, are appropriate. Iodine of Potas- sium may be given in doses of ten to twenty grains three times a day. If 468 OUR FAMILY PHYSICIAN. the blood is much impoverished, one or two grains of the Pyrophosphate of Iron may be given with the Iodine of Potassium. In cases in which the useof these means with Cathartics, Diuretics, etc., fail to remove the liquid, it has been successfully done by tapping, and in some instances the Com- pound Solution of Iodide of Potassium has been injected into the sac." So serious a disease, and one involving such difficulty in its manage- ment, requires, invariably, the services of a physician. HOMOEOPATHIC TREATMENT. The diseases of the heart are all so difficult to understand, and a proper understanding of the case is so important that, although I very much de- sire to bring their treatment within the comprehension of the masses, I am unable, thus far, to do so fully. Appended are many of our most ap- proved remedies with their particular indications, by Lilienthal. The dose should be varied and repeated in proportion to the urgency of the case. From four to eight pills in a little water, repeated at intervals of from one to twelve hours, may be given. Aconite. Oppression about the heart, burning flushes along the back; palpitation, with feeling as if boiling water was poured in the chest; anxiety, difficulty of breathing, flying heat in face, sensation of something rushing into the head ; fainting with tingling. Amon. carb. Audible palpitation, with attacks of great anxiety, as if dying; cold sweat, involuntary flow of tears ; unable to speak ; loud, difficult breathing and trembling of hand ; debility and soreness of the whole body ; pulse hard, tense, frequent. Apis mel. Sudden attack of acute pain just below the heart, soon extending diagonally toward the right chest; blowing sound with the diastole ; sensation as if he Avould not be able to breathe again; great prostration ; pulse accelerated, full and strong, or feeble and imper- ceptible. Argentum met. Full feeling in region of heart; frequent spas- modic, though painless, twitchings of the whole cardiac muscle, espe- cially on lying on back ; fears apoplexy ; lame, weakness with all pains. Arnica. Sensation as if heart were grasped by an iron band; stiches in cardiac region ; region of base of the heart feels as if bruised ; sudden pain, as if the heart got a shock ; intermittent, feeble, hurried, irregular pulse; hypertrophy of heart, induced by over-exertion, especially in young men, as from rowing; the fatty heart. Arsenicum. Palpitation, after suppressed herpes or footsweat, with feeble irregular pulse; the heart beats strong, visible, and audible at night, more rapidly when lying on back ; pericarditis in consquence of suppressed measles, or scarlet fever, with inexpressible anguish and rest- lessness, worse at night, flushed face, paralytic feeling in the upper ex- tremities ; tingling in fingers, cold perspiration. Assafcetida. Nervous palpitations, with small pulse, breathing not oppressed, in women after suppressed discharges, or bodily exertions; pressure in cardiac region, as if heart were too full and expanded; pulse small. inflammation of the heart. 469 Aurum met. Frequent attacks of anguish about the heart, with tremulous tearfulness; violent beating of the heart after exertions, with great agony; strong beating of heart, with anxiety and congestion to head, after metorrhagia; when riding or walking palpitation compels one to stop ; palpitation with irregular intermittent pulse and short breathing. Belladonna. NerA'ous palpitations, Avith congestion to head; pres- sure in cardiac region, which arrests the breathing, and causes a sense of. anxiety; gurgling at the heart, a kind of palpitation when going up- stairs ; throbbing of carotid and temporal arteries. Benzoic acid. Benzoate of Ammonia. Rheumatism of heart; pains change place incessantly, but are not constant around the heart; awak- ens after midnight with violent palpitations of the heart and temporal arteries; internal but no external heat ; at times tearing pains in the ex- tremities, relieving the heart; urine high-colored, offensive, hot, scald- ing, ammoniacal, high specific graA'ity. Bryonia. Pericarditis, with stitching pain in cardiac region, pre- venting motion and even breathing, wants to lie perfectly quiet; heart beats A'iolently and rapidly, strong orgasm of blood ; from re-percussion of measles. Cactus grand. Pericarditis and endocarditis; sensation of con- striction of the heart, as if an iron band prevented its normal movement; acute pains and stitches in the heart; difficulty of breathing ; attacks of suffocation, with fainting ; cold perspiration on face, and loss of pulse ; palpitation Avhen walking, and at night when lying on left side. Nerv- ous palpitations ; easily frightened, often awakes in a fright; numbness of left arm, annoying, creeping sensation from before backwards in car- diac region, oedema of the hands, especially of left one; endocardial murmurs, excessive impulse, increased praecordial dullness; enlarged right ventricle ; irregularity of the heart's action, at times frequent, at others slow ; great irritation of the cardiac nerves ; enlarged left vent- ricle ; pains in the apex of the heart, shooting down the left arm to the ends of the fingers; feeble pulse, dyspnoea; general weakness, prostra- tion, great depression, sleeplessness, fainting. Cimicifuga. Excessive impulse of the heart over an extensive por- tion of the left side, with dullness on percussion ; heart's action ceases suddenly, impending suffocation ; pains from the region of heart, all over the chest and down left arm, palpitation, unconsciousness, cerebral congestion, dyspnoea, face livid, cold sweat on the hands, numbness of the body, the left arm numb, and as if bound to the side ; pulse weak, irregular, trembling ; chorea of heart, tumultuous, irregular, unexpected, and strange motions of the heart; cardiac debility ; rheumatic endo, and pericarditis. Colchicum. Heart disease, following acute rheumatism, dropsy of heart (hydro-pericardium); pressure and anxiety in praecordial region ; fullness and oppression, as from stagnation of blood in the heart at night, while lying on left side, he is obliged to turn to the right side ; dull, ir- regular, seemingly suppressed beats of heart, with a peculiar sensation in chest; pulse small, slow, and weak. Digitalis. Pericarditis, with copious serous exudation ; violent, but 470 OUR FAMILY PHYSICIAN. not Arery rapid beating of the heart, irregular intermittent pulse, brick- dust sediment in urine, during or after rheumatism. Very feeble irregu- lar action of heart, with feeble, small, intermittent pulse; great prostra- tion, fainting on the least movement, even lifting the arms, with palpi- tations, coldness of limbs and body, and dreadful weak feeling in pit of stomach, with or without convulsions of syncope ; profuse expectoration of bloody mucus, and vomiting of food ; sensation as if the heart would stop beating if she moved, with fear of impending death; hydropericar- dium (dropsy of the heart). Ferrum. Consecutive heart disease, especially from chlorosis and onanism; congestion to head, spitting of blood; palpitations, better from moving slowly about; pseudo-plethora, with hard, strong, beating of the heart and throbbing in all bloodvessels ; pulse full, hard, increased by exertion ; soft bellows sound at apex ; nervous restlessness, must walk slowly about. Gelseajium. Cardiac neurosis. Feeling as if the heart would stop beating if she did not move about; a sensible motion of the heart, as though it had attempted to beat, which it failed fully to accomplish, and the pulse then each time intermitted, worse when lying down in bed, es- pecially when lying on left side ; excessive action of heart; stitching sen- sation in cardiac region, heart's action slow and feeble, the beats of heart cannot be felt, chills and pains in head; nervous chills, yet skin is warm, wants to be held that she may not shake so. Iodum. Pericarditis in complication with croupous pneumonia pur- ring feeling in the region of the heart, violent palpitation, increased from the slightest motion, better while lying perfectly quiet on the back; faint- ing spells ; sensation as if the heart were squeezed together ; fluttering sensation in heart; constant, heavy, oppressive pain in cardiac region. Lilium tigrin. Cardiac irritability, nervous palpitation; pains dull pressing and heavy, as if the heart were grasped and released alternately; sensation as if the heart contained too much blood, which might be re- lieved by throwing up blood ; pain, pressure, and fullness about the heart with a feeling of coldness about the heart, but no indication of any or- ganic lesion ; trembling feeling about the apex of the heart, worse on talking; frequent sensation as if the heart stopped, followed by a rush of the blood to the heart and violent palpitations; amelioration by lying on left side. Lycopodium. Hydropericardium ; trembling palpitation, pulsating tearing in the region of heart; sensation as if circulation would stand still, or ebullition of blood ; palpitation of heart nearly every evening in bed; marked palpitation, with flatulence; acceleration of pulse, with coldness of the face and feet; neck drawn towards right side, stitches in left side of chest; typhoid symptoms. Nux moschata. Hysteria cardis; violent action of heart; feels as if her head would burst, and her heart be squeezed off; trembling flutter- ing of heart, as from fright; palpitation and fainting, followed by sleep; irregularity in heart's beat, pulse intermits sometimes so long that it ex- cites fear of death; murmur in carotids; frequent trembling pulse, accel- erated after wine; disposition to faint even from slight pains. INFLAMMATION OF THE HEART. 471 Nux vomica. Hypertrophy of heart from portal obstruction; pal- pitation in frequent short paroxysms, with pulsating throbs in the direc- tion of the heart, especially from mental emotions, protracted study, af- ter eating highly-seasoned food; tired sensation of heart, with palpitation when lying down, frequent belching; dilation of heart (weakened heart) with nervous palpitation, with nausea, inclination to vomit, and heavi- ness of the chest. Phosphorus. Disease of right heart, with consequent stagnation; dilation of the heart following endocarditis; fatty degeneration of heart; dyspnoea, tightness across the chest; great weakness, with inability to exert himself; palpitation from every emotion, with rush of blood to the chest, especially in rapidly-growing youths ; over-sensitiveness to exter- nal impressions; congestion to lungs, tightness across chest, and tight cough ; painless diarrhoea. Phytolacca. Chronic rheumatic endocarditis; shocks of pain in cardiac region, pain goes into right arm; awakens with lameness near heart, worse during expiration, cannot get to sleep again ; heart's action weak (fatty heart), with constipation ; great exhaustion. Podophyllum. NerA'ous palpitation, in consequence of excessive hepatic action ; sensation in chest as if heart were ascending to throat; palpitation, Avith a clucking sensation rising up the throat, obstructing respiration ; palpitation from mental emotion or exertion, with rumbling in ascending colon ; heavy sleep, fatigue on waking in morning. Pulsatilla. Nervous palpitation in young girls during the time of puberty, or from amenorrhcea; catching pain in cardiac region; better for a time from pressure of hand; rheumatic irritation of heart, the pains shifting rapidly from one part of the body to another ; constant chilli- ness ; worse nights, especially after getting feet wet; burning in cardiac region; violent fits of palpitation, often with anguish and obscuration of sight. Rhus tox. Uncomplicated hypertrophy, from violent exercise ; or- ganic heart disease, with sticking pain and soreness; numbness and lameness of the left arm ; chest and heart feel weak after a walk; violent palpitations when sitting still; pulse sometimes quicker than the heart's beat, irregular; restlessness, must change position ; always worse when keeping quiet. Scutellaria. Irregular action of the heart, from derangement of the cardiac nerves; tremulousness and twitching of the cardiac muscles ; oppression of the chest, with a sticking pain in cardiac region ; sensation of throbbing about the heart, with flushed face; nervous disorders of heart, as palpitation, tremor, and strange sensations, from emotional ex- citement; hysteria; reflex nervous irritation, from ovarian or uterine disorders. Sepia. Suppressed menses; congestion of blood to the chest, with violent palpitations; an occasional hard thump of the heart; palpita- tions, with anxiety about things which happened years ago; palpitation after mental emotion ; interruption of the beating of the heart, most af- ter dinner ; alarming, quivering motion ; restless, fidgety; sensation of ball in inner parts. 472 OUR FAMILY PHYSICIAN. Spigelia. Rheumatic pericarditis. Undulating motion of the heart; indistinct beats of the heart, running one into another ; tumultuous beating of the heart in recumbent as well as in sitting positions, not syn- chronous with the radial pulse; spasms of the chest; suffocative com- plaints ; tremulous sensation in chest and temples, increased by motion ; tearing sensation in chest when raising the arms overhead and when touching pit of stomach ; purring murmur during the beats of the heart; stitches in cardiac region ; pulsation of carotids, with tremulous motion ; great dyspnoea at every change of position ; bright redness of lips and cheeks, changing to pallor during every motion ; audible beating of the heart, causing a pain that is felt through to the back ; cutting pains from the heart to shoulders, as far as the head and arms; arthritic pain and stiffness in joints; dull stitches where the beats of heart are felt, and re- curring with the measured regularity of the pulse; scraping in throat; affection of the tracheal and bronchial mucuous membranes; systolic blowing at the apex ; pulse irregular, strong, but slow. Spongia. Aneurisma aortae; dry paroxysmal cough; worse lying down ; rheumatic endocarditis; loud blowing with each heart-beat; at- tack of oppression and cardiac pain; worse when lying with the head low; stinging-pressing pain in praecordial region; violent palpitation; awakens at night with a sense of suffocation ; violent gasping respira- tion ; loud cough ; great alarm; agitation and anxiety ; valvular insuf- ficiency ; feeling of numbness of lower part of the body; trembling in all the limbs. Veratrum album. Tumultuous irregular contractions of heart, forerunners of paralysis ; intermittent action of heart in feeble persons, with some obstruction to heptic circulation; violent, visible, anxious pal- pitation, with fainting; pulse sometimes slower than heart-beat. Veratrum viride. Idiopathic and rheumatic peri- and endo-card- itis; violent fever ; full, hard, bounding pulse; congestion to the head, without delirium; throbbing carotids ; constant burning pain, with op- pression of the chest; sensation as of a heavy load on the chest; heart's action violent and tumultuous; respiration rapid, labored, and sighing ; faintness and blindness when rising from lying, from sudden motions ; patient feels best when lying quietly. PALPITATION OF THE HEART. Palpitation of the Heart is symptomatic of some other disease, but is often so severe as to require a distinct consideration. There is a rapid beating or fluttering motion of the heart which may be felt very plainly when the hand is placed upon the chest over this organ. Various other symptoms may accompany it, as a shortness of respiration, a sense of pain in the neighborhood of the heart, a feeling of constriction across the chest, inability to lie down, pale countenance, swollen feet, a real debility, irregular or intermittent pulse, much distress on slight exertion, etc. The palpitation may vary from a simple, full, uniform, powerful beating of the heart to a rapid, violent, confused and irregular action, shaking the whole system, and producing very disagreeable sensations. palpitation Of the heart. 473 Causes.—Palpitation of the heart is generally owing to dyspepsia, or some derangement of the digestive functions; occasionally it occurs as a symptom of some nervous disorders and it frequently accompanies enlargement of the heart, dropsy of the heart, and other diseases of this organ and its arteries. It may also be brought on by great mental excite- ment, intemperance, masturbation, excess in venery, etc. Treatment.—When the palpitation is owing to disease of the heart, relief is all that can be expected unless the disease be cured, and the same may be said when it is owing to the dyspepsia or other affections; but diseases of the heart are not so readily cured as many other maladies. Whatever may be the disease occasioning the palpitation, it should be treated and removed, if possible. ALLOPATHIC TREATMENT. Many cases of palpitation of the heart depend on an impoverished condition of the blood (anaemia), in which case the remedy is to restore the blood to its natural richness by the use of Iron and Quinine, good food and hygiene. The Citrate of Iron and Quinine is one of the suitable remedies given in doses of three to five grains in solution three times a day, other tasteless forms of Iron may be used as the Pyrophosphate, or the Soluble Citrate, and the Quinine may be taken in pills of one or tAvo grains. Many cases of feeble heart, rapid in its action, are greatly relieved by five to twenty drops of Tincture of Digitalis three or four times a day. If the patient is strong and robust, and the action of the heart vigor- ous and the arterial high, the physician would be justified in resorting to the use of such arterial sedatives, as Tincture of Aconite in doses of two or three drops, or Tincture of Veratrum-viride in doses of two to five drops sufficiently often to produce a sedative effect on the action of the heart. The Bromides are suited to cases of irregular action of the heart, and in cases having an irregular circulation in one extremity, Avhile it is regu- lar in the other, and various other irregular symptoms referable to the circulation. The Bromide of Potassium may be given in doses of ten to thirty grains three or four times a day. For feeble patients the Bromide of Iron in one or two grain doses may be given at the same time, or other Tonics may be taken. A Belladonna plaster over the region of the heart will sometimes give relief, especially, if there is pain. Prolonged attacks of palpitation are often speedily relieved by half tea- spoonful doses of Chloric Ether, or Hoffman's Anodyne every fifteen or twenty minutes until relief is obtained. If valvular disease, or dilatation of the heartexist, exercise should be of the most moderate kind, and all excitement of every kind avoided. This trouble may be caused by tobacco, coffee, tea, stimulants, narco- tics, mental depression, or excessive venery. Such causes are to be sought for, and if discovered they are to be removed. HOMOEOPATHIC TREATMENT. Aconitum may be recommended for palpitation of the heat attended with a sensation of anguish and intense oppression at the chest, and 474 OUR FAMILY PHYSICIAN. generally with weight and Aveariness of the extremities, flushing of heat, especially in the face, short, painful and anxious respiration, or shortness of breath, particularly during sleep; sometimes pricking sensations in the chest, or sensation of compression, or as if bruised in the left side, or, again, shooting pains in the left side, particularly during motion, and on going up stairs; palpitation caused by fright. Dose: Six pills in a teaspoonful of water, repeated at intervals of an hour, until the particularly indicative symptoms are moderated ; or afterwards again, from time to time, should those indications occur. Belladonna, when there are violent pulsations of the heart, reverber- ated, as it were, through the whole chest, and sometimes to the extremi- ties and head; sensation as of a heavy weight on, or firm band about, the chest, with pains in the shoulder-blades ; irregular and sometimes interrupted breathing, Avith an occasional effort to expand the chest for breath, or short, anxious, and very accelerated respiration; palpitation, sometimes attended with intense anxiety, particularly in the evening in bed; tremulous palpitation of the heart, with anguish; or palpitation generally on going up stairs. Dose: Six pills in a teaspoonful of water, as directed for Aconitum. Nux vomica is more particularly of service for palpitation of the heart, occurring in persons of dry, meagre habit, but also in persons of robust constitution and sanguine or bilious temperament, and particular- ly when the paroxysms are liable to come on either in the morning— sometimes attended Avith nausea, and even inclination to vomit, or with pressure at the chest—or more especially upon first lying down or after eating {sometimes after every meal), heat, or even burning sensation in the chest, occasionally occurring at night, and attended with great anxiety, sleeplessness, and agitation ; or if coming on after the use of coffee or liquors. Dose: Six pills, as directed for Aconitum. Sulphur is generally of service after one or more of the foregoing medicines, in completing the cure, but particularly when the attacks are provoked by ascending stairs, etc., and are accompanied by a feeling of anxiety or dread. This remedy is also very serviceable when the affec- tion has ensued after the suppression of an eruption or the sudden healing of an old sore. Dose: Six pills, as directed for Aconitum. Arsenicum may sometimes be required after the previous adminis- tration of Sulphur, in cases in which the symptoms have not yielded to a second course of the last-named medicine, and when the affection has ensued as the consequence of a suppressed eruption, or of the sudden healing of an old sore. Dose: Six pills, as directed for Aconitum. Lachesis is indicated when there is frequent desire to draw a long or deep breath, or shortness of breath chiefly prevalent after eating or after any exertion of the limbs (particularly of the arms), generally attended with deep despondency; also by suffocative attacks at night; or spasmodic affections of the heart, attended with a peculiar pulsative sensation deep ANGINA PECTORIS. 475 (as if on the drum) in the ear, which make it appear as if the membrane would burst—or again, in very severe cases, and when fainting-fits and cold sweats attend upon spasmodic attacks of the heart, and there is ex- treme shortness of breath. Dose: Six pills, as directed for Aconitum. Pulsatilla is a remedy of great value in the generality of cases in which palpitation of the heart occurs as a nervous or hysterical symptom, or in young girls during the time of puberty, or from suppressed men- struation. Dose: Six pills, as directed for Aconitum. Cocculus is more particularly required when there is a suffocative palpitation of the heart associated with weakness, trembling of the limbs and extreme languor, dizziness and faintishness, and when the attacks are aggravated or excited by talking, eating, or drinking. Dose: Six pills as directed for Aconitum. Cactus is indicated in palpitation occurring in persons who are usually low-spirited or hypochondriacal ; palpitation worse when walk- ing, and at night, when lying on the left side; general prostration of strength, and sleeplessness. Dose: Six pills, as directed for Aconitum. Coffea is more especially required, in recent cases particularly, when the palpitation is attended with excessive nervous excitement, with suffo- cative attacks and excessive anxiety, attended with groundless apprehen- sions, torture of conscience, great despondency, restlessness, and some- times complaints ; or again, when sudden emotions of joy have induced the attack. Dose: Six pills, as directed for Aconitum. ANGINA PECTORIS.—ALLOPATHIC TREATMENT. Attacks of Angina Pectoris are most speedily relievea by the inhala- tion of five or six drops Nitrite of Amyl. If the circulation is feeble a teaspoonful of brandy, or one or two teaspoonsful of Ether or Hoffman's Anodyne may be given. The hypodermic injection of Mophine in doses of a third to half a grain is another effectual method. Mustard may be ap- plied over the chest, and Mustard drafts to the extremities. During the interval between the attacks, excitement of all kinds, ac- tive exercise, immoderate eating, and the use of Alcoholic liquors are to be avoided. The general health requires attention. Arsenic appears to have the power of preventing the attacks, or les- sening their severity. It may be given in the form of Fowler's Solution in doses of three to five drops three times a day in water, after meals. Its use should be directed by a physician. During its administration, if puffy- ness of the eye lids, or pain in the bowels occur, it should not be taken until these symptoms disappear. 476 OUR FAMILY PHYSICIAN. CHAPTER XXIV. DISEASES OF THE ARTERIES AND VEINS. DISEASES OF THE ARTERIES. The various diseases of the arteries are of very little importance in a book like this, for the simple reason that they cannot be treated medic- inally. Arterial inflammation, mostly only a symptom of other diseases, is scarcely recognizable with positive certainty, even in the case of larger arterial trunks. Of cousre, an inflammation of the larger arteries is highly interesting, because the closure of an arterial trunk near the heart may give rise to cardiac hypertrophy. Aneurisms (dilatation of an artery with rupture of one or more of its coats), are not exactly diseases, but consequences of other influences. We do not see how medicines are to accomplish anything in such cases. It is only the disturbances which such arterial lesions cause in the heart, that suggest the properiety of medicinal interference, and we regard it as downright absurdity to recommend medicines for the cure of aneurisms, as has indeed been done. DISEASES OF THE VEINS. PHLEBITIS.—INFLAMMATION OF VEINS. Phlebitis, the correct diagnosis of which is a recent triumph, is, so far as its consequences are concerned, one of the most important of all known morbid processes. The veins of the lower extremities and of the cavity of the skull are particularly liable to inflammation, besides all the veins whose sides do not collapse, such as, above all other veins, those of the gravid uterus. The causes of phlebitis are: Direct injuries of the vessel; coagula aris- ing from impediments to the circulation occasioned by dilatation of the vessel; introduction of foreign substances resulting in a decomposition of the blocd. This last-named explanation is applicable to phlebitis which sets in in an epedemic form in limited localities; or else the disease may arise secondarily from inflammatory affections of neighboring parts, or of remote parts, but lying in the tract of the vein; or from puerperal con- ditions, suppurations of bones, especially caries of the bones of the ear. The symptoms of phlebitis vary according to its extent and intensity. The most intense forms of phlebitis orginate in suppuration to which we therefore refer; in this category belongs especially epidemic phlebitis, where the local process is rapidly extended through the whole organism. The less intense cases very usually set in with a chill recurring either irregularly with more or less frequency or otherwise, or else setting in typically, like an intermittent paroxysm. The diseased vein is of- ten indicated by a seated, circumscribed, burning pain, but is quite A'ARICOSE VEINS. 477 often altogether painless. The chill is succeeded by a feeling of ill- ness, usually so severe that it is entirely out of all proportion to the objective symptoms. The pulse is accelerated and very much re- duced in volume, the digestion is interfered with, a tendency to per- spire sets in, the tract of the vein becomes cedematous. If the circula- tion in the vein is restored, all these symptoms may disappear as rapidly as they came. If the vein remains closed, oedema develops itself beyond the closure, and, if a collateral circulation can be established, may last only a short while, or else remain permanent. In such a case lassitude, chills at irregular intervals, irregular flashes of heat sometimes continue for weeks. The terminations of phlebitis depend upon the changes going on in the inflammatory exudation. If no purulent decomposition takes place, life is not exactly in danger : if pus forms, it may be carried along with the current of blood, and a most malignant phlebitis may suddenly arise notwithstanding the trifling character of the symptoms at the outset of the inflammation. It is in this manner that lying-in women and persons that had been operated upon, often perish quite suddenly, although not a single symptom existed at first that could have given rise to the least ap- prehensions of danger. The prognosis is uncertain. If the chills recur but seldom and with increasing weakness, the danger is less; whereas frequent chills, prostra- tion and sopor, are decidedly ominous signs. The treatment should only be in the hands of the best physician you can possibly obtain. The subsequently remaining and very prominent oedema of the parts which lose their normal circulation in consequence of the obstruction of the vein, cannot be removed by treatment. It does not disappear until the collateral circulation is restored, which it sometimes takes years to accomplish ; the uniform pressure of a bandage, if it can be applied, may, if it does not effect a cure, afford at least a good deal of relief. VARICOSE VEINS. PHLEBECTASIA—VARICES. DILATION OF VEINS. In most cases the causes of these very frequent dilations can be deter- mined with perfect certainty ; in other cases, however, they are involved in obscurity. These are the cases where the disease cannot well be traced to some mechanical obstruction in the circulation of the blood. At all events, these cases are the least frequent. The existence of a peculiar predisposition in the walls of the veins, or else the subsequent supervention of a morbid change in those walls, will have to be taken for granted. The most frequent causes are: Obli- teration of the vein, owing to which the portion beyond the obliterated A'ein dilates in its whole extent; dilation or contraction of the venous trunk, which has the same effect as obliterations, only in a less degree; every change that interferes with the flow of blood to the heart, such as dilation of the right heart, affections of the liver, tumors compressing the vein, tight clothing. In all such cases, varicose veins are of a secondary 478 OUR FAMILY PHYSICIAN. character; it may likewise occur as a primary disease in the case of men who have to be continually in a position that interferes with the reflux of the blood, persons for instance who have to be continually in a sitting or standing posture. In a sitting posture, the dilation of the vessels can often be accounted for by the pressure exerted upon the abdominal or- gans in the stooping posture; in the standing posture on the contrary the dilation is entirely owing to the circumstance that the vertical posi- tion of the body embarrasses the course of the blood onwards through the veins. Every vein in the body may become dilated; dilations occur most frequently in the veins of the rectum, (then called piles), lower extremi- ties and spermatic cord. We will briefly dwell here upon varices of the lower extremities. They occur more frequently among women in whom the cause of the dilation is traceable to the impregnated uterus, whereas primary dilations are decidedly of more frequent occurrence among men. What we have said just now concerning the originating causes of dilation is particularly applicable to this form. At first one of the larger cutane- ous veins of the leg is most commonly affected, whence it does not usually extend to the thigh, but involves very regularly the larger as well as the more minute veins of the foot, especially of the veins situated around the ankles, where they give rise to a considerable swelling covered with a blu- ish net of both delicate and coarser vessels. In most cases these varicose veins are painless. In other cases the leg pains for a short time, after which the pain again disappears. Very often the pain is felt while a portion of the skin assumes a bluish redness, swells and becomes quite hard ; the pain increases continually, finally the skin suddenly breaks at the place of infiltration, without being caused by mechanical injury as most of these patients fancy, and an ulcer of the size of a pea forms, which is at first round and provided with thin, somewhat undermined edges. Without proper management and hygienic precautions the pains increase all the time; the ulcer spreads, its edges gradually swell, the surrounding skin becomes hypertrophied, (thickened) the ulcer secretes a watery and sometimes exceedingly fetid fluid, and its base has a sickly color. If the same mode of living is continued, during which walking hurts only a little, but standing hurts a great deal, the ulcer may spread over the Avhole surface of the leg from the ankle to the calf, and may even penetrate to the bone. Ulcers below the ankle and on the front portion of the foot are of rare occurrence. The fetor of the ulcer increases in proportion as the ulcer spreads over a larger surface. Persons go about with such ulcers for years, and it is inconceivable that the constant drain of their vital fluids does not result in speedy emaciation. If a fever or some other constitutional disease breaks out during the existence of the ulcer, it seems to heal spontaneously, in which case the disease is very commonly, but improperly, regarded as the consequence of the healing. If the patients are so situated as to be able to remain at once in a re- cumbent posture, the little sores heal very speedily, but break open again very easily if the person has to stand a great deal, so that the existence of such ulcers at any previous period leaves a constant liability to their returning again at a subsequent time. VARICOSE VEINS. 479 In the higher walks of life, where every measure is taken fr om the start to prevent the formation of ulcers, a peculiar cutaneous affection is witnessed in their stead. The skin assumes a very dark and bluish color, and scattered and violently itching pustules form very frequently, or else the skin peels off in scales, leaving the surface moist. This form of the varicose affection is by far the most malignant and distressing. With an entire change in the mode of living the varicose ulcers may heal of themselves,but this is undoubtedly a very rare occurren ce. ALLOPATHIC TREATMENT. The radical cure of varicose veins is purely surgical and consists in obliterating the veins. The means for this purpose will be enumerated, but not described. The large trunk above the dilated veins is occluded to prevent the return flow of blood through it, and consequently through the dilated veins leading to it, by pressure from metallic clamps, by cauteriza- tion, by incision, by ligature, by elecrolysis, by injection of the Subsulphate of Iron. These operations are effectual, but owing to occasional accidents resulting from the attempts to thus obliterate the veins, it is not attemp- ted, except there is urgent necessity. Palliative treatment requires an artificial support to the column of blood in the veins. In the lower extremities, this is done by an elastic stocking, a band stocking, or a well adapted bandage. They may be re- moved at night, but reapplied before the patient rises in the morning. In other situations than this most common one, the same principle will gov- ern the treatment, and the ingenuity of the physician will meet the re- quired indication, as in varicocele (varicose veins of the spermatic cord), a well adjusted suspensory bandage of silk or muslin will be constantly worn. Varicose veins are subject to inflammation (phlebitis). If this con- dition occurs whether the veins are varicose, or not, the patient should remain in bed. If there are wounds or ulcers, they should be poulticed; if there is suppuration the surface of the wound or poultice should be lightly covered with Carbolic Acid in Glycerine, one or to drams to the ounce. Generally, without the temperature is too low, cool evaporating lotions over the inflammed veins will be most useful. A piece of muslin wet in a solution of forty grains of Sugar of Lead, and a scruple of Acitate of Morphine in a quart of water may be laid over the inflammed region, two to four ounces of Laudanum may be used instead of Morphine, the cloth should be kept constantly wet. In other cases hot fomentations are more suitable, towels or flannels may be rung out of hot water, spread over the inflammed surface, and covered to retain the heat, or hot poultices may be applied, Hops, Laudanum, Strammonium, (Jamestown weed), To- bacco, or Belladonna A brisk chathartic should be given. One or two tablespoonsful of Epsom Salts, (Sulphate of Magnesia) is a suitable one. Steeping the Salts with a third its bulk of Coffee, covers the taste. Pain should be relieved with Opium in doses of a grain, a quarter of a grain of Morphine, or twenty-five drops of Laudanum. If the blood should become poisoned from the products of inflammation, Quinine in large doses, ten or fifteen grains four times a day for two or three days. Stimulants will be required. 480 OUR FAMILY PHYSICIAN. Tonics, as two grains of Quinine four times a day are needed, if the dis- ease continues long. The patient should, also, be well nourished. HOMOEOPATHIC TREATMENT. Painless varices, without ulceration, cannot be regarded as an object of treatment, nor do we believe that anybody can imagine the feasibility of removing them by means of medicines. If pains are felt, and the sub- cutaneous cellular tissue becomes infiltrated, it would seem as though medicines might be useful; at any rate we have seen a rapid improvement take place after the use of Staphysagria, Lycopodium and Graphites. These are the only remedies which we can recommend as long as the ulcers are painful. If the ulcer has become old, even the three first-named remedies are no longer of any use, and a mechanical treatment is the only treatment that can prove of any use. These three remedies are likewise the only ones that we can recommend for the peculiar cutaneous affection, but we must confess that they, too, will often leave us in the lurch. Our main re- source in treating these varicose disorders are external or mechanical means. The dilatation of the veins being chiefly a passively mechanical change, it is evident that moderate compression by means of a good band- age will moderate and finally remove the varicose dilatation altogether. If individuals with marked A'aricose dilatations constantly wear a bandage, or silk elastic stocking, they will never be troubled with ulcers nor with any other cutaneous affection. Existing ulcers heal very rapidly under a carefully-applied bandage, so much more rapidly if we first cover them with strips of adhesive plaster and a layer of cotton wadding over these, so as to protect them from all contact with atmospheric air. By pursuing this course, we have never known ulcers of any size or of upwards of twenty years' standing to remain uncured; but we have never shunned the trouble of applying the bandage ourselves. The longest time it has taken us to heal these ulcers, is six months. If the excessive sensitiveness does not admit of the immediate application of a bandage, the patient must be kept for a short time in a recumbent position with his leg raised; in such a case, warm poultices afford a good deal of relief. DISEASES OF THE BONES. 481 Part Eleventh. DISEASES OF SINGLE SYSTEMS. CHAPTER XXV. DISEASES OF THE BONES, MUSCLES, AND JOINTS. OSTITIS, PERIOSTITIS—POTT'S DISEASE. Inflammation of the Bones and Periosteum. Inflammations of the bones occur in every age, less frequently, how- ever, before the second and after the fiftieth or sixtieth year. In most cases they originate in mechanical injuries or mechanically acting influ- ences; they are less frequently owing to the extension of inflammation from the soft parts. In the great majority of cases the mechanical is associated with a constitutional cause, very frequently the latter existing alone. Among the constitutional diseases it is more particularly scrofula, consumption, syphilis and calomel that give rise to ostitis. Very often it is very difficult to trace the cause with anything like certainty, especially, so far as an inflammation of the substance of the bones is concerned, because it generally develops itself with scarcely perceptible symptoms, and in a very insidious manner, hence too long a period of time may have elapsed since the cause first began to act, to permit of the disease being traced to a definite origin. / Bones that are but thinly covered by soft parts, are particularly ex- posed to inflammation from mechanical causes; inflammation arising from more dynamic or constitutional causes may attack any bone; never- theless inflammations of the lower jaw, of the vertebrae (back bone), the bones of the hands and feet and of the ribs, occur most frequently and are of particular importance. Periostitis (inflammation of the membrane covering the bones) occurs more particularly on the fingers, on the bones of the lower extremities and on the skull-bones. The symptoms and course of ostitis differ very remarkably in ex- tent as well as intensity. It is very often found that at the outset the disease is entirely without any symptoms, until the disease is finally revealed by the process of suppuration. It A'ery seldom runs an acute and rapid course; this is generally the case, if the inflammation at- tacks the outer surface of the bone. In such a case the intensity of the pain depends upon the extent of the inflammation; the fever is high, delirium sometimes sets in, slight chills are common and the patient very soon begins to lose his strength. Cases of this kind, which run a rapid 31 482 our family physician. course, always terminate in suppuration, and the artificial removal of pus is in most cases a matter of absolute necessity. After the pus is evacu- ated, a cure does not always take place immediately ; the bone divested of its periosteum becomes more or less carious before a cicatrix has time to form. If the periostitis runs a slow and somewhat chronic course, the inflam- mation of itself is not very painful; but very violent pains can be excited by contact; here too the exudation may be transformed into pus, but is likewise apt to result in bony growths and to form extensive flat or tuber- ous bony indurations. If the inflammation is located in the interior of the bone, the latter is generally distended in its whole length, is not very sensitive to pressure, but the patient is tormented by paroxysms of peculiar dull boring pains, Avhich, even in the absence of any specific cause, are particularly apt to set in, and to become aggravated at night. These pains are usually felt for some time before the bone commences to swell; they interfere with the mobility of the limb more or less, generally the less the more re- motely they are felt from the joint. Ostitis of this central character ahvays runs a chronic course. Its terminations are suppuration or ossification of the exudation. If one of the large bones is invaded by the suppurath'e process, death almost al- ways results, although in some cases not till the patient has lived through year's of suffering. An important diagnostic symptom is the presence of albumen in the urine; it almost always occurs if the suppuration is ex- tensive and augurs very badly for the final result. The importance of inflammations of bones varies a good deal. Age exerts a characteristic influence; children and young people generally recover from such inflammations, even if these should last a long while, unless they originate in inveterate, constitutional maladies; older per- sons, especially when on the other side of forty, generally fall victims to such inflammations. Children very often recover when the second peri- od of dentition sets in, or when they enter upon the period of pubescence The seat of ostitis is of no small importance ; inflammation of the bones in the upper part of the body is less dangerous than inflammation of the pelvic bones, or the bones of the lower extremities. It is likewise im- portant to determine whether the inflammation is so located that vital organs may become involved; on this account inflammations of the skull bones and ribs are more threatening on account of the danger to impor- tant organs resulting from them. Sometimes the inflammatory symptoms disappear entirely for a time, and then suddenly reappear again from some cause or other, or without any cause ; or else, in one portion of the bone the inflammation runs a favorable course, and then all at once takes a new start either continu- ously in the tissue of the bone or in separate portions. Every inflamma- tion involving more than one bone, renders the prognosis so much more unfavorable. ALLOPATHIC TREATMENT. Inflammation of bone can scarcely, in any case, be treated intelligent- ly except by a skillful surgeon. Rest and cold or cooling applications are DISEASES of the bones. 483 the most important means of local treatment. If cold is not agreeable it should be replaced by hot fomentation—a flannel wrung out of hot water and applied to the part, then covered well to retain the heat. In Chronic Ostitis counter-irritation by means of blisters or the fre- quent (daily) application of Tincture of Iodine should be resorted to. Sometimes deep incisions into the membrane coA-ering the bone afford relief in both the acute and chronic forms of the disease. Pus should be evacuated by the trephine (an instrument for taking out a disc of bone.) If the inflammation has continued long, especially at the end of a bone, it is probable pus has formed and the trephine should be used. When the medullary tissue (marrow) of the bone is inflamed (Ostes- myelitis) the bone as well as its medulla is generally involved. When the disease is the result of wounds, the dressings must often be changed and the wound disinfected with a solution of Carbolic Acid in water, one dram to the pint, or Chlorine water, or the solution of Chlorinated Soda (Labarrague's Solution) diluted until they are unirritating. Absolute cleanliness and fresh air must be secured. The diet should be good. Tonics may be necessary, two or three grains of Quinine three times a day seems the most suitable. Both tonics and stimulants may be em- ployed. Cold is often the most useful and may be applied by means of bags of ice. If cold causes pain or chills, hot applications should be used instead as directed for Ostitis. Free incisions through the periosteum (membrane covering the bone) and superficial tissues give some relief. If there is no opening into the cavity of the bone and from the amount of inflamma- tion, and the length of time which has elapsed, there is reason to suspect pus has formed, the trephine should be used, and the pus let out. As a rule amputation is inadmissible, but if resorted to it must be at the near- est joint towards the direction of the body or above it. In Chronic Ostes-myelitis counter-irritation with Tincture of Iodine or blisters and the internal use of Iodide of"Potassium in doses of ten grains or more, three times a day, should be resorted to. Where matter forms it should be let out with the trephine. Excision (taking out a piece) may be resorted to in the chronic affection, but not in the acute. When amputation is called for, it may often be performed through the shaft of the affected bone, if the point of amputation is Avell above the diseased portion. Periostitis (inflammation of the periosteum membrane covering bone), in acute cases, requires perfect rest. Cold should be applied, either of cold water or bags of ice. If these cause pain, hot fomentations should be ap- plied, or hot poultices used. Pain must be relieved by Opium in doses of a grain, a quarter of a grain of Morphine, or thirty dorps of Laudanum given one, two, or more hours apart as may be required. If these means do not succeed free incisions must be made through the periosteum. If the dis- ease is primary, and necrosis (death of bone) follow, it is generally con- fined to the outer lamina (layer). If the disease is secondary, resulting from ostitis or ostes-myelitis, and necrosis occurs, it is much more exten- sive, which will be considered under necrosis. Specific forms of this dis- 4S4 our family physician. ease (periostitis) from syphilis, scrofula, etc., generally yield to appropriate constitutional treatment. One of the results of inflammed bone is caries,—a kind of surface soft- ening and disintegration of the bone tissue. The constitutional treat- ment relates to the cause of the inflammation, whether specific or scroful- ous, and the appropriate constitutional remedies should be taken. In the former case Iodide of Potassium, or Murcury, or both and Iron. In the latter, Iodide of Potassium, Iron and other Tonics. The local treatment consists in the complete removal of all the dis- eased portion. First, by excision Avith instruments; second, by the appli- cation of Acids. When a joint is carious, amputation is generally re- quired, though sometimes excision may be practiced. Another of the results of inflammation of bone, and its membranes is necrosis (death of bone). The treatment required is its removal. While it remains, it is only a source of irritation; but its removal must not be attempted before complete separation has taken place. The suppuration which has gone on during the process of separation gen- erally requires supporting treatment—Tonics of Iron, Quinine, nutri- tious food, and in some instances, Cod Liver Oil. HOMOEOPATHIC TREAMENT. The frequent occurrence of ostitis in individuals whose constitutions are tainted with some constitutional dyscrasia, invites a careful inquiry into the presence of such a constitutional taint, even though not mani- fested by any outward signs; and, in the second place, to employ such remedies as not only correspond with the constitutional affection, but likewise aim at remedying the local disease. A mere comparison of symptoms will scarcely ever answer the purpose, for the reason that the localities may differ too much ; it is only for a few definite localizations of ostitis that we possess real remedies. In general we advise therefore that the general, not the local symptoms be taken as our guide ; on this account we mention the following remedies with a few short comments: Mercurius is a medicine of Avhose specific and almost constantly definite relation to the osseous tissue we may always rest satisfied. It is indeed suitable in most cases of ostitis and periostitis, provided they do not originate in calomel poisoning. It is particularly indicated by: Vio- lent bone-pains, distention, swelling, redness of the skin, and in general by the more acute symptoms of the disease. The infantile organism is more rapidly and certainly affected by Mercurius. The dose had better be as small as possible; the slow course of the disease would seem to point to small doses and given at comparatively long intervals, as preferable to large doses of this agent. Dose: Four pills daily. Mezereum antidotes Calomel in the bone-range. Mezereum is particularly adapted to periostitis; less to ostitis, and is particularly ap- propriate at a period of the disease when no complete suppuration has yet set in. Dose: Four pills daily. RICKETS. 485 Phosphoric acid is generally preferred to Nitric Acid in non-mercu- rial ostitis ; it is indicated in the inflammatory bone-affections of children, especially in inflammations of the vertebra?, (back bone) if there is an evident disposition to caries. In fully developed caries with symptoms of slow hectic fever, Phosphoric Acid is one of the most important reme- dies. Dose: Four pills daily. Phosphorus is inferior to Phosphoric Acid, for the reason that the latter acts more specifically and more penetratingly in chronic affections. In other respects the curative action of both remedies is very similar ; we would accord the preference to Phosphorus, if con- sumption with unceasing diarrhoea has set in. Dose: As for Mercurius. Staphysagria is indicated, if the ostitis runs its course with severe pains, and the bone and its covering are affected at the same time ; in the case of scrofulous individuals ; if the facial bones or those of the legs and feet are involved. Dose: Same as for Mercurius. Baryta carbonica is eminently adapted to a slow and almost pain- less scrofulous inflammation of the bones of the extremities, after suppu- ration has begun to set in. Dose: As for Mercurius. Aurum is, like Nitric Acid, an exquisitely anti-Calomel medicine, and hence deserves special attention in cases of mercurial ostitis. It has likewise an excellent effect in non-mercurial ostitis with caries, and vio- lent pains, especially at night. Aurum is a specific remedy for inflam- matory ulceration of the nasal bones and facial bones generally. In af- fections of this kind we prefer Aurum muriaticum to the common gold. Dose: As for Mercurius. Silicea is one of the most important remedies in caries from any cause and at any age, as soon as the inflammatory stage has run its course; it is adapted to every constitution, but may not have a very favorable effect in acute ichorous suppuration. We must not forget that Silicea acts very slowly ; we recommend small doses at long intervals. Dose: Same as above. Calcarea. This agent is not so much indicated in uncomplicated ostitis, as in ostitis depending upon scrofula; it does not act directly as a curative, but by virtue of the favorable change it effects in the scrofulous disease. On this account its use should be deferred until the suppurative process is fully established. Dose: Same as for Merc. RICKETS. Early Signs.—This distressing disease commonly begins to show itself about the tender age of from one to two years. It is generally pre- ceded, for a longer or a shorter period, by derangement of the general 486 OUR FAMILY PHYSICIAN. health, before any of its well-known characteristic features become de- veloped. Pale and sickly countenance ; dry, harsh skin; soft and flabby flesh; irregular appetite, sometimes with desire for indigestible or unnatural food ; constipation or diarrhoea ; general febrile excitement, fretfulness, and languor. General Symptoms.—After which, the head is observed to become preternaturally enlarged, and the forehead unusually prominent. The breast-bone projects; the ribs appear flattened; the belly is much dis- tended ; while the rest of the body, and the limbs in particular, are greatly emaciated, and the debility is extreme. As the disease advances, the muscles become more flaccid, the wrists and ankles become swollen, the legs, thighs, and arms distorted, and the spine partakes in the general deformity, by becoming shorter, and curved in various directions. When the disease is early attended to, and the more general exciting causes,—such as defective nursing, damp or wet, ill-ventilated dwellings, insufficient exercise out of doors, improper food, and uncleanliness,—are capable of being removed,—the chances of recovery are much increased, and the deformity is frequently materially, if not wholly, diminished as the patient grows up. Otherwise, if life be spared, it is liable to be ren- dered miserable by a state of almost continuous suffering. HOMOEOPATHIC TREATMENT. When there is an hereditary predisposition to this disease, too great attention cannot be paid to the first manifestations of ill-health. Great care should, at the same time, be taken to avoid undue pressure upon the chest and other parts. The bones of a rickety child are wanting in the natural and requisite strength or firmness to support the weight of the frame. Consequently, when every precaution is not adopted, and the child is allowed, or rather compelled, by its heedless or culpable parents or others, to use muscular exertion, deformity invariably results. It will, therefore, be necessary to deal gently and cautiously with the child from the first day of its earthly existence. And while every care is observed to escape the mischief alluded to, other means, having for their object the improvement of health, must be strictly followed. The child should be regularly in the open air, when the weather permits ; its apartments ought to be well ventilated ; its personal cleanliness should be constantly ensured; and wholesome and appropriate nourishment provided. When the health and strength are improving, but the limbs and other parts have become deformed to a greater or less extent, in defiance of every solicitude,—or, as more frequently happens, from oft-repeated infractions of the rules laid down,—considerable benefit may yet be accomplished by judiciously applied mechanical aid. MECHANICAL MEASURES. At the head of the artificial contrivances for counteracting deform- ity, may be placed the gentle and cautious use of gymnastic exercises, as soon as the child is old enough to undergo them; and it is surprising how early they may be advantageously resorted to. Without these, all instru- ments are often futile, not to say hurtful. But in combination with them, Rickets. 487 the objection to the temporary employment of an appropriate apparatus for the purpose of exercising compression, is I believe, in certain cases removed. I allude, more especially, to the instance in which the legs have become very much bent, either in consequence of neglect, or from its having been found impracticable to prevent a high-spirited child from constantly getting on his feet before his delicate frame had become suffi- ciently invigorated by suitable treatment. I am free to admit, however, that instruments should always be rejecte'd whenever and wherever they can possibly be dispensed with. Calcarea is a medicine of the most essential importance in all cases of rickety disease, and is more particularly required when the fontanels remain open too long, and when the process of teething is unduly pro- tracted, or the teeth that are protruding have a tendency to premature decay; or, again, Avhen there is curvature of the spine and of the limbs, with enlargement of the joints, and very undue dimensions of the skull. Calcarea, again, is yet more especially indicated, if, in addition to these manifestations, there be incrustations on the face, or if the belly be en- larged and hard, and whilst rapid or gradual loss of flesh takes place, the appetite is morbidly voracious; the skin is commonly dry and flaccid, and the child Avears the appearance of being much older than it really is, although it be commonly diminutive and fragile; the bowels are habitu- ally costive, or are frequently affected with excessive and protracted re- laxation. Dose: Four pills in a teaspoonful of water, the first thing every morn- ing, for a Aveek (unless decided change should sooner occur); then pause ten days; after which the course should be repeated as before, and so on, until some distinct signs of general improvement follow. Baryta corbonica will be found adapted to some cases, particu- larly of dwarfish children, where there appears to be a general arrest and suspension of development, particularly if there be a tendency to gland- ular enlargements in the neck and elsewhere. Dose: As directed for Calcarea. Mercurius should be employed if the following symptoms should ensue :--Pains in the bones, as if soreness, or as if bruised, with extreme tenderness of the shin-bone and knee-joints to pressure, with or without pressure of the limbs ; dandruff, and other obstinate affections of the scalp and face ; incrustations on the face; extreme susceptibility to take cold, with constant or very frequent prevalence of cold in the head or on the chest, and tendency to excessive perspiration, whether offensive or not; and often a chronic, slimy, or clay-colored diarrhoea. Dose: As directed for Calcarea. Silicea is appropriate to the treatment of almost all cases of disease of the bones; and is more particularly and decisively indicated by a pe- culiar tendency to ulceration manifested by the skin upon the least abra- sion,—that is, when it " heals badly," as it is popularly termed; or when there are scabby eruptions on the scalp, the glands being disposed to sup- purate, the complexion pallid but puffy, and the ears being constantly or frequently affected with discharges of matter. Silicea may be required after Calcarea, to complete the cure. Dose: As directed for Calcarea. 488 OUR FAMILY PHYSICIAN. SulphUr should be employed after Calcarea or Silicea, if these med- icines, having previously been productive of decided good effect, should cease to operate so beneficially, or if the folIoAving symptoms should pre- vail (which, if predominant, hoAvever, might more distinctly indicate the employment of Sulphur at the onset):—Extreme susceptibility to take cold, and to protracted discharges from the nose or from the Avind-pipe, or to excessive or continued relaxation of the bowels ; but still more es- pecially by obstinate and intractable constipation, Avith flabbiness of the flesh or skin, pallor or puffiness of the face; protracted inability to use the legs or to maintain the erect position; tendency to be easily thrown into a violent perspiration by any exertion ; the skin being otherAvise dry, and even harsh, and the eyes and eyelids appearing to be habitually more or less inflamed, and both mind and body languid, and unfit for ex- ertion of any kind. ALLOPATHIC TREATMENT. This is a disease which almost without exception depends on poor feeding and hygiene during the first year of the child's life. Children of unhealthy parents are more liable to the disease, but if the child is well fed, has plenty of fresh air, is kept clean, and is warmly clad, it will not have rickets. If the child is not thriving on its mother's milk it ought to be fed artificially, or, what is better, a vigorous wet nurse procured. In the absence of a wet-nurse rich, fresh cow's or goat's milk may be given. For the first month the milk should be half water, enriched a little with cream, and sweetened with sugar of milk or loaf sugar. At two months old only a quarter part of water need be added; after three or four months genuine milk may be given pure. Eggs beaten up raw with a little sugar and diluted with water may be given if the child likes it. The juice of lean meat may also be given. Strong beef tea made from finely chopped lean meat and cold water, gradually raising the temperature to 160° and maintaining it at that temperature for four hours may be employed for nourishment. Underdone lean beef finely ground in a mortar, a tea- spoonful at a time, may be given. A pound of finely-chopped lean meat with eight ounces of distilled water and eight to ten drops of Hydrochlo- ric Acid and a third to half a teaspoonful of common salt, allowed to macerate for three hours and strained through a hair sieve, then pour on the meat a couple of ounces more of distilled water and squeeze it through. The residue makes a nourishing and valuable food in cases of debility. Milk, however, is the food for babies, and the other articles of food may be resorted to only when the baby does not thrive sufficiently on the milk. From the age of six months to a year, farinaceous food may be given in restricted quantities. One of the best forms is Liebig's Food. Take a heaping tablespoonful of wheat flour (middlings is better), a heaping des- sertspoonful of malt flour, seven and a quarter grains of Carbonate of Potash and an ounce of water. Mix well. Add five ounces of cow's milk and heat gently. When the mixture begins to thicken, remove from the fire and stir for five minutes, heat and stir again until it becomes quite fluid, then boil and strain through a sieve, when it is ready for use. In the absence of malt flour barley may be ground in a coffee mill and LUMBAGO. 489 sifted to remove the husk. This food is a little laxative so it cannot be given more than three times a day. If there is diarrhoea twenty or thirty grains of prepared chalk may be used instead of the Bicarbonate of Potash. For older children the diet must be good containing such articles as meat, eggs, and milk. Nothing must be done to weaken, but everything to strengthen the patient. The child should have such exercise as is consistent with the weakened condition of the bones, such as rolling and tumbling on a hard matress. Older children may walk about some, if provided with proper artificial support, such as a wheel crutch. They should be taken out into the open air every day, or two or three times a day for a ride, or carried out. Bending of the limbs may be overcome by applying a light splint of pasteboard or leather, but the limbs must not be so encumbered as to prevent their pretty free use. A light apparatus may be worn when the child walks, to prevent the curvature of the spine. The child should lie upon a flat matress without a pillow. The principal treatment is dietary and hygienic as given above. For medicinal treatment the Compound Syrup of the Lacto-Phos- phates give the most promise of all medicines of being useful, excepting Cod Liver Oil. It may be given in doses of from ten or fifteen drops to a teaspoonful according to the age of the child, three or four times a day. The dose of Cod Liver Oil may be begun at fifteen to twenty drops and increased to a teaspoonful or a dessertspoonful according to the age of the child and given four times a day. If the oil deranges the digestion it should not be given, otherwise it should be given continously. Other tonics may be given instead of the Lacto-Phosphates as the Syrups of the Phosphates or Hypophosphites in the same doses as the Lacto-Phosphates. The Citrate of Quinine and Iron in doses of half a grain to two grains( three times a day. Complications (other diseases) which may occur will require the appro- priate treatment, keeping this in view that all treatment must be sus- taining. LUMBAGO. CRICK IN THE BACK. Diagnosis.—Violent pain, of a rheumatic character, in the lumbar region, either periodical or permanent, frequently accompanied with a considerable degree of fever. HOMOEOPATHIC TREATMENT. Aconite may be given at the commencement, if such fever declare itself. Bryonia when the pains in the back are of a severe aching or lanci- nating description, constraining the individual to walk in a stooping pos- ture ; aggravated by the slightest motion, or draught of cold air, and at- tended with a general sensation of chilliness. 490 OUR FAMILY PHYSICIAN. Nux-vomica is particularly indicated when the pains resemble those produced by a bruise, or by excessive fatigue: also when they are much in- creased by motion and by turning in bed at night, and are attended with considerable weakness; and moreover, when irritability of temper and constipation are present. Nux-vomica is often of great service after -Bry- onia in acute lumbago. In chronic cases it is a remedy of no mean im- portance. Rhus-toxicodendron is almost specific. It should be preferred to any remedy when the symptoms are as follows: Dragging or shooting pains in the dorsal and lumbar regions: severe aching or pain as if from the effects of a bruise or a sprain in the loins ; a feeling of stiffness or ten- sion in the affected parts on attempting to move, but aggravation of the pains when in a state of rest, or when pressure is made on the seat of the sufferings. It is also a useful remedy in chronic cases. Belladonna, where the pains are deeply seated, causing a sensation of heaviness, gnawing, or stiffness; it may follow Aconite with consider- able benefit, when slight inflammatory symptoms are present. Pulsatilla, when the pains, resembling those mentioned under Nux- vomica, are moreover attended with a sensation of tension or constriction at the affected part; it is particularly indicated for females, or individu- als of mild, sensitive, or phlegmatic temperaments. Mercurius, when the pains are much of the same description as those given under Nux-vomica, but considerably aggravated at night, incapacita- ting the sufferer from taking rest. (See Rheumatism.) ALLOPATHIC TREATMENT. In acute Lumbago, the employment of strong mustard-plasters or re- peated hot wet packs, with a hypodermic injection of a quarter of a grain of Morphine over the seat of pain, repeated sufficiently often to subdue the pain, is generally effectual treatment. A cathartic should be given to move the bowels. If the disease does not subside after the pain is relieA'ed and the boAv- els moved, the treatment by mustard-plasters or hot wet packs and Opi- um should be tried to relieve pain (a quarter of a grain of Morphine, a grain of Opium, or twenty-five drops of Laudanum, may be given by the mouth), and should be continued. The effect of Salicylic Acid, given in doses of ten grains every four hours, should be tried. It can be given in capsules, or mixed with Starch. Chronic Lumbago is most frequently cured by Iodide of Potassium, given in doses of from ten to twenty grains, three times a day. It may be giA-en in Peppermint Water, after meals. Much relief may be obtained by wearing a Belladonna plaster across the loin. Other remedies are the same as those recommended for chronic mus- cular rheumatism. INFLAMMATION OF THE JOINTS. 401 INFLAMMATION OF THE JOINTS. ALLOPATHIC TREATMENT. Acute inflammation of a joint (synovitis), demands in the first place, absolute rest. This is imperative and invariable. This object may be aided by properly adjusted splints. The limb should be in a position, which will relieve the articular surfaces from pressure. If the affected joint is in the lower extremity, the limb should be in the straight posi- tion. If the affection is in the knee, or hip joint, a degree of extension may be secured by the weight and pully, as used for fractured thigh (des- cribed in the treatment for hip joint disease), and relief from pain secured in this way. Rest and extension which Avill separate the joint surfaces, and keep them apart, is in most cases all the treatment needed to ensure recovery. Counter irritation by applying Tincture of Iodine, or blisters, the use of cold by ice bags, compression Avith bandages, and a wet sponge, etc., have all, in some cases, been useful, and are sometimes hurtful, and do not compare with the means just described in efficacy. When the inflamma- tion and heat in the joint is great, a Solution of Sugar of Lead and Opium will benefit. Take of Sugar of Lead thirty grains, Acetate of Morphine five to ten grains, (or two ounces of Laudanum, and rain water a quart, Mix and it is ready for use. The internal use of Opium may be called for by the severe vain. In Chronic Synovitis rest and traction, as in the acute, are appropri- ate means of treatment. The use of blisters and other forms of counter- irritation are more useful and less often hurtful. The constitutional state is generally faulty. This is to be corrected by good nutritious food, fresh air, exercise and sometimes tonics. The Citrate of Iron and Quinine is as frequently useful as any and may be given in doses of three grains, three times a day if the patient is feeble. If absolute rest is enforced in this trouble the joint lacks its natural stimulus—that of motion. At the proper time (which is difficult to deter- mine often) passive motion (moving the joint by the hands of others) must be resorted to,and after a time (which individual judgment only can determine) active motion (by the patient) may be tried. After several weeks have passed it is best to try passive and then active motion. Passive, then active motion, good food, air, and good hygiene generally, have often restored swollen, painful and stiff joints in a few weeks to their natural activity. It is often desirable to keep the surfaces of the joint apart by traction even when motion, both active and passiA'e, is practiced. The weight of the limb may be sufficient in case of the upper extremity. In the lower extremities which must sustain the weight of the body, the end is met by very ingenious splints, invented by Dr. Sayre, of New York. Varieties are made for use of the different joints, hip, knee, and ankle. When these splints are properly adapted, the patient can go about without pain. In this way the functions of the joint are maintained while all irritation is obviated, and the most favorable condition is maintained for recovery. 492 OUR FAMILY PHYSICIAN. COXALGIA. INFLAMMATION OF THE HIP-JOINT. This inflammation, the chronic form of which is called "voluntary limping,'' cannot be traced to any definite cause. It affects principally children and young people during the first years of pubescence. Its ex- tremely frequent occurrence during the years fourteen to seventeen, and in persons of rapid growth, leads us to infer that a rapid growth of the bones constitutes a disposition to this inflammation, and that an exertion, a cold or other scarcely apparent circumstances simply act as exciting causes. Acute inflammation of the hip-joint sets in suddenly even with a vio- lent chill, like all other acute inflammations, with which severe pains are associated. The patient locates these pains at times in the small of the back, at other times more in front, very seldom in the hip-joint; they are extremely acute, tearing, burning, stitching, shooting, aggravated by every motion of the lower extremities, not altogether, and sometimes not at all, relieved by horizontal posture. At the same time a high fever accompanies the pains, the pulse being not unfrequently upwards of 120; this circumstance distinguishes the disease from lumbago with which it is easily confounded. Amid symptoms of this kind which may become sufficiently intense to simulate typhus, the following objective changes become manifest in one, two or more weeks : The affected hip and the buttock of the same side swell, so that the fold between the nates is much deeper; the thigh is somewhat turned outwards and slightly drawn up towards the abdomen ; the knee is half bent; extension and rotation of the thigh are very painful; nor can these movements be executed com- pletely. Walking is not entirely impossible, but can only be performed with the greatest pain. It is very seldom that an improvement begins at this point; as a rule an extensive suppuration sets in, amid frequent chills and burning heat of the skin. After this, a short intermission seems to take place in the further development of the disease, until the abscess reaches the skin and bursts. This may take place backwards, to one side, or in front. After the pus is discharged, the patient feels much better, and then worse again, provided the suppuration becomes very profuse and continuous. As a rule the prospect of a speedy closure of the cavity is very slim. The terminations of the disease are: Very rarely a complete and rapid restoration; long-lasting suppuration with final recovery and a total or partial destruction of the joint. The Chronic or subacute disease presents a very different group of symptoms. The disease commences with vague symptoms in the hip- joint resembling rheumatic pains and alternately exacerbating, remitting, or even intermitting for some time. These pains may be absent and in their stead the patient may only complain of a stiff joint which is more especially felt during motion. Sensible pressure on the hip-joint general- ly causes more or less pain, and the thigh is usually rotated outwards to some extent as soon as the disease commences. With such trifling symp- INFLAMMATION OF THE HIP-JOINT. 493 toms it may go on for some time, before more serious changes become manifest. The pains increase in intensity and cause the patient to limp, the thigh is slightly flexed and turned inwards. Almost without an ex- ception a more or less violent pain is at the same time felt in the knee> very generally surpassing the pain in the hip-joint in intensity. The affected limb becomes lengthened, its muscles become relaxed and flabby. In the further course of the disease suppuration sets in, the pus escaping on the outside and destroying life by caries and hectic fever. A cure at this stage is a rare occurrence, or else the parts grow together and the joint is permanently stiff. ALLOPATHIC TREATMENT. Hip-joint disease is simply an inflammation of that joint, and is to be treated as already described for inflammation of the joints. In incipient hip-joint disease, rest in bed and the straight position, with extension with the weight and pully, is to be maintained, the weight being sufficient to relieve pain. This will vary from three or four to ten pounds. The mode of its application by long adhesive plasters applied to the sides of the leg and well secured by a bandage above the ankle. The foot and ankle should be bandaged, but the plasters must not be included within this part of the bandage. The lower end of the plasters are then fastened to a narrow board (with a hole in the center) which is long enough to separate the plasters from the ankle, and so prevent irritation, a rope is knotted and passed through the hole in the board which is attached to the plasters. The rope is then passed over a pully fastened to the foot of the bed, and the weight then fastened to the rope. The rope must draw in the line of the limb. In addition to this treatment, good hygiene, which consists in plenty of fresh air, comfortable temperature of the room, sponging of the body every other day, with water at an agreeable temperature; good, nutritious food and cheerful surroundings, will be sufficient to carry the patient through the acute inflammation to recovery. It is best to bring the limb at once to a straight line, and the weight applied. It ought not to cause pain, or at least after a few hours. This treatment should continue six weeks or longer. The time comes when exercise must be secured, and at the same time extension contin- ued. This is best secured by a suitable splint for hip-joint disease. There are several varieties of apparatus adapted to this end; one of the best is Dr. Sayre's. The splints of Davis or Bauer meet the required end. Many cases have been successfully treated by the use of the wire- gauze splint of Hamilton or Barwell. If these are used, the body is to be supported by crutches. A sole-leather, felt or gutta-percha splint, similarly constructed, will meet the end. It should extend from the top of the illium (hip-bone) to above the knee, and broad enough to cover the thigh one-half in. A pro- jection from the top of the splint behind, three or four inches wide, 494 OUR FAMILY PHYSICIAN. should extend nearly around the body and fastened in front with a strong piece of elastic band. Leather should be softened with cold water, and gutta-percha Avith hot water, and moulded to the limb and pelvis, and retained with a ban- dage, until it hardens. The inside of the thigh should be covered with a suitable short splint. After the splint hardens, permanent fastenings can be attached. This method of treatment, faithfully and intelligently carried out, as a rule, obviate the necessity of an operation, and secure a satisfactory re- sult. When the disease progresses until the bone becomes extensively diseased, an operation for its removal is demanded. HOMOEOPATHIC TREATMENT. Although the number of homoeopathic remedies for hip joint disease is but small, yet the success with which they are used in this disense, is a source of pride to our practice. In view of the almost positive certainty of a correct diagnosis in most cases of hip-disease, the clinical results that have been obtained in the treatment of this disorder, may be regarded as absolutely reliable testimony. Rhus Tox. At the outset of the disease, when violent feA'er, hur- red pulse, rheumatic pain from the hip to the foot, and constant desire to gain relief by a change of position, but before pus has actually formed, will be found an excellent remedy. Dose: Six pills in a spoonful of Avater, every five to twenty-four hours. Belladonna. Under almost the same indications as Rhus Tox, ex- cept the restlessness is not so marked, and there is more of a tendency to a dark-red appearence of the skin over the affected parts; showing a deep inflammation. Dose: As for Rhus Tox. Mercurius. If the formation of pus has really commenced, no rem- edy Avill compare Avith this, being frequently able to arrest the disease and restore the patient to health as far as the nature of the attack will permit any remedy to do so. Dose: Six pills, or a small powder, three or four times a day. Calcarea carb. After the disease has turned or shoAvs marked signs of turning for the better, helps very much by aiding in the nutri- tion of the parts affected as well as the system in general. Dose: Six pills twice each day. The rest of the treatment may be condensed in the following points: The patients should not remain in a state of absolute rest, on the contra- ry, they had better move about by means of crutches. If pus forms, warm poultices may be applied; they not only promote the formation of pus, but very often favor its reabsorption. Only if carious destruction of the joint has taken place, the patients will have to remain quiet lest spon- taneous luxation should result; in such circumstances a suitable exten- sion apparatus may be resorted to, which will have to be applied, how- ever, with a great deal of caution. The diet should be at all times plain and strengthening; the use of fat is to be rigidly prohibited. WHITE swelling. 495 GONITIS, INFLAMMATION OF THE KNEE-JOINT. white swelling. This is one of the most frequently-occurring inflammations of joints; owing to the exposed situation of the knees, this might indeed be ex- pected. A simple inflammation of the knee, is generally the result of some me- chanical injury or of excessive use, and is an unimportant affection as long as the inflammation is confined to the integuments. It is scarcely ever at- ended with fever, is never ushered in by a chill, and runs its course within a few weeks. HoAvever, as we can never be sure whether such an unimportant disease may not result in the more dangerous white swelling, it ought to be managed with all due precaution. Symptoms. While using the joint, the patient complains of pain and im pared mobility; in more rapidly progressing cases the temperature of the joint is higher than usual. If the inflammation emanates from the soft parts, the pains are generally less than when the bones constitute the starting-point. Sometimes the knee swells rapidly, at other times more slowly, and most slowly if the bones receive the first shock of the disease. In the latter case the knee preserves its form for a long time, in the other cases the swelling soon modifies any former shape of the knee. As the swelling increases, which generally has a very Avhite appearance, it grows progressively softer, elastic, and finally shows symptoms of fluctuation. The cutaneous veins become very much enlarged. The pains generally in- crease Avith an increase of the swelling. Sometimes not till after the lapse of years, and, in a few cases, after that of weeks, distinct fluctuation is perceived in one or more places; here the skin reddens, breaks, and a pus which is mostly thin and mixed, is discharged. In spite of the evacua- tion of pus, the swelling remains almost unchanged. The suppuration in a case of white swelling is generally very tardy. The openings may close for a short time, after which they generally open again, so that, in a fortunate case, suppuration may cease after many months, and the swelling may grow smaller, but the joint remains stiff and thick, and the leg somewhat bent. A cure of this disease is witnessed only in the case of young people. If the case terminates less favorably, the suppuration gradually superinduces hectic fever, and finally ends in death. The prognosis is always bad, for no one escapes from such an attack without some permanent injury; the difference in favor of young and ro- bust individuals is, that death needs not be apprehended in their case, which is generally sure to occur in individuals of upwards of thirty years of age. ALLOPATHIC TREATMENT. The treatment of inflammatory disease of the knee does not differ ma- terially from that given for inflammation of the hip-joint, and joints in general. Rest is the first essential; this may be secured, first, by apply- ing a splint to the posterior of the limb, including both the thigh and leg, to keep the joint perfectly still. Cold applications, or warm, as give the most relief may be employed. The hot wet pack applied to the knee will be useful if cold causes pain. 496 OUR FAMILY PHYSICIAN. The evaporating solution of Lead and Opium, given in the treatment of Synovitis may be used. If the joint continues painful pull moder- ately on the ankle to separate the ends of the bones in the joint, and if this gives relief the weight and pulley should be employed to produce ex- tension, as directed for disease of the hip. A large amount of water in the joint, producing enlargement, should be met by pressure, either an elastic band or bandage and wet sponge. Pressure Avould be painful and harmful without extension. After six Aveeks or more haA'e passed exer- cise of the joint becomes necessary, but extension must be continued. This can be done by the proper application of a Sayre's splint for the knee-joint. If the limb is distorted, the tendons necessary must be divided to bring it into shape. When the fluid in the joint is not removed by absorption from pres- sure, and friction, (rubbing with a simple liniment), aiding nature, it is necessary to remove the liquid with an aspirator, or possibly by incision, but the Avound must be hermetically sealed immediately, and the joint kept motionless by a well-secured splint until the wound heals. Nearly if not all cases can be cured by absolute and permanent rest; extension has been indicated, and, in some cases, compression. When the inflammatory disease in a joint has advanced to suppura- ' tion and decay of tissues, it is commonly spoken of as a "white swelling." If it is the knee-joint that is affected, it is then known as " white swell- ing of the knee-joint." The treatment described for inflammation of the knee or joints, if properly carried out, will preAent this undesirable state of affairs. If it occurs there is pain, irritation, fever, loss of appetite and debility. Extension by means of Sayre's splint for the knee (or for such other joint as is affected) must be made. This will relieve the pain. The services of a surgeon are necessary in the management of these cases. If it is impossible to procure a splint, extension should be made with a weight and pulley. There is the disadvantage of confinement with this manner of extension at a time when it is very important for the patient to be much in the open air. The patient should have the benefit of fresh air, sunlight, and good food. Tonics may be required. There is no better one than the Citrate of Iron and Quinine, given in doses of one to four grains, three times a day. The Compound Syrup of Hypophosphites is another useful one, especially if there is much discharge, as also is the Compound Syrup of the Lacto- Phosphates. The dose of each is a teaspoonful. The former syrup may be combined with a fourth Dilute Phosphoric Acid. The dose then Avill be the same. When an inflamed joint, acute or chronic, will permit the two sur- faces of the joint to come together by ajar, without pain, and Avhen there is no pain on pressure, the instruments may be removed. A condition of irritability remains and the joint cannot be used without pain. The case requires passive motion and rubbing. Gentle but thorough friction to restore the functions of the joint, remove the congestion and irritability. The pretense that the hands of some persons have especial power in this direction is simply pretense. In the successful cases under their hands they ha\'e only by accident stumbled upon the case at a stage when the INFLAMMATION of the joints of the FOOT. 497 rubbing was the element necessary to restore the use of the joint. One so- called cure of this kind at the hands of a pretender is the source of a wonderful amount of fame to the injury of society, and an unfavorable reflection is made on the medical profession which is unjust. HOMOEOPATHIC TREATMENT. Silicea is the medicine of chief importance in the treatment of in- flammation of the lining, or covering membrane of the knee-joints, or for the treatment of the enlargements, and other mischiefs resulting from such inflammation. Dose: Six pills in a teaspoonful of water, three times a day. Sulphur and Calcarea are indicated at the onset, or after the previous administration of some other medicine, to complete the cure, They are of chief importance in scrofulous enlargements of the knee, and may also be required as intermediary remedies, when other medicines, ap- parently indicated, cease to produce any decided effect. Dose: Give six pills in a tablespoonful of water, every morning and evening. Bryonia may be given if the trouble results after rheumatism, Avith red and very painful swelling of the knee, particularly if the slightest motion aggravates the pain. Dose: Same as Silicea. Pulsatilla is an excellent remedy for the treament of glazed or shining, white, soft, or doughy swellings of the knee, and is, indeed, more or less especially appropriate for the treatment of soft, colorless swellings of the knee, in general, whether painful or otherwise. Dose: In every particular as directed for Bryonia and Silicea. External applications are not always appropriate in this disease. Poultices are injurious if they increase the pains; in most cases they not only relieve the pain, but likewise exert a favorable effect upon the re- absorption of the pus in the diseased joint. An uninterrupted recum- bent posture is to be a\'oided as long as the patients remain capable of moving about; only the diseased limb must not be used for a walk. A moderate and constant pressure by a starched bandage is only borne, if the bones are not too much diseased ; it has the double advantage of an- tagonizing the SAvelling and protecting the limb during motion. It has the best effect, if the abscess has already broke, for, in such a case, the bandage most decidedly promotes the course of the suppurath-e process. Amputation is only advisable if the joint is utterly disorganized and the constitution begins to show signs of failing under the constant pain and loss of fluids. INFLAMMATION OF THE JOINTS OF THE FOOT. TARSUS. The inflammation is either seated in the bones or Avhere they articu- late with those of the metatarsus ; or else in the articulation of the tar- 32 498 OUR FAMILY PHYSICIAN. sus and tibia, or in both localities at the same time. Here, too, mechan- ical injuries are rarely the cause of the inflammation. An inflammation of the metatarsus is particularly met with among children and during the age of pubescence; an inflammation of the tibia-tarsal articulation oe- curs more frequently among adults. The Symptoms are most commonly the following : At first a pain is felt in walking, particularly during certain positions of the foot; in a state of rest the pain subsides almost entirely. Gradually the joint be- gins to swell, the swelling increasing more and more and gradually ex- tending over the whole foot; at the same time the pains increase, become continuous, and walking is entirely out of the question. At last the pus finds an outlet in one or more places. In favorable cases the suppuration now decreases, the strength keeps up, the fistulous openings close, al- though sometimes not till years have elapsed. Or else, the swelling con- tinues to increase even after the bursting of the abscess, the foot becomes completely distorted, and hectic fever is the unavoidable consequence. The course of the disease always exceeds one and even more years, until the pus escapes outwardly. At all times life is in danger, even in the case of children ; adults succumb almost always with scarce an ex- ception. A peculiar form of tarsal inflammation is a flat foot. Sometimes it affects small children, although it is only slightly developed at that age; it mostly shows itself after pubescence, most generally among males if they suddenly groAV up in height. Every time after the foot is persever- ingly used, violent pains are experienced in the joint, which becomes stiff after walking, with inability to stand upon the affected limb. Little by little the foot loses its arched shape, and the patients generally walk on the inner edge of the foot. The malformation of the foot may become very considerable, and may materially interfere Avith its use. Sometimes the trouble does not cease spontaneously until after the patient is thirty years old. This form of inflammation, which, under similar circumstan- ces, may likewise occur at the knee, never results in suppuration. Treat only by a physician. ALLOPATHIC TREATMENT. The principles of treatment of inflammatory disease of the ankle joint are essentially the same as is laid down for the treatment of synovites in general, and of the hip and knee joints. Absolute rest is the first essen- tial. Of all the plans of local applications, I believe heat to be the best. It can be applied by the hot wet pack, or by immersing the ankle in water as hot as can be borne, when the pain is relieved by repeated hot packs, or by the hot foot bath, the limb should be elevated, and kept in that position until there is no tenderness on pressure, and until the limb can hang down without causing pain- If there is effusion in the tissues about the joint, compression should be made by firmly bandaging a large sponge around the joint, which has been previously saturated with warm water and squeezed as dry as possible. (The foot, ankle, and leg, should be ban- daged). The sponge and bandage about the joint should be kept wet with warm water. By the swelling of the sponge, and the shrinking of the LYMPHPTIC tumors. 499 bandage, considerable compression is produced. Compression can be made more conveniently by the double India-rubber bag which is inflated with air. After a few; days rubbing the joints with the hand will be useful. In more advanced cases, extension should be made by the use of Sayre's splint for the ankle joint, and the patient permitted to go about on crutches while the surfaces of the joint are kept apart by the extension. The excessive secretion of fluid in the joint may be caused to be absorbed by pressure and rubbing. If pus is formed in the joint, or a thickened fluid which cannot be absorbed, as determined by the exploring-needle, or trocar,— it should be withdrawn by the aspirator, or incision as described in the treatment of the knee joint. Extension by means of Sayre's splint, should be continued. When the disease has advanced to destruction of the tisues of the joint (cartilage or bone), the treatment is too complex to be described here. The reader is referred to some recent complete work on surgery, or dis- eases of the joints. If, however, the treatment described here is thor- oughly carried out in the beginning of the disease, recovery will be reached without serious consequences. CHAPTER XXVI. ULCERS. lymphatic tumors, disease of the cinglobate glands. Abscess—By this term is meant a collection of purulent matter result- ing from morbid action, contained in a sac or cyst of organized coagula- ting lymph furnished with absorbent and secreting vessels. Abscesses are divided into acute and chronic. The acute variety is preceded by sensible inflammation in the affected part, which is soon fol- loAved by suppuration. The commencement of the suppurative process is knoAvn by a change in the description of pain, which becomes more ob- tuse and throbbing, by an increase of the swelling, and when matter is formed, by the perceptible fluctuation of the part, when the abscess is not too deeply seated; lastly, particularly in idiopathic (primary) cases, when the formation of pus is considerable, the fever which had attended the earlier stages is materially lessened, and irregular chills, or rigors, super- vene, succeeded again by heat and increase of fever. When the abscess is mature, the tumor becomes pointed, or presents a conical shape, generally near the center of the inflamed cutaneous sur- face; over this spot the skin assumes a reddish hue, becomes thin, and, ere long, gives way and allows the contents of the cavity to escape. The signs of the formation, or existence of a chronic abscess, on the other hand, are, in the generality of cases, devoid of any apparent disor- 500 INFLAMMATION OF THE LYMPHATIC: GLANDS. der, either local or constitutional, until it begins to approach the surface and form an external swelling. The secreted matter is unhealthy, thin, and contains substances resembling curds or flakes. When the pus is let out (evacuated), and the air admitted into the caA'ity, inflammation of the cyst arises and is beneficial, if the cavity of the abscess is small, but if it be large great constitutional disturbance en- sues, the cavity instead of contracting and filling up by healthy granula- tion goes on discharging copiously until, in the end, hectic fever is pro- duced. ALLOPATHIC TREATMENT. Acute inflammation of the lymphatic vessels (angeiolencitis) requires the applications of heat promptly and constantly. Flannels Avrung out of hot water and the limb covered Avith them, and the whole Avell covered in to retain the heat, is a form of hot Avet pack which is most serviceable. They should be renewed as often as they become cool. The hardened in- flamed lines may be covered with Belladonna Ointment. Any Avound or ulcer causing the inflammation is to receive its appropriate treatment. Pain is to be relieved, if necessary, with Opium in grain doses. Morphine in doses of a quarter of a grain, or Laudanum in doses of twenty-five drops, repeated just often enough to give relief. Free incisions through the inflamed part relieve the tissues strangu- lated by the inflammation and evacuates the pus. Early incisions are very important. Pus has often formed in the subcutaneous tissue, Avhich is not detected by fluctuation. Too great delay in making these incisions may be attended by serious consequences. The patient must be nourished with milk, strong beef tea, and eggs. If much depression occurs Quinine and Brandy or Whisky should be freely administered. The former in doses of five to ten grains, from four to six hours apart, according to the urgency of the symptoms. The latter may be given according to the degree of urgency of the symptoms, in doses of a tablespoonful (half an ounce) to one or two ounces, from half an hour to four hours apart, but ahvays short of symptoms of intoxica- tion . The bowels should be moved by Citrate of Magnesia or an injection of Avarm water. Should the disease become chronic the strength of the patient should be supported by good food and tonics. Poor digestion may be improved by teaspoonful or dessertspoonful doses of Sheffer's Liquid Pepsin, and the blood enriched by the Tincture Muriate of Iron in doses of ten to tAventy drops largely diluted in SAveetened water, three times a day. The best local application is the application of the Biniodide of Mer- cury Ointment in one-half to a full strength applied sufficiently often to produce slight irritation. Inflammation of the lymphatic glands (adenitis) in the acute A-ariety is to be treated precisely as directed for inflammation of the lymphatic vessels. As the inflammation is more localized, hot linseed poultices having the surface strongly impregnated with Laudanum may be used ULCERS. 501 with great advantage. The surface over the inflamed gland may be covered with Belladonna Ointment. Other hot applications are equally appropriate. When the general health is poor or the patient scrofulous, such reme- dies as the Citrate of Iron and Quinine, in doses of two to five grains should be given. Iodide of Potassium with Iron is often an appropriate remedy. Take of Iodide of Potassium five drams, Pyrophosphate of Iron a dram, Peppermint Avater eight ounces. Mix. Dose: A dessertspoonful three times a day. It can be sweetened or not, according to the taste of the patient. The Compressed Syrup of the Phosphates or Hypophosphites in doses of a teaspoonful to a dessertspoonful three times a day is suitable. Cod Liver Oil is often required. After the disappearance of the acute inflammation, if the glands remain, hard rubbing with Iodide of Mercury Ointment will generally produce absorption. This ointment may often be reduced one-half with lard. HOMOEOPATHIC TREATMENT. In acute abscesses, apply poultices and warm, unmedicated fomenta- tions, and forward the suppurative process. The lancet is never necessa- ry, except when the pus, by its extensive diffusion or pressure, especially Avhen deep-seated, is liable to injure important parts ; or when, from its situation, there is reason to apprehend its discharge into any of the cavi- ties of the body. When it is necessary to make an opening Avith the lancet, the incis- ion ought to be made at the loAvest or most dependent point, where this can be safely and readily accomplished; but Avhen this is impracticable, in consequence of the great thickness of the parts between the pus and the skin, the most prominent or pointed part should be selected. When, on the other hand, this latter point happens to be at the up- per part of the abscess, the lancet had better not be used at all, "but trust rather to the use of remedies. Hepar Sul., Silicea, Arsenicum, and Lachesis. In chronic abscesses, it has usually been found most beneficial to make an outlet for the matter (pus) as early as possible, so as to pre\rent its large accumulation, and thereby avoid the consequent frightful consti- tutional disturbance so liable to occur in such cases from the extent of the inflammation after the bursting of the abscess, make the opening merely large enough to admit of the exit of thcmatter. When the collection of pus is very extensive, it frequently accumulates again after having been evacuated, hence it has been recommended to heal up the opening imme- diately, and to make a new one when necessary, but before the pus has accumulated in anything near like the first quantity evacuated. 502 DISEASES OF THE SKIN. CHAPTER XXVII. DISEASES OF THE SKIN. ERYTHEMA. SIMPLE REDNESS OF THE SKIN. Erythema occupies a middle rank between congestion and inflamma- tion of the skin; it is easily confounded Avith a benign form of erysipelas. Its causes are: Mechanical injuries of the skin; the influence of a high temperature, of various medicinal agents; continual moistening of one part of the skin by urine, liquid stool, perspiration, tears and even the constant use of moist compresses ; constant irritation of the skin by rough clothes. In the case of children, erythema seems to be likewise caused by hearty and fat food. Erythema seldom occurs as a Avide spread affection, to which the designation of "epidemic" might be applied. Chronic erythema breaks out chiefly in the face, and more especially on the nose; its causes sometimes seem to be purely local, and at other times constitutional. Erythema is characterized by a more or less diffuse redness of the skin, not separated from the normal redness by sharply-drawn outlines, assum- ing a yellowish, not a white tint under the pressure of the finger, and con- tinuing for some time and, finally terminating in desquamation (peeling off). These characteristics belong to all forms of erythema. Erythema caused by external irritants, most generally breaks out on the scrotum, at the anus, between the thighs, in the axillae (arm pits), face, and in the deep integumentous folds of fleshy persons, or at the place where the irritating cause exerts its influence. After the cause ceases to act, the erythema generally disappears of itself in a few days. If the irritation continues, the skin may become detached (intertrigo), and ulcers may form, or the skin may even become gangrenous. Erythema arising from internal causes, is almost exclusively located on the dorsal surface of the bands and feet, where it is never absent, even if other parts are likewise affec- ted. At first the place exhibits a redness, and in a few days darker-colored papules of various sizes spring up, which remain even" for some time after the diffuse redness has disappeared; the affected spot likewise retains a yellowish tint for some time after. In particular circumstances subse- quent crops of this eruption break out on its borders, by which means the affection runs a very protracted course. This form of erythema is gener- ally attended with a little fever, and at the diseased spot a darting-burning pain is generally experienced. The former variety, on the contrary, has no fever as long as the erythema is of the simple kind, whereas the in- tertrigo of sensitive children may be attended with fever. The second variety, without any subsequent crops, lasts from one to two weeks. In treating the first variety, all that it may be necessary for us to do, is to remove the exciting cause. In some individuals the disposition to erythema is so great, and it leads so easily to more serious consequences, that we are led to suspect behind the local irritation the existence of some ERYSIPELAS, 503 constitutional disposition. This is particularly the case with the inter- trigo or soreness of children. Since this soreness is often caused by im- proper diet, the first thing to be done is to regulate it with care; if the soreness continues in spite of this change, a few doses of Mercurius vivus or solubilis will cure the trouble very speedily. ERYSIPELAS. Erysipelas proper is altogether a primary affection, the cause of which it is difficult to trace in every case. The disease occurs almost ex- clusively between the age of pubescence and that of sixty, and is of less frequent occurrence among old people than among children. Atmos- pheric influences are generally regarded as the cause of erysipelas, but this theory is not justified by the evidence of fact All we know posi tively is that erysipelas often sets in as a sporadic disease, and that some- times it breaks out in the form of a limited epidemic, which never assumes a very extensh'e range and has given rise to the erroneous view that erysipelas is a contagious disease. It is a characteristic feature of this disease that every new attack of erysipelas increases the patient's liability to other attacks, which only becomes extinct at an advanced age. The cause of successh'e attacks of erysipelas is very often to be found in violent emotions, gross errors in diet, and in colds, more especially in the action qf severe cold upon a heated skin. The origin of wandering erysipelas is inA'olved in complete mystery it is to be observed that it inclines to set in previous to the age of pubes- cence. . Traumatic erysipelas arises in consequence of injuries if suppuration ensues, or eA'en at the start, soon after the infliction of the injury; or it accompanies suppurating inflammatory processes, such as gum-boils. It may be looked upon as an excess of reaction against the inflammation from which it proceeds. This circumstance likewise accounts for those cases of erysipelas that supervenes during typhus and other constitutional diseases as a malignant complication or as a terminal disease. Symptoms and Course.—True, or the so-called exanthematic erysip- elas really only breaks out in the face, whereas erysipelas on other parts of the body is, properly speaking, erythema. The appearance of the exanthem upon the skin is generally preceded for a few hours or even days by a preliminary stage consisting of a severe fever Avith marked gas- tric symptoms, with which symptoms of cerebral hyperemia, and more especially a violent headache, sometimes become associated at an early period. During a first attack these precursory symptoms are scarcely ever absent; but they do not occur with a return of the disease. While the fever is on the increase, the face feels hot and tense, and sometimes rheumatic pains in the nape of the neck are complained of, a vivid red- ness breaks out at a certain circumscribed spot in the face, which spreads rapidly and causes a burning pain. In proportion as the redness becomes more intense, the swelling likewise increases and the skin assumes a glistening appearance. Erysipelas generally breaks out on one cheek whence it spreads to the nose, the eyelids, forehead, ears, less frequently 504 DISEASES OF THE SKIN. to the lips, and scarcely ever to the chin. Within two or three days, and sometimes in thirty-six hours the erysipelas, reaches its acme at the spot where it first appeared, amid febrile symptoms Avhich are sometimes ex- ceedingly severe, attended with a foul-smelling catarrh of the mouth, vomiting, and most generally delirium; these symptoms, hoAvever, are not constant, whereas the headache and soporous stupefaction are exceed- ingly annoying. The face is now very much swollen, the features are disfigured to such an extent that they are no longer recogniza- ble, the redness has a bluish and even brown-red tint, and vesicles of various sizes sometimes spring up upon the inflamed surface, which always indicate an intense degree of illness. The inflammation decreases very rapidly ; the redness disappears after the existing vessicles had dried up preA'iously, and had become transformed into thin and flat crusts, and very soon desquamation commences first in large patches, and afterwards in very small scales. But inasmuch as the disease never terminates with its first appearance, and usually spreads over the Avhole head, we find erysipelas in full bloom close to the original spot in process of healing, and find the redness gradually diffusing itself into this spot, whereas it forms a sharp contrast with the surrounding normal parts of the face. In this manner erysipelas gradually wanders over the whole face, even beyond the ears, invading a portion of the nape of the neck, and spread- ing over the forehead and the hairy scalp. In this latter case the pa- tients suffer severe local pains, even after the fever abates. The intensity of the fever, as it first breaks out at the commencement of the clisease, does not keep pace with its gradual progression. Whereas, at one spot, the inflammation runs its full course in five to six days, yet, on account of its progressive appearance in different localities, the whole course of the disease lasts from ten days to a fortnight. The process of desquama- tion may last much longer, and the most severely affected parts often ex- hibit for a long time a yellowish tint with signs of serous infiltration. Deviations from this course are not unfrequent. The whole face may be covered so rapidly that it would seem as though the exanthem had broke out all over at once. These are cases of intense virulence, where one ear, however, commonly remains uninvaded. Moreover, the inflam- mation may communicate itself to the cerebral meninga3; generally, how- ever, this does not take place until the local process has reached its bight. In such a case the redness very soon assumes a dingy and livid look ; the skin becomes lax and wrinkled, a most violent delirium sets in, and co- ma and death speedily superA'ene. This course has been mistaken for a metastasis of erysipelas; whereas, in such a case, the same changes take place as in other similar cases, namely: that, with the appearance of a violent disorder, the previously-existing lesser disease abates and disap- pears. Erysipelas seldom becomes associated with diseases of other im- portant organs. Attacks of erysipelas succeeding the first attack are very apt to show deviations from the normal course. These attacks are very seldom preceded by precursory symptoms, the less so the more fre- quently the attacks have occurred. Nor is the fever as severe, the swell- ing is less, and the spread of the disease over the face takes place more slowly. It not unfrequently happens that in subsequent attacks the pa- tients are not obliged to lie down, and that their appetite remains the ERYSIPELAS. 505 same as in their normal condition. Subsequent attacks are more like erythema than erysipelas. The frequency of the attacks differs greatly in different individuals; sometimes there are several attacks in a few weeks and, after a short time, cease entirely; or months and even years intervene between the attacks; in such cases a spontaneous cessation is much less frequent. Among the consequences of true erysipelas the following deserve par- ticular mention: Swelling of the skin, especially that of the lids, nose and lips ; the swelling is mostly puffy, the skin having a pale look, and being disposed to the formation of comedones; if the attacks are very frequent, the swelling may reach a considerable degree of thickness, and is very obstinate. Loss of the hair, which almost always falls out if the scalp had been intensely affected by the disease; in most cases the hair grows again, but there are exceptions to this rule. Severe catarrh of the ear, with obstinate hardness of hearing. Disposition to neuralgia. Wandering erysipelas, or erysipelas ambulans or erraticum, attacks the face less frequently than the extremities. On one of the extremities an erysipelatous spot appears which heals exactly like the above de- scribed spots, only there is very little tension and pain, and the general organism is nol so much involved. From this spot, the erysipelas spreads toward the trunk; the spot which is attacked next, being either in close contact Avith the first, or else all subsequent spots being more or less re- mote from each other. Symptomatic erysipelas, as an accompaniment of inflammatory pro- cesses, is of no great importance, except Avhen it covers a large extent of surface and depends upon septic causes. Generally it disappears of itself as soon as the cause that occasions it, is removed. If it is very intense, it may result in suppuration or gangrenous destruction of the skin. If the erysipelas sets in in the course of serious, constitutional diseases, with fe- ver, it is always a bad omen. In such cases the redness is never very vivid —rather dingy, having a bluish tint; the swelling is not excessive and yet the disposition to form blisters is very great; these blisters do not ahvays dry up, but often become transformed into badly-looking ulcers which are apt to become gangrenous. The fever accompanying this form of ery- sipelas, always increases to a high degree, but speedily assumes the char- acter of an adynamic fever, the pulse becomes very small and frequent, the temperature increases considerably, the cerebral phenomena become very marked, and sOpor and coma set in at an early period, and death sometimes takes place so rapidly that life becomes extinct already on the third day after the appearance of the inflammation. Erysipelas of babes generally set in in the first week after the birth of the infant, very seldom after the first month. It almost always proceeds from the umbilicus, on Avhich account it has been traced with great pro- bability to the consequences of an improper management of this organ, more especially to a purulent inflammation of this organ which can easily be accounted for by bad management.—As a rule the erysipelas spreads from the umbilicus over the abdomen, the sexual organs, thighs, less fre- quently over the thorax and back. The redness is not very vivid, the swelling, on the contrary, is very considerable. The children are exceed- 506 DISEASES OF THE SKIN. ingly restless, feverish, and incline greatly to spasmodic affections and sopor. ALLOPATHIC TREATMENT. A patient with erysipelas (erysipelatous fever) should be confined to bed in a well A'entilated room. The diet should be light but consisting largely of milk. Cold drinks may be given as desired. If the bowels are constipated they should be moved by a saline cathartic, as the Citrate of Magnesia, aided, if necessary, by an injection of warm water. If the case be a mild one, and the fever not high, it is not generally necessary to re- sort to the use of drugs. In severe cases, the remedies most useful are Quinine and the Muriate Tincture of Iron. Quinine in these eases should be given in doses of five to ten or more grains every four hours. If a slight ringing in the ears is produced, the doses are sufficiently large. It is best given in powder enveloped in medicine wafers. The Tincture Muriate (Chloride) of Iron is very generally given by physicians in doses of from ten to thirty drops every four hours. It should be largely diluted with sweetened Avater, and may be given immediately after tlie Quinine. Beyond the support it gives to the system laboring under so debilitating a disease, the (direct) benefits from the Iron are questionable, but as it is beneficial in this way, it ought not to be omitted in any severe case. Belladonna is especially antagonistic to this disease. The Extract may be giA'en in doses of a quarter of a grain in pill, three or four hours apart, or the Tincture may be given in doses of five to ten drops at the same intervals. The Belladonna may be given with the Quinine. In cases with high fever, the pulse strong, and there is no depression of the system, the Tincture of Aconite should be gh'en in doses of half a drop to a drop every hour until an impression is made on the fever move- ment, and then continued two or three hours apart or just sufficiently often to continue the effect of moderating the fever. This remedy does not require the suspension of any of the others mentioned, but it should not be given when there is prostration. There is no treatment which will limit the inflammation. The sooth- ing effect of the Lead and Opium Avash, is often extremely grateful to the patient. A half a dram of Sugar of Lead and ten grains of the Acetate of Morphine are dissolved in a quart of rain water. A soft muslin cloth is dipped in this solution and spread over the inflammed surface. The cloth should be kept wet. If this does not relieve the pain markedly, it is well to try anointing the surface well with Olive Oil. Two drams of the Fluid Extract of Belladonna to six drams of Oil will give the Oil a decided ano- dyne property. Glycerine with ten to tAventy drops of Carbolic Acid to the ounce, is another good application. Prostration or debility, occurring in the course of the disease, should be treated in the same manner as when it occurs with continued, or other fevers, with nutritious food, milk, beef, essence, raAv eggs beaten up with sugar and water or milk. Nourishment should be given in these cases four hours apart. If the pulse should be very rapid and feeble brandy, or whisky in doses of one or two tablespoonsful may be given with the nourishment. The stimulant is beneficial, if the pulse becomes fuller, ERYSIPELAS. 507 slower, and more regular. Sago, Rice, or other farinaceous articles are not to be excluded, if agreeable to the patient. HOMOEOPATHIC TREATMENT. Aconite may be required at the onset, only in case there be much fever, or hot, dry skin at the commencement; or even during the course of the disease, if required. Dose: Dissolve six pills in three tablespoonsful of water, and give a teaspoonful of the solution every three hours, until the pulse becomes diminished in force and frequency, and the skin moist. Belladonna, when the redness expands in rays, and an acute shoot- ing pain with heat and tingling, is experienced in the affected part, which is aggravated by movement. Erysipelas of the face, with burning heat, excessive swelling, so that the eyes are almost closed, violent head- ache, thirst, dry, hot skin, restlessness, disturbed sleep, delirium. In such instances, Belladonna, is, generally, alone sufficient to effect a cure. There are cases, however, in which it will be found necessary to have recourse to Rhus-toxicodendron, in alternation with Belladonna, according to the particular symptoms, or group of symptoms present. Dose: If singly, of a solution of eight pills to two tablespoonsful of Avater, give a teaspoonful every two hours, until change, when the inteivals should be extended to six hours, until the symptoms are wholly overcome, or assume distinctive features indicative of another remedy. But in those cases, of occasional occurrence, in which the symptoms, being severe, are but little moderated, within three hours after the fourth dose of Belladonna, Rhus, a similar solution of each medicine, administered by teaspoonsful, at inter- vals of two hours, until change. Rhus-toxicodendron is to be preferred particularly when the disease manifests a tendency to extend itself to the brain and its membranes, and the symptoms closely resemble those which characterize Brain Fever. Rhus is especially suitable for the treatment of erysipelas, arising from particular kinds of food, operating upon certain individual peculiarities of constitution which predispose the patient to such attacks. Dose: As directed for and under Bell. Arsenicum is required either after the previous administration of one or more of the foregoing medicines alone, or in alternation with Rhus when A'esicles of a blackish hue, with a tendency to degenerate into a gan- grene, present themselves; or, still more essentially, if great (and rapid) prostration of strength occurs. Dose: In all respects, whether singly or in alternation, as directed under the head of Belladonna. Pulsatilla is more especially indicated when the hue of the skin is less intense, or of a bluish-red, and the morbid spots frequently disappear from one place to reappear in another (fugitive erysipelas). It is further- more appropriate when the disease affects the internal and external ear, especially in the vesicular variety of erysipelas, and after the employment of Rhus-toxicodendron. Dose: Six pills in a teaspoonful of water, every three hours. Nux-vomica is often of service in cases of erysipelas developed in the 508 DISEASES OF TnE SKIN. knee or foot, and characterized by extremely painful, bright-red SAvelling. It is more especially advantageous in cases of spurious erysipelas occurring in irritable subjects, particularly females, and when mortification of the sub-cutaneous cellular tissue has ensued. Dose: As for Pulsatilla. ERYSIPELAS TERMINATING IN ULCERATION. Sulphur, Arsenicum. See the article on "Ulcers." SUSCEPTIBILITY TO ERYSIPELAS IN THE FACE. Belladonna, Rhus. When this disease is repeatedly developed in the face, and there is, in fact, an habitual tendency to attacks of this na- ture, Belladonna and Rhus (in particular), either singly, alternately, or successively, according to circumstances, are frequently capable of per- manently removing the complaint, and of obviating the return of at- tacks. Dose: If singly, of either remedy, give six pills, night and morn- ing, for a week (as soon as the acute symptoms of an attack have been subdued); then pause four days, after which the course may be repeated, as before, and so on from time to time. If in al- ternation—give first the one (as just directed), and then after an in- terval of twenty-four hours or longer, proceed with the other, in like manner, and so on, occasionally, until the predisposition seems conquered. NETTLE-BASH. HIVES. Urticaria, Diagnosis.—Spots or wheals, flat or prominent, and of a dull Avhite color, like the sting of a nettle, or redder than the surrounding skin, generally encircled with a rosy areola, disappearing in warmth, and re- appearing when exposed to cold, evolved suddenly, and continually changing their situation. This eruption is brought to the surface by various causes, not unfre- quently arising from indigestion, caused by the use of improper articles of food. Before the eruption discloses itself, the patient is affected with restlessness, languor, oppression, and want of appetite, derangement of the digestive functions, and fever. When the eruption breaks out, the above symptoms become relieved, but considerable suffering arises from heat and itching, sometimes accompanied with swelling of the parts affected. This disease, in almost all cases arising from a constitutional cause, requires for its total eradication a regular course of treatment. ALLOPATHIC TREATMENT. Acute Urticaria depending on irritation of the stomach, especially if caused by some food which has been eaten, an emetic of twenty grains of Ipecacuanha in half a glass of water should be given. After the vomit a simple laxative should be given. A Seidlitz Powder or Citrate of Mag- NETTLE-RASH. 509 nesia, in a dose of a tablespoonful in half a glass of water and drunk during effervescence. The diet should be simple for several days consisting of rare lean beef or mutton, milk, eggs, bread, and farinaceous food. Bismuth in doses of ten or fifteen grains should be given (in milk) before each meal. Alkaline drinks should be taken to overcome acidity or irritation of the bowel. Ten to twenty grains of the Citrate of Potash in lemonade every four hours will be sufficient. In the chronic disease the cause must be carefully sought out and re- moved. Articles of food which are found to disagree must be avoided. Sometimes it is necessary to omit one article after another until the of- fending one is found. A pure milk diet is sometimes necessary. Bismuth and Citrate of Potash recommended above are often useful. In many instances the Solution of Pepsin and Bismuth (Sheffer's formula) in doses of a dessertspoonful before eating, should be tried. If the patient is rheu- matic or gouty Wine of Colchium should be tried in doses of a teaspoon- ful one or more times a day, to produce a slight action on the bowels. When causes in the stomach or bowels are excluded Fowler's Solution in doses of three to Ave drops after meals should be tried; the remedy should be omitted for a time if it causes puffy lids, watery eyes, or abdominal pains. If the disease occurs periodically Quinine should be given in doses of five grains three to six times a day. The presence of fleas and insects as causes should be sought for. A solution of Corroshre Sublimate in half a pint of water is a useful appli- cation where the disease depends on the bite of insects. Bathing Avith vinegar and water is often beneficial or sponging with a tablespoonful of Dilute Nitric Acid in a quart of Avater. HOMOEOPATHIC TREATMENT. In acute cases, the remedies found most useful are Dulcamara, Aconite, Nux-vomicei, Pidsatilla, Antimonium crudum, Belladonna, Hepar sulphur- is, Rhus-toxicodendrmi, and Bryonia. Dulcamara, when the exciting cause has been cold or damp, when the affection occurs in wet weather, or Avhen we find considerable fever Avith bitter taste in the mouth, foul tongue, diarrhoea, pains in the limbs, and extreme itching, with a burning sensation after scratching. Aconite, when the febrile symptoms are more intense, the pulse high, the skin hot and dry, and great restlessness and anxiety are present. Nux vomica, when there is considerable gastric derangement, with constipation, more especially when arising from wine, stimulants, or indigestible substances ; it may, if necessary, follow Aconite in eight or tAvelve hours after the febrile symptoms are someAvhat modified. Pulsatilla deserves a preference, under similar circumstances, when the bowels are relaxed, and the patient is of a quiet disposition and lym- phatic temperament, and the attack has apparently been excited by indi- gestible food. 510 DISEASES OF THE SKIN. Antimonium crudum may follow Pulsatilla, should the latter have failed to relieve the affection. Belladonna is indicated when the affection is attended with a severe throbbing headache, Avith redness of the face. Hepar sulphuris has frequently been found useful in urticaria ac- companied by cold in the head, and particularly Avhen the coryza was confined to one nostril. Rhus-toxicodendron is one of the most useful remedies in a great majority of cases of this eruption, and especially when the affection has apparently arisen from some idiosyncrasy of constitution, in which the eruption has been thrown out by the use of some particular article of food. Prescription.—In ordinary cases, we may prescribe 6-12 globules of the sixth dilution in six dessertspoonsful of water, and order one to be taken morning and evening, except in the case of Aconite, which may be more frequently repeated, when the febrile symptoms seem to demand it. In this, as in every other cutaneous eruption, great care ought to be taken against driving it inward, by external application or lotions; a sud- den retropulsion, as noted under Scarlatina and Small-pox, being fre- quently attended with fatal consequences. When, however, from im- proper treatment, we have reason to dread this having taken place, we may generally succeed in re-establishing the eruption, and thereby avert- ing any dangerous consequences, by the employment of Bryonia in repeated doses. Should, however, marked cerebral symptoms declare themselves, the complaint should be treated as described under Scarlatina. Urtica urens has been found useful in some cases ; and in those of a chronic or extremely obstinate character, Calcarea, Lycopodium, Sul- phur, Carb veg., Causticum, Acid, nitric, Conium, Natr. mur., etc.; the last two, particularly, when the eruption is liable to reappear after vio- lent exercise or exertion of any kind; Calcarea, when exposure to cold fresh air produces it; and Acid, nitricum when it arises from the patient going into the open air, after having kept within doors for a day or tAvo. DANDRUFF. PITYRIASIS. Pityriasis is a throwing off of the skin, either in thin>cales, or in larger patches; it may or may not be accompanied by some other affection of the skin, and the skin thrown off may, to all appearance, belperfectly sound ; or else the process may be accompanied by trifling local or more extensive symptoms of thickening of the skin. According as the'skinMs unchanged or looks red under the scales, the affection is designated as pityriasis simplex or rubra (red). The causes of this affection are very obscure; in some cases'the dis- ease can be traced, with some certainty, to a derangement of the functions of the liver and of the female sexual organs. Pityriasis rubra, when spread over more extensive portions of the DANDRUFF. 511 skin, not unfrequently sets in with slight febrile motions which may break out at every renewed appearance of the exanthem. On portions of the skin, Avhich itch and burn A'ery fiercely, large red spots of indefinite and irregular shapes make their appearance. Accompanied by a peculiar feeling of tension, the skin on these spots very soon begins to exfoliate. The eruption first manifests itself on the trunk, and only invades the face if exceedingly severe. The almost inevitable itching may cause a moisture to ooze from the otherwise dry spots on the skin. This itching which is absolutely agonizing, very commonly interferes with the sleep. The affection is very obstinate, but at the same time one of the rarer forms of cutaneous diseases. Pityriasis, confined to isolated spots, is much less frequently of the character rubra than a general pityriasis; it is most commonly met with on the hairy scalp, in the palms of the hands, on the soles of the feet and in the face. The itching is much less distressing, but is still very violent on the hairy scalp. By scratching the skin until it tears, a moisture is secreted from the irritated spot, resulting in the formation of superficial scurfs and crusts and agglutination of the hair. In treating a case of general pityriasis, we must not forget that we are dealing with a A'ery chronic affection which never promises rapid suc- cess, and where it would be consequently improper to make a frequent change of medicines, or to repeat the dose too often. The most import- ant remedies are Graphites and Arsenicum, with which it is most likely that a cure can best be effected. The attack may be modified in any and every degree, from that just described to that resulting only in the throwing off of small dry scales from the hairy scalp. The treatment is one of the most difficult known to the profession of medicine only on account of its tediousness and the absolute carelessness of patients who more than half the time neglect to use the means Avhich would cure if used as directed. Sepia is particularly indicated in the case of females, if the spots break out in consequence of menstrual irregularities, or at definite periods of the year. ALLOPATHIC TREATMENT. For dandruff there is no more effectual application than keeping the scalp clean with a strong solution of Borax. Frequent daily (or often enough to keep off the scales) shampooing, with a mixture of equal parts of Soft Soap (Sapo Veridis, made of Olive Oil and Caustic Potash) and Al- cohol is most useful. Washing the head Avith weak alkaline solutions is also useful. If the scales are thick the use of a five per cent solution of Oleate of Mercury is very beneficial. An ointment of fifteen grains of Red Oxide of Mercury or thirty grains of the AVnite Precipitate with an ounce of lard and half an ounce of Sweet Oil is beneficial. After each washing of the head the hair should be well oiled to pre- vent the skin becoming too dry. Olive or Almond Oil, scented to suit, are appropriate for this. In old cases with no derangement of the stomach or bowels, three drops of Fowler's Solution should be given after each meal. 512 DISEASES OF THE SKIN. Derangement of digestion or other indisposition demands suitable treatment. PSORIASIS. SCALEY TETTER. This is pre-eminently an affection of the male sex; in the case of fe- males it is neA'er attended with sexual disorders. It attacks individuals between the seventh and fiftieth year, and occurs most frequently in the cold season. It cannot be traced to constitutional derangements, since persons who are afflicted with this disease, otherwise enjoy the most per- fect health. AVith the appearence of some constitutional disease, thepso- riasis disappears at once, but returns again as soon as the disease is re- moved. Psoriasis begins thus: at various, more or less numerous scattered spots, the detached epidermis (skin) forms a small, white rising (psoriasis puncta- ta.) These spots gradually spread until they reach the size of drops (psoriasis guttata); on removing the scales, Ave find the skin underneath slightly red and bleeding. In proportion as the circumference continues to ex- pand, the original spot becomes cleansed of its scales, and a ring forms surrounding a healthy-looking skin (psoriasis annularis); in the further progress of the exanthem, this ring opens, loosing its roundness (psoriasis gyrata) and finally disappearing altogether. All these stages, or most of them, coexist side by side in almost every case of this disease. Psoriasis is not attended with itching, or at most only at the commencement, but in no case if it has become an inveterate disease. It may remain station- ary, though breaking out in new places, or it may intermit in its mani- festations for months and even years. Among external remedies Avhich are never hurtful and usually effi- cient, is the vapor bath, accompanied by frictions with castile soap, or brown soap ; cold bathing is of decided benefit, but its effects are not at once perceptible. -------■ «^> ■------- SYCOSIS MENTAGRA. barber's itch. This is exclusively a disease of the male sex. If persons avIio do not shave are attacked by it, which is a very rare occurrence, its causes are very obscure. In cases where the beard is shaved, the eruption may be caused by bad or irritating soap or by a dull razor, but is almost ahvays the result of shaving by a careless and uncleanly barber, who does not properly clean and scald his razor, and, although generally so frightfully obstinate, yet may heal spontaneously even Avithout much loss of time; all that need be done is to omit shaving the affected parts. Dirt and snuff likewise seem to occasion sycosis (barber itch). The disease generally sets in, like herpes labialis (cold blisters), with a sensation of burning, heat and tension; most commonly we first notice on BOTTLE-NOSE. 513 the chin a small cluster of isolated, red knobs or pimples (tubercles) of a pretty large size, each of which is perforated by a hair. Some of these tubercles in a few days change to pustules, break and form dark crusts. without the infiltration Avhich forms the little tubercle, disappearing on that account. In spite of all care, and generally in consequence of con- tinued irritation, the number of tubercles increases slowly but uninterrupt- edly, the former ones growing larger; the skin upon which they are seated, becomes more and more infiltrated; after breaking, the pustules change to ulcers. The patients do not complain of much pain, but their ugly appear- ance fills them with anxiety. The disease is extremely obstinate and may last for years. It is true that it not unfrequently abates in severity, and at times even disappears altogether; but it breaks out again with renewed fierceness, and in such a case in more than one spot simultaneously. Its first appearance is almost always on the chin ; it is here that the disorder exists most commonly in its fiercest intensity, but it likewise invades every other bearded portion of the face, and in severe cases even the eyebrows. Fifteen grains of Carbolic Acid to one ounce of Glycerine, applied in small quantity after pulling the hair out of the center of each tubercle, every day tAvice after a thorough washing with good soap, is a very cer- tain cure. ALLOPATHIC TREATMENT. Removal of the diseased hair by extraction with a pair of forceps, a few at a time, is the first requisite after subduing the inflammation with warm poultices. Then the application of an ointment of Carbonate of Copper two drams to an ounce of lard will complete the cure. The Ole- ate of Mercury: or a solution of Corrosive Sublimate fifteen grains with Muriate of Ammonia thirty grains in eight ounces of Distilled Water : or a dram of Sulphate of Copper and four drams of Sulphate of Zinc dis- solved in a pint of water, are effectual applications. The general health and state of the bowels require attention. ACNA ROSACEA, GUTTA ROSACEA. COPPER-NOSE, BOTTLE-NOSE. Acna Rosacea is an exanthem consisting of tubercles with some dis- position -to suppurate, suppurating tubercles ; and, moreover, of contin- ual venous congestion. Italmost always commeneesat the tip of thenose.whenceit spreads over the nose and over both cheeks, finally over the forehead and rest of the face. First, we notice a spot of small extent, painless, and distinctly tra- versed by dilated cutaneous veins. Upon this base single tubercles start up, which sometimes suppurate at an early period, but likewise spread in size after the pus is discharged. New tubercles keep constantly forming, new spots keep constantly breaking out, the skin becomes more and more thickened, the veins become more and more varicose, the isolated little blotches change to large tubercles, cracks and deep rhagades, and even ulcers make their appearance, and the face looks very much disfigured in conse- 33 514 DISEASES OF THE SKIN. quence of this extreme development of nasal exanthem. At first the affection has remissions, but the dark redness never disappears entirely; at a later period the disorder keeps groAving all the time. Abuse of wine and spirits is the cause of the disease in by far the larger number of cases ; but it likeAvise breaks out on individuals of very moderate habits, as drinkers. Among women the disease is of rare occurrence, and only among drinkers of spirits as a rule, and associated with menstrual anomalies. The disease is not often seen previous to the tAventy-fifth year; its most frequent occurrence is after the fortieth. Overheating the system and immoderate drinking are very apt to cause a renewed outbreak of the disease. It is exceedingly obstinate, and, in its higher grades, is considered incurable. HERPES. TETTER. All forms of herpes (and they are many), are characterized by the for- mation of little blisters, clusters of which are seated upon and inflamed' red epidermis; the vesicles of one cluster breaking out simultaneously and running an acute course. HERPES FACIALIS, FACIAL HERPES. This form of herpes accompanies a large number of fevers and chronic diseases without exerting any specially modifying influences over their course; except in pneumonia where this form of herpes is said to consti- tute a decidedly favorable omen. As an independent exanthem it seems to manifest itself when indicating the commencement of a catarrhal af- fection, provided the catarrhal irritation is not very intense. A first ap- pearance predisposes most decidedly to relapses. Herpes facialis (cold blisters), most generally breaks out on the lips less frequently on the cheeks, forehead, ears, eyelids. A tension, burning, and a marked sensation of swelling are experienced at a certain infiltrated spot, where the blisters start up amid slight febrile motions and an un- usual feeling of lassitude. In the face they are always of a tolerably large size, but there are not many of them clustered together, they incline to run into one another; the skin of the spot where they are located does not show a very vivid redness; sometimes they are pitted or cleft- They con- tain a clear liquid Avhich soon becomes dim and changes to a rather dark scurf that soon falls off, leaving for some time a red, somewhat infiltrated spot; burning pains likewise remain for some time. A few doses of Rhus Tox. will cure this form. SHINGLES. HERPES ZOSTER, ZONA. This form is characterized by the development of clusters of blisters (vesicles), of Avhich there are generally several, along the tract of one or more spinal nerves, assuming on the trunk the shape of a zone or belt, but on the extremities breaking out in a more irregular form. Shingles commence almost without exception Avith rheumatic pains RINGWORM. 515 in the parts where it is to break out, and is often attended with' great lassitude and fever. The preliminary pains are not unfrequently like inflammatory pains. With violent and painful burning, an efflorescence breaks out, after which pimples without pus arise, next, clusters of vesi- cles (blisters) with tendency to run into one another. These vesicles remain out for four to six days, after which they change to flat scurfs. But as a new cluster may arise after the first, and these succesive crops may continue even after the first vesicles are entirely healed, the whole process may last even three weeks. It is very seldom the case that scratch- ing or the friction of the clothes will cause a superficial ulceration. There may be no pain during the continuance, except the slight burning attend- ing the successive breaking out of new crops of vesicles; but the greatest distress to the patient is the burning itching which is especially severe in bed. After the falling off of the crusts all pain is gone, or the peculiar itching may perhaps continue for some time, or finally—and this is not by any means a rare occurrence—intercostal neuralgia of a very obstinate type may set in, apparently the more readily the less scantily the herpes was out on the skin. HOMOEOPATHIC TREATMENT. Mezereum is to be relied on, given four doses daily, six pills at a dose. RINGWORM. HERPES IRIS AND CIRCINNATUS. Herpes iris consists of a larger blister which is not unfrequently filled with a blood-tinged liquid, and is surrounded by a wreath of smaller vesi- cles, around whose external border another and larger wreath may form. The course is the same as that of other herpetic vesicles. The affection first appears on the dorsa of the feet or hands, spreading on the extensor- surfaces from below upwards, and the new clusters of vesicles appearing either in the same relative position as the vesicles of herpes generally, or else again assuming the form of herpes iris. This form of herpes most frequently occurs among women and children. Herpes circinnatus which comes out in the same manner as herpes iris, is distinguished from the latter by the circumstance that the central blister is missing, and that only the wreath of vesicles is present. ALLOPATHIC TREATMENT. In the treatment of "ringworm'' (herpes circinnatus) simple meas- ures generally succeed at om-e, as the application of a strong solution of Nitrate of Silver, from ten grains to a dram to the ounce; an ointment of ten grains Acetate of Copper to the ounce of Lard ; a five-percent solution of Oleate of Mercury in Oleic Acid containing a dram of Ether to the ounce; a solution of Corrosive Sublimate two grains and upAvard to the ounce of water, or the Sulphur Ointment with frorh ten to twenty grains of Corrosive Sublimate to the ounce ; or Tincture of Iodine, will suffice. These applications destroy the parasitic plant which causes the cjisease. In ringworm of the scalp (tinea tonsuraus) the first indication, as in 516 DISEASES OF THE SKIN. ring-worm or scald-head, is the same, to destroy the parasitic plant. This is best done by applying a blistering fluid (Blistering Collodeon) remove the loosened epedermis, and then apply an ointment made by mixing twenty grains of Corrosive Sublimate, or forty grains of White Precipi- tate with an ounce of Sulphur Ointment, or some of the mixtures given for ring-worm. The scalp should be carefully cleansed eA'ery day to re- move any loosened scarf-skin which may interfere with the ointment (or other application reaching the parasite), and the application made twice a day. Scrofulous or poorly nourished children will need tonic treatment, as a teaspoonful or more of Cod Liver Oil and a teaspoonful of the Com- pound Syrup of Hypo-Phosphites daily. It is claimed that the continuous use of Soft Soap (Sapo Veridis), made with Olive Oil and Potash, will cure the disease in two weeks. ECZEMA. SALT RHEUM. The causes of eczema are either external irritants acting directly upon the skin, or else substances that affect this organ through the general circulation into which they had been absorbed, or finally constitutional influences. Heat, for instance, causes the so-called baker's itch; and heat, intense cold, salt-baths, mercurial frictions, Croton-oil, etc., a number of medicinal agents taken internally, fat food or food giving rise to an unusual deposition of fat, scrofulosis, affections of the female organs of generation, varicose veins, and in gen- eral all kinds of stoppage in the venous system, and a number of other sim- ilar circumstances and influences uniformly occasion eczema. Among the direct cutaneous irritants we distinguish : neglect in attending to the skin, vermin, friction by the clothes, continued rubbing of a part, for in- stance between the thighs when riding on horseback, and by continued walking. A good example of eczema is obtained by rubbing Croton Oil upon the skin. Upon a red surface a number of vesicles (blisters) or pimples shoot up which, if carefully guarded, heal in a few days leaving the af- fected portion of the skin injected. If the vesicles are not protected, if they are scratched or rubbed against by the clothes, they break, and crusts form, beneath which, if the irritation continues, the exuda- tion continues likewise, or else the exudation may be so copious that no crusts can form, in which case the affected part ahvays looks red and moist. If the irritation continues, the eczema spreads to the adjoining parts; scratching even communicates it to remote parts ; besides the vesicles, pus- tules form likewise. Eczema of the legs (salt-rheum) really depends almost exclusively upon varicose veins, nfore especially upon dilation of the small cutaneous veins, whereas the larger vessels may continue in a perfectly normal con- dition. This eczema is extremely obstinate, itches most horribly, gener- ally exacerbates in the spring and fall, and is a species of eczema rubrum salt Rheum. 517 with occasional formation of pustules and an infiltration of the skin that makes it look very badly. Eczema seldom runs an acute course; the extremely acute form of " eczema universale'' is very rare; on the other hand, it not unfrequently commences as an acute exanthem, with slight fever, but very soon as- sumes a chronic character. All the different forms of eczema itch more or less ; scratching, which it is impossible to avoid, is a main cause of the onward spread and the protracted course of the disease. Every kind of eczema may heal and does heal spontaneously, provided the chief requi- site toAvards a cure, namely, rest in a lying position and absolute cleanli- ness is attended to. Eczema of the leg and scrotum give the least hope of a cure. ALLOPATHIC TREATMENT. In an acute attack of Eczema in a person of robust constitution, the bowels ought to be briskly moved. Ten grains of Calomel, followed after six hours, by a dessert to.a tablespoonful of Epsom Salts, or Citrate of Magnesia, or a double Seidlitz PoAvder. This should be followed by ten to fifteen grain doses of Citrate of Potash or Cream of Tartar in Lemon- ade, a sixth of a grain of Tartar Emetic should be added to each dose, and given from two to four hours apart. If the patient is not strong, Calomel should not be given, but a saline laxative of a dessert to a tablespoonful of Epsom Salts or Citrate of Mag- nesia, or a Seidlitz Powder. This should be followed by Cream of Tartar in doses of ten to twenty grains, in Lemonade, from two to four hours apart. The eruption should be poulticed with flaxseed meal or slippery elm spread thin between very thin layers of muslin or soft linen dipped in warm water, spread over the eruption, and covered Avith oiled muslin. When there is much burning, the following powder, sprinkled on the eruption, before the poultice is put on, is useful: Take Camphor half a dram, Ether a sufficient quantity to powder the Camphor, four drams each of Oxide of Zinc and Starch. Mix. Old chronic cases of this disease are known as Salt Rheum. The crusts should be softened by poulticing with Flaxseed meal or Powdered Slippery Elm, until they can be easily removed. After the crusts are removed and the surface carefully dried, the Ben- zoated Oxide of Zinc Ointment should be applied constantly, and all irri- tating applications cease, though an occasional cleansing may be neces- sary. If the secretion does not disappear, or greatly diminish, one of the best applications which can be made is a dram of Tannin dissolved in an ounce of Glycerine. The ointment may be used again a short time after the Tannin and Glycerine are used. Tonics will be needed, and the principal ones are Quinine, Iron, Ar- senic and Cod Liver Oil. The Cod Liver Oil may be given in doses of a teaspoonful three or four times a day. The Citrate of Iron and Qinine in two to five grain doses, three times a day; it should be dissolved in Syrup of Ginger or Orange Flower Water. These are particularly indicated if the patient is in poor health, with impoverished blood. All chronic cases 518 DISEASES OF THE SKIN. are benefited by Arsenic. It should be given as Fowler's Solution, in doses of three to six drops, after meals. It can be combined with the Ci- trate of Iron and Quinine, as in the following formula: Take of Citrate of Iron and Quinine a dram and a half, Syrup of Ginger or Orange Flow- er Water four ounces, add Fowler's Solution a dram and a half. Dose: A teaspoonful, three times a day. BOIL. FERUNCULUS—ABSCESSUS NUCLEATUS. Diagnosis.—Round or rather cone-shaped hard elevations of different sizes slowly inflaming and suppurating, discharging matter generally at first, tinged Avith blood, but still retaining a portion of morbidly-altered cellular tissue, which may form the nucleus of other elevations after those which appeared first have healed. These sores yield readily to internal treatment and Avithout pain, while the treatment with drawing salves is often, distressingly painful. No ex- ternal application need be used, but as soon as the parts begin to look red and cause pain we give Arnica every two to four hours. If the SAvelling still increases and a small spot of pus has already made its appearance, give Arnica and Hepar Sul. in alternation every two to four hours. If the tumor has been allowed to go on so long that pus has formed deep in, the sore has become very painful and still does not discharge, but fluctu- ates on sudden pressure, an incision may be made with a lancet, after which the pain will cease and the pus run out. Poultices of bread and milk or kindred substances should not be ap- plied too soon, lest the natural development of the tumor should be inter- fered with. This is the reason why many persons are afflicted with fresh boils, every six to eight weeks; the acrid matter is not permitted to be fully expelled from the organism. Pork and fat food must be avoided by those Avho are the subjects of such sores. A single small dose of Sulphur allowed to act for months will entirely eradicate the tendency to boils. ALLOPATHIC TREATMENT. The maturity of a boil may be hastened by poulticing with Flaxseed meal, or powdered Slippery Elm, when it may be allowed to break and run out into a poultice. Water dressings covered with oiled muslin may be used instead. Boils which contain pus, and do not come to a head, should be opened. Boils occurring singly, or in crops which do not soon suppurate, but re- main hard may be made to disappear by brushing them over with Tinc- ture of Iodine, sometimes crops of them may be suppressed by early re- sorting to this. When boils occur in successive crops, it is probable, poultices will in- duce their farther development, and should not be used if this appears to be the case. But if they are painful a poultice made, having incorporated in it stramonium (Jamestown weed), or Tobacco, or that has Laudanum, or Fluid Extract ofJBelladonna poured upon its surface. A plegget of CARBUNCLES. 519 cotton saturated with equal parts of Carbolic and Glycerine with or with- out one half part of Fluid Extract of Belladonna placed over a group of boils is often effectual in relieving the pain. Soap plaster is a good appli- cation for these groups of boils, but after they open Rosin plaster should be used. The diet should be plain and nutritious. Occasionally a boil can be aborted by touching the inflammed pimple with the Acid Nitrate of Mercury, or the solid stick of Nitrate of Silver. The system of persons having boils requires supporting. For this pur- pose, Quinine and Iron should be given. The former may be given in Sugar coated pills (Warner's), in doses of from two to six grains three times a day. When ringing of the ears is produced, the dose should be decreased. The latter may be given with Chlorate of Potash. Dissolve four drams of Chlorate of Potash in four ounces of boiling water, add three and a half ounces of Simple Syrup, and half an ounce of Tincture of the Chloride of Iron. Dose a tablespoonful three times a day. If the case does not improve, Iron and Arsenic may be given instead of Iron and Chlorate of Potash. Take of the Citrate of Iron and Ammonia two drams, Fowler's Solution eighty minims, Simple Syrup one ounce, Anise water sufficient to make eight ounces. Dose a dessertspoonful three times a day. A tenth of a grain of the Sulphide of Calcicum given hourly, is claimed to prevent the recurring crops of boils. Sometimes a trip into the country is necessary for their cure. CARBUNCLE. Anthrax. Ferunculus Malignans. Pustula Nigra. Diagnosis.—A livid, bluish, or black spot upon an extended surface extremely painful, readily running to gangrene, and proving fatal, occa- sionally, from the extension of mortification. The disease is attended by headache, thirst, foul tongue, sickness, loathing of food, languor, jactita- tion (trembling) and sleeplessness. ALLOPATHIC TREATMENT. Carbuncles should be early cut through to their base by a crucial (+) incision and dressed with a flaxseed meal poultice or the mixture of Car- bolic Acid one part, and Glycerine two parts. After the slough comes away the ulcer may be washed with a solution of Carbolic Acid one dram in five ounces of water, or oiled with Olive Oil or Glycerine containing twelve drops of Carbolic Acid to the ounce. The internal treatment is the same as recommended for boil*. The diet should be plain and nutritious, as lean meat, milk, eggs, and simple starchy articles of food. HOMOEOPATHIC TREATMENT. The best remedies in this affection are in the order of their names: Ars., Silicea, Mercurius. Arsenicum is, by all means, the most efficacious remedy, and the more especially so if gangrene is approaching or has appeared. Silicea. When administered, in the beginning, in simple carbuncle is frequently found sufficient to effect a perfect cure. 520 DISEASES of the SKlN. Mercurius. Pain worse at night, attended with copious sweats which give no relief. If the strength is greatly reduced by the loss of blood, etc., China, three doses a day for a week, will greatly assist nature. FAVUS. HONEY-COMB TETTER, SCALD-HEAD. This cutaneous affection is characterized by the accumulation of mul- titudes of fungi around the roots of the hairs, hence their exclusive ap- pearance on the hairy portions of the skin. Favus is a disease of the loAver classes. It only attacks individuals who pay no sort of attention to cleanliness. In other respects such indi- viduals may either enjoy the most perfect health, or else be of sickly and cachectic constitutions ; favus may attack either sex This exanthem can be transferred to other persons by hats, caps and other head-gear, likewise by sleeping in the same bed; it has likewise been transmitted purposely from one individual to another. A single favus-efflorescence has its origin in the orifice of a small gland in the form of a small, imbedded, not painful papule, which is perforated by the hair and keeps constantly increasing in breadth and height, until the characteristic crust finally arises from it. This crust has the shape of a dish, with a rounded central depression and round elevated borders; it has a yellowish or gray tint, without any exudation underneath, and has a peculiar odor. The consequences of favus' are: Partial atrophy of the skin in consequence of the crusts being imbedded in it; eczema occasioned by the scratching; destruction of the hair on the affected parts; on the other hand, this disorder has no influence upon the general state of the constitution. The disease runs a very chronic course yet spontaneous cures occur, although very tardily and not without cor- responding modifications in the hygienic circumstances of the patients. According to what we have stated concerning the history of the dis- ease, we deem an internal treatment of it useless and [ineffectual. This can only be cured by removing the crusts in which the fungi are imbed- ded, and by preventing their return. The surest means of accomplishing this result, is care and cleanliness. The removal of the crusts is secured by softening them with oil, and afterwards removing them together with the perforating hair. This is a very tedious, but sure undertaking. Every sickly-4ooking hair has to be pulled out singly, for the reason that the dis- ease has already invaded the soil in which it grows. Dr. Hole of Chicago says this eruption is treated Avith success in some cases by means of Iris versicolor ; a cerate is applied to the scalp, and a feAV drops of the tincture, even as many as twenty, in half a tumblerful of water given internally, in teaspoonful doses, three or four times a day. ALLOPATHIC TREATMENT. In this disease (Scald-head—Favus) as in ringworm and tine-a-tonsur- ans and barber's itch, the object of treatment is to destroy the parasitic plant occasioning the disease. The crusts may be got rid of by poultices SCABIES—ITCH. 521 or preferably by constantly applying a mixture of equal parts of Sulphur- ous Acid and Glycerine. A piece of lint may be saturated with the mixture, laid over the part and then covered with oiled muslin. This same mixture may complete the cure, or a solution of Corrosive Sublimate five to ten grains to the ounce may be used. The hair must be pulled out in the affected part and for a little space around it. The cure is now easy, but without which is almost impos- sible. The food should be good. Two to five grains of the Soluble Citrate of Iron and Quinine may be given three times a day. After the cure is complete the occasional application of the Oleate of Mercury should be made, or a hair pomade used, with which has been mixed five grains of Corrosive Sublimate to the ounce: Take of Corrosive Sublimate five grains, Simple Ointment an ounce, Ottar of Roses three or four drops. Mix and use for a hair pomade. ITCH. SCABIES. This contagious, inflammatory affection of the skin, is characterized by an eruption of pointed vesicles, transparent at the summit, and filled with a viscid and serous fluid, in which lives a very small insect. These are subsequently mixed with, or terminate in, pustules. With the excep- tion of the face, they appear in every part of the body, but much more frequently and abundantly about the wrists, betAveen the fingers, and at the bend of the joints, etc., and are accompanied by incessant and almost insuperable itching, without fever. There are several varieties of the disorder, but it is often very difficult to distinguish their characteristic differences. EXTERNAL TREATMENT. The local application of Sulphur, either in the form of lotion or oint- ment, should be used. The above method of treatment, combined with the free and frequent use of soap and water, undoubtedly suffices, in mild and recent cases, to remove this troublesome affection; but as in those of longer standing it may be found inadequate to destroy the mites which have now been clearly demonstrated to be the cause (not the result) of the disease, the following course of treatment should be adopted, and will usually succeed in accomplishing a speedy and permanent cure: Let the patient be placed in a hot bath, and the hands, wrists, and other affected parts be well rubbed with fine sand (or a sand ball), for the purpose of tearing open the passages and cells where the vermin have burrowed and located themselves. In persons of tender or delicate skins, brisk rubbing Avith a coarse towel, after the bath, may be sufficient to effect the required ob- ject; but the use of fine sand, or pounded chalk, is to be preferred. When the patient has been dried, all the affected parts should then be well rubbed with a lotion made of Olive or Almond Oil and a few drops of some essen- tial oil, thus: To two tablespoonsful of Almond-oil add twenty drops of Oil of Sassa- fras. 522 DISEASES OF THE SKIN. The rubbing in, and, if needful, in in\reterate cases, the hot bath and frictions, should be repeated every three days for a fortnight or so, or un- til the cure is complete. When, as is sometimes the ease in certain habits, boils are associated with itch, and continue to break out for some time after the removal of the latter, the remedies prescribed in the article on Boils should be had recourse to. The sudden suppression, by external means, of some of the eruptions which have been mistaken for or occasionally follow, or haA'e been devel- oped during the existence of inveterate itch, has, undoutedly, as not unfrequently happens in other chronic eruptions, been repeatedly attend- ed with serious consequences. ALLOPATHIC TREATMENT. The remedy for scabies itch, is Sulphur upon going to bed. The body should be rubbed well with soft soap and a little warm Avater for fifteen or twenty minutes, then a warm bath for thirty minutes or more, then an Ointment Compound of two parts Sulphur, one part Carbonate of Pot- ash, andtAvelve parts lard should be thoroughly rubbed over the whole body, especially, to the affected parts. The patient may bathe the next morning. This treatment should be repeated for three separate nights. A Solution of Sulphate of Copper—one ounce to the pint—may be used after the bath- ing, instead of the Sulphur Ointment Clothes should be exposed to the fumes of burning Sulphur (Sulphurous Acid Gas). ABSCESS. PSOUS-PSOITIS. (Lat. Abscedere, to separate), a collection of pus in a circumscribed cavity. The causes of abscess are often involved in obscurity, excessive exer- tions, a cold, rheumatism, mechanical injuries, caries of the bones, may be mentioned as probable ^causes. The name is given to collections of pus in some of the naturally existing cavities of the body. Of these we do not propose to treat in this article. An abscess may be acute or chronic according to the character of the inflammation which produces it. The formation of an acute abscess is ushered in by a sudden or else rapidly increasing violent pain which it is difficult to define. It often radiates upwards or downwards, and soon produces a stiffness which materially interferes with the natural motions of the adjacent parts, the pain is generally, not always, of a throbbing character, and soon shows redness of the surface, if not too tt deeply seated; swelling and violent fever is mostly present, attended with increase in the pulse very marked. Pus forms rapidly, and is often so profuse in quantity as to indicate its first appearance by a succession of chills, distinct or suddenly following each other, called creeping chills, known by the sensation of " little chills playing tag up the patient's back." The fully-formed abscess can be reabsorbed, which is, however, rarely the case. When the pus has formed in consider- ABSCESS. 523 able quantity near the surface, its presence may be readily discovered by the feeling of "fluctuation" produced by placing the fingers of one hand on one side of the swelling, and with those of the other gh'- ing a smart tap on the opposite side. If the cavity formed, and con- taining the pus is very deeply seated, it often baffles the skill of the most experienced surgeon to determine its presence and exact location. The pus usually tends towards the surface Avhich it reaches by a grad- ual thinning of the intervening tissues; but if these be very resisting it may travel in other directions, possibly to break into some of the natural cavities, lungs or abdominal cavity, Avhen it will be likely to result in death. It is in these cases that an early incision by the surgeon is espe. cially called for before "pointing" has taken place. In chronic abscess the pain, redness, fever, and increased temperature of the parts, may be absent, and for this reason it is, also, commonly known as cold abscess. In most cases, its progress is slow, and it may remain for a long time Avithout any increase in size, or any tendency to open through the skin. Usually, it is necessary to open it; this may be done by simply cutting directly into the cavity. Treatment is not surgical, except so far as the necessary slight amount of cutting into the caA-ity. In the first place, we have to try to scatter the inflammation before suppuration sets in, even if this cannot be accomplished in all cases, it is at all events certain that the spread of the inflammation may be prevented by appropriate treatment. The following is the best : ALLOPATHIC TREATMENT. Ulcers will be benefited by some of the following applications: Ten or twenty drops of Carbolic Acid in Glycerine, sometimes half a dram to a dram of Tannin should be added: a strong Solution of N itrate of Silver —forty grains to the ounce—or the solid Stick; a Solution of Sulphate of Copper, three to ten grains to the ounce: Powdered Iodoform dusted over the ulcer, is an excellent application, as is pure Solicylic Acid. An Alum Curd (Alum dissolved in white of an egg) may be used, or if it prove in- effectual the surface may be dusted with powdered burnt Alum. HOMOEOPATHIC TREATMENT. Bell, especially if the fever is accompanied by copious perspira- tion, and every motion aggravates the pain extremely. Rhus should be given if the fever consists of a burning, dry heat, with intense thirst, if the trouble seems to have originated in a cold, and the pains are worse at night, and when the patient is lying down, or at rest. If these two remedies do not effect an improvement, and the fever is mingled with chilly creepings, the pulse becomes very much accelerated, and the skin is at times very hot, and at other times drenched with per- spiration, we should at once give Mercurius, which is the only remedy that can at this stage arrest suppuration, if such a result can be accom- plished at all. 524 DISEASES OF THE SKIN. If an abscess forms, we give Hepar Sulph. in order to promote the suppuration, for the main point now is to evacuate the pus as rapidly as possible, and by this means to heal the sore as soon as the pus is dis- charged. If the opening becomes fistulous, we must be prepared for a very tardy recoA'ery. Sulphur is especially suited for chronic abscess, and for a tendency to suppuration, depending on a scrofulous constitution, when the pains are stinging in their character, and the pus of a healthy color. WHITLOW OR FELON. Is so well known that no dsecription is needed. As soon as it is sus- pected that one is beginning to appear on the finger, remove the kind of skin lining from the inside of an egg shell in as long a strip as you can and rap tightly around the affected finger. This will, if used in time, stop the further progress of the disease, but is painful. If it has gone on until pus is already formed, the lance applied clear to, and a little way along the bone at the seat of pain, being careful that the knife does not cut across any muscle. After it is lanced apply poultices. Among the best of which is a linen pad, saturated with cold Avater, frequently removed and covered closely with a piece of oiled silk, bladder or similar substance. ALLOPATHIC TREATMENT. The earlier the periosteum (membrane covering the affected bone) is divided with the knife, the sooner will the patient have relief. Saving the bone depends on the promptness of this measure, and serious difficul- ty is prevented by early resorting to it. Subsequent dressings are the same as for Carbuncles or Boils. CHILBLAINS. EXTERNAL TREATMENT. Tincture of Arnica may in many cases be advantageously applied externally to the parts affected simultaneously with the internal exhibi- ition of the same medicine, in repeated doses. Application: To five parts of Avater add one of the concentrated 1 mcture of Arnica, and bathe the parts freely with this lotion, three times a day. Tincture of cantharides. In recent chilblains, induced by ex- posure to intense cold, this remedy may be applied externally with great success. It operates against the formation of vesicles or blisters, and aids in subduing the congestive action. Application: Add four drops of the tincture, to two tablespoonsful of water, and bathe the parts with the lotion three times a day. Tincture of Costicum is to be preferred to either of the foregoing, for broken chilblains of old standing, and for those cases in which the ul- ceiation has eaten deeply into the flesh. Application: Add four drops of the Tincture to two tablespoonsful of water, and apply the lotion as directed for Cantharides. frozen limbs.—corns. 525 ALLOPATHIC TREATMENT. Useful applications for Chilblains are: Take of Carbolic Acid a dram, Simple Ointment (or Lard) two ounces. Mix for an ointment; the sur- face may be painted with Tincture of Iodine. Equal parts of Turpentine and Chloroform will give relief. FROZEN LIMBS. Application of Snow. In slight cases of "Frozen Fingers," or other limbs, or portions of the body, the well-known practice of applying snow to the affected parts, is beneficial. Camphor {Saturated Tincture). When Snow cannot be procured, this is a valuable substitute. For young children this is more particularly applicable, especially, when the face is the seat of the injury. Application: To five parts of Spirits of Wine add one of the Tincture of Camphor, and bathe the parts with this lotion freely twice a day. Acidum-nitricum is a most efficient remedy in severer cases, both for internal and external exhibition. Dose: Of a solution of six pills to the wine-glassful of water, give a teaspoonful every three hours. Acidum-nitricum {externally—second dilution). This remedy may simultaneously with its internal administration, be applied externally. Application: Add four drops of the Tincture, at the second dilution, to tAvo tablespoonsful of Avater, and bathe the parts with this lotion three times a day. If convenient, it Avere preferable to saturate a piece of linen rag with the lotion, and to apply it to the frost-bitten part, covering the whole over with oiled silk. Diet and Regimen. Plain, wholesome, nutritious, but unstimulat- ing diet; a sufficiency of active exercise in the open air; free ventilation ; frequent change of linen; the free use of cold water. CORNS. That these troublesome excrescences not unfrequently arise from an inherent vice of constitution, is evident, from the fact of many individu- als who wear tight boots and shoes (unquestionably the principal exciting- cause) escaping them, while others, with every precaution, suffer severely; such being the case, the main object must be, by a course of properly-se- lected internal remedies, to eradicate the predisposing cause or condition. palliative treatment. Great alleviation of suffering has been found to result from bathing the feet in warm water, and from subsequently resorting to the following application: Tincture of Arnica. A lotion composed of a week solution, should be employed, the corn after it has been previously soaked in warm water, after being pared down with great care. The skillful reduction of the corn by an experienced operator, may likewise be mentioned as a ready and prom pt palliative treatment. Equal parts Spirits Ammonia and lemon juice applied twice daily after thoroughly soaking the feet in warm water is excellent. 526 acute contagious diseases. Fart Twelfth. CONSTITUTIONAL DISEASES. CHAPTER XXVIII. ACUTE CONTAGIOUS DISEASES. MEASLES. MORBILLI. Measles attack individuals of eA'ery age and sex, but least frequently very old people and infants. Inasmuch as almost everybody has an at- tack of measles in his early youth, they are on this account seldom met Avith among old people. One attack of measles generally protects per- sons against a second one ; exceptions, however, are not very rare, al- though it behooves us to guard against mistaking roseola for measles. The ordinary season for measles are the months Avhen catarrhs are common, from October till April. Symptoms and Course. The incubation-period of the measle-con- tagium, until the efflorescences break out upon tin' skin, is eleA'en or at most twelve days. The general health does not seem in the least dis- turbed in the first eight to nine days of this period, definite preliminary symptoms shoAV themseh'es in the last two or three days. These prelim- inary signs are falsely said to have been noticed at an earlier period ; but as catarrhal affections are very preA'alent during epidemic measles, it is Aery likely that purely catarrhal symptoms have been mistaken for the prodromi (premonitory symptoms) of measles. The prodromi proper begin A\rith a slight catarrh of the nose, lassitude and some fever. This fever increases considerably on the second day, frontal headache super- venes, the eyes look red, are sensitive to the light, but the conjuneth'a is seldom puffed up. On the third day there is another increase of fever, the patients feel unable to sit up, the tongue is thickly coated, the appe- tite gone, and in the night from the third to the fourth day, immedi- ately previous to the appearance of the exanthem, a hoarse, barking cough sets in resembling croup, which, however, is scarcely ever at- tended with the danger that generally characterizes croup, and never changes to true croup. These symptoms may increase to a considerable degree of intensity, may be associated with vomiting, delirium, sopor; at times, however, they are entirely wanting or so slight that it is not deem- ed necessary to confine children to the room. This is the reason why the measles spread so rapidly through the schools, for it is on the day pre- vious to the breaking out of the measles that the infectious principle is most active, and that the measles are most easily communicated. We MEASLES. 527 account for this circumstance by the fact that in the last twenty-four to twelve hours previous to the appearance of the exanthem upon the skin, distinct, lentil-sized measle-spots are perceived, in almost every case, on the sides of the fauces. Without doubt, it is the extension of these spots to the larynx and trachea that causes the peculiar croupy cough, and we have always considered it an excellent diagnostic sign to find this cough associated Avith red spots on the palate, in which case we were able to positively predict the appearance of the eruption within twenty-four hours. In other respects the prodromi have no distinctive peculiarity from which the character of the exanthem might be inferred ; it can at most only be suspected after several cases had already occurred in the place, or in its immediate vicinity. The measle-exanthem breaks out gradually, in one case more rapidly than another. The first spots always show themselves in the face, most commonly on the cheeks and temples. They are of the same size of a bright redness and Avith rather sharp outlines ; after being out for a short time, they become somewhat raised above the skin and harder. With more or less speed, generally within twenty-four to thirty-six hours, the exanthem comes out over the whole body from above downwards, and is fully out in forty-eight to sixty hours, so that no new spots appear; up to that time, new spots had continued to break out in addition to the first spots that were more or less scattered and isolated. The spots keep grow- ing in size to such an extent that some of them run together, and the nor- mal skin, in the place of spots, exhibits here and there irregular red patches. In proportion as the exanthem comes out more profusely, its color generally grows darker, sometimes with a bluish tint. With the fuller deA'elopment of the eruption the constitutional symptoms most common- ly increase in intensity. The catarrh of the conjunctiva and the cough, especially, groAV much worse. The pulse sometimes increases to one hundred and forty beats. Sometimes the skin is dry, but at other times covered with perspiration. In very rare cases the constitutional equilib- rium remains undisturbed, even during the eruptive stage; however, in eA'ery considerable epidemic a child with measles is occasionally seen run- ning about the streets. If the exanthem runs a mild course, its decrease commences at the end of the third day, seldom before this time, and continues with great rapidity until the eruption has entirely disappeared. The spots grow smaller, assume a distinctly yellowish tint, which is especially marked on pressure with the finger, and within twelve to twenty-four hours the spots have completed their disappearance without leaving a vestige of their existence. Very frequently, however, the yellowish tint remains for several days. The fever declines very speedily, but the bronchial ca^ tarrh most generally continues for a few days longer, and resolution, sometimes does not take place until a considerable quantity of mucus has formed. Not unfrequently the patient is, at this period, attacked with diarrhoea for one or two days. Profuse perspiration is not the rule, but is not by any means an unusual occurrence. Desquamation (peeling off) commonly commences on the seventh day but may delay until the fourteenth. The skin comes off in bran-shaped 528 ACUTE CONTAGIOUS DISEASES. scales, \*ery seldom in larger patches ; in the face and on the extremities the desquamation is most distinct. During this period, the general health is generally good ; except that the bronchial catarrh and still less fre- quently the diarrhoea may continue to some extent. Among the malignant deviations we name the following : The spots, when first coming out, are of a pale-red color which do not increase in intensity, nor does it acquire the yellowish tint. Within the spots hemorrhagic appearances are manifested, and between the spots ecchymoses are noticed. The spots fade away soon after their appearance, or else they fade very suddenly at the regular period or before. In the case of children the pulse exceeds 140 beats, and in the case of adults 120 beats; moreover it is a small pulse. The tongue is dry. An- gina tonsillaris. Diphtheritic membranes form in the buccal cavity. The respiration becomes hurried and superficial. Sopor and delirium after the second day of the eruption. Of great importance are certain complications of measles, that are very apt to occur and Avhich were formerly regarded as metastases, because the exanthem disappears with the appearance of these complications. Laryngitis Avith croupous exudation is of rare occurrence while the exan- them is still out; it is more commonly met Avith after the exanthem has left the skin. A slight bronchitis is an accompaniment of every case of measles; it only assumes a dangerous character, if it continues beyond the stage of decline, or reappears again during the stage of desquamation, or otherwise assumes a very acute form. It is A'ery apt to run into an exceed- ingly obstinate chronic catarrh. Enteritis (inflammation of the bowels) is a rather frequent complica- tion in some epidemics ; it excites legitimate apprehensions, for the rea- son that other consecutive diseases, more particularly scrofulosis, are apt to follow in its train. Affections of the brain are rare ; their intensity is rarely such as to excite apprehensions; the supervention of sopor is a bad sign, because it may usher in a fatal general paralysis. Of the highest importance are likewise the numerous and always ob- stinate sequelae (result of the diseases) of the measles, which make this exanthem one of the most malignant, whereas, its ordinary normal course and character entitle it to be regarded as one of the most harmless. Among these sequelae we distinguish : Chronic conjunctivitis (inflammation of the eyes), with impaired vis- ion ; chronic ostitis, with deafness^; chronic ozsena; chronic inflammation of the lymphatic glands, mostly Avithout suppuration ; chronic inflam- mation of the parotid and submaxillary glands. Chronic bronchial catarrh, which gives rise to a peculiar spasmodic cough ; or real whooping-cough which is much more seA'ere as a sequela of measles than Avhen setting in at other periods, and which very often developes almost dangerous pneumonia. After measles, children are very frequently attacked with scrofulous symptoms. It is very likely .that, in the'case of little children, the mea- sles simply act as an exciting'causeof scrofulosis; but it is likewise among larger children that, after an attack of measles, all sorts of phenomena MEASLES. 529 make their appearance, which we are in the habit of designating as scrof- ulous, and which go to show that a morbid change has been impressed upon the whole activity of the organism. Tuberculosis (consumption) likewise frequently breaks out after meals. ALLOPATHIC TREATMENT. In mild cases of uncomplicated measles the treatment will consist of good hygiene and the relief of such symptoms as annoy or give trouble. The patient should be in a large Avell ventilated but somewhat dar- kened room, with a temperature Avhich will be comfortable for attendants to sit in—68° or 70°—and should be uniform day and night. Such a tem- perature is comfortable and in it there is no danger of taking cold from temporary or accidental uncovering of the patient. The diet should be light and simple, consisting of milk or milk and water, raAv eggs beaten up with sugar and water, gruel, toast, and such other farinaceous articles as the patient desires. Any simple drinks, cold water, lemon- or orangeade, gum- barley- or riceAvater, flaxseed tea, etc., may be allo\ved as freely as desired. Emetics and cathartics are not to be given, but if the bowels have not moved for a couple of days, an injection of warm water or a laxative dose of Castor Oil (a dessertspoonful) or Citrate of Magnesia (a teaspoonful to a dessertspoonful for older children.) The injection is to be preferred on account of the irritable state of the bowels. Remedies are indicated for the relief of bronchitis and cough or rest- lessness. Opium and Hyoscyamus are best suited for this. From five to ten grains of Dover's Powder with half a grain of the solid Extract of Hyoscyamus or fifteen to twenty drops of Laudanum with an equal quantity of Fluid Extract of Hyoscyamus may be given from two to six times in the twenty-four hours. For children opiates may be giA'en as directed for bronchitis or pneumonia. Owing to the danger from severe bronchitis or pneumonia it is best in severe cases to have an oiled muslin jacket worn over a flannel shirt. A malignant form of the disease will require tonics and stimulants. Of these Quinine may be given in doses of half a grain to three grains, three to six times a day. If the pulse is weak Carbonate of Ammonia in doses of one to ten grains in half a teaspoonful to a tablespoonful of Spirits Mendereees two to six hours apart. Brandy is similarly indicated and should be given in liquid food in doses of half a teaspoonful to a tablespoonful, or more, according to the age of the patient and severity of the symptoms of prostration, and may be given from three or four times a day to hourly. For high fever, Avith a strong bounding pulse, no remedy acts better than Aconite. A drop of the Tincture can be given to an adult every hour until an impression is made on the fever, and then at longer inter- vals to maintain the effect. When the eruption is especially irritating much relief will be afforded by oiling the skin as in scarlet fever. Complications of any kind should be treated as directed for the spe- cial diseases, bearing in mind that supporting treatment only is appropri- 34 530 ACUTE CONTAGIOUS DISEASES. ate for serious complications. The precautions directed by the Ncav York Board of Health against the spread of Scarlet Fever and Measles should be observed. An unusually high fever, when there is no sweating, will be benefited by a cool sponge bath or wet pack. Sleeplessness, which is not relieved by the Opium or Opium and Hyos- cyamus given for cough, may be relieved by giving to an adult twenty grains each of Chloral Hydrate and Bromide of Potassium in syrup and Avater in one dose at bed time. The Health Board of New York enforce the following Sanitary Regu- lations against Scarlet Fever and Measles: "Care of Patients.—The patient should be placed in a seperate room, and no person except the physician, nurse, or mother, allowed to enter the room, or to touch the bedding or clothing used in the sick room, until they have been thoroughly disinfected. "Infected Articles.—All clothing, bedding, or other articles not absolutely necessary for the use of the patient, should be removed from the sick room. Articles used about the patient, such as sheets, pillow cases, blankets, or clothes, must not be removed from the sick room until they have been disinfected, by placing them in a tub with the following disinfecting fluid: eight ounces of Sulphate of Zinc, one ounce of Carbolic Acid, three gallons of water. "They should be soaked in this fluid for at least one hour, and then placed in boiling water for washing. "A piece of muslin one foot square, should be dipped in the same so- lution and suspended in the sick room constantly, and the same should be done in the hall way adjoining the sick room. "Feather beds and pillows, hair pillows and mattresses, and flannels or wollen goods, require fumigation, and should not be removed from the sick room until this has been done. Whenever the patient is removed from the sick room inform the Bureau of Sanitary Inspection when the disinfecting corps will, as soon as possible thereafter, perform the work of fumigation. "All vessels used for receiving the discharges of patients, should have some of the same disinfecting fluid constantly therein, and immediately after use by the patient, be emptied and cleansed with boiling Avater. Water closets and privies should also be disinfected daily with the same fluid, or a Solution of Chloride of Iron, one pound to the gallon of water, adding one or two ounces of Carbolic Acid. "All straw beds should be burned, but must not be removed from the sick room Avithout a permit from this department. They will be removed by the disinfecting corps. "It is advised not to use handkerchiefs about the patient, but rather soft rags for cleansing the nostrils and mouth, which should be immedia- tely thereafter burned. "The ceilings and side walls of the sick room after removal of the pa- tient, should be thoroughly cleaned and lime-washed, and the wood-work and floor thoroughly scrubbed with soap and .water. "As a fumigating, antiseptic, and disinfectant, Chlorine Gas stands unrivaled. The ingredients used in its production should be in glass or MEASLES. 531 earthen deep dishes or saucers placed in the higher parts of the room. The ' Gas will descend, being heavier than the air, and becomes mixed with sur- rounding air. The following articles are used for its production: One part of common Salt mixed with one part Black Oxide of Manganese, and placed in shalloAv earthen vessels; two parts Sulphuric Acid previously diluted with two parts by measure of water, is then to be pourd over it and the whole stirred with a stick. The room with the infected articles, should be then shut up tightly, and remain closed for several days. The cleaning, scrubbing, and Avhite washing can then follow. HOMOEOPATHIC TREATMENT. Aconite,—which is particularly indicated when the fever assumes an inflammatory form, attended with dry heat of the skin, heat in the head, with confusion and giddiness, redness of the eyes, intolerance of light, general Aveakness or prostration ; whenever marked febrile or inflammatory action becomes prominent. Dose: Six pills every two to four hours, in water. Pulsatilla is also very efficacious in this affection, and is frequently indicated in the commencement, by the striking predominance of the characteristic catarrhal symptoms attendant upon measles, further quali- fied by aggravation towards evening. This remedy is of great utility in bringing out the eruption, when it is longer than the average period in mak- ing its appearance. Pulsatilla is also valuable when any derangment of the stomach is present, or when the cough, which so generally accompa- nies the disease, is worse towards evening or in the night, and is attended with considerable rattling of phlegm in the chest, or copious, thick, yellow- ish or whitish expectoration, sometimes followed by vomiting, or symp- toms of approaching suffocation; further, when there is cold in the head, with a thick, yellowish or greenish nasal discharge. Dose: Six pills every four hours, in water. Bryonia is an excellent remedy, when the eruption is faint, retarded, or imperfectly developed, and the respiration much repressed and laborious, attended with achings in the limbs; also, when there is a dry cough and the patient complains of shooting pains in the chest, increased by a full inspi* ration, Dose: As for Pulsatilla. Sulphur is, in general highly beneficial after the active symptoms of the disease have yielded to the action of immediate treatment, and espe- cially after the previous administration of Pulsatilla, particularly when we have reason to suspect a scrofulous or other constitutional taint. Sub phur will, frequently, in such cases, be most effective in ©radicating the predisposition to Chronic affections engendered by measles. Dose: Six pills in a tablespoonful of water, every morning (fasting) for ten days. CHECK OF THE ERUPTION. The disease has frequently terminated fatally, from the eruption be- ing driven in by sudden exposure to cold or change of temperature. 532 ACUTE CONTAGIOUS DISEASES. Bryonia is generally found efficacious in re-evolving the eruption, and preventing disastrous consequences. Dose: As directed above Pulsatilla is indicated, if looseness of the boAvels, Avifh mucus discharge, follow the suppression. Dose: As directed for Bryonia. AFTER-EFFCTS OF MEASLES. COUGHS. In general the treatment of such affections will be most effectually conducted by following the instructions furnished separately in the arti- cle on " Coughs.'' looseness of the bowels. Explicit directions on this subject will be found in the article on "Di- arrhoea." INFLAMMATION OF, OR DISCHARGE FROM, THE EARS. (See page 199.) TENDERNESS OF THE SKIN. Mercurius. This remedy, administered for a brief time is generally sufficient to remove the tenderness Avhich is so peculiarly apt to result from measles. ERUPTIONS ON THE. SKIN. Nux-vomica is indicated, in cases of this kind resulting from mea- sles, by the presence of an eruption of minute white grain-like eleva- tions. Dose: Six pills every evening for a week. SCARLET FEVER. SCARLATINA. This is distinguished from other eruptive fevers by the fact of the eruption being an exanthema, an efflorescence, or a rash ; these terms not being strictly applicable to vesicles and pustules. Scarlet fever is highly contagious, and it may be communicated by means of fomites (producers of contagious disease). The infectious material remains for a long time in garments, bedding, carpets, Avail-paper, etc., preserving its power of producing the disease. It is, doubtless, occasionally transmit- ted through the air at great distances; and, hence, sometimes breaks out spontaneously without any agency of affected individuals, or clothes of any kind. It is difficult to determine the duration of the period from the time of exposure to the contagious principle to the full development of the first well-marked symptoms. Austin Flint, and other recog- nized authorities, argue that 24 hours, often, is the extent; but 8 days is generally allowed to be the period in a vast majority of cases. As a rule the disease is experienced but once; but exceptions are not very rare; the author has knoAvn of a case where the same individual has been attacked SCARLET FEVER. 533 four times. The contagion is most freely active soon after the appearance of the exanthem. As soon as the fever has subsided, the contagious nature of the disease has, most probably, become extinct. Children are much more susceptible to the special cause than adults. After 40 years, very few persons are attacked; also children, under two years, rarely contract the disease, and many persons appear to be entirely free through life, notwithstanding numerous exposures. The largest number, and most malignant cases occur between the second and seventh year; a much smaller number betAveen the eighth and twenty-fifth year; from twenty- five to forty it is very rare. Scarlatina A'ery often occurs in a neighborhood, either in company with or immediately after, epidemic measles. It also, not unfrequently occurs in company Avith small-pox. Symptoms and Course.—The disease is variable, both in its symp- toms and course, and we will now endeavor to point out the fixed types of scarlet fever: The patients exhibit the symptoms of a severe cold (catarrhal fever), which, unlike measles, is not often attended with a cough, but Avith inflammation of the throat, and loss of appetite and generally, occasional A'omiting; the pulse is very rapid; the skin seldom moist. After the preliminary stage has lasted tAvo days, the exanthem makes its appearance, generally Avith a marked increase of the fever, and other preliminary symptoms. Children are attacked Avith convulsions at this stage more frequently than at any other. The eruption is first visi- ble in the throat, on the tonsils, etc.; externally, on the neck, whence it spreads dowmvards over the rest of the body. First, we notice closely- crowded red spots (stigmata), these very speedily run into each other, causing a homogeneous, faintly-dotted redness, or else they grow in size, and running together form single spots of a darker color, seated upon a faintly-red skin ; or, finally, small vesicles spring up upon the red surface, most generally in consequence of the intense character of the skin affec- tion. The exanthem is, in cases running a natural course, generally fully out in twenty-four hours after the first external appearance; during all this time the fever has continued as high, or even more intense, than before; the thirst great, the tongue coated, or, cleared of its coat, showing a dark strawberry appearance. One of the most constant of the symptoms of this fever is this strawberry tongue. The urinary secretion is much less ; sometimes a little cough makes its appearance now, but rarely assumes a violent form. The throat is very sore, dark red, and swollen ; the surface of the body is also swollen. On the fifth or sixth day after the appearance of the eruption, it begins to pale off, with less- ening of the fever and much more so the sore throat {angina). Soon after this, the process of desquamation (peeling off), begins. It always begins on the neck with small scales; on the body, and more par- ticularly on the hands, the skin peels off in large patches; the itching is now severe, and may be allayed by rubbing the itching parts with some pure clean oil ; the appetite now speedily returns and the patient feels quite well; in fourteen days at the latest the desquamation is com- pleted. Such is a plain case, and unless some important variation takes place 531 Acute contagious diseases. frequent sponging of the whole body, cooling drinks and pure air, are all the remedies needed. But A-ariations are so frequent that too much watch- fulness is impossible. As soon as a change takes place in any symptom, study, at once, its meaning, and if not fully satisfied as to the result being favorable, call aid without delay. ALLOPATHIC TREATMENT. Rigid isolation should be provided in all cases of Scarlet Fever, as a precaution against its spreading. They must be watched most carefully in every instance, for some of the most dangerous complications (co-exist- ing diseases) and sequelae (resulting diseases) occur in those cases, Avhich, from their very mild character, have been left almost, if not entirely, to themselves. Competent medical aid should, in all cases, be called upon the first appearance of a serious symptom, or one that is not wellunder- stood or certain to result favorably. Mild cases of scarlet fever do not call for active measures of treatment but whether the disease is mild or severe, the strictest attention should be paid to hygiene (health rules). To this alone mild cases can be safely trusted. The room ought to be large and freely ventilated. The temper- ature of the room should be carefully kept at 70,° except when the fever is extremely high it may be as low as 65°. The clothing on the bed should not be heavy enough to increase the heat of the body or to be disagreeable to the patient, nor light enough to cause chilliness. The body linen and the bed linen must be changed every day. After the fever has begun to decline and the heat of the skin greatly diminished during the latter part of the disease, the heat of the room should not fall below 7u° day or night. If the child is pale, weak, and chilly, the temperature of the room should be kept as high as 72°. Chilliness and taking cold must in all cases be avoided after the fever has begun to decline and the scarf skin shed off (disquamation) on account of the liability of causing inflammation of the kidneys and dropsy, the most dangerous complications and sequelae we haA'e to contend with. The patient should be kept in bed until the disquamation entirely ceases, nor should he be allowed to leave the house within four weeks. At first light food only should be given, such as milk and its prepara- tions, meat broths, egg beaten up with sugar and water, given raw, arrowroot prepared with milk and water, and gruels, but nothing more substantial should be given during the earlier stages of the disease. Cold water, lemonade, and juice of fruits may be freely allowed, As the fever declines and the patient recovers, the regular diet should be gradually resumed. If, however, there is great weakness or the case has run some time beef essence, juice of meats, egg beat up with sugar and milk should be given frequently and in such quantities as the child can be induced to take. Small quantities of wine, wine whey, milk punch or egg-nog should also be given. A teaspoonful of whisky or brandy and two or three table- spoonsful of sherry wine, is a dose for a child one to three years old. One or two tablespoonsful of whisky or brandy and a wineglassful of wine is a dose for an adult (grown person.) In general a tepid bath should be ejiven twice u day, the temperature Scarlet fever; 535 of Which should be 90°, if the fever is moderate, or 80° if very high. The patient is undressed and immersed in the water for fifteen minutes or half an hour, until the heat of the body is reduced and the patient qui- eted. If the bath is not practicable, frequent sponging of the whole body with tepid or cool water, as the fever is moderate or high, every two, three or four hours, or the application of the wet sheet- -wet pack—once a day, should be practiced. In the applications of the wet sheet, the sheet should be wrung out of cool Avater of 60° or 70°, according to the degree of fever, and the patient, stripped of all clothing, is enveloped in the sheet and then surrounded Avith several blankets. Usually, after remain- ing in the pack for about an hour, free SAveating takes place. The pack is then removed, the patient wiped dry and placed in bed. When the heat of the body is 104 degrees, or higher, the cold wet pack should always be used, and will render most signal service. If not as high, frequent sponging is preferable in domestic practice. In no case should the bath with water, in any form, be giA'en when the patient is SAveating, or the skin moist. When the body is wiped dry, after each bath, sponging, or pack, it should be Avell rubbed with oil, from head to foot, except the face and scalp. One of the best ointments for this purpose is the folIoAving : Take of Glycerine one dram, Rosewater Ointment one ounce. Mix. Only that part of the body Avhich is being rubbed should be uncovered at a time, or the whole can be done under the bedclothes. Glycerine one part and SAveet Oil four parts is a good application, or pure Lard may be used alone for the purpose. This oiling of the body relieves the itching and burn- ing of the skin, keeps it moist and soft, and is, in a general Avay, benefi- cial, as is shown by the lowered temperature and pulse. It should be ap- plied at least tAvice a day, even if a bath is not given as often, and contin- ued during the stage of disquamation. As a rule, cathartics should not be giA'en, but constipation should be relieved by injections of warm water. For the sore throat, a solution of Chlorate of Potash one dram to the pint of water, of which the patient can drink at will, is probably all that is needed to be done in mild cases. This remedy is beneficial in a general way, as well as giving relief to the throat. If the glands are enlarged (hard lumps about the neck), Tincture of Iodine may be applied with a camel's hair brush or feather. When the throat is severely inflamed, compresses wet with cold water should be applied to the sides of the neck. They should be changed often, to maintain a uniform degree of cold. Pounded ice may be applied to the sides of the neck in little bags, if the inflammation of the throat is so violent and the fever high. The solution of Chlorate of Potash, kept cold, should be given often as a drink and a gargle, if the patient is old enough. Small lumps of ice may be held in the mouth, or ice water frequently swallowed. When the vio- lence of the inflammation has begun to decline, or the cold becomes disa- greeable to the patient, or if suppuration (forming pus or matter) begins, the cold should be displaced by warm applications; warm poultices kept on the neck by a light kerchief, or a flannel cloth wrung out of hot water and applied to the neck well covered with cloths to retain the heat. I 536 ACUTE CONTAGIOUS DISEASES the discharge accumulates in the throat and nose, it should be removed by a soft cloth swab or feather wetted in a solution of Alum, in green tea or sage tea, or Borax mixed with honey and Avater. When the discharge is of a fetid or suppurative (pus-like) character, the following application should be made to the throat, with a soft swab, three or four times a day: Take of Carbolic Acid tweh'e drops, Glycerine one ounce. Mix. If the nose is invaded with the inflammation, it should be carefully cleansed and the same mixture carefully and thoroughly applied Avith a feather or camel's hair brush. Quinine should be given through the whole course of the disease, from the beginning of high fever until recovery is well established, and the appetite good. The dose is from one to two grains, for a child, three or four times in the twenty-four hours; and three to five grains for a grown person, at the same intervals. As soon as the desquamation (shedding off of scarf skin) begins, the Tincture of the Chloride of Iron should be giA'en in five-drop doses to a child, and from fifteen to twenty drops to an adult, three times a day. It should be given well diluted in water. In malignant cases, in which the system is overspread by the disease, denoted by excessive frequency of the pulse, the chief reliance is on alco- holic stimulants, in the forms before mentioned, and they should be free- ly given. Uremia (Urea, constituent of urine remaining in the blood) is the most serious result of diseased kidneys, and is indicated by prolonged convul- sions, headache, disturbance of the sight, or insensibility, and should be promptly met by a cathartic dose of Epsom Salts—two tablespoonsful for a grown person, and one to two tablespoonsful for a child. Free sweat- ing should be produced quickly, by the use of the warm wet pack, or better, by the hot-air bath, once or twice a day. The hot air-bath can be given by putting the patient, stripped of clothing, in a cane-seated chair, then wrap a large blanket around both the patient and the chair, from his neck to the floor, covering the whole in tightly, except the patient's head ; then burn alcohol in a saucer under the chair until free sweating is produced. Hot flannels should be applied constantly to the loins. The physician should be promptly sent for upon the first appearance of any of these symptoms. He will probably give Elatereum for a cathartic. Dropsy will be treated by hot-air baths, or the hot wet pack, once or twice a day. The bowels should be kept open by Rochelle Salts or Castor Oil, in doses of a teaspoonful for a child, or a tablespoonful for an adult, repeated every six hours until the bowels open. The Quinine and Iron, before mentioned, should be given through this complication. The fol- lowing mixture, to act on the kidneys, is useful: Take of Acetate of Potash one dram, or half an ounce ; Tincture-of Digitalis one dram, or half an ounce; Syrup of Squills three drams, or an ounce and a half; Water two ounces or eight ounces. Mix, and give a teaspoonful every four hours, to a child; or a tablespoonful, for an adult. Use the smaller quantities in filling the formula for a child, and the lar- ger for a grown person. In the absence of this mixture, the patient may SCARLET FEVER. 537 drink quite freely of a decoction (tea) of Juniperberries or Watermelon Seeds. If discharge from the ear occurs, it should be frequently syringed with Avarm castile soapsuds, and the Carbolic Acid in Glycerine, before mentioned, applied. As a preventive of Scarlet Fever, Belladonna has some reputation. Take of Extract of Belladonna three grains, Alcohol one dram, water half ounce. Mix. A drop morning and evening, for each year of the child's age, is the dose. Clothing, and other articles, which have been exposed to the poison of Scarlet Fever can be cleansed by immersing them in boiling hot water, or exposing them to a heat of over 200°. All unnecssary articles of furniture or clothing should be removed from the room, before the Scarlet Fever patient occupies it. HOMOEOPATHIC TREATMENT. In those cases in Avhich the disease appears in its simple form, the skin presenting the characteristic hue, with a smooth and glossy surface, Bell, is a specific remedy. Even in the severer forms of Scarlet Fever, when the throat is con- siderably affected, and high fever or congestive symptoms set in, and which, if not properly treated: or if they occur in a bad habit of body, may assume the malignant type, attended with ulcerated sore throat, extension of the inflammation to the air-passages, delirium, spasm, etc., Bell, is a very valuable remedy. Itshould be given as soon as the throat and tongue become affected with dryness and burning, and there is a desire, but com- plete inability to swallow even drinks or saliva; with sense of suffocation; further, when the throat is of a bright-red color, having its surface ex- coriated, or covered with white specks, or stringy mucus, or presenting the appearance of thrush; the tonsils swollen, and the tongue of a bright fiery- red hue, sometimes interspersed with dark-red patches at a later period of the disease; also when delirium exists. If the disease have taken a fa- vorable turn, we may allow Bell, to continue its action; but if, after twenty- four or thirty-six hours, the swelling and inflammation increase rather than diminish, as is the case sometimes in strumous constitutions, or if we already perceive an appearance of ulceration commencing, with increase of mucus, give at once Mercurius. If. on the other hand, the ulcers pre- sent a livid appearance about the edges, and emit an offensive odor, or, when there is an excessive thirst for small quantities of water, and an ex- treme prostration of strength, Arsenicum is to be preferred to Mercurius, and if this medicine prove inadequate to a complete cure, it should be fol- lowed by Nux-w., (see ulcerated sore throat). Nux-v. is moreover of consid- erable efficacy, when a large quantity of viscid mucus is secreted from the inflamed and tumefied lining of the fauces, which adheres so tenaciously, that it is with difficulty expelled, and sometimes even threatens suffoca- tion. Pulsatilla is also useful in such cases. When the fever assumes a clearly inflammatory type, and the pulse runs high, we may administer Aconite in the same manner as given under Inflammatory Fever, which see. 538 ACUTE CONTAGIOUS DISEASES. When the quickness of the pulse, and other febrile inflammatory symp- toms are subdued, and the affection of the throat again appears most prominent, we may return to Bell., especially if the skin retain the peculiar scarlet hue. Opium may follow the Bell. Avhen there is burning heat of the skin, drowsiness, stupor, heavy breathing, open mouth, eyes half closed, restless- ness with vomiting, or convulsions. Pulsatilla is indicated when derangement of the stomach and diges- tive organs is a prominent symptom, the face pale, red, or bloated; dispo- sition fretful and sensitive, or melancholy, with crying or tears without sufficient cause. COMPLICATED FORMS OF SCARLET FEVER, Varieties of Scarlatina not unfrequently occur in which the character- istic peculiarities of the efflorescence are wanting, namely the color, which is not a bright scarlet but of a darker hue, and the effect of pressure which does not leave the white impression after it. There are, also, cases in which small granular elevations appear upon the surface of the red patches. These variations from the foregoing description of the manifestations afforded by Scarlet FeA'er are not to be mistaken for indications of a dif- ferent disease, but should be accepted as signs of a different type of the same disease, There are also instances in which the eruption is confined to internal parts, when, with the characteristic acceleration of pulse, there is sore throat, and the mouth and throat are bright, red, hot SAvoUen, and often very dry. This variety will be subject to treat- ment, such as that already detailed, according to the special indications present. Other instances, again, occur of a yet more insidious character, which are not distinguished until the dropsical swellings supervene, and which either evince no eruption at all, or so slightly as to escape notice. This variety, must in all instances, be treated as directed for the like symptoms supervening, as the after-effects of the disease when the erup- tion has been struck in or imperfectly developed. Another very danger- ous complication, which is frequently associated with scarlet fever, con- sists of inflammation of the upper part of the windpipe. This variety should be subjected to the treatment prescribed in the article devoted to the consideration of that particular disease, so long as symptoms of this nature continue—returning, however, to the specific treatment of the primary disease (Scarlet Fever) as already directed in this chapter, as soon as the complication is subdued. Another variety is characterized by degenerating into a low typhoid type, in which cases the following treatment becomes requisite. Ammonicum-carb., Aresincum, Acidum-phosph., Secale-corn. From amongst these remedies a selection should be made by accurately studying the symptoms of the case, and by comparing them with the indi- cations afforded under the head of each symptom respectively, in the article "Repertory." Cases in which the throat becomes the chief seat of danger, require the following treatment: SCARLET fever. 539 Arsenicum is indicated in the majority of cases in which severe and dangerous sore-throat accompanies Scarlatina, the tonsils being swollen into hard tumors, often as large as apples, attended with snorting and dif- ficult breathing, enlargement of the adjacent glands, remittent pulse, and Dose: Six pills every two to four hours. Acidum-nitric., Aconitum, Lycopodium, Belladonna.—If little or no improvement should haA'e followed the administration of Arsenicum within the time just stated, proceed with these remedies in succession in the order in which they are placed, (dose as for Arsenicum). AFTER-EFFECTS OF SCARLET FEVER. Scrofulous subjects in particular are subject to a multitude of consecu- tive ailments of Scarlet Fever, which are often of an obstinate character, and require careful treatment and great precaution. Excessive Susceptibility to take Cold. In general, also, we may number amongst these after-effects, when the skin has been cast, an exceeding susceptibility to take cold, which, if not obviated, may entail serious consequences. Treatment.—As accessory precaution we may mention great care as to diet, sufficient exercise out of doors, if possible, but only in very dry weather, warm clothing, and avoidance of drafts, without, however, re- sorting to the extreme of coddling or the exclusion of free ventilation, which is as essential to thorough recovery as medicine. Calcarea should, in the majority of cases, be administered (unless there be symptoms which distinctly point to other remedies) in repeated doses. rawness of the face. Chamomilla, Belladonna, Aurum-trip. Chamomilla may, in most cases, be employed singly with perfect success against this trouble- some consequence. When, however, an inflammatory tendency continues, and the affected parts are much swollen and painful, etc., it will be desir- able to resort to alternate administration of Chamomilla and Belladonna as follows; and if no relief follows take Aurum-trip. Four doses daily. offensive discharge from the nose, Aurum is indicated by offensive discharge of matter, from the nose, with soreness and swelling of the interior, following Scarlet Fever. soreness of the nose, etc., with swelling of the glands. Mercurius and Hepar-s., Silicea, Sulphur, Calcarea.—Mercu- rius is required when there is soreness ot the nose and face, with swelling of the glands on the inner side of the lower jaw, followed, if necessary, by one or more of the other remedies named. PUFFINESS AND SWELLING OF THE FACE AND EXTREMITIES, ETC. Belladonna is in most cases sufficient to overcome the following 540 ACUTE CONTAGIOUS DISEASES. symptoms, occurring as the after-effects of Scarlet Fever, namely:— Puffiness of the face, swelling of the hands and feet, lingering fever in the evening, gladular enlargements, chaps about the mouth, severe headaches, stammering, etc. dropsical savellings, etc. Arnica, Belladonna, Helleborus, Acidum-Phosph., Gelsemi- num. One or more of these remedies respectively acccording to the de- tailed indications afforded respecting them in the Repertory should be administered, when symptoms of Water on the Brain supervene, such as dullness of the mental faculties, with evident painful effort to think clear- ly; excessive drowsiness ; weakness of the feet and repeated falling doAvn; squinting dilation of the pupils, etc., etc. Arsenicum, Helleborus, Digitalis. Selection should be made from these remedies, particularly when symptoms of Water on the Chest super- vene, such as : painful oppression of respiration aggravated by motion or by lying on the back ; the patient is suddenly disturbed in sleep by a suffo- cative sensation, which compels him to sit up, or even to get up, and seek for air; or even inability to lie doAvn, necessitating a sitting or even a perfectly erect posture; short, dry, and even spasmodic cough, and stitching crampy pains between the shoulders ; excessive anxiety, etc. MUMPS. Mercurius, Cabo-veg. Mercurius is specific in the majority of cases of Mumps under these circumstances. Dose: Four globules in a teaspoonful of water every six hours, until amelioration or change; but if no improvement whatever should ensue within four hours after the second dose, or especially if there be reason to believe that the patient has been treated Avith Mercury, proceed with the next remedy. Carbo-veg. This remedy is required in cases in which a few doses of Mercurius produce no effect whatever, and more particularly when the patient has been subjected to doses of Mercury, or if induration begin to be developed. Dose: In every respect as stated for Mercurius. Calcarea, Kali-carb. These remedies are invaluable in very obsti- nate and continuous cases, and should be selected, if the symptoms be conformable to those recorded of these medicines in referring to the " Repertory." Dose: Of either remedy, as selected, give six globules in a tablespoon- ful of water, morning and evening for ten days (if the malady does not sooner yield.) SMALLPOX. This disease is, by medical practitioners of the present day, divided into two varieties:—the distinct, when the pustules on the face are clearly defined, and do not run into each other,—and the confluent, when they coalesce and form one continuous whole. SMALLPOX. 541 When the symptoms are less severe than those properly characteristic of the disease, and the eruption on the face slight, it is called the modified smallpox. We generally find this description in such persons as have been properly vaccinated,—a precaution, which, although not always a preserva- tive against the attacks of smallpox, greatly lessens its virulence, and gives a milder character to the complaint, when taken. Symptoms.—The disease is frequently very sudden in its attacks, com- mencing with chilliness and shivering, followed by symptoms of fever headache, severe pains in the small of the back and loins, languor, weari- ness and faintness; the patient also complains of oppression of the chest, and acute pain in the pit of the stomach, increased by pressure. The eruption makes its appearance at the close of the third day, first on the face and hairy scalp, then on the neck, and afterwards spreads over the whole body. Symptoms of cold—as sneezing, coughing, wheezing, and fre- quently difficulty of breathing, often accompany this disease. The eruption first displays itself in the shape of small, hard-pointed, red elevations, which can be felt under the skin of the forehead, before it is possible to discover any eruption with the eye which, in about three days, present a bladder-like appearance, surrounded by an inflamed cir- cular margin, and become depressed in the center as they enlarge. About the sixth or eighth day, the watery secretion in the pustule becomes con- verted into matter, and the depression in the center disappears. When the pustules are very numerous on the face, it generally be- comes much swollen, and the eyelids are frequently closed up. On the first day, a small lump, like a millet-seed, may be felt in each of the eleva- tions above noticed, distinguishing this eruption from all others. The pocks continue coming on during the first three eruptive days, and each pock runs its regular course; thus, those which first appeared are forming into scabs or drying off, whilst the others are suppurating. The drying off commonly takes place on or about the eighth or fourteenth day, accord- ing as the pustules may happen to be distinct or confluent. When the pustules have obtained their full development, they gener- ally burst, in mild cases emitting an opaque, watery discharge, which dries into a crust and falls off; whilst, in severe ones, we find a discharge of thick, yellowish matter, forming scabs and sores, which leave, on their healing, permanent marks or pits. Red stains, caused by increased vascu- lar action, always remain for a while after the eruption; but if no ulcera- tion has taken place, they disappear in process of time. In Confluent Smallpox, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course of the disease; the pain in the pit of the stomach and difficulty of breath- ing are more complained of, and in children the eruption is frequently preceded by convulsions and delirium ; the latter symptom, indeed is fre- quently present with adults, during the suppurative or secondary fever, which not uncommonly assumes a character akin to typhus, and sometimes carries off the patient on the eleventh day. All cases in which we have generally a deeply-rooted morbid constitutional taint to contend against, require the utmost skill of the experienced practitioner to ward off a fatal result. An extensive inflammatory blush of the face or trunk almost in- variably precedes the eruption in the confluent variety of smallpox. 542 ACUTE CONTAGIOUS DISEASES. Salivation, with soreness of the throat and small white ulcers or pus- tules on the tongue and in the upper part of the gullet, frequently declares itself in both forms of this disease, but more particularly in the confluent. Before we come to the medicines to be administered in the different stages of the disease, we may say a few words upon the general treatment of the patient. Cool and fresh air are our best auxiliaries, the emanations from the patient in this complaint being of a nature to react upon the organism, and warmth being calculated to increase its activity. So beneficial is cool air found in this malady, that taking a child to an open window when at- tacked Avith the convulsions, frequently present, will generally be found to afford immediate relief. Great cleanliness must also be observed, and the linen frequently changed. When the vesicles declare themselves, and begin to form into pustules, the room ought to be kept as dark as possible, to aid in preA'enting the risk of disfigurement, a precaution deducible from common experience, since Ave find that the parts of the frame exposed to the action of light are always those most strongly marked by the ravages of the disease. To aA'oid the pits, and consequent disfigurement left by this disease, many physicians have adopted a mask or plaster for the face, of different substances, such as gum, mucilage, calamine, etc. The application of collodion to the face, or of oil Avhen the collodion cannot be tolerated— has been found of service in preventing disfiguration from pock-marks, but the most successful of all means so far employed is that followed by physicians of the Regular Homoeopathic school. ALLOPATHIC TREATMENT. As there are no specific remedies for smallpox, its treatment will be palliative and supporting. If the person has not been vaccinated, this is the first thing to be done after exposure. Five or six points should be in- serted in each arm. It is good practice to resort to this in any one Avhether i vaccinated or not, at any time before the appearance of the eruption. It will mitigate, if not prevent the disease. Aside from this, the treatment is the same as in other continued fevers. The room should be large and well ventilated, and all unnecessary articles removed from it, that they may not be infected and act as conductors of the disease (fomites). car- pets, curtains, etc. The best disinfectant in this disease is Iodine. A couple of drams should be placed in the vessels which receive the sputa or other excretions, and three drams of the scales may be put in a chip- basket and hung over the patient's bed. If the room is not kept free from smell, the number of A'essels containing Iodine maybe increased, or a few scales may be vaporized by sprinkling them on a hot shovel. Carbolic Acid may be used with the Iodine by moistening one or two cloths, a little over a foot square, Avith a solution of Carbolic Acid in Ava- ter, and hanging them up in the room, and adding a quarter part of Car- bolic Acid to the Iodine in the vessels receiving the excretions. Chlorinated Lime and Labarraque's Solution, Quick Lime and Per- manganate of Potash in solution, are also useful disinfectants, and may be employed on account of cheapness. The nurse should, after waiting SMALLPOX. 543 on the patient, wash his hands in clear water with soap, and then wash them in a disinfectant fluid. Complete isolation is the only real safeguard against a spread of the disease. Destruction of clothing used about the patient, and in the sick- room, is necessary. During the invasion of the disease, the febrile movement may be lessened by frequent tepid sponging, cool drinks, such as cold water, lem- onade or orangeade, or cold barley or rice water. The Avriter favors full doses of Quinine, five to ten grains every four hours, until the fever is lessened, and if the pulse be bounding, strong and frequent, Tincture of Aconite may be given in doses of one drop ev- ery hour, to an adult, until tlie fever and pulse are comfortably reduced. Emetics and cathartics are not to be given, but constipation is to be relieved by injections of Avarm water, or the mildest laxatives. During the eruption, and before suppuration, the measures before mentioned are to be continued or not, according to the severity of the symptoms. Nausea and vomiting Avill be relieved by fh'e to ten grain doses of Bismuth, with fh-e grains of Oxalate of Cerium, or five-drop doses of Dilute Hydrocyanic Acid, or one drop-doses of Carbolic Acid or Creo- sote in water every hour, until relief follows. Cold or possibly heat ap- plied over the stomach will aid. Diarrhoea is to be relieved by Bismuth in ten to fifteen grain-doses in milk, with, if necessary, an opiate, as a desertspoonful of Paregoric or ten or fifteen drops of Laudanum. Restlessness and watchfulness will be relieA'ed by a grain of Opi- um, and one or tAvo grains of Extract of Hyoscyamus Acid, or twenty grains each of Hydrate of Chloral and Bromide of Potassium, given in solution with sugar, giA'en at bed time, This will insure a night's sleep It is to be expected that Dilute Hydrochloric in doses of ten to twenty drops, or Dilute Phosphoric Acid in doses of half a teaspoonful largely diluted in sweetened water, and taken three or four times in course of the day, as a drink, Avill proA'e beneficial, as it has done in other continued fevers. Systematic feeding should be begun in this stage and should consist largely of milk, eggs beat up with sugar and milk, or water (as directed in scarlet fever) strong beef tea or essence, poached eggs or cooked in the shell in hot (not boiling) water, toast, rice and water, simple farinaceous food may be given. The patient should be fed during this stage four times a day, and oftener if there is any appearance of the strength failing, when food, such as milk or eggs should be given at not longer intervals than four hours. Feeding is most important during the suppurative stage. Upon any appearance of exhaustion alcoholic stimulants should be given ; from one to three teaspoonsful of brandy or whisky may be given with three or four ounces of milk or egg and water, a couple of hours apart. If the symptoms of prostration increase the stimulant may need to be increased. It is beneficial when it renders the pulse fuller, slower, softer, and regular. 544 ACUTE CONTAGIOUS DISEASES. Complications require treatment appropriate to those diseases. Lo- cal treatment consists of measures to prevent the pitting and to relieve itching, Avhich becomes intolerable. For the former purpose the following have been found, in a degree, useful: Careful evacuation of the vesicles with a fine needle; it is a tedi- ous thing to do. Second, after rupture inserting into each vesicle a fine point of Nitrate of Silver. It is claimed to be most successful if done on the second day of the eruption. Third, the application of the Tincture of Iodine twice a day during the papular stage of the eruption. Fourth, exclusion of the light and air by means of a plaster. A mixture of Tan- nin and Iron is employed in cases in the N. Y. Hospitals. It produces a black mask. Coating the face with Olive Oil and dusting upon the oiled surface tAvice a day with equal parts of the Sub-Nitrate of Bismuth and prepared chalk. Pulverized Charcoal made into a paste Avith Olive Oil or Glycerine is a simple application and as effectual as any. Calamine is used in the same way as the pulverized charcoal. The application of Collodion once or twice daily with a camels' hair brush while the eruption is papular, is said to be successful. It should be begun when the eruption first appears, and acts by excluding the air and compressing the papule. The application of gutta-percha dissolved in Chloroform acts in the same way. These applications are made usually to the face only. The terrible itching is thought to be greatly relieved by smearing the pustules with cold cream, a mixture of equal parts, by bulk, of lime-water and Linseed or Olive Oil or a mixture of one part of the solution of the Subacetate of Lead to seven parts of Almond Oil. When the pustules burst they should be dusted and kept coated with Oxide of Zinc in powder, or mixed with pulverized starch. If fissures (cracks in the skin) and excoriations occur a mixture of Oxide of Zinc in Glycerine or Olive Oil two drams to the ounce should be made. Thorough vaccination at four or five points is an almost sure protection against smallpox and a certain protection against the disease proving fatal. Children should be vaccinated in infancy and revaccinated not later than six or eight years, and|still again before childhood passes. When epi- demics of smallpox occur all persons who have not been vaccinated within three or four years should be revaccinated. HOMOEOPATHIC TREATMENT. Aconitum may be required in the first, and early in the second stage; if the fever runs high, the thirst is excessh'e, the skin very hot and dry, the pulse quick, hard and full, and the breathing laborious and rapid. Aconite should also be resorted to as an intermediary remedy, at any stage of the disease, when distinctly indicated by symptoms of this de- scription. Dose: Six pills every tAvo to four hours. . Antimonium-tart., {Tartar Emetic) is well indicated in this disease, from the close analogy which the eruption it is capable of producing SMALLPOX. 545 bears to that of smallpox, and may, therefore, be also administered with advantage during all stages of the disease, unless some other remedies should be more urgently called for by the nature of the symptoms; this should be a constant remedy, tightness across the chest, perhaps attend- ed with nausea and vomiting or diarrhoea before the eruption is fully out and the existence of a hollow, sounding cough, with loud, mucus rat- tling, is an additional index for the employment of Antimonium-tartari- cum. Dose: Dissolve ten pills in two tablespoonsful of water, and give a teaspoonful of the solution every three hours, until amelioration or change. Chamomilla is sometimes of great service during the course of the disease in children, when the following distinctive symptoms appear:— difficulty of breathing, Avith predominant looseness of the bowels, deep green stools, severe colic, tenderness of the belly, and vomiting; it is like- wise calculated to be useful during the maturative stage, when much restlessness and whining prevail, and the rest is much disturbed by a troublesome cough at night. Dose: Four pills in a teaspoonful of water, every two hours. Belladonna.—This remedy may folloAV Aconite or Chamomilla, when either of the latter have been indicated, should symptoms of disturb- ance of the brain haA'e set in, characterized by flushed countenance, intolerance of the eyes for light, headache and delirium, great thirst, nausea and vomiting, or, when there is redness of the tongue at the tip and margins ; belly tumid and painful, particularly about the region of the stomach, Avith sensibility on pressure; prostration of strength and stupor. Dose: Of a solution of four pills to two tablespoonsful of water, give a teaspoonful every two hours. Opium is useful, when there are symptoms of stupor or strong inclina- tion to sleep ; it may be employed after Belladonna, or even preferred to the latter remedy, in cases in which there is continuous lethargy, with open mouth, half-closed eyes, and snoring breath; or again, when there is violent delirium, Avith incessant tossing about of the hands. Dose: Six pills carefully placed upon the back part of the tongue, every three hours until change. confluent smallpox. Aconite is indispensable when the fever runs high, and threatens to continue, as it usually does in this more malignant form of the disease; and it will be necessary to diverge even from other important considera- tions from time to time (having commenced with the administration of this remedy), to return to it for the purpose of effectually acquiring an ascendency over the fever. The alternate administration of Sulphur is often necessary Avhen the fever does not appear to be the least modified. within Iavo hours after a second dose of Aconite. Mercurius is highly serviceable in confluent smallpox, after the pre- vious administration of two doses of Aconite, as above directed, Avhenthe following symptoms predominate:—Inflammation of the eyes, soreness of the throat and nose, offensive breath (salivation), cough, hoarseness 35 .546 acute contagious diseases. tenderness of the stomach, excessive looseness of the bowels, particularly characterized by incessant, straining, and, sometimes, bloody evacuations. Dose: As for Chamomilla. Pulsatilla is highly useful in confluent smallpox, characterized by the presence of an efflorescence analogous to that of measles, before or du- ring the development of the eruption, especially Avhen nausea or vomit- ing, and marked aggravation towards night, additionally qualify the general symptoms. Dose: Six pills every two hours. Arsenicuai should be administered after the second dose of Pulsa- tilla, (or even of Antimonium-tart. or Ipecacuanha, in the event of nei- ther of the others having proved efficacious), when the nausea and vom- iting continue unallayed, especially if the patient complains of excessive thirst and dryness of the mouth, the tongue being foul and dark, and the prostration of strength severe. Arsenicum is also of great value in cases of a hard type, and Avhen livid spots are obserA'ed on the skin before the eruption is out, or when- other symptoms corresponding—the scabs are of a dark brown color and very offensive, more particularly if this manifestation be further charac- terized by intense weakness and languor, thirst, nausea, or vomiting, with more or less severe pain in the region of the stomach,—or, again, when the fever assumes a putrid typhoid character. Dose: Six pills every two hours. Carbo-veg. should be administered when the eruption assumes a gangrenous appearance; or when the pustules are thin and unhealthy, and the scabs and incrustations are of a dark-brown color, and emit a very offensive smell. Dose: As directed for Arsenicum. Actum-muriaticum may be employed with great advantage in cases of a bad type, in which the fever assumes a typhoid character, and when the patient exhibits a continual tendency to sink downwards (towards the foot) in bed. Dose: As for Arsenicum. China may be advantageously administered against the debility re- sulting from profuse diarrhoza or discharge from the pustules. Dose: Six pills every four hours. Sulphur is a useful remedy at the maturity of the eruption, and as the drying process is about to set in; it will often tend materially to forward the total disappearance of lingering traces of the disease, as Avell as to overcome any latent mischief which has been left to rankle in the system by this virulent disorder. The alternate administration of Rhus at this period will be required, if there be aching pains in the back and extremities, aggravated toAvards night, but someAvhat relieved by motion. Dose: Of Sulphur, singly, six pills (for adults), or for young per- sons four pills in a wineglassful of water every morning the first thing (fasting), continuing this course for a week ; if in alter- nation Avith Rhus, give three globules of either medicine in rotation the one six hours after the other, until amelioration or change. SMALLPOX. 547 CHECK OF THE ERUPTION. Bryonia, Antimonium-tart.—The administration of either of these remedies, according to special indications, will become requisite when the eruption is checked and the chest is more prominently affected. Dose: Of either remedy, six pills every two hours. MODIFIED SMALLPOX. VARIOLOID. This is merely a mild description of the above, and, as we have before said, is the form which the disease generally assumes when it attacks those who have been properly vaccinated. We must regulate our treat- ment according to the symptoms, being guided in the selection of the remedies by the indications before given. COMPLICATIONS AND AFTER-EFFECTS OF SMALLPOX. We should watch closely, during the progress of the disease, for symp- toms of "Inflammation of the Lungs," or of their enveloping membranes (pleurisy), and the treatment, in cases in which such complications occur, should be regulated according to the directions especially afforded under the head of those particular maladies respectively. BOILS, GLANDULAR SWELLINGS, ETC. Amongst the many severer after-effects of smallpox, we may number glandular swellings and other scrofulous affections, developed by the malignancy of the disease, inflammation of the eyes, boils, etc., which will be most effectually treated by reference to the separate articles de- voted to these subjects respectively. COUGH. In this respect the reader is recommended to refer to the separate arti- cle on this subject. ASTHMATIC AFFECTIONS. Antimonium-tart., is, in the generality of cases, the most available remedy in cases of this kind, resulting from the smallpox. Dose: Four pills night and morning, until amelioration or change. LOOSENESS OF THE BOWELS. China, Phosphorus.—China is, in the majority of cases, more avail- able when there has previously been excessive loss of animal fluids. especially if the symptoms assume an intermittent character. Dose: Six pills in a wineglassful of water daily, the first thing in the morning, until change. Phosphorus is especially adapted for the treatment of blond subjects or of a spare, slender habit of body and fragile frame, when this relaxa- tion continues any length of time. Dose: As directed for China. Diet and Regimen.—In these particulars we should be guided by the virulence of the attack ; but, in all instances, the beverages should be 548 ACUTE CONTAGIOUS DISEASES. cold, as a warm diet, and neglect of the precautions before mentioned may convert the mild into the malignant form. Whilst the fever runs high, water, or toast and water should alone be allowed; but when the affection is going off mildly nutritious food, such as lean meat, farinaceous food, cocoa, and plain broths, or beef tea, are allowable. In mild cases thin gruel or farinaceous food, in small quantities, may be allowedt throughout. Even after recovery in some cases, it is necessary tha the patient abstain, for a considerable time, from animal food in large quantity. It should not be omitted, that a plain, nutritious, and even generous diet, taken in small quantities at a time, and at regular periods (when there are no lingering after-effects), combined with regular habits in other respects, and with the bracing effects of the open air, tend greatly to per- fect the cure. The general regulations in respect of diet and regimen, which apply to other eruptive fevers, or to fevers in general, hold good with regard to smallpox. It may be remarked that, after recovery from an attack of malignant smallpox, the patient's constitution often requires a thorough renovation and that he should, therefore, be put under a course of medicine best cal- culated to attain that result. accessory measures. In severe cases, when the pustules are very troublesome, they may be anointed with Oil of Almonds, or gently sponged with tepid water, when they become hard,—or dusted with pure starch, when a thin, acrid, or otherwise unhealthy discharge runs from them. The hair of the head should be clipped, for the sake of the cleanliness and comfort of the pa- tient; and the hands should be muffled, to prevent injury to the pustules from scratching. CHICKEN-POCK. Symptoms.—A disease, bearing a considerable resemblance, in its ex- ternal character, to smallpox, but differing in its duration, and symp- tomatically, being considerably milder, generally requiring no medical assistance, but merely attention to diet, and but rarely becoming danger- ous, except when it extends itself to the lungs or brain. The fever, how- ever, occasionally runs high. When this affection attacks an individual, and smallpox is epidemic, which is not unfrequently the case, it is often mistaken for that disorder, but it soon discovers its real character, by the rapidity with which the eruption declared itself, the vesicles (in many instances closely resembling the pustules of the smallpox) being generally fully matured by the third day, and the whole eruption disappearing at the end of the fourth or fifth, without leaving any mark. HOMOEOPATHIC TREATMENT. Aconite is required when much fever is present. Dose: Of a solution of four pills to two tablespoonsful of water, give a teaspoonful every six hours, until amelioration or change. Coffea is to be preferred when extreme restlessness and anxiety are present without a great degree of fever. FEVER AND AGUE. 540 Dose: A solution of four pills, as directed for Aconite. Belladonna should be given if the brain become evidently affected. Dose: A solution of four pills, as directed for Aconite. Antimonium-tartaricum may be given to accelerate the develop- ment of the eruption, when it is slow in making its appearance. Dose: Dissolve six pills in two tablespoonsful of water, and give a teaspoonful of the solution every four hours, until the eruption is thoroughly evolved, and the fever subsides. Mercurius may be given, Avhen the watery secretion of the vesicles becomes converted into thick, yelloAvish matter, as in the smallpox, and is also beneficial, if strangury be present. Dose: Tavo pills in a teaspoonful of water, every four hours, until amelioration or change. CHECK OF THE ERUPTION. This should be treated as directed for smallpox under similar circum- stances, (see page 547 ). Cases, in Avhich this disorder appears with manifestations closely re- sembling many of those which characterize smallpox, may be similarly treated, according to the particular indications present. CHAPTER XXIX. EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. FEVER AND AGUE. INTERMITTENT FEVER. We have now to enter upon a class of fevers differing essentially from those already considered, in possessing a marked character of their own, in the simplicity of their form, the periodicity of the different stages, (although the periods of fever-fits are not, necessarily, regular), and the uncertainty of their duration; at the same time it maybe noticed that one of the distinctive features of intermittent fever consists in the fact that the febrile action does not individually constitute the disease, but appears rather as an occasional development of other morbid processes. Intermittent fevers cannot be better described than as a compound of acute and chronic disease; acute during the continuance of each attack, and chronic in the continuance of liability to the attacks. Symptoms. These must be classified in three distinctive stages; (1) a chill or cold fit (2) followed by heat, and terminating (3) in perspira- tion more or less profuse; these three stages constitute a paroxysm; after which, for a certain period, called the interval or respite, the patient is generally free from suffering. The fever-fits are characterized by the red deposit in the urine. 550 epidemic and endemic diseases. These periods are generally of definite duration ; but occasionally in- definite and irregular. If the paroxysms return at regular inter A-als of twenty-four hours, the fever is termed a i^notidian,—of forty-eight, a Ter- tian,—of seventy-two, a Quartan; eA'en longer intervals have been observed between the attacks, as that of seven days, which is somewhat inappro- priately termed an eight-day intermittent fever. If two fever-fits take place within each period, the ague is said to be doubled; as a double Quo- tidian, or Tertian, etc. These feA'ers are sometimes found existing in the simple form above noted; that is, that each fever-fit (as it occurs) assumes the character of simple fever; in other instances, hoAvever, the fever-fits, (as they occur) assume the characteristic features of inflammatory or typhoid fever, or of complications involving the respiratory or digest- ive functions respectively, etc., etc. The absence of continuity or regular process to a crisis Avill then identify the febrile symptoms as appertaining to this class in general, whereas the peculiar implication of particular or- gans will qualify the specific character of any particular variety. They are exceedingly indefinite in duration, and frequently assume a tediously chronic form. An individual once attacked with ague, is fre- quently liable to a return of it in after life, if the disease has not been radically extirpated in the first instance ; nay more, any attacks of dis- ease to which he may afterwards be subjected are peculiarly apt to assume the intermittent form. Ague is rarely dangerous in this country, except when of long con- tinuance, and then, oAving to the weakness Avhich it occasions, and the injury which it inflicts upon the constitution; it may, however, lead to obstructions and indurations of the more important organs, particularly of the liver and spleen, or may induce dropsical affections. It should not be omitted, however, that the sudden development of peculiar symptoms in connection with the fever-fits may be more or less ominous, and should be watched and treated with especial care. Some- times, however, intermittent fevers appear (as a wholesome crisis) in the last effort of the constitution to expel morbid humors which have long preyed upon the system ; and in such cases, if treated with due care by homoeopathic means (which will assist in their development), they will serve to carry off the causes of tedious chronic disorders. But in hot climates, or in low, marshy countries, this disease is ex- ceedingly fatal, in consequence of the brain and its tissues, the lining membrane of the stomach and bowels, the lungs, and the investing membrane of the stomach and bowels becoming affected: in such in- stances, when the disease gains ground, the patient loses strength and becomes emaciated, every fresh paroxysm entails an increase of suf- fering, and the perspiration fails to relieve; he complains of a sense of weight in the region under the false ribs, particularly the right, Avith griping pain in the bowels, flatulent distention of the belly, looseness of the bowels or constipation, and constant thirst; or of headache, cough, and shortness of breath; the tongue is furred, and dry at the tip; the skin hot, harsh, and dry; the urine scanty, the belly tumid, the extremities be- come dropsical, and sleep is restless or broken. INTERMITTENT FEVER. 551 Death may ensue from collapse in the cold stage, from the absence of perspiration, and from the disease passing into continued or remittent fever, or from disorganization of some important part, such as the brain, lungs, spleen, or liver. We shall now proceed to a general consideration of the three stages of the disease, premising that the various modifications of the symptoms will be found more in detail, under the medicaments, when we enter upon the consideration of the remedial treatment. PREMONITORY SYMPTOMS. Sense of languor, or general uneasiness; yawning, headache, stupor, pains in the limbs or back; the toes and fingers becoming numb, and the nails blue. 1. THE COLD STAGE (CONGESTIVE STAGE). Coldness of the extremities, with a feeling as of stream of cold water running down the back, and extending itself to the chest and belly; general prostration of strength, insupportable coldness, external and internal tre- mors, chattering of the teeth, respiration labored and hurried, with ina- bility to draAv a full inspiration, and oppression at the chest. The head is variously affected, sometimes with headache, at others with droAvsiness, stupor, or delirium; the pains noticed in the premonitory symptoms are generally present, and, in some instances, the patient complains of pain all over; the tongue is moist, the eyes are heavy and sunken, the features pinched, and the lips and cheeks livid; the rigors sometimes run on to convulsions. The pulse is weak and oppressed, sometimes sIoav, at others quick, and frequently intermitting, and often, from the severity of the rigors, scarcely perceptible. The heat of the body, except at the extremities, is generally above the natural standard, while the patient complains of cold. Sometimes the patient feels only a slight degree of cold, Avithout tre- mors, but accompanied with symptoms of functional derangement, and in a few hours the hot fit declares itself. The duration of the cold stage is from an hour to four hours; and it runs into the hot without any marked interval. 2. THE HOT STAGE. Presents all the characteristics of a modified inflammatory attack, with hot, dry skin, and thirst, oppression at the chest, hurried and anxious breathing, and acute pains in the head, regions of the spleen, liver, etc.; there is also occasionally a degree of disturbance about the brain, or even delirium. The general duration of the hot fit is from four to tAvelve hours, when it terminates in the sweating stage; when this does not take place, it is apt to run on to continuous fever, or take the form of a remittent,—a not uncommon issue of this disease in warm climates. 3. THE SWEATING STAGE. After the hot fit has continued a longer or shorter period, profuse perspiration sets in, commencing in the forehead and extremities, and >52 EPIDEMIC AND ENDEMIC DISEASES. quickly diffusing itself over the whole body; as soon as it makes its ap- pearance, the uneasiness and other symptoms begin to disappear, and the patient, in simple ague, continues free from suffering until the next paroxysm. Causes. Marshy districts are noted as being the hotbeds of this mal- ady; the presence of stagnant water in the immediate vicinity of dwel- lings will provoke it; as occasionally, also, conditions which will engender low typhus; the continued prevalence of epidemic disorders may also be cited amongst the causes of intermittent fever; a continuance of fish or farinaceous diet is also apt to produce it; it may, moreover, arise from taking cold, indigestion, internal obstructions, the presence of inactive humors which oppress particular organs, from peculiar constitutional ten- dency or the like, occasioned by acute diseases, or by difficult chronic af- fections, or even from purely local irritation. Nervous or inflammatory fever may change into an intermittent, or the latter take upon itself, if it continue, the character of either of the tAvo former, or become remittent; this frequently happens in hot cli- mates. METHOD OF TREATMENT, PECULIARLY ADAPTED TO INTERMITTENT AFFECTIONS. The medicines should generally be administered in the interval be- tween the paroxysms, but when these are extremely short, or when they are attended with after-pains of the preceding paroxysms, they should be administered when the sweats, or other concluding features of the attacks, begin to subside. ALLOPATHIC TREATMENT. The principles of treatment of Intermittent Fever may be briefly given as follows : When there is violent derangement of the functions of the bowels or in cases of long standing intermittents, it is well to begin treatment with a cathartic. In the former condition a healthy actionofthe bowels is to restore, and, in the latter case a cathartic unloads from the intestines and intes- tinal glands the accumulated diseased secretions and leave the intestinal tract, free and active to absorb the anti-malarial remedies. Two to four Compound Cathartic Pills, or such other laxatives as will move the bowels thoroughly without being severe, may be used equally as well. The calomel has no special application beyond its action as a cathartic. If, however, there is not time to move the bowels and get the system under the effect of the antimalarial remedies, time ought not to be lost by waiting for the action of a cathartic, but the specific treatment should be begun at once. An efficient cathartic for this purpose is five grains of Calomel with half a grain to a grain of Resin of Podophyllum, followed in six hours by a Seidlitz Powder or a tablespoonful of Citrate of Magne- sia or Castor Oil (the Oil mixed with an equal part of Glycerine and flavored with Oil of Cinnamon or Wintergreen). INTERMITTENT FEVER. 553 The remedies which act with complete certainty against this disease are the preparations of Peruvian Bark, preferably the Sulphate of Quin- ine. The system comes fully under the effect of Quinine in five or six hours after it is taken. It is a point in the proper treatment that suffi- cient of the remedy be given before five hours of the time of the next expected paroxysm, to thoroughly effect the system. To do this, a safe and effectual plan is to give ten (10) grains of the Sulphate of Quinine as soon as the feA'er of a paroxysm has passed and another dose of ten (10) grains six hours before the time of the next expected paroxysm. A better effect is obtained by giving Avith the Quinine on this plan an eighth to a quarter of a grain of Morphine. The Quinine may be given in black coffee, with chocolate and sugar, or liquorice and sugar. One of the nicest ways of giving Quinine is to envelop the powder in a moistened medicine wafer when it is easily swallowed. It may also be given in capsule or in Gelatine or Sugar Coated Pills. These pills should always be examined before purchasing, by cutting one of them open with a knife to see that the interior is fresh and soft. Quinine is most active Avhen given in solution. This is effected by adding to a mixture of Quinine and water a minim drop of Aromatic Sulphuric Acid or each grain of Quinine. If generally have the acidin excess as in the following prescription: Take of Sulphate of Quinine forty grains, Aromatic Sulphuric Acid one dram, water to make four ounces. Mix. Each tablespoonful contains five grains of Quinine. If this mixture is used chewing a little liquorice or chocolate until the mouth is well coated just before taking the mixture, will mask the taste of the Quinine. If taken in some of the previous ways the efficacy of the Quinine will be increased by a dose of Aromatic Sulphuric Acid two or three times as many drops as there were grains of Quinine taken diluted in sufficient sweetened water to make a pleasant drink. If sufficient Quinine is taken to produce a ringing of the ears before an expected paroxysm, that paroxysm will in all probability be prevented. Other plans of administering this drug are: in doses of three to five grains from two to four hours apart until the ringing of the ears (called cinchonism) is produced. It is also an effectual plan. The tendency of the disease is to recur at its regular periodical peri- ods—the third, fifth and seventh days. After a week has passed, the ten- dency of the disease, generally, is to return every seventh day until three or four septenary (seventh day) periods have passed. It is advis- able, therefore, to continue the use of the Quinine in daily quantities of three to five grains, until ten days have passed ; but on the seventh day, or late in the sixth day, a full dose of ten or fifteen grains should be taken and every seventh day thereafter until four septenary periods have passed. Even then it is not safe to abandon the use of-the remedy unless the patient has become strong and hearty. It should be remembered that the remedy is just as effective against the next seizure, if given during a paroxysm, as if given during the in- terval, so that if paroxysms occur with great frequency, no delay ought to be allowed before giving the remedy, but it should be given at once. 554 EPIDEMIC AND ENDEMIC DISEASES. If only five to tweh'e hours can elapse before an expected seizure, twenty grains of Quinine ought to be given in tAvo doses in the latter case, and fifteen or twenty grains in one dose in the former. Ten grains of Quinine possess a greater anti-periodic effect if given at one dose than twenty grains given in small doses at short intervals dur- ing the intervals betAveen paroxysms. Other preparations of Peruvian Bark are effecth'e, given in the same way, but less so than Quinine. Quinidia, Cinchonidia, Cinchonia, the two latter have the advantage of being cheaper than Quinine. The pre- cipitated Extract of Bark given in double the quantities of Quinine is also efficient, and is very cheap. The Cincho-Quinine is also an effectual remedy, is less bitter than Quinine, and costs about one-third less. The impure alkaloid is comparatively tasteless, especially when mixed in three-fifths its quantity of Tannin—sugar may be added—and taken in powder, dry on the tongue, and swalloAved with a drink of water. All these preparations, not taken in solution, should be followed by a dose of Aromatic Sulphuric Acid, as directed above under the directions for Quinine. When a tonic effect of Bark is needed, the other preparations are generally to be preferred to Quinine. The dose for this purpose is gen- erally two grains three times a day. In case they are used in this way, it is generally advisable to give an anti-periodic dose of Quinine at the weekly periods, as before mentioned. In all cases where ague has existed for some time, the blood has be- come impoverished, of poor quality—the patient is anaemic, and requires the use of Iron. It is aA'isable to give it in connection with tonic doses of some of the preparations of Bark. The Citrate of Iron and Quinine or Cinchonidia, in doses of from three to five grains, generally meets the required indication. The Sulphate of Cinchonia may be given in pill Avith Iron, as follows : Take of Sulphate of Cinchonia a dram, Reduced Iron half a dram. Make into thirty pills. Take one three times a day. The other Alkaloids of Bark, and the Precipitated Extract of Bark may be used instead of the Sulphate of Cinchonia. Other Salts of Iron, as the Dried Sulphate of Iron, may be used in- stead of the Reduced Iron. The Muriate Tincture of Iron is one of the best preparations of Iron in these cases In doses of fifteen or twenty drops given in sweetened water three times a day, or other preparations of Iron may be used alone, in which case the tonic doses of the preparations of Bark should be given separately. In some cases I have found the Ci- trate of Iron and Strychnine in doses of two or three grains three times a day, a most useful tonic. Other medicines sometimes have to be resorted to in the cure of ague, from force of circumstances, or other causes. The one most useful after the preparations of bark is Arsenic. The most eligible form for giving this remedy, is in Fowler's Solution. It is not very suitable as a sole remedy against Ague, but if given for this pur- pose, the dose is ten or fifteen drops in water, three times a day after meals, when given as the sole cure for Ague. Puffiness of the eye lids INTERMITTENT FEVER. 555 and watering of the eyes may be disregarded, if the stomach or bowels do not become disordered, after a feAV days—three to five, according to the susceptibility of the patient—the dose should be decreased by two drops each day, until a dose of two drops is reached. The most important part which Arsenic plays in the cure of intermit- tents, is in the cure of chronic malarial infections, and to prevent relapses, when the paroxysms are broken up by the preparations of bark. For this purpose it is often combined Avith Tonic doses of Bark and Iron, as in the folIoAving: Take of Quinine a dram, Vallet's Mess of the Carbonate of Iron, Arsenious Acid one grain. Make into thirty pills according to art. It is advised, hoAvever, that the Arsenic be ahvays giA'en seperately in the form of Fowler's Solution, (because it may be necessary to suspend its use for a time, when the other Tonics ought to be continued; another reason, the Arsenious Acid may not be properly mixed in the mass, on account of unskillful druggist's, and, serious consequences might follow), and Iron and Tonic doses of Bark given, also, seperately. The dose of Fowler's So- lution for this purpose, is three to six drops after meals, upon puffiness, or watering of the eyes, or derangement of the stomach or bowels occurring, its use ought to be suspended for tAvo or three days, (until these symptoms disappear), and then began again. Full doses of Quinine should be given at the septenary periods as before directed. The Sulphate, or Muriate of Berberina and Hydrastis, probably rank next to the preparations of Bark, in the cure of intermittents. The dose of Berberina is fifteen to twenty grains given in Capsules, Medicine wafers of pills on the same plan as directed for Quinine, or in five grain doses every three hours, until tAventy grains are taken. Hydrastia, which is really a Mu- riate of Berberia, may be given in the same way. It may be combined with Iron in pill. Salaciu (Alkaloid of Wilhrw Bark), is sometimes successfu in arresting the paroxysms. Thirty to forty grains should be given in the intervals. Eight or ten teaspoonsful (even), of common Salt, taken with intermission, will often arrest the disease. Ten drops of Nitric Acid in a glass of sugar and water taken every six hours, will sometimes succeed The Hydrochlorate of Ammonia a dram between paroxysms, will often arrest the disease. The Carbagolate (picrate), of Ammonia in doses of a quarter to half a grain in pill three times a day, is an old remedy which often succeeds. Just previous to an expected paroxysm a hypodermic injection of a quarter of a grain of Morphine will often arrest or mitigate it. A full dose of Opium by the mouth is in a less degree efficacious. During the hot stage cold drinks and cold bathing may be freely in- dulged in. If any medicines are needed in this stage a half a drop to a drop of Tincture of Aconite may be given every half hour until the pulse and fever is reduced, when its administration should be stopped. Taking the bed before the expected chill, covering the body and keeping it warm with hot bottles has warded off " the chill." A teaspoonful of Chloro- form swallowed with mucilage or syrup has prevented the paroxysm. The difficulty of effecting a cure, especially in chronic cases, is experi- enced by the patient remaining in the malarious district where he is con- stantly receiving additional doses of the poison. So that sometimes it is 556 EPIDEMIC AND ENDEMIC DISEASES. necessary for the patient to remove to a locality where malaria is un- known. The best preventive of ague, aside from removal from the malarious district, is frequent doses of Quinine from daily to twice a Aveek of two to five grains each, and the use of iron to OA'ercome the anaemia. The pre- judice against taking Quinine for a long time, for fear of injury, is wholly without foundation. Poisoning by malaria is most apt to occur in the eAening, night, and early morning. It is obvious, then, that remaining in the house during these parts of the day is advisable, preferably in an upper room (it is pro- bable that the poison does not rise as high as the second story of a house which is high —10 or 12 feet betAveen joists.) It is also claimed that if the open doors and windows are closed Avith fine muslin screens from sunset until the dew is off' in the morning the occupants of the house are in no danger—the poison cannot pass through these screens. The enlarged spleen from ague, will generally yield to the remedies which cure the ague. This difficulty is treated of in diseases of the spleen (Chap. XV). The ointment of the Red Iodide of Mercury seems particu- larly applicable in cases of chronic enlargement. A Belladonna plaster worn.over the side generally relieves the pain materially. The anaemia and dropsy occasioned by chronic ague will be relieved by the tonic treatment recommended to prevent relapses. In pernicious (congestive or sinking chills) intermittent, no time should be lost in giving an anti-periodic, and nothing but Quinine is to be relied on. Twenty grains should be given at once, by the mouth, or forty grains by injection into the rectum. The dose should be repeated every five hours during the intervals, unless marked Cinchonism (ringing of the ears) is produced. This effect has, in some instances been kept un- der this effect of the remedy for a long time subsequent; subsequent doses after the patient merges from the paroxysm, will vary from ten to twenty grains. The hypodermic injection of Quinine is sometimes necessary here. From five to ten grains may be given at a dose. Take of Sulphate of Quinine a dram, Sulphate of Morphine a <:rain, Dilute Sulphuric Acid forty minims, Water one ounce. Mix and filter. A dram contains seven and a half grains. The dose may be repeated, given in this way, in half the time given by the mouth or bowel. Excessive Cinchonism is not necessary, but promptness and intelli- gent boldness are necessary for success. Large doses must be given for a longer period than for the milder disease, but the treatment is governed by the same principles. HOMOEOPATHIC TREATMENT. In the treatmnt of Ague, the type, although by no means to be held as unimportant, is yet of very secondary consideration to the other features of the malady. PARTICULAR INDICATIONS. For the use of Remedies generally called for in Ague. China or Quinine.—This well-known but too frequently abused remedy is undoubtedly of great efficacy in those fevers which owe their INTERMITTENT FEVER. 557 origin to the influence of marsh miasm, and are peculiarly prevalent at particular seasons of the year. It may be given when the fever com- mences Avith a sense of languor or general uneasiness of the heart, anxi- ety, headache, sneezing, great thirst, craA'ing hunger or nausea, and pain in the bowels. It is also indicated Avhen the feA'er has set in with absence of natural thirst—during the cold stage—but thirst is experienced after the heat and during the sweating, or thirst between the hot and the cold stage, and when the chill and fever are followed by a copious sweat. It is contra-indicated when thirst exists during the hot stage. Turgidity of the veins, Avith heat in the head, and natural Avarmth or increased heat of the body, with or without increased heat of the surface. Or, again, deter- mination of blood to the head, commonly with redness and heat in the face, with chilliness of all the other parts of the body, and even external coldness, or only a feeling of internal heat in the face, with coldness of the cheeks to the touch, and cold sweat on the forehead, are further indi- cations for the employment of this remedy. In many cases, China, although not capable of effecting a radical cure, is yet of great utility as a palliative; it should, under such circumstances, be exhibited immedi- ately before the cold stage. In such instances, the consecutive treatment Bhould be adapted to the remaining or supervening symptoms. Dose: Of China. Four drops in a teaspoonful of Avater every hour in the interval between the fever-fits—the same dose being repeated as long as the symptoms occur in like manner. When directly spe- cific, however, a single dose of this medicine will generally remove the fever. Of Quinine. One grain in the same intervals. Lobelia-inflata.—This remedy promises to be of equal efficiency with China in the treatment of ague, and may be particularly selected, in many instances, even in preference to China; but in the majority of cases which appear to indicate the latter remedy, when that, however, has been productive of only temporary relief, and particularly when derangement or foulness of the stomach is present. Dose: Of a solution of ten pills to four tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change; or a dose in the like proportions two hours before the anticipated return of the attack. Arsenicum is one of the most important remedies in intermittent fevers. It is indicated when the different stages are not definitely marked, but the fever and heat and shivering appear simultaneously—or when we find cold shuddering alternately with heat, or a sensation of cold in- ternally, with heat, or an imperfect development of the paroxysms; or burning heat, as if molten lead were coursing through the veins, commu- nicating an unpleasant sensation of heat to the hand, when placed upon the body of the patient; great restlessness; excessive, almost insatiable thirst, obliging the sufferer to drink constantly, although but little at a time; depression, marked prostration of strength and anxiety; nausea, de- sire to vomit, retching, and even vomiting; severe and burning pains in the stomach, and insupportable pains all over the body, especially in the limbs. One marked characteristic of Arsenicum is, that all the suf- ferings of the patient, pains in the limbs, etc., increase in intensity during the paroxysm, and others develop themselves; another is, its marked 558 EPIDEMIC AND ENDEMIC DISEASES. periodicity, generally either Tertian or Quartan, and the rigors gener- ally setting in towards evening. It is therefore called for in these cases, Avhere we meet with a well-marked periodicity of imperfectly devel- oped paroxysms, with some or any of the symptoms above mentioned. It is the remedy when large doses of Quinine have been used with no good result. Dose: Six pills in a tablespoonful of water, administer during the in- terval between the fever-fits, three doses, as often as they continue to recur. Or in cases of the continuance of the cold fit, or of ex- haustion so severe that the patient is unable to rally, even during the intervals,—of a solution of twelve globules to three tablespoons- ful of Avater, give a teaspoonful at intervals varying from a quarter of an hour to two hours, according to the severity of the case, doubling the intervals, or suspending treatment as soon as reaction sets in. The 30th potency is best. Ipecacuanha is usefully employed in the majority of cases of marsh fever, at some stage of the disorder, especially in the earlier periods. Some instances occur in which it is sufficient of itself to effect a cure ; in other instances it is most successfully followed by other and appropriate remedies, or coupled with Nux-v. in particular. It is indicated by the following symptoms: much shivering, with but little heat, or vice versa; increase of the shivering by external warmth; oppression at the forepart of the chest; want of natural thirst, or at least, little thirst; dryness of the mouth, nausea, vomiting, and other symptoms of deranged digestion. Dose: As directed for Lobelia. Nux-vomica is especially indicated by excessive weakness at the commencement of the fever; the shuddering mixed with or immediately followed by heat; warmth of the cheeks, with internal chilliness ; feel- ing of heat in the face, with shuddering in the remaining parts of the body ; heat in the head, with coldness of the body; burning pain in the eyes; or, giddiness, Avith feeling in the head as if from intoxication, de- sire to lie down, with trembling of the limbs; fainting, or a sensation of paralytic Aveakness and prostration, with cramps in the different extrem- ities, particularly the calves of the legs and feet; difficulty of breathing, palpitation of the heart, anxiety, irascibility, fear of death, and even vi- olent delirium ; derangements of the alimentary organs, such as want of appetite; dislike to bread; bitter and sour eructations, tension of the bel- ly or spasms of the muscles in that region, and constipation; burning, itching miliary eruption, and burning itching sensations over the whole body. Ihiring the fever: coldness and blueness of the skin, desire to be constantly covered, even during the access of heat and perspiration ; oc- casionally stitches in the side, shooting pains in the belly, aching in the back and limbs, and dragging pain in the belly during the rigors. During the hot fit particularly : headache, buzzing in the ears, beat in the head or face, with redness of the cheeks, and thirst. Dose: As for Lobelia. Pulsatilla, like the tAvo medicines last mentioned, is an excellent remedy in Agues complicated with the stomach or bilious symptoms, av hen ever the slightest attack of indigestion brings on a relapse. It" more peculiar indications are vomiting of phlegm at the commence- intermittent fever. .559 rrient of the cold stage; want of natural thirst, all through the fever, —or thirst, only during the hot fit; simultaneous heat and shivering— aggravated in tlie afternoon or towards evening; shivering when un- covered ; anxiety and oppression of the chest during the shivering. During the hot stage, redness and swelling of the face, or redness of the cheeks only, and prespiration on the face. The presence of diarrhoea, and the patient being of a mild disposition, are corroborative indica- tions for its employment. Dose: Six pills every four hours. Antimonium-crudum . The indications for this remedy closely re- sesemble those of Pulsatilla, but it is particularly called for, when the perspiration breaks out simultaneously with the access of heat and then sud- denly disappears leaving the skin dry and hot. Dose: Four globules in a teaspoonful of water, as directed for Pulsa- tilla. Belladonna. SeA'ere headache, with giddiness, or heat and redness of the face, pulsation of the large blood-vessels of the neck, and excess- ive aggravation of pain from meditation ; partial shivering and shudder- ing, with heat in other parts ; great heat with slight shivering; or violent shivering with moderate heat; absence of natural thirst, or, on the con- trary, intense thirst; extreme susceptibility, tearfulness, or depression of spirits, and desire for death, particularly when the sufferings are at their height. Dose; Four pills in a teaspoonful of water every three hours during the first interval which occurs after treatment has been undertaken and afterwards at lengthening intervals. Ignatia is indicated, Avhen, with heat of some parts of the body, there is coldness, chill, and shuddering of others; also where the heat is only external. Its best characteristic is, when the chills are easily re- lieved by external warmth, and, attended, with thirst. Dose: As for Bryonia. Apis. Violent headache, amounting almost to unconsciousness ; pain in the limbs and all over the body, thirst more during the heat; sensitiv- ness at the pit of the stomach; scanty urine and swollen feet. Chill about 4 p. M. Dose: As directed for Ignitia. Natrum-m. is especially advantageous, for cases which have been mismanaged with excessive doses of Bark or Quinine, particularly as fol- lows:--Ague-fits, commencing with headache, general aching pains, pre- dominant or prolonged shh'ering, great thirst during the hot-fit, and nearly to the same extent during the cold stage; also dryness of the mouth and tongue; tenderness of the pit of the stomach to the touch ; bitter taste and loss of appetite; debility; saliow complexion; soreness of the corners of the mouth. Dose: Six pills in a teaspoonful of Avater every four hours, the first interval after treatment is undertaken, and three hours before the return of every attack, until amelioration or change; and after- ward at longer and longer intervals. 560 epidemic and endemic diseases. Carbo-ategetabilis is particularly indicated, when throbbing at the temples, aching in the teeth, and in the bones of the extremities, and the coldness of the feet precede the paroxysm ; Avhen thirst is present only during the shh'erings, and there are rheumatic pains in tbe teeth or limbs before or during the attack ; or nausea, giddiness, and redness of the face during the hot-fit; further, Avhen an intense, burning pain, oc- cupying the prominent part of the forehead and the eye on the right side accompanies the fever. Where Quinine has failed, this is another excellent remedy. Dose: As for Natrum. INFLAMMATORY FEVER. SYNOCHIA. Diagnosis.— Rigors (chills) — generally considerable—folloAved by burning heat; pulse strong, hard, and greatly accelerated ; dryness of the skin, mouth, lips, and tongue ; the latter generally of a bright red, in some cases slightly coated with Avhite; thirst; urine red and scanty; con- stipation; respiration hurried in accordance Avith the pulse; amelioration of symptoms as the pulse assumes a more normal state. Tt runs its course with rapidity, rarely exceeding fourteen days, and progressing Avith regu- larity to a crisis, Avhich shows itself in profuse perspirations, diarrhoea or hemorrhage, principally epistaxis (nose bleeding.) The period mentioned is its ordinary period of duration, but under careful treatment the perfect crisis is considerably hastened and Avithout the long conA'alesence entailed by the usual heroic antiphlogistic treatment. It is peculiarly apt, if not carefully treated, to change to typhus, or, by mestastasis, to fix upon some important organ. Causes.—Sudden chill, or check of perspiration, exposure to Avet or damp winds, or dry, easterly Avinds, violent emotions such as grief, joy, anger, etc., high lh'ing, external injury, local inflammations, and from slight attacks of feA'er mismanaged. Individuals of what is termed a plethoric habit are particularly sub- ject to this disease; it mostly attacks betAveen the ages of fifteen and thirty years. Under diagnosis Ave have just now given the symptoms usually present in Synochia; we, hoAvever, find it complicated in many cases Avith cerebral (brain) disturbance which you will find more fully considered under In- flammation of the Brain. HOMOEOPATHIC TREATMENT. When the symptoms aboA'e described are present give at once a dose of Aconite, every two to six hours according to the intensity of the fever. The pulse should be carefully Avatched and also the appearance, first, of simple moisture of the skin, and aftenvard, of copious sweating, Avhich generally takes place after a few doses of Aconite. The intervals between the doses must be lengthened as soon as this favorable change takes place. INFLAMMATORY FEA'ER. 561 A slight degree of delirium is frequently present in this affection, chiefly at night, Avhich—unless it threatens to run on to inflammation of the brain, in which case Belladonna must be given—Aconite of itself is suffi- cient to subdue. When, however, during the course of the disease, other important symptoms besides those mentioned develop themselves, differ- ent remedies such as Bell., Bry., etc., must be given. Belladonna is especially useful after the previous employment of Aconite ; but it may also be employed at the commencement of the attack in all cases Avhere the cerebral (brain) system seems most prominently affected, and there is great heat in the head, with violent headache, parti- cularly in the forehead, and redness of the face; distention of the arteries of the temples; nocturnal sleeplessness, with furious delirium; eyes red, shining and fiery; general internal and external heat; burning thirstand agonizing restlessness. Bryonia.—When the state of excitement is chiefly confined to the organs of the chest (thoracic viscera) or Avhen there is gastric complica- tion and the fever inclines to degenerate into typhus. This medicine is accordingly indicated Avhen, in addition to the usual symptoms of inflammatory fever already given, Ave find a heavy, stupe- fying headache, with a sensation as if the head would burst at the tem- ples, much aggravated by movement, vertigo and giddiness on rising up or moving, burning heat of the head and face, with redness and swelling of the latter; delirium; oppression at the pit of the stomach; excessive thirst, sometimes followed by vomiting; constipation; aching or shooting pains in the limbs, short cough, oppression of the chest, and laborious breathing. A dose every three to six hours, according to the urgency of the symptoms. Cantharis is good in irritative fever, especially Avhen the following symptoms are developed : the fever is very intense during the night, and is accompanied by burning of the skin, strong accelerated pulse, general redness of the surface, dryness of the mouth, and A'iolent thirst. Fur- ther, when pains are complained of in the right side of the body, at- tended with great anxiety and raving. Chamomilla is best when the attack is brought on by a fit of anger or vexation; present burning heat and bright redness of the cheeks, tremulous, anxious, palpitation of the heart, extreme irritability of tem- per, and over-sensibility of the senses, alternate chill and heat and some- times spasmodic attacks. A dose or two of Aconite is generally needed in the beginning. When inflammatory fever seems to arise from a primary inflamma- tion of some important organ, such as head, lungs, liver, stomach or bow- els, the appropriate treatment will be found under the title " Inflamma- tion of Head, Lungs, Liver," etc. Bryokia is indicated by headache and giddiness, with dry heat pre- ceding the attacks of shivering; by the predominance of cold or shiver- ing, with redness of the cheeks, heat in the head, and headache; or marked heat, followed by shivering; by stitches in the side, excessive 3^ 562 EPIDEMIC AND ENDEMIC DISEASES. thirst, thickly coated tongue, bitter taste in the mouth, disgust at the sight of food, nausea or vomiting, and constipation, especially in cases oc" curring in the spring. Dose: Six pills in a tablespoonful of water every morning, or as nearly at that period as possible, during the interval between the at- tacks. -----**m*----- TYPHOID FEVER. TYPHUS. Enteric Fever. Typhus occurs in tAvo forms that do not differ much from each other, namely : abdominal typhus and exanthematic typhus. More recently _ this last-named form has become much less frequent than the former. In spite of these differences, the etiology of both forms is pretty much the same; up to this period we have not succeeded in discovering the reasons for the appearance of either one or the other form. Typhus originates in some infectious agent; all that is known of this agent is: that it is caused by the decomposition of animal substances. Hence, typhus occurs most frequently where the decomposition of ani- mal matter is most favored by circumstances, namely: in large cities and hospitals ; likewise in localities which are least favorably situated for carrying away the products of decomposition, such as cities built in a flat country and with imperfect drainage. The infectious principle at times seems to act with great intensity ; at other times very mildly, so that ty- phus in crowded localities sometimes breaks out with an extraordinary virulence; and other times with comparative mildness. According to all probability, a graduated difference of this kind is chiefly owing to the quantity of the infectious agent that acts upon the organism, not to its quality. The contagion is reproduced by the patient. We cannot share the views which prevail concerning the formation of a contagion. We do not consider any form of typhus contagious. An apparently conta- gious transmission of typhus only takes place among those who have been for some time exposed to the emanations from the infected individ- ual, not among those who have only been in contact with the patient for a short period of time. These remarks apply to exanthematic typhus which is considered as decidedly contagious, but which only appears so for the reason that it produces a larger quantity and a more infectious quality of contagious matter. Physicians in private practice are seldom attacked, notwithstanding they are brought in closest contact with the patients when exploring their chests ; hopital-physicians and nurses, on the contrary, are taken down very often. More recently the level of the surface-water has been more particularly examined with reference to ty- phus and cholera ; a high level is supposed to favor the breaking out of these plagues. We are still without any reliable data in this respect. In large cities the construction of wells and Avater-closets deserves great at- tention ; where both are so close together that the well-water can be con- taminated by the contents of the closets, typhus is very likely to occur. TYPHOID FEVER. 563 This subject is, without doubt, worthy the most serious attention of the Board of Health, for typhus is not only one of the most dangerous, but likewise, one of the most frequent diseases. A few points can easily be inferred from what Ave have said, such as : epidemic and endemic, slightly endemic and sporadic type of typhus; breaking out of typhus in A'ery damp and hot years, during the hot months of the summer and in the fall; likewise in crowded hospitals, more particularly if they are full of wounded soldiers ; or in densely pop- ulated streets, tenement-houses, on ship-board, etc. Typhus occasioned by an insufficient supply of food, or by unwholesome and deteriorated food, is less easily accounted for. One attack of typhus does not always, but very generally, protect against a second attack. There are certain other circumstances that al- most positively preclude the possibility of typhus, especially abdominal typhus; these are: Intermittent fever, consumption, cancer, heart-dis- ease of the higher grade. Age does not establish any posith'e lines of demarcation; except infants, persons of any age may be attacked, but more particularly young people and individuals up to the age of fifty. Vigorous constitutions are more easily attacked and likewise more severely. Exciting causes are: Fear and anxiety; a sudden change of die*, when persons settle in a locality where typhus is endemic ; catarrh of the intestines; mental depression, both by excessive mental labor as well as by care and grief. Symptoms and Course.—We deem it unnecessary to analyze the pathological anatomy of typhus, for the reason that the prominent post- mortem phenomena scarcely ever correspond Avith definite groups of symptoms in the phenomenal totality of the disease. Hence, we confine ourselves to a feAV more important data In abdominal typhus the ulcers in the intestines act the most important part; they have even given rise to the name of this form of the disease. HoAvever, it behooves us to pre- mise the statement that in their various phases these ulcers do not corres- pond Avith definite phases in the total course of the disease. Except these two almost constant phenomena, typhus does not offer any permanent, characteristic signs. The brain, especially, remains un- altered • the lungs, on the contrary, sIioav at first symptoms of irritation ; afterwards pneumonia. During the first weeks of the disease the mus- cles have a someAvhat characteristically dark color, and the internal surface of the arteries has likewise a dark-red appearance. In exanthem- atic typhus the intestinal ulceration does not exist, whereas in this form likewise the spleen is considerably hypertrophied and softened and the vessels also have a bright appearance as if injected. Abdominal typhus very rarely breaks out suddenly ; it is generally preceded for a few days or even a Aveek by indefinite symptoms, such as lassitude, indisposition to work, loss of spirits, impaired appetite, very seldom hunger almost bordering upon a voracious desire for food ; wan- dering rheumatoid pains in the limbs, especially in the back, headache of the indeterminate type, sleep full of dreams. 564 EPIDEMIC AND ENDEMIC DISEASES. The disease is generally ushered in by a chill of moderate vio- lence, or by a marked fainting' sensation which is soon folloAved by the characteristic feeling of illness, namely: an inability to stand erect or move about, and a desire to lie doAvn. Very seldom one of these conditions is entirely wanting, so that it is difficult to point out the real beginning of the disease ; instead of one severe chill Ave often meet Avith a succession of very feeble chills. The disease noAv de- velops itself in the following manner : The patients feel weak, have nei- ther the strength nor the desire to rise from their beds ; headache, at times more frontal; and at other times, in the more violent cases, in the occiput, throbbing and very distressing; complete loss of appetite; al- tered, generally pasty taste; vomiting not very frequent; bowels quite torpid in the first week ; restless sleep; when waking early in the morn- ing, the patients commence very soon to complain of phantasms which they cannot avoid ; yet they talk very rationally and are perfectly con- scious of seeing phantasms. The pulse is generally full, very seldom ex- ceeding one hundred beats, very often dicrotic (double, or rebounding), the temperature is high, the skin feels burning hot. The breathing is almost constantly hurried, anxious, the patient talks hurriedly, yet is able to take a long breath. The spleen is generally swollen, the swelling in- creasing rapidly in size, and is not unfrequently painful. The abdomen does not show any constant alterations, but when pressed upon, the pa- tients complain of pain in this region, and a gurgling sensation is com- municated to the finger, with which the pressure is made. The tongue is at times coated very thickly, at other times it only has a whitish coating, and again it looks quite clean, but the coating changes as the disease pro- gresses. Sometimes the patients complain of a little hacking cough, and exhibit symptoms of a slight bronchial catarrh. The urine is less in quantity, saturated, notwithstanding that the patients often experience a very violent thirst. All these symptoms remain in force only in very vi- olent cases; most generally a sensible remission of these symptoms takes place towards the end of the first week. Second week.—In the second week the symptoms of the disease un- dergo a marked change, unless the morbid process takes a turn toAvards recovery, which is very seldom the case. For the present, we only speak of typhus of a moderately severe type. In this stage, the patients lose their consciousness more and more ; they are either lying in a state of lethargic apathy, or else it is only with great difficulty that they are able to reply to questions or to give utterance to their OAvn ideas. In the eve- ning and during the night this soporous prostration is generally inter- rupted by a state of nervous exultation, during which the patients mani- fest their internal nervousness by animated talking or by a constant en- deavor to escape from their beds. Sensations of pain now cease entirely; when asked how they feel, they answer: " Quite well; " they express no desire for drink, but they swallow the offered beverage hurriedly and greedily; when repeatedly asked to do so, they put out their tongues slowly and tremulously, and forget to draAV them in again. Another evidence that the influence of,the brain is almost entirely suspended is, that the patients persevere for a long time in an uncom- Typhoid fearer. 565 fortable position, and that they allow the urine and faeces to dsCape into their beds. At the beginning of the second, and very frequently already at the end of the first Aveek, the patients complain of a violent buzzing in the ears, afterwards they are evidently hard of hearing. Corresponding with these changes, the countenances of the patients become altered. Al- though the complexion seems to shine, yet it has a livid hue ; the eyes stare, or they have a vague and unsteady expression ; when raised in their beds, the patients at once turn pale and look as if they would faint. The various functions show the folIoAving deviations from their normal con- dition : The pulse is seldom beloAV 100, nor is it often above 120, it is Aveaker than usual and sometimes dicrotic. The tongue, which already showed a good deal of dryness in the first Aveek, now is constantly dry ; the streaked coating, Avhich had marked it hitherto, now vanishes; it shows a peculiarly red color, and the papillae seem to have become ef- faced ; toAvards the end of the second Aveek the the tongue appears cov- ered Avith a brownish incrustation. The appetite is entirely wanting, yet the patients Avill taste of what they are offered to eat. They do not seem thirsty, yet they drink greedily the proffered beverage. At this stage the abdomen begins to bloat quite considerably; when the ilio- coecal region is pressed upon A'ery hard, the patients distort the corners of their mouths. Diarrhoea now usually sets in, from four to eight pas- sages taking place iriA'oluntarily every day. They have a yellowish color, deposit a sediment of thick consistence over Avhich floats a watery, opa- lescent substance. The urine is secreted in smaller quantities, it is dark and is frequently voided involuntarily ; sometimes it is retained alto- gether, so that the bladder becomes very much distended. The respira- tion is still accelerated, yet the peculiar hurried breathing of the first week is scarcely yet perceived ; catarrhal symptoms are likewise discov- ered, although the patients scarcely ever cough and only rarely brings up a tenacious, yellowish mucus. The spleen continues to enlarge, although oAving to the distention of the bowels, and the consequent displacement of the spleen upAvards, the enlargement cannot well be discovered by ex- amination. Upon the abdomen, thorax and back, roseola-spots break out in greater or less number, some of which are usually present at the end of the first week. About the middle of the second week all these symptoms generally show an increase, less frequently a remission ; both the increase and the remission are, however, of short duration. Third Week. In the third week, especially at the commencement, the symptoms continue to increase in intensity. The patients are now lying in a state of complete apathy; in the day-time they are only slight- ly delirious, but during the night the nervous exaltation is much worse, attended with grasping at flocks. The prostration is so great that the patients are no longer able to sit erect; they are constantly lying on their backs, and the body, yielding to the law of gravitation, settles from the pillow downwards towards the middle of the bed. The tongue is only slowly protruded after loud and repeated requests; it is quite dry, with a brownish coating which is likewise exhibited on the teeth and at the 566 EIMDEM1C AND ENDKMIC DISEASKS. nostrils. Deglutition is very difficult, and it is only Avith a great effort that the patient is able to sAvallow very small quantities of liquid at one time. The diarrhoea continues, but the passages are generally less eopi- ous, and not unfrequently tinged with blood. The urinary secretions continue to decrease and paralysis of the bladder is not an unfrequent occurrence. The abdomen is greatly distended and is.no longer sensitive to pressure. The other symptoms continue unchanged, except that the roseola-spots pale off and become complicated with miliaria (measle-like) and sometimes with ecchymoses (black-like bruised place). Bedsores are now very apt to torment the patient. Emaciation proceeds A'ery rapidly and the whole appearance is that of a general collapse. Up to the middle of the third week, the fever maintains its intensity. In cases where the disease continues during the fourth Aveek no remission of the fever is perceptible. In most cases, however, the seventeenth day is characterized by a sudden abatement of the fever and of most of the other derangement of the functions. This improvement at times is only apparent, as in a few hours the symptoms again exacerbate; but at other times it is a real improvement marking the beginning of recovery. If the patients die, it is most generally at this period; the remission just alluded to, when followed by exacerbation of the symptoms, is generally looked upon as a fatal change. Death takes place with symptoms of paralysis of the heart and lungs. In favorable cases the fever remits every morning on the last days of the third Aveek, Avhereas the evening-exacerbations de- crease in violence, the consciousness returns gradually and with it a desire for food and drink. At this stage the fever scarcely shows a sudden and considerable decrease, with a correspondingly sudden beginning of convalescence. With the third week typhus of a medium grade has reached its inten- sity in so far as signs of convalescence now begin to show themselves, although very slowly. Every case of typhus out-lasting the third week, may be safely regarded as very severe. Except complications take place, no new symptoms develop themselves during the fourth and fifth weeks. The remissions of the fever are very distinct and grow more decided in character ; the pulse, on the contrary, increases in weakness and frequen- cy. The patient looks as if he were in a state of terrible collapse; occasionally threatening paroxysms of collapse really take place, more particularly in the night; in the latter course of the disease, such parox- ysms are, however, not as dangerous as they seem. In the case of adults the consciousness usually returns towards the end of the fourth week; but, if the fever continues, delirium is still very frequent towards evening. The diarrhoea is at times less than it was, and at other times more profuse; in some cases it now ceases altogether. The skin looks clean, with the exception of miliaria here and there. The bed-sores which are never wanting during such a protracted course of the disease, grow rapidly in extent and malignancy. If the fever runs a course of four weeks, recovery takes place very slowly. In very fortunate cases recovery goes on uninterruptedly, but most frequently its course is disturbed by all sorts of accidental inconve- niences, such as vomiting after certain kinds of food, or even after any TYPHOID fever. 567 kind; sudden disappearance of the appetite that had just begun to return; return or protracted continuance of the diarrhoea; exacerbations of the fever. The decubitus, the nature and conduct of Avhich afford an excel- lent criterion by Avhich the amount of progress in the recovery of the pa- tient can be measured, sometimes causes a great deal of serious trouble, provided the final cure of the fever is very much delayed. Death either takes place in consequence of the utter prostration of the patient, from exhaustion, or from sudden and complete overpowering of the whole of the vital powers of the system. ALLOPATHIC TREATMENT. The first requisite for the proper treatment of typhoid fever is, that the patient shall be in a large room, ventilated by means of several wind- ows, that the air may be constantly changed by the free entrance of pure fresh air. Disinfection should be constantly practiced. The generation of Ozone (active oxygen) constantly in the sick rooiri) is very beneficial. This is best done by a mixture of two parts of Per- manganate of Potash and three parts strong Sulphuric Acid in a broad, open vessel. An iiiA'igorating quality is imparted to the atmosphere of the room, and is especially beneficial when, for any reason, the room can- not be freely open. Dry scales of Iodine, in a chip-basket, hung over the bed, and placed in saucers in different parts of the room, are valuable in removing any unpleasant odor in the atmosphere. A few of the scales may be vaporized, occasionally, by sprinkling on a hot shovel. Another available disinfectant is Carbolic Acid; a feAV drops may be put on wetted cloths which are hung up in the room. The floor may be oc- casionally sprinkled with Labarraque's Solution (Chlorinated Soda) The vessels Avhich are to receive the excretions should always contain a little of the Solution of Chlorinated Soda, Permanganate of Potash, or Carbolic Acid, five or ten drops in Avater. It is needless to remark that carpets, curtains, and all unnecessary ar- ticles, ought to be removed from the room. The proper temperature of the room is 60°. The bed linen should be changed daily. As soon as it is determined that the patient has typhoid fever, the hair should be shingled. The most effectual plan for controlling the temperature is, by the use of water. Where there are proper facilities for it, the bath is the surest and most efficient method for reducing a high fever. The patient should be placed in the bath at a temperature of 98° F., and the temperature of the water lowered to 80°, or to 60°, by the addition of ice or ice-Avater. After a time varying from five minutes to half an hour, a marked re- duction of the temperature is produced, as shown by a thermometer placed in the rectum (bowel), when the patient is removed from the bath, wiped dry and placed in bed. For this is necessary a bath-tub, large enough to receive the body, provided with a discharge pipe to convey off the extra water, a strong sheet to lift the patient, a thermometer to test the temper- ature of the bath, and a fever thermometer to ascertain the amount of re- duction in the heat of the patient. 56S EPIDEMIC AND ENDEMIC DISEASES. The most suitable method of applying water in private practice, and in families, is, by the use of the cold wet pack. A sheet is wrung out of cold water and placed on the bed. The patient is then laid on the sheet, with a proper support for his head. Each side of the sheet is then brought over the patient and tucked under the opposite side. The legs are well wrapped in, and the patient is Avell covered with blankets. He may re- main in tne pack from ten minutes to an hour. The pack may be repeated several times a day, the frequency being determined by the rise of tem- perature. When taken from the pack, the patient is to be wiped dry. An agreeable, but less effectual plan, is, cool sponging and having the cloths dipped in cold water and laid upon portions of the body. When there is any tendency to collapse, wet baths should not be given There can be no doubt of a greatly diminished mortality by the use of cold baths, the disease pursuing a milder course under their use. If, in the use of water, the circulation becomes feeble, the skin blue or the extremeties cold, stimulants should be given, and bottles of hot water placed at the feet. The use of the mineral acids is of marked benefit in this disease by aiding the gastric secretion and improving digestion and in increasing the mucous secretions, and relieves somewhat the dryness of the tongue. The Dilute Hydrochloric (Muriatic) Acid is as applicable as any given in doses of ten drops diluted in Avater SAveetened with simple Syrup or Syrup of Orange Peel. It seems better suited to aid digestion. If the teeth become set on edge it is well to wipe them off after each dose of the Acid with a cloth wet with a solution of Bicarbonate of Soda. This Avill do much toward preserving the teeth from the injurious effects of the Acid. In case of apparent exhaustion of the nervous system the Dilute Phosphoric Acid may be given in doses of ten or fifteen drop9 every hour or two, properly diluted and sweetened. It is given habitually by some physicians in this disease. It is conclusive that the use of the Acids diminish the mortality of the disease very greatly, besides being very grateful to the teeth. The patient may also drink freely of cold water or iced water, barley or rice Avater acidulated with lemon or orange juice; the only limit neces- sary to be observed is thatthe amount taken does not derange the sto- mach. In view of the fact that typhoid fever is a self limited disease, the essential element in the treatment is to support the powers of life and keep the patient alive until the disease shall disappear. The means for this purpose are food, (nourishment) alcoholic stimulants and tonic doses of Quinine. Regarding the nourishment of the patient it is important that system- atic feeding be begun early in the course of the disease and continued throughout. In the beginning of the disease but very little food will pro- bably be taken, owing to a repugnance to it, but if liquid food is given cold the patient will often take it to relieve his thirst, and in this Avay enough nourishment will be taken to maintain the strength. It should not be given to the extent of producing vomiting or a feeling of discomfort from \ TYPHOID FEVER. 669 over-fullness or indigestion. The forms of food best suited for fever pa- tients are milk, strong beef tea or essence, and fresh raw eggs beaten with a teaspoonful of sugar and half a cup (four ounces) of water or milk. Fur- ther on in the disease there is an indifference to food, but if it is given it is digested; it should be regularly given. If only about four ounces of milk, beef tea, or egg and water or milk are taken at a time, it should be given eA'ery tAvo hours. If an ordinary drinking glass full (eight ounces) is taken at a time, four hours should be the intervals of taking food. If the patient expresses a desire for any particular kinds of food, the wish should be complied with, as far as possible. It is a good rule, however, not to give solid food when there is diarrhoea. With the three articles mentioned, sufficient nourishment may be given. In making beef tea a pound of finely chopped lean beef will make a pint of strong tea. A pint of cold water is poured upon the beef and brought to a temperature not above 160° F. and kept at that point for four hours, a little water being added from time to time to supply the loss from evaporation. (The Hydrochloric Acid previously directed can be given in the beef tea.) Mutton or chicken can be used instead of beef. Finely divided lean beef pounded in a mortar until the nutritious elements are separated from the fibre maybe given. Nothing excels a milk diet. Everything else should) as a rule, be supplementary. By early and couttnuous feeding the severer symptoms are generally obviated as they generally depend on the exhaus- tion and prostration, which is prevented by nourishment. In the course of the disease, if severe, Alcoholic stimulants are al- most ahvays required. They should be given from an early period in the attack, as aid to digestion, a teaspoonful to a dessertspoonful of Whisky or Brandy with each half glass (four ounces) of milk or other liquid food, but not oftener than two hours, greatly aids in the feeding of the patient, and so prevents, in many cases, the innutrition and its results, Avhich is shoAvn by delirium, a rapid, feeble pulse, twitching of the muscles, picking at the bedclothes, coma with watchfulness, restlessness, etc. In a stage of this fever Avhere there is marked exhaustion, Brandy or Whisky should be given freely and to the extent of relieving the symptoms above enumerated. I believe life is saved by the free but judicious administration of Alcohol in the advanced stage of prostrating diseases in obedience to the scriptural injunction, "Give strong drink unto him thatis ready to perish." The appropriate dose will be from one to two tablespoonsful of Brandy or Whisky, given from one to four hours apart. The stimulant is doing good when the weak, rapid pulse becomes stronger, slower, fuller (a pulse of 120 is generally a weak pulse; one of 130, or more, always so), when the dry tongue becomes more moist, the delirium, vigil, restlessness, etc., lessened and the sleep becomes more refreshing. It does harm if the pulse is quickened, the tongue dryer, the delirium greater, the restlessness in- creased and is being given too freely. The tonic effect of Quinine is best produced by doses of t\vo or three grains four times in the tAventy-four hours. In the early part, headache may be relieved by cold water, either by keeping a thin cloth on the head, which will keep cool by evaporation, or by the use of ice-water, vinegar and water, pouring water upon the head (douche), or by bladders of ice. 570 EPIDEMIC AND ENDEMIC DISEASES. Vigil (or wakefulness), sleeplessness, or delirium should be relieved. For this purpose there is nothing better than ten grains of Dover's Pow- der, or a grain of Opium Avith a grain of the Extract of Hyoscyamus, at night, Avhich will produce a refreshing sleep. A condition of semi-coma (insensibility) with Avatchfulness, does not prevent the use of Opium to produce sleep. It is, sometimes, better to give at night, especially when there is delirium, twenty grains of Hydrate of Chloral Avith an equal quan- tity of Bromide of Potassium, dissolved in water Avith syrup. Nausea and vomiting are generally relieved by greater care in giving food and drink, especially a more limited amount of the latter. Cold or Mustard may be applied over the stomach. Ten grains of Bismuth, Sub- Nitrate, with five grains of Oxalate of Cerium, or a drop of Carbolic Acid in water, may be given hourly, if needed. Diarrhoea is generally present, and may require to be restrained by opiates and astringents, directed in the treatment of that disease. Some- times a large injection of thin Starch will suffice. Merely a looseness of the bowels does not need treatment. Cathartics are not to be given; but if constipation exists, it is to be re- lieved by injections or mild laxatives, as a dessertspoonful of Castor Oil in emulsion with Glycerine, flavored with Oil of Wintergreen (Gantheria) or Cinnamon. Should ulceration of the intestines occur, a peritonitis or a hemor- rhage is almost sure to occur. The former result is to be treated by full doses of Opium, to relieve the pain and support life. Large, Avarm poul- tices should be kept on the abdomen. Peritonitis not caused by ulceration, is not so fatal, but is to be met by the same means. Hemorrhage into the intestines will call for Opium in doses of a grain Avith ten grains of Gallic Acid, in solution, with ten drops of Aromatic Sulphuric Acid. Nose-bleeding, if excessive, will call for the treatment directed in the article on that trouble. The distention of the abdomen from gas in the intestines (called tym- panites) occasions great discomfort. It may be relieved by a large injection of warm water containing a tablespoonful of Turpentine previously mixed with Glycerine. A flannel cloth wrung out of hot water and then wet with Turpentine, laid over the abdomen, will afford relief. The urine should be examined frequently to ascertain whether a defi- ciency in the amount of urea may not warn of Uraemia (poisoning by this ingredient of the urine remaining in the blood.) The smell of Ammo. nia in the exspired breath also indicates Uraemia. Diuretics (medicines to act on the kidneys) are required, as, a half a teaspoonful of Vinegar of Squill in a tablespoonful of Infusion of Digitalis every four hours until urine is passed freely, and if the symptoms are urgent, hot air baths should be given. Profound sleep (coma) will call for these measures for relieving the blood of urea, and blisters to the back of the neck, by means of Blistering Collodion. DIVISION AND TREATMENT. It were of no service, as it would also be a difficult task, to define ex- actly the varieties of complication which may attend disorders of this TYPHOID FEA'ER. 571 kind. The broad distinction consists in the organs which are especially affected. But, in order to facilitate the discrimination of unprofessional per- sons in the treatment of this most difficult species of disorders, we will di- vide their indication, progress, and issue, into three dinstinct stages, the Premonitory and Incipient, the Acute, and the Debilitated and Convales- cent stages. It is not, however, to be assumed that these gradations are always clearly defined. They may merge imperceptibly, may be arrested by treatment, or may be suspended by fatal results. The incipient stages are, however, naturally distinguishable until the positive development of the fever becomes evident, and the stage of debility, which is a conse- quence of the ravages of the fever, differs from the two former in the substance of active symptoms, and in the accompanying prostration of animal power. In the treatment of all alike Ave must be guided by the symptoms, and select the most appropriate remedy according to the characteristic indications afforded. HOMCEOPATHIC TREATMENT. DURING THE PREMONITORY AND INCIPIENT STAGES. Bryonia-alba. Rhus-toxicodendron. These remedies, either singly (according to the subjoined symptomatic indications of each), or in alternation (where the symptoms of the disease embrace the charac- teristics of both), have, Avhen seasonably administered in the incipient stages of many varieties of these fevers, been found sufficient to arrest the progress and development of the malady altogether, or at all events so far to modify its future course, as to deprive it of much of its malignancy. Bryonia and Rhus are, in fact, the medicines whose ascertained operation is most closely akin to that of this class of disorders. Bryonia. This remedy is especially applicable to cases which man- ifest an inflammatory tendency. It should be selected in the incipient stage, Avhen the following symptoms are present:—After a slight cold the patient complains of aching pains over the whole body, which admit of no relief from a change of posture ; seA'ere, throbbing, bursting, front- al headache (aggravated by opening or turning the eyes) prevails; the scalp is tender to the touch, and the head burning hot, yet the forehead is, nevertheless, frequently bathed with cold sweat; the sitting or even the recumbent posture is rendered compulsory by the prevalence of debil- ity, languor, and heaviness of the limbs, and there is an aversion to cold air; the nights are disturbed, more especially the fore-part of the night, by ebullition or congestion of blood, heat, and anxiety ; the patient sighs and groans during sleep, and is often aroused by agonizing or frightful dreams, which continue to haunt him even whilst awake. The digestive functions are considerably deranged, as exemplified by the presence of bitter taste, loathing of food, nausea and inclination to vomit, a yellow, furred and dry tongue, pressure or weight and pricking in the pit of the stomach, with sensation of distention about the lower ribs on both sides, and costiveness. Dose: If singly, dissolve six globules in two tablespoonsful of water, and give a teaspoonful of the solution every two hours; if in alter- \ 6712 Acute contagious diseases. nation with Rhus., dissolve six globules of each remedy separately in tAvo tablespoonsful of Avater, and give a teaspoonful of the one solution four hours after the other, in rotation, until amelioration or change. Rhus-toxicodendron is especially applicable to the low, nervous variety in the premonitory stage of typhus. It should be employed when, either after exposure to a thorough wetting, or without any assignable reason, the patient is seized with violent relaxation of the bowels, accom- panied by colic, and complains of chilliness even when seated close to the fire; further, when aching pains (or pains as if arising from the effects of contusions) are experienced in particular parts of the body, or when a painful sensation is experienced, as if the flesh had been torn from the bones ; the tongue is furred white, and giddiness, inclination to vomit, or actual vomiting of phlegm, is present; the patient is tormented by numb- ness, creeping and tingling in the parts of the body on Avhich he lies, together with lancinations, drawing pains, and stiffness in the nape of the neck and in the back, rigidity and feeling of paralysis in the extremi- ties, with trembling on holding out the arms ; the chief qualifying condi- tion is that all the symptoms are, generally speaking, exacerbated, during rest and at night. Dose: If singly: Of a solution of six globules to two tablespoonsful of water, give a teaspoonful every tAvo hours, until amelioration or change. If in alternation with Bryonia, dissolve six globules of each remedy separately in two tablespoonsful of Avater, and give a teaspoonful of the one solution four hours after the other, in rota- tion, until amelioration or change. Ipecacuanha may be selected in the early stage of typhus, when it is ushered in by prominent symptoms of derangement in the digestive organs, such as headache, giddiness, nausea, vomiting, watery, yellow or greenish, slimy evacuations; particularly Avhen these are associated with slight chills alternately withheat, or considerable shivering with slight heat or marked heat with but little shivering. Dose: Four globules in a teaspoonful of water every three hours un- til amelioration or change. Pulsatilla may also be selected in this stage of the disorder, when frequent shivering, bitter taste, whitish tongue, loss of appetite, nausea, vomiting of phlegm, slimy evacuations, and febrile heat intermingled with chills prevail; and more particularly when these symptoms become exacerbated towards evening, and occur in mild, temperate, or phlegma- tic subjects, or in females, with extreme depression of spirits and tear- fulness. Dose: Four globules in a teaspoonful of Avater in every three hours, until amelioration or change. Digitalis is indicated when nervous fever, or rather typhus, accom- panied by bilious derangement, is ushered in by yellow, jaundiced hue of the skin ; violent, bilious, spasmodic pains in the stomach ; sensibility of the upper part of the stomach on the left side, on pressure; frequent urging to make water, particularly at night, Avith scanty urine; burning heat of the head and face; anxiety of mind and dread of some imaginary TYPHOID fever. 573 impending misfortune; urination painful and difficult, or entirely sup- pressed. Dose: Six globules in a tablespoonful of water every three hours, until amelioration or change. Nux-vomicA.—Symptoms of stomachal derangement, constipation, Avith frequent inclination and ineffectual efforts to evacuate. Nux-Aromica is further indicated av!ien the spasms, which not unfrequently accompany this disease, are confined to the stomach and intestines, particularly the inferior boAvel—a frequent cause of the above-mentioned constipation; painful and difficult emission of urine; painful pressure and tension in the regions about the stomach and the lower ribs; sensation as if the limbs were bruised ; general nervous excitability, with great nocturnal restlessness and slight delirium; Aveakness and aggravation of the symp- toms in the morning. Temperament, sanguine or bilious; disposition, irritable and impatient. Dose: Six globules in a tablespoonful of water every four hours, un- til amelioration or change. China.—This remedy is frequently of service in the first stage, or Avhen paleness of the face, lancinating, rending, aching, or pressive head- ache, cloudiness of vision, buzzing or roaring in the ears, dullness of hearing are present; yelloAV or white coating on the tongue, dryness of the mouth, insipid, clammy, or bitter taste; inclination to vomit; sensi- bility and distention of the belly; thin, yellow, watery motions, occasion- ally intermixed with undigested substances ; urine scanty, pale or dark colored and cloudy ; oppression at the chest; dragging, shooting pains in the limbs; anxiety, sleeplessness, and general coldness and shivering. Dose: Six globules in a tablespoonful of water every six hours, until amelioration or change. Aconitum. Belladonna. These are the best remedies in the incipient stage of the disorder, Avhen inflammatory symptoms declare themselves from the commencement. The selection betAveen Aconite and Belladonna will be gathered from the subjoined symptomatic in- dications, and from the article on the " characteristic symptoms," un- der the head of these remedies respectiA'ely. It should be added here, that when the disease becomes further developed, and still retains the inflammatory character—Bryonia and Rhus respectively, according to the symptoms, are generally preferable. Aconitum is indicated in the incipient stage by the presence of the following symptoms :—Chill folloAved by the burning heat, strong, hard, and quick pulse; dry skin, mouth, lips and tongue; the latter being generally of a bright red, but sometimes also slightly coated with white; excessive thirst; red and scanty urine; hurried breathing ; the symptoms being aggravated or modified, according to the greater or less irregularity of the pulse. The condition which distinctly points to Aconite, as the remedy (when other complications are not present), consists in the ag- gravation of the above symptoms at night, often attended with slight de- lirium. Should the delirium become violent, and considerable cerebral disturbance be otherwise manifested, or should this particular symptom not yield rapidly to the action of Aconite;—when, moreover, the skin 574 EPIDEMIC AND ENDEMIC DISEASES. continues hot and dry, and the bowels relaxed, or the motions are even passed involuntarily, or Avhen there is inflammation of the glands of the throat (tonsils), or red, parched tongue, great thirst Avith disinclination or dread to satisfy it, it will be preferable to administer Belladonna until the indicative symptoms yield. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change. In mild cases in which the symptoms yield readily to the action of the medicine, the repetition may be deferred to intervals extending to tAvelve hours. Belladonna is particularly indicated by the following symptoms, in addition to those above enumerated : alternate heat and chills, or general heat externally and internally, with redness, burning heat, and bloated appearance of the face, or alternations of coldness and paleness, and heat and redness of the face, violent throbbing of the large arteries of the neck ; redness, sparkling, and protrusion of the eyes, Avith dilation of the pupils, extreme sensibility to light, and distortion of the eyes; sing- ing or noise in the ears to a greater or less degree ; wild expression of the countenance, Avith uneasy glancing around, as if from fear, sometimes attended with a marked inclination to run aAvay ; violent shooting pains in the forehead ; or dull heavy pain, causing the patient to put his hand frequently to his head ; sopor; furious delirium or loss of consciousness ; delirium and snatching at the bedclothes, or spasmodic or coiiA-ulsive at- tacks ; parched lips, soreness of the corners of the mouth, redness and dryness of the tongue, which is also sometimes foul, and coA'ered Avith a yellow coating; skin hot and* dry; bitter taste in the mouth, intense thirst, difficulty of deglutition, especially of liquids; nausea; pressure at the pit of the stomach ; excessive distention of the boAvels, and constipa- tion, or watery motions; scanty and red or amber-colored urine; rapid respiration; pulse full and accelerated, or quick, hard and wiry; inflam- mation and swelling of the glands before and beneath the ears. Dose: Dissolve six globules in three tablespoonsful of Avater. and give a teaspoonful of the solution every four hours, until amelioration or change. In mild cases, or when the symptoms yield readily to the action of the medicine, the repetition may be deferred to a period of tweh'e hours, and repeated at such intervals, until amelioration or change. Stramonium is indicated by symptoms of the same nature as those Avhich indicate Belladonna, with the addition of the following:—twitch- ing of the muscles of the face, starting of the tendons, squinting, trem- bling of the extremities, tremulous motion of the tongue on protrusion, burning heat of the body, suppression of the urine, fantastic gesticula- tions, and involuntary spasmodic smiling. Dose: Four globules in a teaspoonful of water every three hours, un- til amelioration or change. Hyoscyamus is indicated by the same symptoms as have been stated at length under the head of Belladonna, Avith the addition of the follow- ing :—twitching of the tendons, strong, full pulse, fullness of the veins, burning heat of the skin, sensation of pricking all over the body, and constant delirium ; frequent but ineffectual urging to urinate. Dose: Three globules in a teaspoonful of water every three hours, until the symptoms are distinctly modified or changed. TYPHOID FEVER. 575 BAPTisiA(Wild Indigo) is specially required when the Aveak and trem- ulous feeling ; the quick (90), full, and soft pulse; the internal and exter- nal heat, with thirst; the headache and tendency to delirium ; the tongue yellowish-brown in the center, and red at the edges ; the constipation alternating with diarrhoea ; all contribute to make up the morbid picture;—hot, dry skin and a quick, full pulse; the tongue is thickly coated with a whitney-broton fur ; the head aches, and there is at least nocturnal delirium ; no appetite and great thirst; the urine is high colored, and generally with constipation. Dose: The same as directed for stramonium. TREATMENT OF ABDOMINAL TYPHUS ; That]is, Typhus with tenderness and distention of the belly, griping, or some times dull, continuous pain, diarrhaza, etc. Mercurius will be found a most efficient medicine, if immediately employed when the disorder assumes the low form of abdominal typhus, or occurs in persons of sluggish constitution and slow circulation, and is attended with pale, yellowish appearance of the face, severe headache, or sensation as if a tight band were across the forehead; thickly-coated tongue; bitter or foul taste; little thirst; sensitiveness of the region about the navel and the pit of the stomach, to the touch, and distention of the belly ; evacuations, copious, Avatery, floculent, or slimy and even bloody, sometimes qualified by straining without evacuation ; at first, dry burn- ing skin followed by profuse, debilitating sweats; depressed pulse, and great prostration ; extreme restlessness and anxiety, with constant toss- ing about in bed; and disturbed and unrefreshing sleep with anxious dreams. Dose: Six globules in a teaspoonful of Avater, every two hours, until the evacuations become diminished in number and improved in appearance, and the tenderness and pain in the lower part of the stomach, etc., are relieved. After which some other remedy must be selected, in accordance with the remaining symptoms ; consider Acidum Nitricum, amongst others. Rhus-toxicodendron is especially indicated in abdominal typhus characterized by continued heat and dryness of the skin; violent deliri- um ; oppression at the heart, with sighing and moaning; pains in the limbs ; extreme debility ; tongue and lips dry and red, or covered with a brown or blackish, tenaeeous fur; red, burning, cheeks; convulsive twitching of the tendons, snatching at the bedclothes, drowsiness or stu- por, with muttering and loud, nasal breathing ; weak, accelerated pulse; anxious expression of countenance ; sleep disturbed, or prevented by the frequent recurrence of sudden starts ; eyes inflamed, watery and insens- ible; features collapsed; breath exceedingly offensive; involuntary evac- uation of the excrement and urine; coldness of the extremities; sinking energies; livid spots and miliary eruption. Dose: Dissolve twelve globules in three tablespoonsful of Avater, and give a teaspoonful of the solution every two hours until three doses have been given ; then extend the intervals (or sooner, if distinct improvement takes place) to four hours, and continue the adminis- tration until the symptoms particularly indicative subside or be- 576 EPIDEMIC AND ENDEMIC DISEASES. come altered. If no alteration follow the fourth dose, or the aspect of the symptoms be as folloAvs, proceed with the next remedy. Camphok frequently proves useful after Rhus, particularly when the following symptoms pre\'ail: heat of the head, Avith confusion of ideas, or A'iolent delirium ; giddiness ; throbbing headache ; burning heat in the forehead ; cold and clammy skin ; continuous coldness of the bands and feet; debilitating and clammy sweat; tendency to violent relaxation of the bowels ; scanty cloudy urine, which deposits a thick sediment; great Aveakness, and feeble, scarcely perceptible pulse. Dose: One drop of the saturated tincture on a small lump of loaf su- gar, every quarter of an hour, until distinct amelioration or change: —or if the more urgent symptoms have yielded, and the following remain, proceed Avith the next remedy. Cocculus may often follow either Rhus or Camphor (after the previ- ous employment of Rhus), especially Avhen the great debility continues, and the patient complains of giddiness and headache; or when there is a tendency to swooning or paralysis of the limbs, and Avhen there are prominent symptoms of derangement of the digestive functions. Dose: Of a solution of six globules to three tablespoonsful of water, give a teaspoonful every tAvo hours, until amelioration or change. These remedies, either singly or in alternation, are amongst the most important, in cases of a desperate character, and Avhen the most alarm- ing symptoms occur. Arsenicum. This is decidedly one of the most important remedies in abdominal typhus, especially in the second and third stages, some- times restoring the patient when almost beyond the reach of hope, and renovating the vital spark. The chief indications for its employment are:—extreme prostration of strength,—falling of the lower jaw,—open mouth,—dull and glassy eyes,—bitter taste, inclination to A'omit,—press- ure and aching at the pit of the stomach, pain in the right side of the in- ferior region of the belly,—bursting headache,—giddiness,—violent or low delirium,—droAVsiness,—flatulent distention of the bowels,—burning thirst,—dry, hot skin,—parched, cracked, sometimes blackish-looking clammy tongue,—and violent and continuous relaxation of the bowels; pulselscarcely perceptible, and intermittent. Dose: If singly, of a solution of six globules to three tablespoonsful of water, give a teaspoonful every quarter of an hour (in very crit- ical cases), or every hour (in less urgent instances) until ameliora- tion or change, doubling the length of the intervals as soon as dis- tinct improvement occurs. If in alternation Avith Veratrum, dis- solve separately six globules of each remedy in three tablespoons- ful of water, and give one teaspoonful of the one, half an hour after a similar dose of the other (in very critical cases), in rotation—or at intervals of one hour (in less urgent instances), until amelioration or change. Veratrum is occasionally useful after or in alternation Avith Arseni- cum, when the inferior extremities become cold and covered with cold SAveat. Dose: In every respect, singly or in alternation with Arsenicum, as directed for the latter remedy. Carbo-vegetabilis may also prove serviceable in very critical cases TYPHOID fever. 577 It is indicated where we find drowsiness with rattling respiration,—face pinched, sunken, and death-like,—pupils insensible to light, pulse scarcely perceptible, and the vital poAver rapidly sinking,—cold perspirations on the face and extremities,—involuntary and offensive evacuations,—deep- red urine, with a cloud floating in it, or rising towards the surface. In abdominal typhus. hoAvever, the more particular indication consists in symptoms of incipient ulceration, or in signs of so-called putrescency. The following symptoms are also distinctly indicative of this remedy: —burning, lancinating pains about the region of the stomach, and deep in the bowels, which become reneAved after partaking of food of any kind, and are accompanied by great anxiety, excessive flatulency, and the evac- uation of burning, light-colored, fetid, watery, bloody stools, attended with painful urging; desire for salt food, and for coffee, with aversion to meat, generally, and dread of indmging the craving, lest the sufferings be aggravated. Dose: In every respect, singly or in alternation with Arsenicum, as directed for that remedy, above. TREATMENT OF THE SECOND OR-ACTIVE STAGE IN TYPHUS, Whether of the inflammatory or low variety. Bryonia is more particularly indicated when the disorder assumes the character of inflammatory nervous fever, or typhus especially af^ feeting the brain, with violent, stupefying headache, as from a blow, and pain across the forehead and at the temples, as if the head would burst; frequently raising of the hands to the head. Aggravation of these sensations by movement—continued, violent delirium Avith ex- cessive febrile heats; foul, thickly-coated, yelloAV tongue, or dry, cracked tongue, with pinched mouth and great thirst, and vesicles in the mouth or on the tongue ; furred lips; nausea, inclination to vomit, or vomiting of mucous and bilious matter; tenderness of the pit cf the sto- mach, when touched; general heat of the whole body, dryness of the skin, redness of the face, and profuse perspiration during the fever ; sen- sibility about the region of the stomach ; distention of the belly, oppres- sion at the chest, and frequent sighing and moaning, indicath'e of threatening miliary eruption ; constipation, or relaxed stools; urine of a deep orange color or bright yellow, with yellow sediment; sensation as of a plug in the throat, with difficulty of hearing; stitches in the side; drowsiness or disposition to sleep during the day ; sleeplessness, fugitive heat, and excessive restlessness, or continued drowsiness or stupor, Avith startings and unpleasant dreams; painful shootings and soreness of the limbs, aggravated by movement; trembling of the bands ; pulse quick, soft, frequent, or irregular, small and intermitting; miliary interrup- tion, livid spots ; irritability, irascibility, despair of recovery. Dose: If singly. Under very faA'orable circumstances, of a solution of six globules to three tablespoonsful of Avater, give a teaspoonful every twelve hours. In cases which assume the more serious fea- tures, a similar dose should be repeated every three hours, until amelioration or change. If in alternation with Rhus. Dissolve separately, six globules of each remedy in three tablespoonsful of water, and give a teaspconfg.il of one solution four hours after the like dose of the other, in rotation, until amelioration or change. 37 578 EPIDEMIC and endemic diseases. EuPATORii'Ar-PERFOLiATUM.—Pain in the bones, attended with hot dry skin. This remedy has been highly recommended by the most suc- cessful practitioners as Drs. Williamson, Neidhard and others. Dose: The same as is directed for Bryonia. Rhus-toxicodendron.—This medicine is more peculiarly suitable to the low form or stage, Bryonia being more applicable to the inflammatory, but will frequently be found serviceable in all the stages of the disease, parti- cularly when there is undue relaxation of the bowels, congestion to the head, oppression at the chest, and great weakness. The headache is generally of a stupefying nature, with a feeling as if from a bruise, but not so severe as that indicating Bryonia; the tongue presents nearly the same character, less nausea and inclination to vomit exist; violent pain is present about the region of the stomach, especially when touched. Con- stipation as named of Bryonia, but more frequently copious, yellowish or loose, bloody evacuations, with severe cutting pains in the belly; the symptoms are general heat, and those of the face resemble those mention- ed under Bryonia, but without the perspiration, or at most, a clammy feeling of the skin. The urine is hot, dark colored, or at first clear, and afterwards turbid ; the symptoms of the ears the same; sleep also the same; difficult deglutition of solids, as if from contraction, of the throat ^and the gullet; general trembling, debility, and prostration, almost amounting to paralytic Aveakness of the different limbs; shooting pains in various parts of the body, aggraA'ated when at rest or' at night, and momentarily relieved by moving the part affected ; pulse quick and small or weak and slow ; as mental or moral symptoms, we may notice, exces- sive anguish, anxiety, extreme lowness of sjnrits, and disposition to weep. Dose: Whether singly or in alternation Avith Bryonia, in all respects as directed for the latter remedy above. Arnica is also of some importance in low or sluggish nervous fever, with lethargy, or delirium, and snatching at the bedclothes; or when the patient lies in a state of unconciousness, as if he had been stunned by a concussion of the brain. Dose: Three globules in a teaspoonful of water every four hours, un- til amelioration or change. Pulsatilla is often of considerable service in the second stage of typhus, when slight delirium, tears and lamentations, alternating with drowsiness, prevail. Dose: Three globules in a teaspoonful of Avater, repeated, if necessary at the expiration of four hours, and so on until amelioration or change. But if any of the undermentioned symptoms declare themseh'es, proceed with the next remedy. Acidum-phosphoricum is frequently required, either when, at the commencement of the disease Ave find great exhaustion and prostration with wandering even Avhen awake; or in almost hopeless eases (alone or still better in alternation with Rhus) Avhen the patient is always found lying on the back in a drowsy state, and either makes no reply Avhen spoken to, or answers incoherently ; or in other instances, and especially af- ter the previous employment of Pulsatilla, when the following symptoms TYPHOID FEVER. 579 prevail:—constant, loquacious delirium or low muttering; snatching at the bedclothes ; fixed looks ; seeming efforts to escape from some alarm- ing object; black incrustations on the lips ; dry, hot, skin ; continual, copious, watery discharges from the bowels, the motions, being in general involuntary ; bloody evacuations ; frequent, weak, and occasionally an intermitting pulse. Dose: Three globules in a teaspoonful of water, at first every hour, extending the intervals to three hours as soon as the symptoms are modified, and continuing the administration until posith'e amelior- ation or change. Or if the under-mentioned symptoms should in particular continue unmodified, proceed with the next remedy after a lapse of three hours from the last dose. Acidum-nitricum should be administered after or during the course of Acidum-phosphoricum—but not Avithin less than three hours of a pre- vious dose of the latter—if the bloody evacuations fail to yield readily to the previous treatment. Acidum-nitricum is, moreover, particularly useful Avhen there are white specks in the mouth and throat; sensibility of the belly on pressure; relaxation of the bowels, and slimy, acrid* greenish-colored stools ; straining; intestinal ulcerations ; shooting pains in the lower boAvel; scalding when passing Avater; and tendency to col- lapse. In some cases it is necessary to administer this remedy by injec- tion or enema, as below stated. Dose: Three globules in a teaspoonful of water, repeated, if necessary after four hours (or every four hours till the symptoms yield), return- ing to Acidum-phosphoricum, if requisite, or proceeding with the next remedy, after a pause of three hours, if the under-mentioned symptoms, in particular, supervene. The Enema should consist of six drops of the tincture at the third dilution to every two table- spoonsful of water. Cantharides should be administered after or during the course of either of the three foregoing remedies, but not within less than three hours of a dose of any other medicine, if painful evacuation of water be distinctly manifested. Dose: Three globules in a teaspoonful of water, repeated, if neces- sary after an interval of three hours (or continuing at such intervals until the indicative symptom is positively subdued), returning to either of the foregoing, or proceeding with other treatment, or sus- pending treatment, according to the prevalence of particular symp- toms or general improvement be manifested. China is sometimes of considerable value in the second stage of this disease, especially when the attack has become protracted and tedious:— nocturnal sweats, obstinate relaxation of the bowels, but unattended with pain in the bowels, the tongue at the same time being clean. Dose: Three globules in a teaspoonful of water, every four hours, until amelioration or change, unless, after the third dose, the sweats remain unmodified, when proceed with the next remedy, after a pause of four hours. Sulphur should follow the third dose of China in the event of the continuance of the sweating, notAvithstanding the previous administration of the latter remedy. Sulphur has always been found of considerable ser- vice— Bryonia, Rhus, or Acidum phosphoricum having been fruitlessly ad- ministered, but particluarly when the following symptoms were encoun- 580 * EPIDEMIC AND ENDEMIC DISEASES. tered: pale and collapsed countenance, burning, itching eruptions on the lips, dryness of the mouth; f ml, dry tongue; bitter taste; slimy or bilious vomiting; tenderness of the region about the stomach, and pain as from excoriation of the parts above the navel, increased on pressure; flatulent rumbling in the bowels; frequent, watery, flocculent, or yellow evacua- tions; cloudy urine, depositing a reddish sediment; miliary eruption; eruption with a discharge of matter; bleeding at the nose; stitches in the chest, oppressed breathing; dry cough, worse towards evening and at night; sleeplessness, or whining during sleep; dry heat during the day, with moderately quick pulse, and profuse sweating at night, Dose.: Dissolve six globules in three tablespoonsful of water, and give a teaspoonful of the solution every six hours, unless, after the second dose, the following symptoms be present, when proceed with the next remedy. Acidum-sulphuricum should follow the seconi dose of Sulphur after an interval of six hours, if the sweating bsyet vsry profuse, particularly if so when lying still and modified by movement; or it should even precede either or both of the preceding remedies, if the sweating be very profuse when lying still and diminished by movement. Dose: Three globules in a teaspoonful of water, every four hours, until amelioration or change Calcarea, ) Calcarea-c. may sometime be administered Hepar-sulphuris, r advantageously, alternately with Belladonna, Ar- Lycopodium. ) senicum or Rhus, according to the symptoms; it is further, occasionally, a most efficient remedy in cases in which debilita- ting relaxation of the bowels, or bleeding of the nose, will not yield to such remedies as Aeielum-phosph., Rhus, China, etc-; lastly, Calcarea-c. may be exhibited with advantage where there are symptoms of impending miliary eruption, jerking or tAvitchings in the limbs, particularly in children, ten- dency to inflammation of the membranes of the brain, delirium, etc. Dose: Of a solution of six globules to three tablespoonsful of water, give a teaspoonful every three hours until amelioration or change. Or if the undermentioned symptom should declare itself, or having been previously present, should continue unmodified after the third dose of Calcarea, proceed with the next remedy, after a pause of four hours. Hepar-sulphuris should follow the third dose of Calcarea after an interval of four hours, if discharge of blood from the nose should supervene, or, having been previously present, should continue without material im- provement; except, indeed, the presence of other symptoms of a more ur- gent character, should require the administration of other remedies, such as Pidsatilla, Belladonna, Rhus or Sulphur. Dose: Three globules in a teaspoonful of water, repeated, if neces- sary, after an interval of four hours—or continued, at such intervals, if requisite, until the distinct modification of the indicative symptom. Lycopodium is often a valuable remedy after Calcarea, (with or with- out the intermediate administration of Hepar-s. according to the circum- stances,) in the second stage of typhus, Avhen miliary eruption is slowly and scantily developed, and the folIoAving symptoms occur: drowsiness with muttering delirum; confounding of Avords; stammering; tAvitching TYPHOID fever. 581 of the tendons, snatching at the bedclothes, flatulent distention of the boAvels, Avith constipation; affections of the bladder; or when there are shiverings alternating with heat; circumscribed redness of the cheeks; debilitating SAveats; excessive debility; complete hanging of the lower jaAv; half-closed eyes; slow respiration; or, state of excitement, without heat or congestion in the head or face; redness of the tongue; constipation; burning urine; tranquil and resigned state of mind, or surliness and ma- levolence, especially on waking. Dose: Three globules, in a teaspoonful of water, every three hours, until amelioration or change. In case of amelioration, pause until the symptoms evidently retrograde, Avhen resume, at intervals of six hours, as long as necessarv. In the case of change suspend treat- ment for four hours, and continue with the remedy newly indicated. Lachesis may prove serviceable in fever analogous to typhus, attend" ed with giddiness on rising or sitting up; muttering; bitter taste ; deliri' um; hanging of the lower jaw; vacant expression of countenance; sunk- en features; yellowish tongue, with bright-red margins; cracked tongue; smooth, dry tongue, with difficulty of protruding it, and inarticulate speech; seeming paralysis of the eyelids; lethargic sleep, and tendency to lie in the prone position; thirst, with disinclination todrink; brownish-red, copious urine. Dose: Three globules, in a teaspoonful of water, as directed for Lyco- podium—or if the symptoms be very urgent, begin by administering at intervals of two hours—extending the intervals to four hours after two doses have been given. Phosphorus is of great service where we find great dryness of the tongue, heat of the skin, small, hard, quick pulse, painless relaxation of the boAvels, Avith excessive flatulent rumblings; or when the disease becomes, as it were, concentrated in the lungs, and there is consequently congestion, Avith extremely laborious breathing and excessive anxiety, dullness on percussion, mucous rattling, stiches during respiration, cough, with copi- ous expectoration of phlegm mixed with blood or even offensive matter, more benefit may be looked for from this than from any other remedy. Phosphorus is also serviceable when, notwithstanding the pneumonic con- centration, there is, moreover, sensibility and rumbling on the right side of the loAver part of the belly, or when there is continued heat of skin, with small, hard, accelerated pulse, throbbing of the great arteries of the neck, and nocturnal sweats; sleep disturbed by crowding of ideas, weep. ing, whimpering sudden cries, and restlessness. The patient awakes from sleep complaining of great thirst and dryness of the mouth, excessive heat, and aching of the whole body. In addition to these symptoms, there is a burning sensation in the belly and fundament, with frequent semi-fluid stools, streaked with blood; giddiness, confusion, and throbbing pains in the head; deafness: frequent discharge of blood on blowing the nose, and heat in the face; tongue and lips dry and cracked; bitter taste; copious evacu- ations of urine, v/hich deposits a whitish or reddish sediment; delirium; obstupefaction. Dose: Dissolve six globules in three tablespoonsful of water, and give a teaspoonful of the solution every four hours, until amelioration or change. Acidum-muriaticum. Weakness, with a constant tendency to sink 582 EPIDEMIC AND ENDEMIC DISEASES. down in the bed, with groaning during sleep, almost paralytic state of the tongue, rendering it nearly impossible for the patient to speak, even when in a collected state, and great dryness of the mouth. Dose: Of a solution of six globules to three tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change. Natrum-muriaticum is recommended in nervous fevers with great debility, insatible thirst, dryness of the tongue, and loss of consciousness, and particularly when they follow in the course of antecedent debilitating diseases. Dose: Of a solution of six globules to three tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change. Helleborus has also been found of great utility in nervous fever, occurring after other febrile affections, such as scarlatina, measles, stom- achal fever, worm fever, and cholera, with pain as from contusion, com- bined with tumefaction, in the integuments, of the head; disposition to somnolency, Avith confusion of ideas, and extreme restlessness: dark, cloudy urine; heaviness, or feeling of stiffness and powerlessness in the limbs; depression of spirits, and obtuseness of the faculties. Dose: A solution of six globules, as directed for Natrum-muriaticum. Secale-cornutum is, in like manner, with Natrum-m. and Helleborus, recommended by many homceopathists Avho have had frequent opportuni- ties of treating nervous fevers, particularly in cases, occurring in the wake of other diseases ; but is more especially appropriate where the symptoms developed clearly proceed from irritation of spinal nerves, with wander- ing, fugitive, spasmodic pains, extending from the base and column of the spine into different parts of the body; the spasms which affect the face be- come subsequently of an intermittent nature; whilst those that have their seat in the hands and feet partake of a continued character. This remedy is further indicated by dry heat of the skin, insatible thirst, accelerated pulse, great restlessness and sleeplessness; excessive languor, and aver- sion to food. Should the spasmodic affections readily yield to the employ- ment of this remedy, but if the febrile symptoms continue, some other remedy appropriate thereto must be prescribed. Dose: Dissolve six globules in three tablespoonsful of water, and give a teaspoonful of the solution every three hours, until amelioration or change. Arsenicum, ) These remedies are of signal importance, either Veratrum, V singly, in succession, or in alternation, according to the Carbo-veg. ) individuality, succession, or combination of the symp- toms present, in the second stage of typhus, in all desperate cases in which vitality becomes nearly extinct. For distinctive indications the reader is referred to the foregoing prescription of these remedies, under the head of Abdominal Typhus. Dose: If singly, of either remedy:—Dissolve six globules in three tablespoonsful of water, and give one teaspoonful of the solution every quarter of an hour (in very critical cases), or every hour (in less urgent instances), until amelioration or change, doubling the length of the intervals as soon as distinct improvement ensues. If in alternation. Dissolve, separately, six globules of the remedies to be used alternately injthree tablespoonsful of water, and give a tea- TYPHOID fever 583 spoonful of one, half an hour after a similar dose of the other (in very critical cases), in rotation, or at intervals of an hour (in less ur- gent instances), until positive amelioration or change doubling the length of the intervals as soon as a degree of improvement is evi- dent. Carbo-a'EG. In addition to the indications given for this remedy, under the head of Abdominal Typhus, the following symptoms are char- acteristic of its employment in the second stage: excessive anxiety, and burning heat of the skin, arising from congestions to the head and chest; the eyelids agglutinated during the night; deafness and ringing in the ears: bleeding from the nose, and obstruction of the nose from incrustations, eruption around the nose, and brown or blackish, cracked lips ; the legs drawn up during sleep, and the sleep restless, nd disturbed by frequent waking. Dose: Three globules in a teaspoonful of Avater, every three hours, until amelioration or change, when thus specially indicated ;—Avhen, as above, singly or in alternation, tlie dose should be as directed under the last head. TREATMENT OF TYPHI'S CHARACTERIZED BY STUPOR In treating of this variety of the malady it will be unnecessary to recapitulate the remedies already enumerated, in relation to the various stages and varieties hereinbefore described. Suffice it co say, that the same features and conditions would indicate their employment in this variety, and that the method of administration should be in every respect similar. But the symptoms which more particularly distinguish this species of typhus, especially indicate, by assimilating most closely to the specific operation of Opium. This remedy should accordingly be given when the folIoAving group of symptoms preA'ails :—-great drowsiness or lethargy, Avith sterto- rous breathing, open mouth, half-closed eyes or fixed look; slight deliri- um or muttering, snatching, at the bedclothes; the patient being in a continual state of stupor, from which it is extremely difficult to rouse him, and from which he is scarcely aroused before he relapses into his former state; furious delirium, and incessant restlessness; dry, offensive stools, Avith involuntary evacuations of excrement and urine. Dose: Of a solution of six globules to three teaspoonsful of Avater, give a teaspoonful eA'ery three hours, until amelioration or change. TREATMENT OF THE STAGES OF DEBILITY AND CONVALESCENCE AFTER TYPHUS. Rhus-toxicodendron. This remedy retains its importance in the treatment of typhus throughout all the stages of the malady, and is amongst the best appliances during the period of debility which gener- ally supervenes after the issue of this fever. Rhus is more especially in- dicated in this stage, when the progress towards recovery is sluggish, the pulse retaining a febrile character, the appetite, although improved, be- ing capricious, the boAvels predisposed to relaxation, and the chest not yet exempt from feelings of oppression. Dose: Three globules, in a teaspoonful of water, night and morning, until distinct amelioration or change. Upon evident improvement taking place under this treatment, it will be sufficient to repeat the dose every night. 584 EPIDEMIC AND ENDEMIC DISEASES. China is frequently of great use, in this stage, against the debility resulting from the effects of the malady, more especially when the pa- tient has suffered much from violent relaxation of the bowels during the previous course of the disease ; or if there be a tendency to continuance in this symptom. China is also particularly useful when debilitating sweats supervene. In this case it should be followed by Sulphur, if that symptom has not yielded distinctly, after the second dose. Dose: In the case first described, three globules, in a teaspoonful of water, repeated, at intervals of twelve hours, until three doses have been taken. Under the last-stated circumstances, a similar dose night and morning,—and if the symptom does not distinctly yield Avithin tweh'e hours after the second dose, proceed with the next remedy. Sulphur should follow, tweh'e hours after the second dose of China, in case of the obstinate continuance of the sweats, or of the presence of dry cough at night. Dose: Three globules, in a teaspoonful of water, every twelve hours, until amelioration or change. Ferrum-metallicum is a preferable remedy when the pulse contin- ues weak or frequent, after a profuse discharge of blood, particularly in the case of females affected with green-sickness, or who have previously suffered from it. Dose: Three globules, in a teaspoonful of water, morning and eve- ning, for a Aveek. ACCESSORY MEASURES DURING THE PERIOD OF DEBILITY. The fever having subsided, and the patient being able to sit up, should first be removed to another apartment, free ventilation, and a moderate degree of warmness being simultaneously secured. By degrees, and as soon as possible, passive motion, and from thence, if possible, walking exercise (not sufficient to exhaust the patient), should be daily sought in the open air, in fine weather, with, however, particular precautions against damp or chill. Nothing will conduce to restore the patient to health and strength more rapidly and thoroughly than such accessory treatment with proper precautions in respect of diet, as stated below. AFTER EFFECTS OF TYPHUS. Bedsores, Abscesses, Boils, Swelling of the Feet, Weakness of Digestion, and General Derangements. These are more or less frequently the results of very severe or pro- tracted cases,—especially when the reactionary process is sluggish,—and require simultaneous local and constitutional treatment, with this reser- vation : that when the local application is unmedicated (such as pure spir- its), we may select the constitutional remedy, irrespective of such appli- cation, according to the particular features of the case, by'consulting the symptoms present, and the article on " Boils '' and " Abscesses," as re- gards those particular affections. EXTERNAL TREATMENT OF BED-SORES. Spirits-of-wine, Collodion, or Glycerine, will in general, suffice to remove this troublesome affection. YELLOW FEVER. 585 Application. To one part of the Spirit, add two parts of pure water, and saturate with this solution a linen pad, which must be applied to the parts and kept moist. Arnica (tincture) should be employed, if the diluted Spirit has proved insufficient and inflammation has not supervened. Application. To one part of the Tincture add twenty parts of water, and proceed as directed for Spirits of Wine. Tincture of Carbo-vbg., ) When mortification su- Tincture of Arsenicum, [-pervenes we may suc- Tincture of Cinchona (concentrated). ) cessfully employ either of these remedies (according to symptomatic indications), simultaneously with the internal administration of the same medicine as stated below. Application. To a wine-glassful of water add five drops (of the Tinct- ure of Arsenicum), or ten drops (of either of the others), and satur- ate Avith this solution a linen pad, which apply to the parts and keep moist. YELLOW FEVER. In this article we have quoted freely from the report of that commis- sionof eminent physicians appointed 1878 by the oldest National Medical Association in America. This commission was composed of eleven of the most thoroughly educated physicians in the U. S., seven of whom were experts in this disease in all its phases. CAUSES AND PREVENTION. Yellow Fever is a specific disease, entirely independent of malaria, occurring rarely a second time in the same person. It is infectious and capable of transmission to any distance by means of fomites or infected material. The yellow fever germs, for we accept provisionally the germ theory of the disease, are indigenous to the West Indies and perhaps to the west coast of Africa, and have been thoroughly naturalized in many localities in the southern portion of the United States. They were imported into New Orleans during the last quarter of the eighteenth century, and have existed in the soil or atmosphere of that place ever since, either in a latent or an active condition. They may lie dormant for many years consecutively, and they require a concurrence of causes to develop them into a state of disease-producing activity. Some of the factors which seem to be favorable to the excitation of the yellow fever germ are the following : Low, swampy ground near the level of a tropical sea. Long continuance of very high temperature, following heavy rains. Long continuance of south and east winds. Aggregations of human beings with the excreta of their bodies in a small space. A crowded and dirty ship may be a nidus for yellow fever, as well as a crowded and dirty city. 586 epidemic and endemic diseases. Long continuance of calm weather, unbroken by thunder-storms. Exposure of decaying A'egetable and animal matter to a burning sun. Inefficient drainage and the general accumulation of filth, especially the city garbage. Deficiency of ozone in the atmosphere. Pestilential exhalations from an upturned soil. When the yellow fever germ has been wftked into activity by these causes, it may be transported to places where none of them exist. It seems that a certain concurrence of several of the above factors is neces- sary to the generation of yelloAV feA'er. There is probably one combina- tion in one epidemic, and a somewhat different combination in the next epidemic. An epidimic may be mild or severe according to the num- ber and force of the concurring causes. There may also be other unknown but discoverable factors, Avhich may be necessary at one time to produce an epidemic, and not necessary another. No one of the aboA'e suggested causes could excite an epidemic by itself, and it is not probable that they all ever concurred equally to the formation of the disease The most ex- tensive collections and comparison of facts are necessary to illumine the very great darkness which lies upon these complex questions. The naturalized yellow fever germs may receive so slight a stimulus as to produce only a few sporadic cases. Or they may be vitalized in certain localities to such a degree as to occasion quite an outbreak in those localities, not easily communicated to other quarters. Or thirdly, the disseminated germs may be vivified in all directions, and a general epidemic excited. Or lastly, the naturalized germs may lie entirely qui- escent, until fresh and active germs are brought in from foreign ports, which then act as sparks to ignite the inflammable material already existing. We thus have four shades or degrees of yelloAV fever visitation: sporadic cases : local and limited outbursts : epidemics from naturalized germs, and epidemics from importation. In sporadic cases and limited outbreaks the specific nature of the fever is not clearly brought to light, and it is sometimes difficult to diag- nose it from the dominant malarial or bilious diseases. The imported epidemic, whether from Havana to New Orleans or from New Orleans to Memphis, etc., etc., is always a more quickspreading and malignant dis- ease than that arising from our naturalized germs. The comparative mildness of the late epidemic in New Orleans, is one out of several rea- sons for believing that the disease was of local origin. The yellow fever of domestic origin can only be prevented by local sanitary measures. So long as the public authorities ignore the crying evils at home, and watch only for the enemy at the seaside, we shall con- tinue to be scourged with repeated epidemics of yellow fever. Quarantine may or may not keep out the tropical foe, but our utmost energies should be concentrated against the enemy which has been domiciliated in our households for nearly a century. Is there any personal prophylactic against yellow fever? None which has the least scientific value. Quinine is probably serviceable when malarial fevers are simultaneously prevailing, not because it has any YELLOW FEVER. 587 power against yellow fever, but because an attack of malarial fever, pre- ventable by Quinine, might, if allowed to occur, precipitate an attack of yellow fever. Quinine for intermittents, Belladonna for scarlet fever, and vaccina- tion for small pox, are the only prophylactics which have commanded even the partial belief of the profession. They are all confessedly homoe- pathic in their actions, and we confidently belieA-e, if prophylactics for yelloAV fever or any other disease exist, that they will be found only by study and experiment in that direction. " To prevent the development of yellow fever, Are recommend : 1st. The thorough drainage of the city. This mighty Avork can only be efficiently achieved by the general government. Whether that would be constitutional or not we need not pause to inquire. An intelligent people will some time or other so modify their government, that it shall recognize the superior claims of the health and lives of its population over those of railroad companies and harbor improvements. As is well known, the topography of New Orleans presents A'ery considerable diffi- culties in the way of a perfect system of drainage, but not such as to be insuperable to engineering skill. 2d. The constant irrigation or flushing of the street gutters and ca- nals, by fresh water pumped in daily by steam apparatus. Allied to this measure is a perfect system of water works, which shall give an abund- ant supply of river water for drinking, bathing and cleansing purposes, so as to supercede the use of cistern water almost altogether. In this con- nection we may mention a curious fact communicated to the Commission by Mr. Harry Hammersly, Avho keeps a floating bathing establishment in the Mississippi river. One hundred and fifty boys under twelve years of age took one, and some of them two baths a day during the whole sea- son, and not one of them had the yeliow fever, although it prevailed ex- tensively among their families, and children of that age were peculiarly . liable to it. 3d. The consumption of all the city garbage by cremation. This new process has been extensively experimented upon during the last six months in the city of New York, and with extraordinary success. The plan has been described to us by Dr. George F. Foote, of Stamford, Con- necticut, a brother of the inventor. A single large furnace has been so constructed as to consume 1,000 foads in twenty-four hours. The garbage is not handled, but dumped immediately from the carts into the furnace. The combustible material mingled with it—old rags, paper, straw, veget- able debris, unburnt coal in ashes, the sweepings of stores, factories, streets, etc., is about a sufficient supply of fuel for the whole work, when the fire is once started under a full blast. The gases from the combustion —carbonic oxide and carburetted hydrogen—are brought under the boiler and again burned to generate steam to drive the blowing engine. The expense for fuel is light ; there is no escaping odor, and the residue or slag, about eight per cent, by weight, can be made available for useful purposes. One such furnace in each district of New Orleans would consume daily every atom of its garbage, deliver it from every pestilential emana- 588 EPIDEMIC AND ENDEMIC DISEASES. tion and odor, and give its atmosphere something like the sweetness and purity of mountain air. Nor will it be many years, in our opinion, be- fore the people of Ncav Orleans. Avho are compelled by the nature of the soil to bury their dead abo\Te ground, will discover that in their case, at least, cremation is the A'ery best disposition to make of the human body when the principle of life has abandoned its tissues. 4th. The generation of ozone to supply its deficiency in the atmos- phere when detected by the proper instruments. This should be made one of the most special and important duties of the Sanitary Commission. Ozone is a peculiar gas, a modified form of oxygen, generated by elec- trical storms and violent concussions of the atmosphere. It is so power- ful as a disinfectant that one part of it will purify three million parts of atmospheric air. Ozone is thus nature's great disinfector and purifier, more subtle, powerful and ubiquitous than all others, and we must learn to utilize this splendid gift of the Creator for our own sanitary blessing. When it is deficient, deleterious gases accumulate and produce diseases of various kinds, and when the other factors of yelloAV fever productions are present, the deficiency of ozone may be the determining element for the manifestation of the disease. The scientists of the sanitary Commission will be provided with the instruments and chemical means for detecting its slightest variation, and for restoring it in suitable quantity to the air, where by the law of the equitable diffusion of gases, it will be almost in- stantly distributed many miles around. There are many measures of great sanitary importance over which the Commission would exercise a strict supervision. It would enforce the frequent emptying and disinfection of water-closets, sewers and all places containing putrescent matters, vegetable or animal. It would see that no sacks of decaying coffee, or chaff' in rice pits, or dead animals, or any offensive matter was left exposed so as to poison the atmosphere. It would prevent, so far as possible, the destruction of trees, and in every way encourage their planting and growth. Above all, it Avould forbid . the upturning of the soil during the spring and summer months, as epi- demics of yellow fever have followed such upturning at New Orleans, Natchez and Vicksburg, in such a manner as very strongly to suggest that the relation of cause and effect existed between this exposure of the earth and the development of the disease." YELLOW FEVER—ITS SYMPTOMS. This fever is a disease of warm climates, and has obtained the name of yellow fever from the hue which the skin of those affected by it very frequently acquires. The more constant symptoms of the disease are : violent vomiting, first of bilious and subsequently of brownish-black matter, which is also passed by stool; great anxiety and prostration, in- tense fever. Remarkable remissions take place in the course of the fever, succeeded in a few hours by exacerbations. The outbreak of the malady is generally preceded by sudden debility and restlessness, which are soon followed by headache, giddiness, faintness, and slight chilliness, to which are added prsecordial oppression, want of appetite, and deranged diges- tion. • YELLOW FEVER. 589 In other cases, the seizure is sudden and unattended with premoni- tory symptoms, and the course of the disease exceedingly rapid, and a fatal termination not unfrequent within thirty-six hours from the acces- sion of the attack. The more usual form which the disease takes is, however, as folloAvs: Immediately after the fit of chilliness and horror, violent reaction sets in, announced by a high degree of fever, with great heat of skin, strong throbbing of all the arteries of the body, and determination of blood to the head. The respiration is hurried and often laborious, attended Avith deep sighing and gasping for air. The face is flushed, the eyes heavy, sensitive to light and affected with burning pains, the tongue Avhite, furred, and sometimes red, but soon becomes parched and dark-colored, and tinged Avith yellow after the vomitings come on; the thirst is excessive. A burning pain is sometimes experienced in the scrobiculus; an excessive sensibility to the touch in the right hypochon- drium; and the stomach, irritable from the first, is rendered so much so as the disease adA'ances, that everything which is taken into it is almost immediately rejected, along with a quantity of bilious matter. Severe darting pains traverse the head, the small of the back, and even extend down the thighs. The pulse is subject to variations, being in some cases quick and strong, in others quick, Ioav and irregular; in plethoric indi- viduals, Avho have not been long exposed to the relaxing effects of the warm climate, it is accelerated, full and bounding, for some hours after the development of the reaction; the urine is suppressed, or scanty and offensive; the stools likewise have a most disagreeable fetor; the patient is excessively restless, tormented with spasms in the abdomen and legs, and tosses about with anguish. These symptoms constitute the first or inflammatory stage of the fever, and may continue from twenty-four to sixty hours and upwards, according to the severity or mildness of the attack. The second stage commences with the abatement of several of the preceding symptoms, and the increase or substitution of others. The skin and eyes present a yellow tinge; the head is confused, or delirium supervenes, and the eyes look glassy. The fits of vomiting are more vio- lent, and the matter ejected becomes thicker and darker; the patient occasionally drops asleep, but instantly aAvakes in a fright, and sometimes he springs out of bed in a state of furious delirium, but instantly sinks to the ground in a state of tremor and exhaustion ; the pulse flags, but is sometimes soft, at others high ; the tongue is generally parched, harsh, and discolored, but sometimes moist and covered Avith a dark fur; there is frequent hiccup, and the skin is soft and clammy. The duration of this stage is also variable; rarely, if ever, longer than forty-eight hours, sometimes only twelve. The first and second stages terminate by a remission of the more alarming symptoms, and a hope of recovery is entertained, but it is too often doomed to disappointment by insidious degeneration of the disease into the third stage, in which the pulse sinks, becomes irregular and in- termittent, yet sometimes increases in frequency; the vomiting becomes incessant, and is attended with great straining and noise, from the vio- lent belching of flatus; the matter vomited is grumous, resembling coffee- 590 EPIDEMIC AND ENDEMIC DISEASES. grounds, and is named the black vomit. The breathing becomes more labored ; the tongue black, or shrunk, dry and red ; the eyes hollow and sunk, and the features shortened. A gradual aggravation of the symp- toms then ensues, attended with starlings or twitchings of the tendons, the limbs become deadly cold, and the hiccup distressingly constant. Hemorrhage, or oozing of blood takes place from different parts of the body; the urine is deep-colored, the stools black or sanguineous ; the ab- domen often tense and tympanitic; vibices make their appearance, and death sloAvly or suddenly terminates the scene. ALLOPATHIC TREATMENT. This disease is one in Avhich the treatment must be directed to guid- ing the patient through it, as in typhoid fever. The fever is self-limited and Avill run its course. The room should be managed as directed for typhoid fever. Disin- fectants should be used as directed for that disease. A very essential point in all cases, Avhether mild or not, is to keep the patient quiet in bed. This cannot be too strongly insisted on, from the first slightest indisposition. During the first stage, the use of water should be resorted to, to mod- erate the intensity of the fever. Preference should be given to the wet sheet or cold sponging. They should be managed in the same way as di- rected for typhoid fever. If there is perspiration (sweating) bathing is not to be followed at all. It is recommended by good authority to give three grains of Quinine, three grains of Dover's PoAvder, and three grains of Calomel, every two or three hours, Avhile this stage of the fever lasts. (The Avriter would omit the Calomel). It is also recommended, if the skin continues hot and the fever high, to produce its reduction with Aconite. Sixteen drops of the Tincture in four ounces of water in doses of a teaspoonful every half hour, may be given until a reduction in the fever is produced. It may then be given e\'ery hour or tAvo to maintain its effect. It certainly is appropriate if the treatment Avith water is not satisfactory. Purgatives are generally giA'en in the beginning of the disease, but they seem uncalled for, except for the relief of constipation, for which Castor Oil is to be preferred, in doses of a dessertspoonful to a tablespoon- ful (mixed well with an equal quantity of Glycerine and flavored with Oil of Cinnamon or Gaultheria), or recourse should be had to injections. Regarding the use of Calomel or other mercurials, it is difficult to see Avhat benefit can accrue from them, further than their action as cathar- tics, the use of Avhich has just been discussed. Emetics are not to be given, but all stomach trouble should be met by proper palliatives. The nausea and vomiting, by the use of Opium to the extent of relieving the pain, Avhen, if the vomiting continue, the addition of drop-doses of Carbolic Acid, or Creosote in doses of one drop, or ten to twenty grains of Sub-Nitrate of Bismuth, or five-drop doses of Dilute Hydrocianic Acid. Small lumps of ice may be swalloAved. Mustard plasters, dry cups, or small blisters, two inches square, may be applied over the stomach. Poultices often relieve the nausea and pain. YELLOW FEVER. 591 Probably as appropriate a way to administer Opium as any, is by the hypodermic injection of a sixth of a grain doses of Morphine, or injec- tion of a teaspoonful (dram) of Laudanum in an ounce of thin starch, in- to the bo avc! . The drug should be given at any time when necessary to relieve suffering. The ordinary close may be given by the mouth, as one- fourth of a grain of Morphine. Any coldness of the extremities should be met by the application of heat by the hot foot-bath made stimulating by adding Mustard or Cay- enne pepper, and Mustard plasters. The bath should be given under the bedclothes. In this way the tendency to internal congestion, upon which may depend the tendency to hemorrhage, is relieved. Cold to the head, by means of cold water, the ice cap, or bladders of pounded ice, may be used to relieve headache. As soon as the amelioration of the symptoms (usually temporary) occur at the close of the second or third day, particular attention must be given to nourishing the patient, and keeping him quiet in bed—perfectly quiet. Food and Alcoholic stimulants must be given as directed in the treat- ment of typhoid feA'er throughout the course of the disease. By this means alone life may be saved. Beginning at the period of amelioration in the symptoms, tonic doses of Quinine from two to three grains four times a day. The mineral acids are indicated the same as in typhoid fever, prefer- ence being for the Aromatic Sulphuric Acid, on account of the tendency to black (hemorrhagic) vomit. The dose is ten drops largely diluted with Avater. It can be given at intervals of two hours or more. The teeth should be wiped Avith a cloth dipped in a solution of Bicarbonate of Soda after giving the Acid to prevent injury to them from the Acid. To prevent hemorrhage into the stomach, and consequent black vom- it, ten or fifteen-drop doses of the tincture of the Chloride of Iron four to six times a clay, largely diluted in sweetened water. If hemorrhage occur ten-grain doses of Gallic Acid should be giA'en in the Acid mixture. Difficulty in the secretion of urine should be met by diuretics, as the infusion of Digitalis in doses of a tablespoonful, or the Tincture in doses of half a teaspoonful with half a teaspoonful of the Vinegar of Squill, given four to eight times a day. If diuretics are inoperative, and especially if there are symptoms of uremia, (poisoning by retention of urea, an ingredient of the urine, in the blood), the smell of Ammonia in the breath, or insensibility, the hot air bath should be used to produce copious sweating. If this does not re- lieve, a cathartic of one or tAvo drops of Croton Oil or a quarter of a grain of Elaterium in Glycerine may be given. When the symptoms of remittent or intermittent fever are associated with yellow feA'er the first remission or intermission should be seized upon for giving thirty grains of Quinine at a dose. Subsequent treat- ment of these complications should be as directed for these diseases. Salycilic Acid has been used by Dr. Buenz of Savannah, in the epi- demic of 1876, in a single dose of a dram and a half in capsules, or rubbed 592 EPIDEMIC AND ENDEMIC DISEASES. up with sugar; if the stomach rejected it, twice the quantity (three drams) was given by the rectum (injections into the bowel.) Out of one hundred and seventy-nine patients only four died. The disease during that epidemic was of intermittent and remittent type. Whether this treatment is generally applicable is a question. During the seA'ere epidemic of 1S7S, in the Southern states, Dr. Mar- shall of Burlington, IoAva, who was then at Jackson, Miss., states while the disease Avas almost universally fatal, wonderful results Avere obtained by treating patients on the general principles appropriate to fevers which must run their course, Avhich we haA'e just sketched. The bowels were kept open and the kidneys active by the use, from the beginning to the end, of the the Hyposulphite of Soda. An ounce of this salt Avas dis- solved in eight ounces of water and a tablespoonful given every four hours. The patient Avas kept Avell covered with blankets and a gentle sweating encouraged by the use of Orange Leaf or Horse-mint tea. Be- sides this, keeping the patient in bed during the stage of calm and giving liquid nourishment and stimulants and tonic doses of Quinine, constitute the treatment. An almost universal fatality Avas reduced to a fatality of one in ten in Avhites, two in fifteen in mulattos, and one in thirty-six in negroes. Getting up, or eating solid food of any kind during the disease, which patients desire to do during the stage of calm, is almost always fatal. HOMCEOPATHIC TREATMENT. All through this Avork numerical comparisons have been steadily avoided, but on account of the thorough reliability and the broad extent of country covered, we think avc may be excused for thus presenting these statistics, when it is so evident that it will be the means of saving very many valuable lives. The treatment here folIoAving has been thus proven, and if these remedies are giA'en in time (as they will be where this work is owned) and the full directions followed, the deaths from this terrible destroyer and foul plague of all hot climates, will, Ave confidently belieA'e, be reduced beloAV 3 per cent of all persons attacked with the disease. We quote again from the before-mentioned report: On analyzing the reports handed into us, we ascertained the following facts: We have here 1,945 cases of yellow fever treated homceopathically in the City of New Orleans, with a loss of 110 patients, a mortality of 5 6-10 per cent. We have 1,909 cases of yellow fever treated in cities and towns outside of New Orleans, with a loss of 151 patients, a mortality of 7 7-10 per cent. This makes a total of 3,914 cases of yellow feA'er treated homceopath- ically, during the epidemic of 1878, with a loss of 261 patients, a mortality of 6 6-10 per cent. We have, moreoA'er, reports of 555 cases treated homoeopathic-ally in the great epidemic of 1853, Avith a loss of 33 patients, a mortality of 6 per cent. YELLOW FEVER. 593 Also, reports of 2,100 cases treated during the several minor and much milder epidemics which occurred betAveen 1853 and 1878, with a loss of 66 patients, a mortality of 3 7-10 per cent. Making a grand total of 6,569 cases treated by homcepathic physicians, with a loss of 360 patients, a mortality of 5 4-10 per cent. The number of cases reported as occurring in 1878, among negroes, including mulattoes, Avas exactly 900—with a loss of 27 patients, a mor- tality of 3 per cent. Some physicians did not distinguish betAveen their patients as to race or color. The number distinctly reported as white was 2,299, of whom 194 died, a mortality of 8 4-10 per cent. This includes the returns from points like Memphis or Chattanooga, where the fever was very malignant and the mortality very great. In four of the New Orleans reports, 1,076 patients are described as being Avhite, of Avhom 66 died, a mortality of 6 1-10 per cent. The number of cases distinctly reported as colored in the city of New Orleans, Avas 107, of whom 3 died, a mortality of a little less than 3 per cent. The total number of cases reported as being under 15 years of age, is 1,089, of whom 48 died, a mortality of 4 4-10 per cent. The total number of recoveries after black vomit was 125. This dreaded symptom, formerly considered so fatal, has been groAvingless and less so since the epidemic of 1853, and a great many recoveries have been recorded during the late visitation by gentlemen of both Schools. Chil- dren seemed to have it more frequently in proportion to numbers, and to recover from it more readily than adults. We must not forget that there are various shades and degrees of black vomit. Blood more or less black- ened by the acids in the stomach, may have been quite healthy when exuded from the mucous membrane of that organ, and be far less prog- nogistic of danger than that sooty, coffee-ground substance, the genuine black vomit, which shoAvs under the microscope a chemical destruction and disintegration of the blood-globules. Among these returns are nine papers to which we attach especial value. These comply fully with the request of the circular letter, to give not only cases and deaths, but the name, age and address of every patient attended, so that Avith these documents in our hands, Ave can verify every statement, and challenge comparison with any member of the Allopathic School who can furnish us with similar accurate data. These returns exhibit an attendance upon 2,010 cases of yellow fever, with a loss of 120 patients, a mortality of 6 4-10 per cent. There were 64 recoveries after black vomit. The number of children under 15 years of age amounted to 828, of whom only 40 died, a mortality of 4 0-10 per cent. IIOMCEOPATHIC TREATMENT. Aconitum has been named as the most direct and positive remedial agent in the early stage of yellow fever; and, indeed, its specific effect upon the human economy in a healthy state, especially under conditions 38 594 EPIDEMIC and endemic DISBASES. of temperature provocative of the generation of fevers of this kind, tends greatly to confirm this opinion. In case of an attack of fever of an in- flammatory character, whether it be apprehended that it may resolve it- self into this form or not, the prompt administration of Aconitum can only have been productive of benefit. Dose: Six pills in a teaspoonful of water, or dry on the tongue, re- peated, after the lapse of one or two hours, and subsequently, at in- tervals of one, two, three or four hours, until the fever symptoms abate, the breathing becomes less laborious, and the pulse more regular, or less quick and frequent. But if symptoms of severe ex- acerbation should threaten to succeed, notwithstanding the admin- istration of Aconitum, proceed promptly with such of the subjoined medicines as may offer the closest analogy to the case. Belladonna may prove of much service after the previous adminis- tration of one or two doses of Aconitum, for the treatment of those cases (during the first stage) which attack young, full-habited subjects, with very marked and predominant brain-symptoms. It is useful in the first or second stages. Dose: As directed for Aconitum. Bryonia may be called for in the first, or even in the second stages, where Aconite or Belladonna have not sufficed to allay the symptoms. It is more particularly indicated when the pains assume a rheumatic character, and all the symptoms are aggravated by motion. Do.se: As directed for Aconitum. Arsenicum. Faintness, depression, nausea with intense burning in the region of the stomach, increased by pressure ; violent vomiting of brown turbid matter, mixed with mucus, and sometimes stained with blood. Pulse small, frequent and irregular; skin cold and clammy in the stage of collapse, at other times it is very hot; breathing feeble and ac- companied with sighing ; great nervous irritability ; intolerable pain in the bowels, with dark or bloody stools ; great emaciation; want of sleep ; urine scanty, high-colored, and passed with an effort; delirium ; jerking; coma; convulsions; thirst frequent, but usually for the moment satisfied with a small quantity of water. Dose: Six pills in a little water, or dry, every one to three hours, or in severe cases, every ten or fifteen minutes. Crotalus has been employed in some cases with very marked suc- cess, all danger having been subdued after a few hours, even in cases which had reached the fully developed third stage. It is more especially indicated by the hemorrhages occurring from the eyes, nose, mouth, ears, stomach and bowels. Dose: As directed for Arsenicum. Argentum nitricum has been employed in some .cases, with good effect, Avhere the patient is sinking, the vomiting becomes worse, Avith broAvnish stains in the matter ejected, or other evidence is given of effu- sion of blood upon the mucous lining of the stomach. Dose: As directed for Arsenicum. Pulsatilla, Mercurius, Nux-vomica, Acid-nitricum, and China may prove of service in the first or second stages, more particularly, and CHOLERA. 595 Cantharis, Digitalis, Carbo-veg., Croton-tiglum, Rhus-tox., and Verat- rum-album, in the second and third stages, more particularly. The selec- tion should be guided, in each case, by the analogy existing between the symptoms of the disease, and those which are specific to each of these medicines, as found by the appended " Repertory." ASIATIC CHOLERA—MALIGNANT CHOLERA. EPIDEMIC CHOLERA. This virulent disease generally commences with giddiness, headache, singing in the ears, and uneasiness, a sensation of flatulence in the sto- mach (rumbling of wind), or griping pains, rapid loss of strength, and a feeling of weight and oppression in the region of the heart. In the severest forms of the malady the patient suddenly falls senseless to the ground, as if struck by electric fluid. But in many instances, diarrhoea is the first symptom, which, if neglected, soon becomes associated with vomiting, severe colic, cramps or convulsions, anxiety, and dread of dis- solution which appears to be inevitable. In some, though not all, cases of Asiatic Cholera, we find the lips, nails, and sometimes the whole skin, of a blue color, but in almost every instance, the frame loses its power of generating heat, the pulse and pul- sation of the heart are almost unfelt, and the circulation of the blood becomes stagnant. Patients who have outlived the second stage sometimes fall victims to a secondary typhoid fever in the third. Predisposing Causes.—The predisposing influences are: intemper- ance in eating and drinking; insufficient of or cold, indigestible fruit and crude vegetables; cold drinks when the body is overheated ; exposure to exhalations from decayed vegetable or animal matter; residence in low, damp, dark, ill-ventilated dwellings; excessive fatigue; suddenly sup- pressed perspiration ; sudden mental shocks, or moral emotions as fright, fear, grief, and especially passion ; neglect of cleanliness, both personal and domestic; constitutional debility, serious derangement of the diges- tive organs, weakness of the bowels, etc. As any, or, at all events, several of these in conjunction, tend to favor the invasion of the disease, they ought, when practicable, to be carefully guarded against or removed. Exciting Causes.—These are generally said to depend upon some peculiar atmospheric conditions. But it is to be remarked, that such at- mosperic conditions (properly so called—in contradistinction to the many other immediate causes of disease, with which the atmosphere may be impregnated), do not appear necessarily to involve whole regions or even extensive tracts of country. Cases are not wanting, especially in tropical climates, in which this disease, in all its distinctive features, has occurred almost in isolated instances, or has been confined to particular spots. 596 EPIDEMIC AND ENDEMIC DISEASES. ALLOPATHIC TREATMENT In the treatment of epidemic or asiatic cholera, this much appears to be settled, that upon the appearance of the diarrhoea which is preliminary to the disease (Cholerine) the patient takes to his bed and remains there; this is essential to success. The remedy which is best suited to control the preliminary diarrhoea, is Opium. Strychnine. Sulphuric Acid, Chloro- form and Camphor have been found useful. The following formula is found useful during this stage. Take a fourth of a grain of the Sulphate of Strychnine, Aromatic Sulphuric Acid half an ounce, Sulphate of Mor- phine two grains, Camphor AVater three and a half ounces. Mix; a tea" spoonful well diluted; may be given every one, two or three hours accord" ing to the severity of the diarrhoea. The plan of checking the diarrhoea by a full dose of Opium varying from a quarter of a grain, to one grain of Morphine, according to the severity of the diarrhoea, The continued use of the above mixture would then be appropriate. But return or increase of the symptom should be met with another full dose of Opium after an interval of not less than an hour. The bowels should move in a bed-pan, the patient not being allowed to rise to stool. The stools should be buried and the vessels thoroughly washed and disinfected by keeping a solution of Permanganate of Potash or Carbolic Acid in them. The floor may be sprinkled with Labarraqu's Solution, or a solution of Carbolic Acid one part to forty of water. The food, when there is diarrhoea, should be composed of farinaceous articles, milk, and beef tea. The drink may be Sulphuric Acid Lemonade, using for a change, and to gratify the taste, plain water, cold tea, or milk and water. Hot poultices or mustard plasters may be applied to the abdomen to relieve pain. When vomiting and purging occur there appears to be no remedy more generally useful than Chloroform given in doses of five to ten drops every half hour or hour. It relieves the A'omiting, pain, and spasms. Lint saturated with Chloroform laid over the stomach and co\'ered with oiled muslin will aid in controlling the vomiting. When collapse occurs the Opium and Strychnine before appropriate are not to be given because they may not be absorbed, and when the pa- tient rallies from the collapse (if he does) there is danger from an over dose by accumulation in the stomach. The use of Chloroform may be continued in five to ten drop doses or teaspoonful closes of Spirits of Chloroform (Chloroform one part to Alco- hol tAvelve parts) every half hour or hour may be continued. The benefit of that variable mixture called Chlorodyne depends large- ly upon the Chloroform it contains. Brandy or Whisky and water should be given as freely as the stomach will retain them, in small quantities at a time. The thirst may be relieved by water rendered slightly sour by the addition of ten to thirty drops of Aromatic Sulphuric Acid to a glass of water. Ice water may be taken in small quantities or simple water may oe used. Water is not harmful, if it does not provoke vomiting. Small lumps of ice may be given. CHOLERA. 597 Concentrated nourishment as milk and meat essences should be fre- quently giA'en in small amounts (with Avhisky or brandy, or without) if the stomach does not reject it. The remedy which has yielded the best results in the stage of collapse or when it was approaching, is the Hydrate of Chloral given by hypoder- mic injection, from ih'e to ten grains in solution in water being the dose given at intervals of half an hour to an hour or tAvo. It is often advan- tageously given Avitb Morphine in closes of from an eighth to a quarter of a grain. The surface of the body should be kept warm if possible by dry heat, such as hot flannels, bott les of hot water, etc. It is not desired to occasion sweating but perspiration should be wiped off with warm dry cloths. Injections of warm Avater or injections of whisky with warm beef tea are permissible. The latter has been known to avert an approaching collapse and arrest the diarrhoea. If the patient rally from the collapse the cautious use of nourishment and stimulants as directed for typhoid fever are indicated. If the kid- neys do not act freely they should be stimulated by the use of half tea- spoonful doses of the Vinegar of Squills in a dessert or tablespoonful of Infusion of Digitalis four times a day, and bland drinks such as flaxseed tea or barley Avater. If coma (insensibility) the hot air bath should be resorted to to throw off the urea by sweating. The danger of uraemic poisoning is averted by getting the kidneys to acting freely. Tonics should be given. For this purpose there is none better than tAvo or three grains of Quinine given four times a day. Thorough cleansing and disinfection of buildings and surroundings, having privy vaults, drains, and vessels which receive excretions, house waste, etc., contain disinfectants, no filth of any kind being allowed to accumulate, the seA'ere ravages of the disease may be prevented. HOMOEOPATHIC TREATMENT. The success of treatment much depends upon the promptness with Avhich remedial resources are exhibited, upon the earliest recogni- tion of the attack. Tincture of Camphor, if administered upon the earliest premoni- tory indications of the attack, will often avail to prevent the further development of the disease, and Avill at all events, in the great majority of cases, aA'ert fatal consequences. The following are the particular indi- cations in the early stage—chilliness, shivering, giddiness, headache, singing in the ears, pain, weight, pressure, or a distressing sensation in the pit of the stomach, cramps with protracted rigidity in the calves of the legs, sensation of general uneasiness, sudden loss of strength;— sunken, blue-encircled eyes; diminution of the senses; sIoav, or scarcely perceptible pulse; blueness and icy coldness of the face and hands, and greatly diminished temperature of the whole body; burning heat in the throat and region of the stomach ; distended bowels; much flatulent rumbling; nausea and even vomiting, and diarrhoea; diminished or sup- pressed urine (an almost constant symptom in Cholera); hoarse voice; 598 epidemic and endemic diseases. countenance expressive of excessive anguish; suffocating oppression. After taking Camphor sweat soon breaks out as a sure sign that an im- provement has commenced. Then the remedy must be given less fre- quently and in smaller doses, or it may give rise to congestion of the brain. Dose: Take of the purest loaf-sugar, or of sngar-of-mi\\i, finely pounded just a sufficiency, upon which deposit one drop of the tincture thus administering the dose, and repeating such dose, at first every five minutes extending the intervals according to the duration of the intermissions between the spasmodic attacks, only repeating the administration as the attack returns, and continuing this course until positive amelioration or change. Decided improvement is readily distinguishable: first, by increased warmth, and, shortly, by diminution of anxiety, by comparatively healthy perspiration, and by an inclination to sleep. After sleeping an hour or two the patient awakes with a sensation of ease, which he can scarcely believe. Veratrum (especially under the particular circumstances just enu- merated) should be employed without a moment's delay, when Cholera sets in in its worst and characteristic form, with sudden and violent fits of vomiting and purging, the evacuations resembling starch or rice- water, after several paroxysms ; flatulent rumblings, excruciating gripes, severe cramps (either with protracted rigidity, or with rapid alternations of contraction—particularly the latter) in the calves of the legs, etc., (second stage), ice-like coldness of the entire body, even of the tongue, cold, clammy sweat, suppressed respiration, feeble pulse, great thirst—the patient, if permitted, drinking large quantities of water—excessive weak- ness, terrified look, weak hollow voice, groaning and yawning. Dose: Six globules in a teaspoonful of water, every quarter of an hour (in extreme cases) or every half hour (in less urgent circum- stances), or even in some very desperate cases, and Avhen a fatal is sue seems imminent, every five minutes,—until the extreme sever ity of the symptoms becomes somewhat abated ; and, subsequently, every time the paroxysms return, and so on until the symptoms yield or change. Arsenicum album displays its curative action in those terribly rapid cases where cholera algida at once sets in without any premonitory symp- toms. The most essential indications for Arsenicum are : Sudden and complete exhaustion, vanishing of the pulse, together with violent palpi- tations of the heart, great dyspnoea, inexpressible anguish, constant toss- ing about, horrid thirst, yet the least quantity of liquid is vomited up again immediately; burning distress in the region of the stomach and upper portion of the bowels; complete suppression of urine. In such cases Arsenicum should be given at once, without any other medicine being resorted to in the first place. After the exhibition of Arsenic the urine is often secreted in large quantity, a very favorable change. Dose. Six pills in a teaspoonful of water, every quarter of an hour (iu urgent cases), or even every five minutes (when a fatal issue ap- pears imminent), or only every half hour (in cases of a less desperate character), until the symptoms are modified, and the sufferings are not so incessant; then extending the intervals according to the du- ration of the periods of remission between the paroxysms, and so on, until positive change. cholera. 599 Aconite is a splendid remedy if, in the beginning, or after the blue cold stage, there is heat of the skin, quickness of the pulse, headache, noise in the ears, dryness of the tongue Avith craving thirst, this remedy should be given in small closes—six pills every ten to thirty minutes. On the other hand, when the skin is cold, clammy and livid, the pulse not perceptible at the wrist, the action of the heart quite feeble and ir- regular, the bead cold, the pupils of the eyes dilated very much, and not sensitive to the effects of light, involuntary discharges from the bowels of a thin stool resembling rice-water, A'omiting of a similar substance, the dose should be large—twentj' drops of the Tincture of Aconite, in a glassful of water, to be given one teaspoonful every fifteen to sixty minutes. Carbo-veg. may often be advantageously employed after the previ- ous administration of one or more of the preceding medicines, or even in alternation Avitb Arsenicum (in some cases) when the patient is reduced to the last extremity, animation being all but completely suspended, and the pulse scarcely perceptible; or when, on the cessation of A'omiting, purging, and cramps or convulsions, determination of blood to the head and chest ensues, attended with oppressed breathing, coldness of the breath, redness or livid hue of the face (which is covered with clammy SAveat i and lethargy—the patient seeming as if seized with an apoplectic fit. Also when every sign of reaction has been extinct from the beginning. Dose: Six pills in a teaspoonful of water (or,—if there be difficulty in ensuring its being sAvallowed thus—dry on the tongue), at intervals of five, ten, and fifteen minutes successively, and then (if the pulse become stronger) every half hour until positive change. But if, upon the development of stronger pulse, and the subsidence of the lethargic symptoms, the pain, vomiting, cramps, etc., should return, at once resume the administration of Veratrum, as before. ADDITIONAL PARTICULARS. Ipecacuanha, Nux-vomica. These remedies (the first either singly or followed by Nux-v.) have been found efficacious either before or after the previous administration of the other medicines (generally when more urgent symptoms had been overcome), or at the onset of the attack (in milder cases), when such indications as the following could positively be identified. Ipecacuanha may be administered under circumstances such as those just stated, either after previous treatment, when the vomitine: be- comes a prominent symptom, and the discharge attending it is more copious, or at the onset of the attack when the vomiting (being copious, and attended with much nausea) predominates, so as to characterize the case distinctly. Further indications for this remedy are such as the fol- lowing .-—sensation of weakness (or of internal sinking), coldnees of the face and limbs, sensation of shivering in the belly, slight cramps in the calves of the legs and in the fingers and toes; or sometimes, again, vomit- ing, alternated Avith watery diarrhoea, accompanied with or preceded by griping, colicky pains; or even yellowish diarrhoea in some cases in which the vomiting does not occur ; or loose evacuations of excremental 600 EPIDEAIIC AND ENDEMIC DISEASES. matter mingled Avith slime (at the commencement of the attack), or evac- uations of a greenish or brownish character. Dose: Of a solution of twelve pills to four tablespoonsful of water' give a teaspoonful every hour, until change. But if, after the more violent symptoms (the vomiting especially) have yielded in a degree to the action of Ipecacuanha, pause three hours, and proceed with the next medicine, if the subjoined symptoms remain. Nux-vomica may be employed Avith great advantage three hours after the last dose of Ipecacuanha, when the vomiting has subsided under the influence of the last-named medicine, but symptoms of spasm of the stomach remain, such as Aveight and constriction in the region of the sto- mach; or again, when anxiety, great debility, griping, frequent, small evacuations with much straining, frontal headache, or aching pain at the back of the head, and shuddering, with predominant internal chill, con- tinue to prevail. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every hour, until the symptoms abate; and then every three hours, until positive change. Cicuta-virosa has proved an appropriate remedy, when there ar e spasms in the muscles of the chest, continuous vomiting, and little diar- rhoea, Avhen the eyes are turned upwards, and the patient is in a drowsy state. Dose: Six pills in a teaspoonful of water, (or, if there be difficulty in this method, dry on the tongue), every ten minutes, until the symp- toms abate, and then every half hour, until positive amelioration or change. TREATMENT OF THE AFTER-EFFECTS OF CHOLERA. Carbo-veg., is of much service in the stage of convalescence when flatulent rumblings and the colic with diarrhoea and excessive flatulence during stool remain. Dose: Four pills in a teaspoonful of water every hour, or after every intestinal evacuation, until a degree of improvement becomes ap- parent, and then every twelve hours. Phosphorus is very useful when debilitating diarrhoea remains after the removal of the more urgent symptoms, and particularly when the stools are watery, and sometimes productive of an acrid, pungent sensa- tion in the last intestine, and attended with belching, weight or oppression at the pit of the stomach and lateral regions (Avithoutthe heat or burning which accompanies this symptom in the cases that call for the employ- ment of Arsenicum), and pain in the region of the navel, rumbling noise in the bowels, either at other times or on pressing the hand against the belly, pricking or shooting pains in the left side of the chest, etc. Phos- phorus is also useful when a tendency to vomit remains, but with the distinctive indication that it only occurs about a quarter of an hour or so after drinking, or Avhen the cold fluid drunk has become Avarm in the stomach. Again, it is a remedy of much importance in the event of con- gestion in the chest, Avith oppressed and laborious breathing, in addition to the before-mentioned symptoms during the course of the disease. Dose: Four pills in a teaspoonful of water, every three hours (or every hour in more urgent cases) until the symptoms abate, and then every six hours. CHOLERA. 601 Acidum-phosphoricum should be administered either after the pre- vious use of Phosphurus, or eA'en before it, in the event of the tongue becoming exceedingly clammy or slimy; or again, if colliquative diarrhoea should ensue with or Avithout the typhoid or congestive symptoms here- after described ; or when the dullness of the head and pallor of the face occur; or the evacuations are watery or slimy; or exhibit a greenish-white hue, and there is inadequate discharge of urine. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every two hours. ACCESSORY TREATMENT. The patient should be kept in a room of a warm temperature, the bed should be heated by artificial means,—bottles of hot water applied to the feet, if necessary, and hot flannels to other parts of the body. The obser- vance of this rule greatly facilitates the action of the medicine employed. Enveloping the patient in a damp sheet (one which has previously been soaked in warm water), and then wrapping him in blankets, is another useful auxiliary mode of treatment. Frictions with woolen cloths, and the act of rubbing and pinching, under the bedclothes, the parts affected Avith spasms, have also been recommended; but if these auxiliary measures prove distressing to the patient, he should be left quietly under the action of the medicine. Anything which might disturb the equanimity of the sufferer, such as noise or contradiction, should be carefully avoided, and his spirits should be sustained as much as possible. Food and Drink. Cold water is the best drink, but the patient should not be allowed to take too much at a time; the occasional adminis- tration of a small piece of ice, if possible, or of iced water in teaspoonsful is often attended with benefit; and injections of iced water are sometimes serviceable in relieving the colic and cramps in the intestines,—or of starch-water in the case of straining. When cold water, in lieu of dimin- ishing, increases the vomiting or other sufferings, and the patient ex- presses a wish for a little nourishment, tepid emulsion of sweet almonds, thin gruel, barley-water, toast-water, milk and water (all warm and given in teaspoonsful at a time), may be administered. During the convalescence following this disease, we must be careful not to indulge the patient to the full extent of his desires. It is therefore advisable, when the appetite returns, to commence with Semolina, Sago, Arrowroot, and such like, as also Cocoa, chicken-broth, or beef-tea; but great caution must be obserA-ed, in order to aA'oid the risk of a relapse from an undue amount of nutriment. This is best accomplished by the administration of a tablespoonful every hour, or only every two or three hours—diminishing or gradually augmenting and varying the quantity and quality of the food, according to the effects produced. GENERAL ACCESSORY PRECAUTIONS. Care ought to be taken to avoid excesses of all kinds, late hours, ex- posure to night air, melancholy thoughts, or fear, which are all predis- posing causes to attacks of this malady. Pure air and thorough ventilation are indispensable, and the precau- tion of providing a free current of water through all drains, etc., is not 602 ' CONSTITUTIONAL DISEASES. to be neglected. If it be known that stagnant or obstructed drains, cess- pools, and the like, are distributing noxious exhalations about a dwelling, the safest course is (if possible), to remove to another locality, the next, to endeavor to neutralize the poison which is given out by these decom- posed deposits, by means of chloride of lime or peat, charcoal, etc. It is, however, very hazardous to set about removing such nuisances during the prevalence of the'epidemy; this should have been done before, or should generally be left until afterwards, and when there is no longer reason to apprehend the distribution of additional causes of disease ; a keen frost may render the cleansing of foul places comparatively safe. Regular exercise should be taken during the best part of the day (in fine weather) in the open air, but excessive fatigue should be avoided. PRESERVATIVE MEASURES DURING THE PREVALENCE OF CHOLERA. Accurate observance of the Homoeopathic Preventive Regulations will in a very great number of cases avert the attack altogether. But even if this should not be the case, the disease will in general be devel- oped in a very modified form, and such as will usually be readily sub- dued by the employment of Camphor (as heretofore directed at page 597.) In some few cases, further treatment may become necessary, according to the directions stated in the foregoing portions of this article, but there will rarely be reason to apprehend a serious issue. See, also, Veratrum. CHAPTER XXX. CONSTITTTIONAL DISEASES WITHOUT DEFINITE INFEC- TION. ACUTE ARTICULAR RHEUMATISM. RHEUMATISM OF THE JOINTS. This form of rheumatism often arises from a cold and from expose- ure to atmospheric influences; it not unfrequently assumes an epidemic type, and, in such a case, breaks out most commonly in the fall and winter. The disease commences very gradually with a vague feeling of fatigue, accompanied with slight catarrhal symptoms; it may break out after severe attacks of angina, very seldom suddenly, and scarcely ever with a chill, but with alternate chills and heat. Simultaneously with the fever, very seldom after, and still less seldom before, one or more joints become painful; the pain rapidly increases, and the joint swells, sometimes with, and at other times without redness; at this period, the least motion and the least pressure cause pain, so that the patients remain perfectly quiet RHEUMATISM OF THE JOINTS. 603 for fear of hurting themselves. Generally, several joints are attacked at once, very seldom only one at a time, never all the joints at once from the start. The disease progresses in a very characteristic manner. While the joint that was first attacked, is getting better in three to flue days, sometimes with a complete cessation of the pain, as well as the swelling, other joints are attacked in the same manner; in this manner most of the other joints are invaded, after which the rheumatism frequently breaks out again in the joint whence it had originally proceeded. At times the swelling is quite considerable, at other times scarcely percept- ible ; sometimes it is confined to the joint alone, at other times the sur- rounding parts are very extensively involved ; not unfrequently the ar- ticular extremities feel enlarged. The constitutional symptoms are at times very violent, at other times very slight; this depends a good deal upon the number of joints involved. The fever runs pretty high, remit- ting very irregularly ; the temperature is not much raised above the nor- mal level; pulse about one hundred, in very acute cases increasing very seldom to one hundred and tAventy and upwards, small and changeable ; a copious perspiration, having a musty-sour smell, continues during the whole course of the disease, corresponding with which the patients are tormentefl by a distressing thirst. The urine is very scanty, saturated, and, on cooling, deposits a copious sediment. The digestion is slow, the appetite impaired, but very seldom entirely suspended. The course of uncomplicated rheumatism is never very rapid, gener- ally more or less Avavering; recovery takes place gradually ; single joints may remain painful and swollen for a long time, the pulse remains ob- stinately accelerated, the perspiration continues, the weakness abates very slowly. A favorable change takes place very seldom after the first week, a little more frequently after the second, but most commonly only after the third and fourth week. Very often we have noticed that, before the disease terminates, every joint is attacked twice, and that the second at- tack only lasts half as long as the first. In violent cases all the joints are affected together at the termination of the attack, some, however, are more acutely inflamed than others. With proper management and care this form of rheumatism ends in recovery in one week at the latest. However, by neglecting to guard against relapses, an acute attack may very easily terminate in a chronic form, and contractions and paralytic conditions may arise which can only be removed with great difficulty. CHRONIC ARTICULAR RHEUMATISM. It most frequently develops itself out of the acute form of which it constitutes a rest as it were; it likewise arises from the continued action of damp and cold places. Chronic rheumatism is less frequently located in the external integu- ments of the joints where acute articular rheumatism is generally seated, than in the synovial (inner) lining, the ligaments and articular carti- lages. . Little by little these grow thicker and rough. The disease seldom involves a number of joints; generally it is limited to one or a few only. Neither the swelling nor the pain is very considerable; to some ex- tent the power of motion remains, yet the patients may be entirely 604 CONSTITUTIONAL DISEASES. deprived of the use of the affected limb, while the rest of the body is per- fectly sound. The rheumatism has remissions followed by exacerbations, each of which leaA'es the joints somcnvhat worse. These exacerbations often look like an attack of acute rheumatism, with fever and slight in- flammation of the affected part; sometimes, however, they are without fever, and distinguished only by pain and loss of mobility. Chronic rheu- matism sometimes remains after repeated attacks of acute rheumatism of which it seems to constitute the ultimate stage. The joint is not greatly distorted by the disease. A complete cure is very much impeded by the extreme obstinacy of the trouble, and likewise by the impossibility of preventing the joint from being acted upon by influences that never cease, by their presence, to perpetuate the disease. DEFORMING RHEUMATISM. Arthritic Rheumatism. This form of articular rheumatism always runs an exceedingly chro- nic course; it does not develop itself out of the acute form, occurs very rarely previous to the thirty-fifth year of age, and is most frequent after the fortieth year. It breaks out among all classes, especially, however, the lower; on this account it is very dtffisult to determine the degree of influence exerted by bad fol or damp dwellings over this disease. Arthritic rheumatism affects more particularly the female sex ; the critical age un- doubtedly favors an outbreak of this disease, for Ave meet Avith it most frequently about this time. This may attack any joint in the body, but it is mostly limited to the joints of the hand and feet, affecting both sides of the body at the same time. It generally commences in the hand, whose joints beome more or less painful, especially when they are moved or pressed upon laterally. Sometimes the pain is principally felt in bed. The joint swells very slow- ly; at times long intervals occur in the further continuance of the swell- ing, after which the arthritic process resumes its course amid renewed paroxysms of pain. Towards the end the shape of the joints is very much altered, especially the shape of the finger joints. They look bul- bous, they are especially enlarged in breadth; they feel hard ; their integumentous covering has a natural color. The power of motion is not entirely suspended, but motion is very painful; in the very highest grades of the disease the joints are entirely immovable. Life is not endangered by this condition, but its curability is very doubtful. The swelling never disappears entirely; all that can be properly aimed at by treatment, is to arrest the further progress of the disease. ALLOPATHIC TREATMENT. In the treatment of inflammatory rheumatism or rheumatic fever, no active single remedy has afforded such good results as Salicylic Acid. Its effectiveness in this disease above all others has caused the repute of the drug. The fever is not unfrequently corrected in forty-eight hours. While not every case is so favorably influenced, yet it exerts a remarkable power in greatly modifying the disease, lessening the fever, pain, and swelling. RHEUMATISM. 605 Fifteen to thirty grains may be given in medicine wafers or capsules, every hour until the fever and pain abate, when the medicine may be continued in doses of ten to fifteen grains every three or four hours for several days. It is claimed that in some instances these large doses cause sickness of the stomach and prostration like collapse, which may be avoided by combining the acid with one-fourth its quantity each of Bi- carbonate of Soda and Carbonate of Ammonia. The formula of Bri- deaux is : Take of Bicarbonate of Soda, Carbonate of Ammonia, each five grains, Salicylic Acid twenty grains, Wrater one ounce. Mix. For one dose. Much the pleasanter way is to take the Acid in capsule or wrapped in medicine wafers. Fifteen grains of Salicine (active principle of WHIoav Bark) every three hours will often give relief Avithin forty-eight hours. It can be given in capsule or wafer or mixed in water. It should be used provided Galicylic Acid is not given. A well tested and beneficial plan of treatment is known as the alka- line treatment. A solution of a teaspoonful of Bicarbonate of Potash should be made in a quarter of a glass of water; to this is added a table- spoonful of a solution of half an ounce of Citric Acid in four ounces of water and drunk during effervescence. More water may be used if de- sired. This should be repeated every three hours until the urine has be- come alkaline (as ascertained by testing freshly voided urine with litmus paper) or the fever has abated, then once in six hours and after three or four days twice a day will be sufficiently often to keep the urine alkaline. After the violence of the symptoms has subsided if anaemia (impoverished blood and feebleness) exist, the Bicarbonate of Potash should be discontin- ued, and twenty to thirty drops of Muriatic Tincture of Iron, largely diluted in water, and ten grains of Iodide of Potash, at different times should be given six hours apart. It is only fair to add that the benefit of the alkaline treatment Avhich has such earnest advocates, is also seriously questioned by some who claim better results by some of the other methods of treatment, such as blisters cold baths, and Quinine. The Chloride of Trimethylamine in doses of two grains every three hours is claimed to moderate the fever and pain immediately and moder- ate and shorten the disease. Take of Chloride of Trimethylamine sixty- four grains, Peppermint Water thirty-two drams. Mix. Dose: A teaspoonful. This drug, if used, should be given alone. Prof. Da Costa recommends ten grains of the Bromide of Ammonium every three hours. It can be given in Avater flavored with Tincture of Orange peel. Quinine is useful in maintaining the reduction of heat produced by a cold bath, if given in a dose of twenty grains upon taking from the bath but it seems to the writer that a more effectual plan is the repeated appli cation of the wet sheet and the use of Aconite. There is no doubt of the benefit of Quinine or some other preparation of bark as a tonic in doses of two or three grains four times a day, after a few days have passed. Large doses of Quinine have been thought to be curative. It has not proved so in the common experience of the profession. 606 CONSTITUTIONAL DISEASES. In patients having a high fever and a strong pulse, the Tincture of Aconite may be given in doses of half a drop every hour or two to main- tain an impression on the fever and to moderate the pulse until such a time as the fever spontaneously subsides, or is prevented raising by the effect of one of the curative remedies before giA'en, viz: Salicylic Acid, Salicine, or Alkalies, etc. In those cases having a sudden rise of temperature to 105° or 107° or more (above which a fatal result is to be expected) the most effectual and speedy method of reducing the fever is by the cold bath as directed in typhoid fever. By promptly reducing the feA'er in these extreme cases life may be saved. While this danger seldom occurs in this disease it should be promptly resorted to if required. Blisters are often applied around the affected joints, followed by poul- tices to keep up the discharge, or a small blister one or to inches square, which is allowed to heal, and another one immediately applied. This is called the flying blister. The preferable local application seems to the outer, and used in his practice, is hot packing of the affected joints, wrap- ping them with flannels wrung out of hot water, and thickly covered in. Cloth saturated with an Alkaline and Opium Solution, simular to that recommended by Fuller may be wrapped about the joint with benefit. Take of Carbonate of Potash six drams, Laudanum one ounce, Glycerine two ounces, Water nine ounces. Rubbing the affected joints carefully with a liniment of one part each, of Chloroform and Tincture of Aconite, and tAvo parts Soap Liniment, will afford relief. Through the whole course of the disease, Opium given to the extent of relieving pain, is most happy in its effects. Two grains of the solid Ex- tract with a third of a grain of the Extract of Belladonna in pills may be given at night if the pain is very severe, and repeated during the day in doses of half this amount, at such intervals (three to six hours) as will make the'pain tolerable, until it disappears in the coarse of the disease, or under the effect of one of the three curative remedies mentioned above Constipation should be relieved by half teaspoonful doses of the Wine of Colchicum six hours apart, until the bowels are moved, Cathartics are not needed. The Appetite should be gratified, and encouraged by nutritious diet. The patient ought to lie between blankets, and wear flannel garments, if any next to the skin, during the whole course of the disease. During the latter part of the disease tonic doses of Quinine, three grains four times a day, or equivelent doses of some other preparation of Cinchona Bark are advantageous. The Salicylic Acid, Saline, and Alkaline treatments, are said to pre- vent heart complications, hence, in part, is the prompt and bold manner with which they are recommended to be given. Should violent and irregular action of the heart, friction sounds, pain in the region of the heart, enlargement of the area of dullness on percus- sion, difficulty of breathing and increase of fever occur in the course of the disease, the dangerous complication, pericarditis, has occurred. Full doses of Opium are to be given. The treatment before recommended for the rheumatism should be RHEUMATISM. 607 continued. Large hot poultices of flaxseed meal and mustard should be kept over the region of the heart. If the action of the skin and kidneys is not sufficient, the hot air bath should be given. Particular attention should be given to nourishing the patient. Milk, raw eggs beaten with milk or water, and strong beef tea or essence, should be freely given. When symptoms of weakness occur, stimulants should be given as are directed in the treatment of typhoid fever. The treatment of pericarditis has been more fully considered else- where. In chronic rheumatism of the joints, attention should be given to the general health, and measures employed to restore it to its fullest vigor. To this end, good food should be taken, avoiding sugar and starchy food, while milk, cream, eggs, and fruits may be freely taken. The Citrate of Iron and Quinine, in solution, in doses of three to five grains, will be serviceable. It is claimed by good authority that the Tincture of Chloride of Iron is curative in acute rheumatism, and another equally high authority claims it to be a preventive of rheumatism. It is equally worthy of a trial in the sub-acute or chronic form. The dose is twenty to thirty drops largely diluted in water, every six hours (four times a day). It will be especially serviceable if the system is debilitated. Iodide of Potassium, in doses of ten grains dissolved in water (Pep- permint or Sarsaparilla covers the taste), three times a day, frequently is very beneficial. A better effect is sometimes produced by giving five drops of Fowler's Solution with the Iodide of Potassium. The remedies so useful in acute rheumatism are not so appropriate in this, though they may be tried. Alkalies are required if the urine is acid, but they should be given more moderately. While Salicylic Acid has succeeded in my hands, it has as often failed. The Hydrochlorate of Ammonia often succeeds admirably in doses of fifteen or twenty grains. It is best given in Elixir of Cinchonia, and giv- en four times a day. Tincture of Guaiac, or the Ammoniated Tincture, in doses of one or two teaspoonsful three times a day, is one of the most successful remedies. It may be given in milk, or the gum prescribed in other mixtures. Prickly Ash (Xanthox Ylum) has a deserved reputation in this dis- ease ; the dose of the Tincture is one or two spoonsful. In domestic use a tea is generally made (an ounce of bark to a pint of tea), and two to four tablespoonsful taken at a time. Poke-root (Phytolacca Decandra) cures some cases of chronic rheum- atism. The dose is ten or twenty drops of the Tincture. A tea made, in domestic practice, from half an ounce of the root to a pint of tea, could be given in doses of a tablespoonful. The waters from Sulphur-springs are helpful in very old cases. 608 CONSTITUTIONAL DISEASES. Warm bathing, alkaline bathings, vapor baths, Turkish baths, and the wet pack, are each in their turn useful means of treatment, and should be given a thorough trial in obstinate cases. The relief of pain is called for in some instances, and should be met, Avhen not afforded by local applications, with Opium—given in half the doses recommended in the acute variety. Local applications are highly useful. Flying blisters from one to two inches square, and allowed to heal at once, following each other over dif- ferent parts of the joint, so that a fresh blister always exists on some part of the surface, is one of the best plans of local treatment. Stimulating liniments are frequently beneficial, as the folIoAving:— Take of Ammonia Liniment an ounce and a half, Chloroform half an ounce, Soap Liniment tAvo ounces, rubbing the joint well with it. If the pain is very great, take of Chloroform and Tincture of Aconite each an ounce, Soap Liniment two ounces. Mix. Wet a flannel with the Lini- ment, apply it round the joint and cover with oiled muslin. Turpentine or Petroleum, well rubbed into the part, or a flannel Avrapped round the part, are sometimes useful. Other useful liniments ; Take of Oil of Cajuput and Laudanum each two drams, Turpentine four drams, Ammonia Liniment an ounce. Mix. Or, Aqua Ammonia a dram, Laudanum four drams, Tincture of Canthar- ides three drams, Soap Liniment ten drams. Mix. Iodine is one of the best local agents in overcoming inflammation, and removing its products. The tincture may be used, but the following ointment is believed to be preferable, because, after a few applications of the Tincture, a dead scarf skin prevents the penetration of the remedy: Take of Iodine thirty grains, Iodide of Potassium a dram, Water a dram, Lard an ounce Mix. If this irritates too much, it can be made weaker with Lard. A certain amount of stiffness, tenderness and inability to use the joints or limbs, is met with in many cases after the inflammation has subsided. This is removed by regular passive motion, /. e., motion by the hands of others, systematic shampooing, kneading and slapping with the hands (called massage). So-called cures of rheumatism effected at this stage by " rubbing,'' slapping," and " messeuric " quacks. Liniments are largely useful in this stage, partly because they neces- sitate a certain amount of rubbing. Flannel ought always to be Avorn by those who suffer from chronic rheumatism. The general treatment of muscular rheumatism is not essentially dif- ferent from that of chronic rheumatism affecting the joints, and it is unnecessary to describe it here. Absolute rest of the affected muscles is necessary. Pain should be relieved by the hypodermic injection, over the affected muscle, of a quarter of a grain of Sulphate of Morphine with a fiftieth of a grain of Sulphate of Atropine in the acute stage, or of Atro- pine alone in the chronic disease. Strong mustard plasters should be applied over the painful muscles and immediately upon their removal a hot poultice of flaxseed meal with Laudanum poured over the surface, or RHEMATISM. 609 hot fomentations of flannel wrung out of hot water and well covered, to retain the heat. Rubbing the part and the use of liniments as in chronic rheumatism of the joints is useful. Sometimes the daily use of the wet pack has proved curative. Aside from tonic remedies probably Iodide of Potassium and Guiacum, as recommended for chronic rheumatism of the joints, and five grain doses of Quinine three or four times a day, are the most frequently curath'e, especially if pain is periodical. Persons subject to this affection should wear flannel the year round. The daily use of the cold sponge bath will invigorate the system against liability to cold, while an over quantity of clothing, night or day, is to be avoided. Invigoration of the system, especially by an out of door life, is to be sought for. RHEUMATISM OF SCIATIC NERVE—ALLOPATHIC TREAT- MENT. This affection is a form of neuralgia, but not unfrequently of a rheuma- tic origin. The remedy which gives the most speedy relief is Morphine by hypodermic injection. A prompt and complete relief of the pain by this means is not unfrequently curative. The injection should be made in the neighborhood of the nerve. The dose to be preferred is a quarter of a grain, which can be repeated in twenty or thirty minutes, if the pain is not relieved. If the Morphine should not succeed the hypodermic injection of a fiftieth of a grain of Atropine should be made. Relief from it is more apt to be permanent than the same degree of relief from Morphine, but this injection cannot generally soon be repeated, but if the pain is not relieved nor excessive dryness of the throat nor other inconvenience experienced, a second injection may be made, but generally, if the pain is not relieved by the first injection of Atropine, it is best as a rule to resort to Morphine. The injection, under the skin, of fifteen or tAventy drops of Ether behind the great trochanter is often followed by quick relief. Electricity is often beneficial. The direct current should be passed down the nerve. In old cases a needle, such as is used in acupuncture, insulated to near its point, should be introduced to near the nerve and attached to the positive pole. The negative pole is then passed down the course of the nerve. A daily sitting of five to ten minutes is appropriate. The neuralgic form of the disease is more often benefited by Electricity than the rheumatic. Acupuncture, in old cases, especially in the form originated by Bau- denscheid, is sometimes particularly beneficial. The general treatment is that given for chronic rheumatism or neu- ralgia, as the affection is of a neuralgic or rheumatic origin. It is not necessary to repeat these directions here. Iodide of Potassium in doses of ten to thirty grains three times a day; Alkalies; Salicine in doses of fifteen grains, four times a day; Quinine 39 610 CONSTITUTIONAL DISEASES. fiA'e grains and Tincture of Nux Vomica five drops three or four times a day; or ten to twenty drops of Turpentine with Honey three or four times a day, are particularly recommended in rheumatic sciatica. The same local measures given for neuralgic and chronic rheumatism are appropriate. In addition may be mentioned as especially applicable a strip of flannel Avet with Chloroform, laid over the course of the nerve and covered with oiled silk (or muslin), or the whole limb cnvered with new flannel Avhich has been thickly sprinkled with sulphur and covered with oiled muslin, are recommended by Fuller. Enveloping the limb is claimed by Trosseau to have cured after blister and Morphine failed Great relief is sometimes given by blistering the head. Flying blisters as directed in neuralgia are generally beneficial. The actual cautery is recommended. HOMOEOPATHIC TREATMENT. Aconitum is the main remedy in acute articular rheumatism, if the pulse is not only frequent but likewise full and hard, the temperature is considerably higher, the joint is red and exceedingly sensitive to contact; it is suitable for nervous, irritable, plethoric individuals; or when heart troubles have set in. Further indications may be gathered from the Repertory. Aconite has been less frequently used in chronic cases where it sometimes acts with great efficacy. Aconite is less adapted to chronic articular, than to muscular rheumatism, especially Avhen the disease is located in the upper extremities. Bryonia alba is a leading remedy for acute and chronic rheuma- tism, except the arthritic form. It is most suitable for rheumatism caused by exposure to cold and dampness after a severe muscular effort; the vio- lent fever soon weakens the patient; the swelling of the joint is dark-red and exceedingly painful; the respiratory organs show symptoms of inflam- mation; the perspiration has a sour smell. In muscular rheumatism, Bryonia is indicated by the following symptoms: The muscles of the trunk are the seat of the disease, especially the muscles belonging to the chest; the patient feels much better during rest; the pains are severe tearing pains, and incline to shift from one place to another. Mercurius. Mercurius is not so much adapted to chronic as to most forms of acute and sub-acute rheumatism, with the following general in- dications: The fever runs high ; the pulse is remarkably quick and hard, the perspiration very copious and having a musty smell, the thirst is ex- ceedingly tormenting. The local swelling is not very great, but painful, intensely red. giving rise to the apprehension of pus forming in the joint; it is not apt to shift about; even if other joints are affected, yet the origi- nal joint remains swollen and painful; the breath is foul, the tongue has a thick, yellow coating, the appetite is gone, every kind of food causes nausea. The pains are worse every night, towards midnight, aggravated by severe cold and ameliorated by external Avarmth. The more frequently relapses set in. the more specially is Mercurius indicated. In muscular rheumatism, Mercurius is indicated by the following circumstances: the pains exacerbate at night, they are deep-seated as if the bone were attacked with great sensitiveness to gentle as well as firm pressure, RHEUMATISM. 611 Rhus toxicodendron is adapted to every form of rheumatism, ex- cept arthritic. In acute articular rheumatism, it is indicated by the following symptoms: Violent fever, with tendency to the adynamic type> delirium and excessive restlessless; the swelling is inconsiderable, admits of some motion, is intensely red and somewhat sensitive to contact. The perspiration is not considerable. The patients are constantly changing their position, for even after lying for a short time in the same position, the pains are very much increased. Feather beds are intolerable, so is ex- ternal artificial warmth. For muscular rheumatism, Rhus tox. is the best remedy, if the attack is caused by exposure to wet; if the above mentioned circumstances either improve or aggravate the symptoms; if the pains at once become associated Avith paralysis and contraction; if the muscles of the lower extremities are the seat of the disease. Rheumatic paralysis particularly points to Rhus. In chronic articular rheumatism, Rhus is of little, if any use. Pulsatilla is indicated in mild, sub-acute rheumatism of the joints and muscles ; the affection shifts about frequently and speedily ; the pain exacerbates in the evening and at night; they are violent, tearing, draw- ing and jerking pains, increased by warmth, improved by cold, at least for a short time. Pulsatilla is seldom appropriate in chronic rheumatism, but more so in the rheumatism of muscles and of the joints. Tartarus emeticus deserves to be used more than it so far has been —it is one of those remedies that have a good effect in exceedingly pain- ful local muscular rheumatism, for instance, rheumatism of the muscles of the back contracted after a cold during the performance of a fatiguing muscular effort. In such a case, Tartar emetic very soon brings relief. In acute articular rheumatism, Tartar emetic is indicated by the follow- ing symptoms: Marked swelling of a number of joints, the pains are not very great during rest, but this rest is frequently interrupted by spon- taneous, spasmodic, very painful contractions of single bundles of mus- cles. There is not much fever; the symptoms of digestive derangement, on the contrary, are very prominent. A condition marked by such symptoms, sometimes occurs during the subsequent course of articular rheumatism, scarcely ever at the commencement. Digitalis purpurea is, in our opinion, a most important remedy in acute articular rheumatism ; in the last few years we have often seen this remedy produce a striking effect and shorten the course of the disease. Hurried,small pulse easily affected by motion; increased strength of the beating of the heart, but the sounds are muffled and indistinct, mingled with arterial murmurs ; hurried respiration, with ability to draw a long breath ; hurried, abrupt speech; almost complete suspension of the urin- ary secretion ; shining-white swelling of the joints, not very sensitive to pressure; a number of joints are attacked at once; the whole body is very pale. During the whole course of the disease we have given this medicine without any other drug, and in spite of the violence of the symptoms, we have never been able to discover any but the best results. In conclusion, we desire to state that Digitalis holds a high rank as a 612 constitutional diseases. remedy for rheumatism among the rational physicians; there is, un- doubtedly a reason for this. Sulphur bears almost a specific relation to the rheumatic process. In an acute attack we would not think of giving Sulphur; on the other hand, Sulphur is indispensable to remove the remaining traces of acute rheumatism, upon which the extraordinary disposition to relapses gen- erally depends. What this remedy is capable of accomplishing in chronic rheumatism, is shown by the numerous cures which are every year wrought by the use of Sulphur-springs, and which it is impossible to doubt. Sulphur exerts a curative power over arthritic rheumatism ; it arrests the progress of the disease, and materially reduces the swelling of the joints, but must be given in large doses. Although Sulphur-springs are the most effectual remedy for constitu- tional rheumatism, yet there are other means calculated either to heal or prevent new attacks; some of these means are often sufficient to perform a cure. In this class Ave rank the cold-water treatment, sea-bathing, the Turkish and Russian baths. The two last-mentioned have to be em- ployed with great care; if they help at all, the favorable effect is seen after a few baths. It is a matter of course that the cause should be removed as much as may be. The diet in acute rheumatism is easily managed ; the patients either do not crave any nourishment, or their appetite is very much impaired. Fat and greasy articles of diet are decidedly injurious ; acid substances, especially stewed fruit, have a very good effect; raw fruit may be par- taken of, but moderately. CHLOROSIS OR GREEN-SICKN KSS. EMANSIO MENSIUM. t Cases in which the Menses have never appeared. Chlorosis is a disease which occurs exclusively among females, chiefly betAveen the ages of thirteen and twenty-four, seldom at a later period ; if it does, it can be traced to secondary disturbances such as : confinements of young Avomen, coming rapidly one after another, more especially if the women nurse their own children. The disease sometimes breaks out previous to the first appearence of the menses, more frequently after several menstrual periods ; as an en- tirely primary disease, it only breaks out among unmarried women, it is, in some degree, hereditary ; females of a pale complexion are more li- able to be attacked Avitb it; though no constitution is exempt from the disease, although delicate individuals with irritable nerves are more sus- ceptible to it. Among other causes, Ave may mention: Insufficient ex- ercise, mental exertions without corresponding muscular activity; ex- citement of the fancy, especially when caused by novel-reading ; excite- ment of the sexual instinct by onanism, improper converse witli the CHLOROSIS OR GREEN-SICKNESS. 613 other sex ; deprivation of the open air, and interference with the free ex- pansion of the chest by tight dresses. Chlorosis is very commonly met with among daughters of a tuberculous mother. Symptoms and Course.—This disease generally conies on very slowly —the patients become more irritable ; they are apt to get tired after every little effort; they are liable to changes of color ; the skin soon loses its bright lustre, and the patient complains of feeling chilly at an early pe- riod of the disease. Inasmuch as the disease may be characterized by a variety of symptoms, avc will describe the derangements as they appear in each special organ and system. The skin at times has the color of Avax; at other times it it is rather yellowish, or of a dingy white, the veins being either not at all percepti- ble, or but indistinctly so. The color of the cheeks may change quite of- ten within a very brief period of time. The visible mucous membranes are more or less without color. Swelling of the feet and limbs sometimes occur, but only in the highest grades of the disease. The folioAving symptoms occur in the digestive range: Impaired ap- petite, aversion to meat, longing for strange articles of diet, such as vine- gar, chalk, coffee, beans; bloating of the stomach after every meal; sour- ness of the stomach, and generally the bowels are very torpid. In the neivous system we discover excessive irritability, neuralgia, hysteric symptoms, fitful mood. The breathing is accelerated ; the least physical exertion causes dyspntea ishortness of breath) sometimes to a very high degree. The circulation is accelerated, very seldom retarded ; disposition to palpitations of the heart, which are easily excited by a physical effort. The menses are irregular, sometimes entirely suppressed or very tardy, sometimes more profuse than usual, but ahvays of a lighter color, or even quite colorless. Accompanying these symptoms are pains of the most diversified kind, very generally uterine catarrh. The urine has a strikingly pale color. The patients generally sleep very soundly, and have to sleep a long time, though sleep never refreshes them. One or the other of these derangements is generally wanting. The one characteristic symptom is never absent: dyspnoea and palpitation of the heart from the least unusual effort, especially after going up stairs. The course of chlorosis is always more or less protracted, sometimes very chronic. If no particular disturbances take place, the affection can sometimes be cured in a few weeks; whereas, if the mode of living which had acted as the exciting cause is persevered in, the trouble may continue for years. The disease is most commonly more violent in summer than in the winter season. Uncomplicated chlorosis always terminates in re- coA'ery. Among the complications, the simultaneous presence of tuberculosis and scrofulosis is most threatening.' We generally find that scrofulous girls who are attacked with chlorosis recover their health to some extent for a year or two, after which they die of consumption, or phthisis may set in as a direct development of a protracted chlorosis. 614 CONSTITUTIONAL DISEASES. HOMOEOPATHIC TREATMENT. The leading remedies which have been found most useful in this af- fection are Pulsatilla, Sepia, Bryonia, Sulphur, Calcaria carb., Ferrum, Lycopodium, and Plumbum. Pulsatilla is peculiarly useful in chlorosis, Avhen the derangement seems to have been excited by, or is connected with, indigestion; and it is accompanied with headache, particularly in the side of the head with shooting pains extending to the head and teeth, sometimes shifting suddenly to the other side; sallow complexion; difficulty of breathing, and sense of suffocation after the slightest movement ; palpitation of the heart; coldness of the hands and feet often changing to sudden heat; disposition to diarrhoza and leucorrhosa; pains in the loins; sensation of weight in the abdomen ; almost constant chilliness and shivering ; spasms in the stomach with nausea, inclination to vomit and vomiting; hunger with repugnance to food; swelling of the feet and ankles, great fatigue, es- pecially in the legs. This medicine is particularly adapted to females of mild disposition, disposed to be sad and tearful. Dose: Six pills every evening. Sepia is a remedy of very great value in this disease when there is a good deal of headache, sallow complexion with dark colored spots; frequent colic and pain as if arising from bruises in the limbs with a drawing, tear ing pain in the thick muscles of the back part of the legs. It may follow Pulsatilla Avith great advantage or be given in alternation with that reme- dy. Dose: Six pills or a powder every morning. Bryonia.—Frequent congestion of the head and chest, bleeding at the nose; dry cough ; coldness and frequent shivering, sometimes alternating with dry and burning heat; constipation or colic, bitter taste in the mouth, tongue coated yellow; sense of pressure in the stomach, as if from a stone. Sulphur is more particularly indicated when there is pressive and tensive pain in the back of the head extending to the nape of the neck; humming in the head ; pimples on the forehead and round the mouth; pale and sickly complexion, with red spots on the cheeks; changeable ap- petite with general emaciation; heaviness in the stomach under the lower ribs and in the abdomen; bowels irregular; great tendency to take cold; irritability and inclination to be angry; redness and melancholy with fre- quent weeping. Dose: Six pills every other day. Calcaria Carb.—Is often of the most striking benefit in chlorosis. Sometimes a complete cure is effected by it alone, even in the worst cases with (oedema) SAvelling of the extremities and extreme dyspnoea. When there is complication with tubercular diathesis accompanied by cough} Sulphur and Calcarea Carb., often prove highly beneficial in alternation, or if oppressive headache is complained of, Sepia may be given in alternation. Sometimes menstruation does not take place for some time afterwards, though the general health is very much improved under the employment; of the remedies prescribed. Dose: Six pills every morning. CONSUMPTION. 615 CONSUMPTION. PHTHISIS PULMONALIS. One of the earliest symptoms of consumption is a short cough, which is either dry or accompanied by the expectoration of a frothy mucus, and is generally slight at the commencement, but more or less constant. Short- ness of breath, is another early symptom of consumption. It is, at first experienced only during exertion, but subsequently comes on after every fit of coughing, or on lying on the one or the other side, and is much in- creased by the slightest movement. Symptoms of gastric derangementi are frequently present, with redness of the tongue, or white furred center, with inflamed and projecting points, and vivid red tip and margins; the patient falls off in flesh, becomes indolent, dejected, and overpowered with languor. A feeling of soreness is often complained of behind the sternum or under the collar bones, particularly after any fatigue, or after a fit of coughing, and sometimes on exposure to cold air. Tne pulse is often nor- mal in the first stage of the disease, but soon becomes full, hard, and accelerated. Fever of an intermittent character soon makes its appear- ance ; it declares itself most towards night, remits from about two in the morning until the following day at noon, when it returns in a slighter de- gree, and continues until about five in the afternoon, and is then folioAved by another remission. This hectic fever is, in the first instance, chiefly manifested by flushing of the face (which is often most apparent after a meal), and heat in the palms of the hands and soles of the feet; but as the disease advances, night sweats supervene, Avhich leave the patient in a state of great exhaustion in the morning. As the expectoration increases it becomes more viscid and opaque, and is often tinged with blood, or a considerable quantity of florid, frothy blood is ejected in consequence of the obstruction offered to the blood-vessels, by the indurations or granula- tions of the lungs. As the disease advances and passes into the second stage, or that in which the dark red or grayish indurations are converted into crude yellow tubercles, the respiration becomes more difficult, the emaciation and debility go on increasing, the cough is rendered more se- vere and troublesome, particularly at night, and the fever, though of shorter duration, is attended with more profuse sweating, and the pulse loses tone. The expectoration becomes, at the same time, more free and copious, particularly towards morning, and is less thin and transparent. During the fever, or after meals, or at times of excitement, a circum- scribed red patch still appears on each cheek, but at other times the color of the cheek is faded, and the countenance wears a dejected expression. In the third (or suppurative or ulcerative) stage of the disorder the tu- bercles become soft, and are expectorated at first in the form of curd or cheese- like particles, and subsequently mixed up with pus, mucus, shreds of lymph, blood, and occasionally, though rarely, portions of the lung. The bowels, from having been more inclined to be costive at the commencement of the disease, are now more prone to be relaxed, so that attacks of diarrhoea often recur frequently, and, by alternating with sweats, induce an exces- sive degree of weakness and prostration. In this, the last stage of the disease, the patient becomes reduced to a skeleton; the face is thinned, the cheek-bones prominent, the eyes look hollow, the hair falls off, the 616 CONSTITUTIONAL DISEASES. nails are livid and incurvated, and the feet swollen; but notwithstanding all this, the countenance presents a degree of clearness, and the eyes a lustre that are rarely, if ever, met with in other maladies, moreover, the state of mind is generally so serene and hopeful, that the patient seems often quite unconscious of his dangerous condition, and speaks and acts as if in full anticipation of a speedy recovery. The senses commonly remain entire and collected to the end of the disorder, but in some cases deli- rium precedes death and continues until life is extinct. The usual dura- tion of phthisis pulmonalis is from eight to nine months to a year and a half; but circumstances tend much to vary the length of the disease; and there is a rapidly fatal form which runs its course in from two to three months, sometimes indeed in only one. When the malady makes slow progress, the patient is affected with cough, weakness, and emacia- tion chiefly in winter and spring, and in many respects restored to com- parative health in summer; but is ahvays extremely susceptible to cold, and commonly complains of breathlessness on the slightest exertion. In this state the patient continues for a considerable time, sometimes even for several years, until at length the symptoms of confirmed consump- tion are developed by the invasion of an inflammatory attack proceeding from cold or some other irritating cause. Therapeutics.—It would require a separate treatise to do justice to the treatment of this deplorable disease, by giving or attempting to give a full and minute description of the characteristic indications for the medicines which are appropriate to the various forms of the different stages of this disorder. We must, therefore, content ourselves here, by presenting our readers with a brief notice of the principal remedies which are employed in homoeopathic practice against the inflammatory, suppurative, and ulcerative stage of tubercular consumption. HOMOEOPATHIC TREATMENT. In the first stage of the malady, when the tubercles are in a crude, unsoftened state, or when they are inflamed and commencing to soften, the remedies by means of which the malady may be retarded, if not ar- rested, and, with due collateral precautions, kept harmless for years, are chiefly Aconitum, Bryonia, Belladonna, Lachesis, Hepar, Spongia, Phos- phorus, Dulcamara, Pulsatilla, Arsenicum, Nux-v., Hyoscyamus, Silicea, Calcarea c, Carbo v., Acidum nitricum, and Sulphur. These must be se- - lected according to the aggravate symptoms of the case under treatment. Their leading indications may be gleaned from the chapters on "Cough," "Pleuritis," "Pneumonia," "Hemoptysis," and "Repertory." In the second stage, with more free, copious, and somewhat purulent expectoration, the most important remedies are: Acidum nitricum, Sili- / cea, Kali-c, Sulphur, Calcarea, Natrum-m., Mercurius, Lachesis, Phospho- rus, Lycopodium, Carbo.-v., Sambucus, Hepar sulphuris, Spongia, Cincho- na, Ferrum, Conium, Zincum, Ammon.-c, Laurocerasus, Graphites, Ni- trum, Iodium, Drosera,Plumbum, etc. In the third, or ulcerative stage, the same remedies as the foregoing, together with Guaiacum, Sepia, Stannum, Staphysagria, Acidum phos- phoricum, Sanguinaria canadensis, are those by means of which the symp- CONSUMPTION, 617 toms may be materially mitigated, and the fatal issue of the disease post- poned. A feAV general indications for most of these will be found in the chapter on "Cough." When the colliquative sweats are particularly dis- tressing, Sambucus, Stannum, Cinchona, Phosphorus, Arsenicum, Carbo v. et a., Silicea, Mercurius, Nitrum, Lachesis, S dphur, and Lycopodium are the medicines which are of the greatest service. The remaining mor- bid symptoms must regulate their selection. When colliquative diarrhoea predominates: China, Ferrum, Arsenicum, Phosphorus, Acid, phosphor- icum, and Sepia, are the most useful. (See " Diarrhoea.") While conducting the treatment of consumption, the state of the di- gestive functions, and in females the condition of the uterine system, like- wise, must be strictly attended to. This is, however, a superfluous pre- caution to the homoeopathic practitioner, as he is eA'er careful to pay due regard to every symptom, not only in this, but in every ether disease. Should none of the remedies, above quoted, correspond to the derange- ments alluded to in particular cases, although they may be otherwise indi- cated, an intercurrent remedy may be selected from amongst those we have mentioned in the articles on "Dyspepsia," "Chlorosis," etc. The temperament and constitution of the patient ought also to claim attention in the selection of the remedies. In conclusion, it must be remarked that as the irritation which is so repeatedly created in the lungs by the vicisitudes of climate, so constantly occurring in most parts of this country, forms a great draAvback to the more or less successful treatment of pulmonary consumption, it is of great moment that every possible means be taken to avoid that pernicious in- fluence. It has been much in vogue with many medical men to recom- mend warm climates, or well-sheltered situations, even, although the at- mosphere might be of humid and relaxing nature. But we confess that we are inclined to side Avith those who do not object to a somewhat bracing and cold atmosphere, provided it be dry and not of variable temperature. Much, however, depends upon the peculiarity of the case,—the air, as well as the food, which may be adapted to one patient, being often perfect- ly inappropriate, and, therefore, injurious to another. 618 DISEASES PECULIAR TO WOMEN. JPart Thirteenth. DISEASES PECULIAR TO WOMEN. CHAPTER XXXI. PREGNANCY. CONDENSED SIGNS OF PREGNANCY. The determination of pregnancy, at the earliest possible period, forms a most difficult problem, on account of the same symptoms having been known to exist through the influences of other derangements. Suspension of the menses is generally the first indication which leads the Avoman, in whom impregnation has been possible, to consider herself enciente. But the importance of this symptom will very greatly depend upon the aitendant circumstances: if the woman has been very regular, and if the cessation of the menses promptly occur after some particular sexual intercourse, the presumption of pregnancy will be very strong in- deed. But if she has always been very irregular, the mere fact of the menses failing to make their appearance at a particular monthly period, will carry with it but little weight. Where the entire absence of the menses for two or three months occurs, from no other assignable cause, and where this suspension is attended with good health and appetite, and some perceptible increase in the size, or, on the other hand, perceptible sinking away of the abdomen, the conclusion of pregnancy may be consid- ered to be well founded. Changes in the breasts very frequently occur; they sometimes feel heavy, are inclined to itch, and the areola around the nipple becomes dark- colored, and sometimes present3 an oily appearance. And yet even these circumstances are far from affording unmistakeable evidences of preg- nancy, since they have been known to arise in this combination from other causes. Another symptom which may and does often occur in the early months of pregnancy, is an itching and irritation of the sexual parts; though in newly-married women the menses are sometimes suspended from irritation of the sexual organs when no conception has taken place, and at the same time there may be an increase in the size of the abdo- men and in the sensibility of the breasts; so that even this very strong combination of symptoms cannot be relied upon. Morning sickness forms, in very many women, the next sign of preg- nancy. As its name indicates, it is a morbid symptom, but on that ac- count none the less valuable as a diagnostic sign. It arises from sympa- thy of the coeliac or solar plexus with the organic nervous system of the PREGNANCY. 619 uterus. This morbid irritability may commence immediately after con- ception, but it generally sets in about the fifth or sixth week after con- ception, and ceases soon after the third month. It may become, in indi- viduals, a positive indication of their being pregnant, since these persons learn by experience that these symptoms occur with certainty and regu- larity at a particular time after conception. Thus, in different persons, the presence or absence of morning sickness will have a A'ery different di- agnostic value. Still, where morning sickness makes its appearance per- sistently attended with suppression of the menses, and in circumstances where there is a liability to impregnation, it can scarcely be attributed to any other more probable cause than pregnancy, and this indication will be strengthened by the character of the sickness itself. The appetite im- proves and is good through the day, in spite of the nausea, vomiting of a peculiar watery fluid, and sinking at the pit of the stomach, which oc- cur and continue for a short time, only on first rising in the morning. The sickness and the fluids vomited up are different from those accompa- nying any other disorder, such as gastric or bilious fevers, for example. While morning sickness, from its peculiar character, brief daily appear- ance, usual temporary continuance and final sudden and perhaps unex- pected disappearance, becomes, where it occurs, a valuable indication of pregnancy, its absence is hardly to be regarded as an opposite sign, as dis- turbances of the uterus, apart from pregnancy, may occasion it, and it sometimes follows suppression of the monthly flow from other causes than conception. Certain other derangements of the digestive organs, such as eructations, heartburn, remarkable longings for some particular article of food or other substance not used as food; and, on the other hand, aversion to some one or more of the common varieties of food, which may occur separately or in connection with morning sickness, or even subsequently to it. The same may be said of salivation, which occurs, in some women, about the fourth or sixth week ; in such cases, the frequent spitting will be equally diagnostic, whether the quantity be large or small. This sali- vation, differing from that which is produced by mercury by the absence of foul breath, sore gums and great prostration; it becomes characteristic of pregnancy, just as the morning sickness, above described, does, by rea- son of its being a sympathetic affection. OBSERVATIONS ON PREGNANCY. This period may be regarded as one of the most interesting eras of a woman's life. She is now no longer acting for herself alone but becomes invested with a new and serious responsibility, and upon some of the most apparently trifling of her actions may depend the future health and happi- ness of a being bound to her by the fondest ties. From the mass of evidence collected by careful observers of the opera" tions of Nature, we are warranted in drawing the conclusion that the actions of the mother exercise a great influence over,;not only the constitu- tional and. physical, but also the. .mental, organization of her offspring. Keeping this fact in view, we shall endeavor to point out the course that mothers, who prefer the welfare of their.future offspring to their own in- 620 DISEASES PECULIAR TO WOMEN. diligence, should pursue, and from which they will derive a double bene- fit, an improvement in their OAvn health Avith exemption from suffering and the delight of seeing their children pass safely through the anxious period of infancy. The leading causes of a weak and sickly child are ill-health or consti- tutional taint of both or either of the parents ; very early or late mar- riages ; great inequality betAveen the ages of the parents ; errors in dress, diet, and general habits of life, and lastly, powerful mental emo- tions. Females should seldom, at least in this country, enter into the mar- riage bond before their twenty-first or twenty-second year ; prior to that period their organization is scarcely ever fully developed ; tliose who marry at sixteen or eighteen years of age incur the risk of a severe after suffering themselves, and also of giving birth to weak and delicate chil- dren. Hoav very often Ave see the first children of such marriages perish in infancy, or after contending through a childhood of continued delicacy sink into a premature grave. Women who marry late in life incur con- siderable personal risk and severe suffering in giving birth to children, and the offspring is seldom healthy. The children of old men, although by a young Avife, are very often extremely delicate and susceptible to ill- ness; they do not unfrequently precede their father to the grave or linger but to drag on a miserable and Avearisome existence. In concluding these observations we may remark, that so far is the period of pregnancy from being destined for one of suffering or danger, that nature has taken every precaution for the protection of the female and her future offspring. While pregnancy runs its equable and uniform course the expectant mother enjoys an almost complete exemption from the power of epidemic or infectious diseases, and cweii chronic complaints are frequently suspended ; in fact Avith the exception of some slight mor- ning sickness and occasional trifling uneasiness, a well-constituted organ- ism should enjoy as good health during pregnancy as at any other time; and many women pass through this period and give birth to vigorous children without even the most trifling inconvenience. Though, as we have said, nature seems during this period to adopt every possible precaution for health and preservation of the parent and her future offspring, yet are her wise arrangements too often rendered void by direct violence of her laws. The expectant mother should there- fore bear in mind that the duty of leading a regular and systematic course so essential to every individual devolves upon her with double force, since every neglect or breach of these ordinances of nature upon her part is fre- quently visited with fearful energy upon her yet unborn infant. HYGIENE OF PREGNANCY. A few words on this subject, which is quite as important as the med- ical treatment of the disorders of pregnancy, inasmuch as it is intended to prevent such disorders from occurring. In order that this period may be passed with as much comfort and its end accomplished as easily and safely as possible, all irregular and, I might say, intemnerate habits, should be laid aside, and all pernicious PREGNANCY. 621 practices abandoned. The pregnant woman should strive to cultivate for herself the utmost cheerfulness and tranquility of mind ; she should strive to be at peace with all the world, and at peace with herself, for her men- tal and moral state will surely be engrafted upon her offspring, the educa- tion of the future being commenced while yet in utero. And in this effort she should be seconded by her husband, Avhose responsibility is very great at this period—whose conduct toward the wife of his bosom, at this period, acting upon her mental organization will be transmitted to their joint-offspring for weal or for woe. A pregnant Avoman, during the whole course of her pregnancy, will require more sleep than at other periods, and an ample allowance of the same should always be indulged in. And yet, at the same time, habits of slothfulness should be avoided. " Early to bed, and early to rise," ap- plies with additional force at this juncture, and nine, or, at the latest, ten o'clock at night, should find her in bed, and six, or, at the latest, seven o'clock in the morning, should find her up. Habits of regularity, in all things, should be cultivated—regularity as to hours for sleeping and wak- ing—and regularity as to meals, exercise, stool, etc. AIR AND EXERCISE. Nothing tends more to the preservation of health than a proper at- tention to these two important points, and yet, unfortunately, there are, perhaps, few more completely lost sight of. During this epoch, carriage riding, alone, is not sufficient; walking brings, not only the physical, but the whole of the organic muscles, into play, and communicates the increasing vigor of the mother to her offspring; therefore, walking is in- dispensable, and every day should find the expectant mother taking a walk, leisurely, and with the mind at ease; and this rule should be ob- served, even in cold and unpleasant weather, excepting when the walk- ing is rendered dangerous from snow and ice. A walk is often an excel- lent remedy for the feeling of drowsiness and heaviness which often creeps over a woman in this condition—a much better remedy than tak- ing a nap or a prescription from the doctor. Some women take a great deal of exercise, yet without corresponding benefit, from their work occupying them wholly indoors, showing the inutility of exercise in itself, unless combined with pure air. Others, again, injure their health, and frequently induce miscarriage, through their excessive levity and thoughtlessness, by unrestrained indulgence in active exercise, riding on horseback, dancing, etc. A woman ought to recollect that, if through her own folly, she has brought on miscarriage, the greatest possible care should be taken to prevent its recurrence; that a second attack increases her liability in future ; and that she Avho has suffered twice or thrice from this misfortune, even when she escapes it, rarely attains her full time. MoreoArer, continued casualties of this na- ture frequently terminaleiu premature death. EMPLOYMENT OF THE MIND, ETC. Useful employment, reading, or useful and agreeable conversation, should engage the waking hours not otherwise employed. In fact, I should like to impress upon the interested portion of my readers the im- 622 DISEASES PECULIAR TO AVOMEN. portance of cultivating a proper condition of mental vitality, as well as physical. How important it is that the expecting mother, as a new thread of life is being spun within her, should think and do that alone which is good and right, for of a certainty her offspring will have woven into the tissues of its existence the resultant of what she is and does during her pregnancy. Experience has presented us Avith many instances in which the pre- dominant feeling in the mind of the mother, during pregnancy, has influ- ence on the future mental organization of the child. The effect of any unpleasant or unsightly object upon the imagination of the mother, and the transmission of that effect to the offspring, evidenced in various men- tal or physical peculiarities, after birth, is a theory as old as tradition. CLOTHING DURING PREGNANCY. The dress of the female should of course be suited to the season, and if she pass from a warm into a cold atmosphere, she ought to keep herself well protected to prevent the risk of taking cold. But a point of far greater importance is the adaptation of the clothing to the form, so as to preclude all unnecessary pressure upon any part of the body, that might interfere Avith the functions of those important organs which are destined for the birth and nourishment of the infant; tight lacing (at all times most objectionable) is particularly injurious during this period, inasmuch as it interferes with the natural action of the body, and bearing directly upon the abdominal muscles, the blood-vessels, lymphatics, and the boAV- els, produces narroAvness of the chest, disturbes the circulation, and causes derangements of the liver, and exercises a most distressing effect upon the breasts and uterus. Females, in their efforts to preserve the elegance of their form during pregnancy, are little aware that the constricting efforts thus exercised upon the abdominal muscles destroys their elasticity, pre- vents a proper retraction after parturition, and thus proves one of the most common causes of abdominal deformity. Moreover, to the vanity of their mothers in this and other respects, many, it is probable, owe their clubfeet and other malformations; and in addition to these evils this practice not unfrequently deranges the position of the foetus—a displace- ment which, together with the consequent want of energy in the muscles and the parts concerned, generally brings on protracted and dangerous labors. Besides this continual pressure on the uterus is liable to bring on premature labors. To tight lacing may be attributed the difficulty which so many mothers of the present day experience in suckling their infant, by the unnatural pressure deranging the process required for the subse- quent secretion of milk; from this also arises sometimes those dangerous indurations, cancers and other affections of the breasts and also retraction of the nipple, from which the act of suckling is rendered difficult and in some instances impossible. Care also should be taken not to wear anything tight about the limbs, such as wrist-bands or garters, even elastic garters spanning the leg may be injurious, as they impede circulation and encourage the development of varicose veins, to which the system is already predisposed and which in many instances, become very painful and troublesome. One fact in PREGNANCY. 623 connection with this question of dress is here noteworthy, viz: that wo- men in the latter months of pregnancy complain of, and really suffer from coldness of the abdomen, the protruding abdomen causing the clothing to set off to the extent of almost completely exposing that part of the body to direct contact with the air. In view of this, the clothing should be so adjusted, or an extra garment worn to obviate the difficulty. Notice of these matters are greatly beneficial, and are so apt to be considered of minor or insignificant importance. DIET. The diet during pregnancy should be generous in meats, vegetables, and fruits, and at the same time plain. Excessive coffee and tea drinking should be laid aside. Sugar, salt, and spices should be taken in modera- tion; stimulants of all kinds, especially such as wines, liquors, beer, etc., should be most strictly avoided. If, however, the female has been long habituated to wine it may be taken in extreme moderation and diluted with Avater. GASTRIC DERANGEMENTS DURING PREGNANCY. Nausea and Vomiting—Morning Sickness.—In many women, nausea and vomiting set in at an early period of pregnancy, and are simply the result of a peculiar reflex irritation of the stomach ; in these cases this affection usually continues but a short time. Next to the ces- sation of the catamenia, and especially in conjunction with it, morning sickness becomes one of the earliest, as well as one of the most reliable, original signs of pregnancy; while for all those who have ever before ex- perienced it, there is little room for mistake in regard to its nature ; for in each individual in Avhom it occurs it has a uniform type and well re- membered character. The nausea may occur, at an early period, in the morning, with un- varying regularity ; or* in the evening, or at any period of the day, or even of the night. For each individual it maintains, also, its uniform- ity as to the date of its first appearance ; in some it appears very soon af- ter conception ; in others it begins toward the third or fourth month, and in others again it comes on only toward the close of gestation ; in these latter cases, it might have appeared, also, for a short time, after concep- tion. In the duration there is, also, the same general variety and indi- vidual uniformity. Thus, in some women, it lasts but a few weeks— from six to eight at most; in others it continues for four or five months ; Avhile in some few most distressingly severe cases, this difficulty persists through the whole period of utero-gestation, unless relieved by art. The nausea and vomiting of pregnancy, as already stated, are most apt to occur on first rising in the morning; sometimes these symptoms disappear in a few minutes, sometimes they last through the greater por- tion of the day. In some, the vomiting is very easy; in others it is at- tended with very severe retching, and even with other painful symptoms- Those who vomit upon waking or rising in the morning, usually throw up some viscid, glairy matters, which are generally colored with a little bile, especially if the retching has been very severe. Others vomit 624 diseases peculiar to women. only after eating, occasionally after only one of the daily meals, but some times after all of them. Again, in some unfortunate cases, the vomitings continue, eA'en in the intervals of the repeats, everything taken into the stomach, whether liquid or solid, being immediately rejected. There are cases, finally, in which the mere thought of food, or the sight or smell of it, is sufficient to induce the vomiting. In some cases, nearly all of the food taken seems to have been thrown up, even for months in succession, and yet a good delivery succeeds at full term ; the repeated and severe A'omitings seeming to exert compara- tively little influence upon the general health. In like manner, preg- nant women may rise from the breakfast table, vomit, and return to their food as if nothing had happened. Such characteristics so different from vomiting, arising from any other cause, almost conclusively indicate the presence of pregnancy. The diet and regimen of the pregnant woman should be carefully at- tended to ; such articles as best agree should be partaken in each ease, and equal care taken to avoid every unwholesome or irritating influence. It has sometimes been found that the excessive irritability of the stom- ach, in pregnancy, is due to the presence of fumes from some neighboring manufactory which, although insufficient to induce any unpleasant symptoms in the ordinary condition of the Avoman, very powerfully af- fect her Avhen pregnant. HOMCEOPATHIC TREATMENT. The following remedies will be found to cover the principal forms of gastric derangements of pregnancy. For particular indications, see " Heartburn." Antimonium Crud.—Nausea and A'omiting or only nausea Avith white-coated tongue. Watery stools with occasional hard lumps; fright- ful vomiting with convulsions; belching with taste of what has been eaten ; painful sense of fullness of the stomach, which is sore on pres- sure. Dose: Six pills night and morning. Arsenicum.—Very great debility and exhaustion; the least effort causes exhaustion. Very pale, white look. Bitterness in the mouth, parti- cularly after eating or drinking. Cold water seems to lie in the stomach until it gets Avarm, after Avhich she vomits it, therefore she cannot drink it although she desires it. Feels cold and Avants to be in a warm room or to be covered up warmly ; very uneasy and restless; vomiting of blackish or greenish matter. Dose: As for Anti. Crud. Bryonia.—Nausea on waking in the morning. Nausea is usually relieved by keeping quiet; dry parched lips, dry mouth and tongue; head aches as if it would split; stool of hard, dry feces as if burnt. All the symptoms Avorse from motion, better when still. Dose: As for Anti. Crud. Calcarea Carb.—She cannot sleep after three in the morning; heartburn and food eructations; soreness of the tongue either on the tip or sides, so that she can scarcely eat or talk. Sensation as if the feet PREGNANCY. 625 were cold or damp. Feels better from warmth, and cannot bear cold air. Vomiting of sour matter. Dose: As for Anti. Crud. Conium.—Vertigo, particularly on turning over in bed. Where the history of the case of vomiting reveals the fact of swelling and soreness of the breasts with each menstrual period, and the patient always feels worse after going to bed, so much so, that she is obliged to sit up or walk about to get relief. The urine intermits at every flow. Dose: Six pills three times each day. Ipecac.—One continual sense of nausea all the time—not a moment's relief. Vomiting of large quantities of mucus. Diarrhoea and colic. Dis- gust for food ; empty retching ; vomiting of food, slime, or blood; sour vomiting; cutting pains about the umbilicus. Dose. As for Conium. Nux a^om.—Nausea and vomiting every morning with constipation; large difficult feces. Food and drinks have a fetid smell to her. Not much appetite, or canine hunger ; aversion to water and bread. Longing for brandy, beer, etc. Bitter or sour taste. Vomiting of food, of bile, of black or sour matter. Dose: As for Conium. Pulsatilla.—Pulsations in the pit of the stomach. Vomiting of mucus. Bad taste in the mouth every morning on waking; she has to Avash it out, soon it is so bad she cannot bear it. Nothing tastes good to her. Absence of thirst; she does not relish as much water as usual. Nightly diarrhoea; stools very changeable. Loss of taste or bitter, fatty, saltish, sour, or sAveetish taste. Dose: As for Conium. Sepia.—Vomiting of milky water or milky mucus. Sense of empti- ness at the pit of the stomach ; the thought of food sickens her; a sense of weight in the anus. Eructations tasting like spoiled eggs. Taste as of manure. Aversion to meat. In the morning nausea as if all the vis- cera were turning inside out. Taste bitter or saltish. Disgust for all kinds of food. Constipation. Dose: Six pills night and morning. HEARTBURN. acidity, waterbrash. These distressing forms of gastric disturbance sometimes make their appearance soon after conception, while in other cases they may not make their appearance until after the fourth month. Some women are remarkably subject to these symptoms -when pregnant; in others they are manifested with less violence; in others not at all. There may be mere- ly a burning sensation—heartburn in the throat—which indicates sympa- thetic irritation; or the severer forms of waterbrash with acidity which arise from more fully developed gastroses. As in the nausea and vomit- 40 626 DISEASES PECULIAR TO WOMEN. ing of pregnancy,so in Avaterbrash, acidity, and heartburn, every degree of intensity and variety of manifestation and complication may be seen in different individual cases. Sometimes these disturbances are found ac- companied with, and greatly aggravating the nausea and vomiting, while at other times they seem to appear instead of the vomiting. As in the cases of ordinary dyspepsia these sufferings are worse after certain articles of food or drink, such as meats, fat meats or gravies, milk, or fruit. In the more severe cases nearly everthing that is eaten becomes but an added fuel to the burning fire. Still a careful avoidance of all tliose articles Avhich, Avhether solid or liquid, are found to disagree most, and a careful selection from the remedies given will, as in cases of nausea and vomiting, go very far to remove the most distressing symp- toms, and eventually to secure a great improvement in the general health. TREATMENT. Antimonium Crudum.—Nausea alone or nausea and frightful vomit- ing with convulsions. Belching with a taste of what has been eaten. Thirst at night. Painful sense of fullness of the stomach, which is sore on pressure. Dose: Eight pills every four hours. Arsenicum is A'ery useful when there is very great debility and ex- baustion. Very pale, white look. Sensation as of a stone in the stomach. Vomiting of fluids as soon as she takes them. Exhausting diarrhoea. Feels cold and wants to be in a warm room. Very uneasy and restless. Dose: Same as for Anti. Crud. Bryonia is particularly indicated when there is distressing heart- burn, dry, parched lips, splitting headache. Stool of dry, hard feces, as if burnt. All the symptoms aggravated by motion. Dose: Six pills every three hours. Calcarea Carb —Heartburn and food eructations. Sensation as if the feet were damp or cold. Dose: As for Ant. Crud. Conium.—Vertigo on turning in bed. Eructations with heartburn. Terrible nausea and vomiting. Where the history of the case reveals the fact of SAvelling and soreness of the breasts with each menstrual period, and the patient always feels worse after going to bed and has to walk about to get relief. Dose: As for Bry. Sepia. The thought of food sickens her. Eructations tasting like bad eggs. Want of appetite. Taste bitter or saltish. Disgust for all kinds of food. Vomiting of food and bile. Constipation. Dose: Six pills every night and morning. CONSTIPATION OF PREGNANCY. Constipation is a very common attendant upon pregnancy, so frequent hat by some it is deemed almost a natural consequence. But it is much pregnancy. 627 more apt to occur, and at the same time be more troublesome and obstin- ate, in pregnant women whose habits of life are confining, and those who are naturally of a more costive habit. When it does not arise from mechanical pressure exerted by the uterus upon the rectum, by which its dimension is lessened, and its action paralyzed, active exercise in the open air (avoiding indigestible food, strong coffee, and other stimulating liquids), is sufficient to remove the complaint, or, at all events, render it less troublesome. When nature requires further assistance, the following remedies have given the best satisfaction in the numerous cases which I have treated. TREATMENT. Nux-v. In women of sedentary habits, accustomed to the use of much coffee, wine, and rich and highly-seasoned food, generally. Stools large and difficult; colicky pains,or loud rumbling or rolling in the bowels. Constipation in persons Avho have been in the habit of using purgatives. Rush of blood to the head during stool. Dose: Four pills every evening, dry on the tongue. Ignatia can be made use of when the same symptoms as given after Nux., with the addition of an empty feeling at the pit of the stomach; sighing and full of grief. Dose: Four pills every morning, dry on the tongue. Bryonia. The stool is mostly dark, dry and hard, as if burnt, and is evacuated with much difficulty. The lips are parched and cracked. Much thirst. Stinking flatulency. Obstruction of the bowels from hard- ened stool. Stool too large to be evacuated without pain. Dose: The same as directed for Nux. Sepia. Sensation of a weight or heavy lump in the anus; this is a very characteristic indication. The stool is very difficult to pass, even with the most terrible and involuntary strainings. Knotty and insuffi- cient stool. Sepia, 200, has given very marked benefits. Dose: A powder each second night. TOOTHACHE DURING PREGNANCY. Toothache is a common and vefy distressing accompaniment of preg- nancy, being in fact only a particular form of neuralgia. If toothache occurs in sound teeth, as is quite frequent, they should never be extracted, and only the greatest care should be used in extracting decayed ones, especially if the patient be of a very nervous temperament. The female should, as soon as she is in proper state, put herself under proper treatment, for this is a valuable indication of some constitutional taint lurking in the system, and no remedies can be otherwise than palli- ative until this tendency is eradicated. TREATMENT. Alumina — (Alum) when the pains are exceited by mastication (chewing of the food), and when they are of a tearing nature, extending to the cheek bone, temple and forehead. 628 DISEASES PECULIAR TO AVOMEN. Calcaria. When the toothache is excited or aggravated by cold air, or anything hot or cold, and atten Is! with piinful sensation of the gums, and pulsative, gnawing, or throbbing pains which are aggravated by noise. ^ Sepia is particularly indicated Avhen there is pulsative, shooting, drawing toothache, with pain extending to the ears or to the arms and fingers, excited by compressing th^teeth or by cold air, and attended with swelling of the cheek, and e'rWargement of the glands under the lower jaw. Magnetia carbonica. Nocturnal pains in the teeth, insupportable when lying down, an I compelling the patient to get up and walk ; pains generally boring, burning, drawing, tearing, and resembling those of ul- ceration, attended Avith swelling of the cheek on the affected side. Dose: These remedies may be given every three hours, six pills at a dose, until relief, and then the time may be lengthened. The above are the four leading medicines for this peculiar condition, though there are others which may be called for by particular symptoms, of which I will mention a few: Arsenicum, Belladonna, Chamomilla, Gelsetninum, H yoscyamus, Merc. Sol., Nux-vom., Pulsatilla. SWELLING OF THE LOWER LIMBS. VARICOSE VEINS. This is a very common attendant of pregnancy ; it often occasions no little inconvenience and is usually confined to the seventh, eighth and ninth months. It is supposed to arise in most instances from mechanical pressure alone, and to be free from constitutional disease. This is true in those cases Avhere it is not accompanied by dropsical affections. Stand- ing and walking serve to aggravate this condition; it becomes worse to Avard evening, gradually increases as pregnancy adA-ances, and is often combined Avith a varicose state of A'eins. Many females suffer much during pregnancy from distention of veins in the thigh and other parts, which, becoming violent, eventually cause great pain and inconvenience. These varicose veins generally arise from obstructed circulation, caused by the pressure of the uterus upon the blood-A'essels. Considerable alleviation is experienced by constant bathing with water or with diluted alcohol or brandy. Also by bandaging from the foot upAvards Avith a gentle and equal pressure, and by preserving a recumbent posture, which is required in severe forms of the complaint, accompanied with considerable swelling of the feet, ankles, etc. In order to afford relief we would recommend the following remedies. TREATMENT. Pulsatilla may be given, particularly Avhen there is excessive pain and swelling with a good deal of inflammation, or when the veins are of a livid color Avhich is imparted to the whole limb. Arnica is of great service when the occupations of the patient render pregnancy. 629 it impossible for her to lay herself up and avoid much standing and mov ing about in discharge of her domestic duties. Pulsatilla and Arnica given in alternation a dose every day will prove very beneficial in such cases. Nux vomica.—When the affection is attended with constipation and piles and irritability of temper. Dose: Six pills eA'ery evening. Ars ionic um.—When the veins are attended with severe burning pain Avith a sensation as if scalding Avater Avas running over them. Dose: Eight pills every second evening. Carbo veg.—When Arsenicum is not sufficient to subdue the scald- ing burning sensation. Dose: As for Arsenicum. Belladonna.—Varices Avitb considerable erysipelatous inflamma- tion. Dose: Six pills every four hours. ITCHING OF THE (1ENITALS -(PRURITUS.) Itching of the genitals, which is a frequent attendant upon pregnancy, is caused by congestion of blood to the parts, and may often be relieved by bathing the parts with water in which borax has been dissolved, or with common soda and water. URINARY DIFFICTLTIES AND DERANGEMENTS DURING PREGNANCY. As gestation advances, the increasing size of the uterus causes it to press more and more against the bladder. Thus the capacity of that or- gan is diminished by the pressure which necessitates a much more fre- quent discharge of urine. The same frequent micturation results, too, from direct irritation of the neck of the bladder ; causing hourly calls to pass Avater, which are sometimes but partially relieved by the flow of a few drops, only, at a time, or the irritation may amount to dysury, (pain- ful urination), or even to a complete retention of urine. Where some displacement seems to be the cause, which may some- times be known by the suddenness of the onset of the difficulty, especial- ly if it follows some accident or over-exertion, the case should receive treatment for the difficulty, different than that which arises from other causes, of which I will mention at the end of this article. Incontinence of urine sometimes appears, especially in the latter stages of pregnancy. When it appears in the early months, it may re- sult from the pressure of the womb upon the neck of the bladder before it rises out of the pelvic cavity, causing the loss of tone of the part. This difficulty will often yield to the proper remedy, but if not, when it comes on in the early stage of pregnancy, it maybe expected to disappear when 630 diseases peculiar to women. quickening takes place, and the uterus emerges from the cavity of the pelvis. For the medical treatment of these difficulties, the following reme- dies should be studied. It is to be noted, likewise, that these remedies should be consulted and may be required for urinary difficulties occur- ring, not only during pregnancy, but before, during and after parturition as well. TREATMENT. Aconite. Retention of urine, with stitches in the region of the kid- neys. Difficult and scanty emission, with pinching around the umbili- cus (naval). Bright-red, hot urine. Desire to urinate, accompanied with great distress, fear and anxiety. Worse from exposure to dry, cold air. Dose: Six pills every half hour or hour owing to the severity of the case. Arnica. After passing a little urine she wishes to pass more, but is unable to do so at that time. Brown urine with brick-red sediment. A bruised and sore feeling exists across the lower part of the abdomen. Dose: Four or six pills every two or three hours. Cantharis. Very frequent urination, even sixty times an hour, with violent cutting pain, causing her to scream. The urine is often bloody. The urine does not flow in a stream, but dribbles away, or passes drop by drop, with cutting and burning pains, and tenesmus of the bladder, which is agonizing in severity. Dose: Same as for Aconite. Causticum. Frequent desire to urinate, a small portion passing away involuntarily. Involuntary passing of urine at night. Dose: As for Arnica. Conium. The urine flows and stops, and flows and stops again, and so on. There are cutting pains during the flow, and burning or smarting afterward. Vertigo, particularly on lying down. Dose: As for Arnica. When the cause can be traced to displacement from accident or over- exertion, Belladonna and Platina have given me the best results. They are to be taken, in alternation, every four hours. Complete rest will be necessary for a few days, in a case of that kind. MISCARRIAGE. Women who have suffered once from this affection are exceedingly subject to its recurrence and this liability is still further increased after a second or a third attack. When it occurs before or about the third or fourth month it is attended with much less pain or danger although fre- quent miscarriages, owing to the abundant discharge that is generally present, break down the constitution, and frequently develop severe chro- nic diseases. When a miscarriage takes place at a later period it assumes MISCARRIAGE. 631 a very serious outlook, and is accompanied with a considerable degree of peril to the patient. Exciting Causes—Are sudden mental emotions, such as fright, grief, or excessive joy, mechanical injuries, or excessive physical exertion, such as lifting too great a Aveight, reaching up high, going up or down stairs, long walks, riding on horseback or in carriage over rough roads, railway traveling at too great a speed, etc. Other causes are, a luxurious mode of life, fashionable habits, neglecting to take air and exercise, while an un- healthy state of the constitution giving rise to numerous local and gene- ral derangements is undoubtedly the predisposing cause. The Symptoms vary so much in particular cases that it is almost impossible to give any particular train of symptoms—though most cases of miscarriage are preceded and attended by the following symptoms: A chilly sensation followed by fever with more or less bearing-down, par- ticularly Avhen occurring late in pregnancy ; also severe pains in the belly ; drawing and cutting pains in the groins; or pains frequently bearing resemblance to those of labor; discharge of viscid mucus and blood some- times bright red frequently mixed with clots; at other times dark and clotted followed by the emission of a thin, colorless fluid. The mis- carriage generally takes place during this discharge which occasionally continues, if not properly checked, to flow for hours, therefore placing the sufferer in considerable jeopardy. After the child has been expelled, the flooding and pains generally disappear gradually; but if a portion of the placenta (after-birth) be left within the womb the pains may continue with more or less severity and irregularity, the flooding will frequently become excessive and alarming, and offensive, putrid discharges Avill take place from the vagina. When miscarriage is threatened the individual must assume the recumbent posture, and in some cases indeed should be strictly confined to the bed, sleeping with few bedclothes; the apartment should be kept cool and every means should be employed to ensure perfect repose to the mind. In all cases of miscarriage medical assistance should be summoned as promptly as possible; but as life may be lost in urgent cases before a phy- sician can be obtained, the following additional particulars should be observed :—When the misfortune gives evidence of being unavoidable and the hemorrhage is excessive and is not promptly arrested by properly selected medicines, the following directions should be observed. Apply cold to the abdomen in the form of cold cloths or sacks of ice or cloths wrung out of ice Avater, etc., which will frequently have the desired effect by causing the womb to contract and discharge its contents. As perma- nent cessation of the flow cannot be expected until this is accomplished, and as it is frequently slow to dilate sufficiently for that purpose, the passage should be plugged to prevent the flow until the womb is suffi- ciently dilated. A piece of sponge of sufficient size or a plug made of old muslin or linen rags with a string attached of sufficient length to disen- gage it when necessary (called a tampon) maybe used for the purpose and should be cautiously inserted. The tampon should be large enough to entirely fill the passage, so as to obstruct the flow of blood. At the same 632 DISEASES PECULIAR TO WOMEN. time the indicated remedy should be given and frequently upon removing the plugs, the womb will be found dilated and will expel its contents. The tampon, (plug) however, is only to be used in miscarriages occurring before the period of quickening, never afterwards. Another and perhaps the best and safest plan to adopt for dilating the mouth of the womb is this: The patient should be placed upon the bed in the same position as for labor. The bed should be flrst protected with oil cloths or india rubber cloth so arranged as to guide a stream of water from the vulva into a pail or tub placed near the bed. Another pail must be provided containing tepid water ; with a common syringe, the warm water should be thrown directly upon the mouth of the womb. This oper- ation irritates and softens the neck of the uterus so that contractions set in in the course of an hour or two, and thus labor is provoked and takes place in the most natural manner possible, except when it occurs in na- ture's own way at full term. This operation should be repeated in the course of two hours, if the first experiment should not prove sufficient. This will fail unless the stream is directed upon the mouth of the womb. The following are remedies. TO PREVENT AND ERADICATE A TENDENCY TO MISCARRIAGE. Sabina is particularly applicable to women who habitually miscarry about the third month. Feeling of sinking or faintness in the abdomen- Violent forcing or dragging pains extending from the back through to the pubis. Dose: Six pills in a teaspoonful of water, repeated after the lapse of twelve hours, and again after the lapse of tAventy-four hours, grad- ually lengthening the interval for each successive dose, until the period of danger is past;—being careful, however, to watch the ef- fect of each administration to discontinue or lengthen the intervals as the case may require. $?.; Secale. Especially after miscarriage has already occurred more than once, and is generally more suitable to thin, scrawny, exhausted women; passive hemorrhage with little or no pain. Great debility, feeble almost extinct pulse. Dose: Six globules, as directed for Sabina. Sepia. Painful sensation of emptiness at the pit of the stomach. Sense of weight in the anus like a heavy ball. Yellow saddle across the nose. Pressing in the womb, with oppressed breathing. Veryfetid urine, depositing a clay-colored sediment which adheres to the vessel Avith great tenacity. Dose: As directed for Sabin. Viburnum Prun. Spasmodic pains shooting from the abdomen in- to the legs. Frequent and very early miscarriages, thus causing sterility. This remedy is almost specific for miscarriage, as a preventive. Dose: Six drops of the tincture to be taken every evening, in mild cases, in urgent ones, every morning, noon and evening. [the actual attack. Arnica. When the symptoms have been excited by an accident— miscarriage. 633 such as a fall, blow or concussion, and there is a sore, bruised feeling, this remedy will prove effectual if administered as follows:— Dose: Take six pills every ten, fifteen or twenty minutes (in very urgent cases), and subsequently every half hour, gradually extend- ing the intervals to three hours, and continuing the administration until decided improvement or change. Rhus. If the symptoms have originated in a strain from lifting, pulling, or dragging a heavy weight. Pains worse in the latter part of the night. Dose: As for Arnica. Belladonna. Flushed face, red eyes, throbbing and heat in the head. Pain in the back, as if it would break. Severe bearing down, as if everything would fall out. Profuse discharge of blood, neither very bright nor very dark colored. Pains which come on suddenly and ceases just as suddenly. Great intolerance to light and noise. Dose: As for Arnica. Chamomilla. Periodical pains resembling those of labor, with dis- charge of dark colored or coagulated blood. Violent pains in the bowels extending to the sides Avith frequent urination. Becomes almost furi- ous about the pains. Hot perspiration about the head. Dose: In every respect as for Arnica. Nux Vom. Every pain produces a desire to evacuate the bowels or to urinate. Much pain in small of the back which is made worse by turning in bed, writhing pains in the abdomen accompanied by nausea or pains in the back or loins as if dislocated, constipation of large diffi- cult stools. Persons of sedentary habits. Dose: As for Arnica. Pulsatilla. Labor-like pains, attended with hemorrhage; rest- lessness. The discharge is arrested for a little while, then returns with redoubled violence. Suffocative spells. She craves fresh air, and is worse in a warm, close room. Inclination to be chilly, even in a warm room. Mild, tearful women. Dose: As for Arnica. Ipp:cac. Profuse and continuous discharge of bright red blood, ac- companied with a pressure downward. Cutting pains around the naval. Continual sense of nausea, without a moment's relief. Disposition to faint. Dose: As for Arnica. China. In weak and exhausted persons, when there is loss of fluids. After miscarriage, when there has been loss of blood unto fainting, gid- diness, drowsiness and loss of consciousness. Heaviness of the head, ringing of the ears, and coldness of the extremities. Twitching and jerking of single muscles. Dose: As for Arnica. Home Remedies.—Something simple, and in almost every house, is Nutmeg, of which take one and grate into a boAvl or cup, and pour boil- ing water on. Drink the tea. This often arrests very severe cases of hemorrhages. 634 DISEASES PECULIAR TO WOMEN. TREATMENT BEFORE CONFINEMENT. PREPARATION OF THE BREASTS. Young mothers frequently find much difficulty in nursing their in- fants in consequence of some defect or incapacity of the nipple. In many instances the structure of the breasts is disorganized by an ignorant nurse having compressed them in childhood, under the idea tbat such barbarous management was necessary to expel some of the contents of the breast; mothers should be particularly watchful against this practice. The use of improper stays in after life, by which the cuticle is rendered so tender as to preclude suckling, often occurs. The first two cases are beyond the power of art, and if suckling be attempted hardening of the nipple and breast ensues, attended with severe suffering. Another difficulty frequently occurring is a shortness or retraction of the nipple so that it is impossible for the infant to take hold of it. I ha\re frequently had charge of young mothers whose nip- ples were so small that they were unable to nurse their babe. If this should be the case—if the nipple should be sunken instead of protruding- it has to be drawn out by means of some suitable instrument in the shape of shields or an exhausting pump; a convenient one, in many instances, can be made in this way : Take a bottle with rather a large neck, pour hot water into it, then empty and place the neck of the bottle over the nipple; the air cooling in the bottle will cause the nipple to draw down and thus lengthen it. After the nipples have been drawn out they have to be gently pressed and worked with the fingers in order to harden them, lest the delicate skin should be injured by the sucking of the infant. During the two months previous to the expected confinement, the nipples should be washed every day with cold water, borax and water, alum and water or with rum or brandy. The whole breast should be Avashed quite frequent- ly, more especially during pregnancy. It may also be here remarked that when any tenderness exists during the period of nursing the shield should be resumed between the intervals of the infant being applied to the breast, and the bathing continued—due care being ahvays taken to lave the nipple carefully with tepid water before it is again offered to the child. Sulphur will frequently be found useful if an eruption breaks out on the nipples, six pills the first thing in the morning, after which the erup- tion generally disappears. PRECURSORY SIGNS OF PARTURITION. A few days, or even two weeks, before confinement, the uterus begins to descend. Until the thirty-eighth to the thirty-ninth week of pregnancy the uterus keeps rising in the abdominal cavity, and the breathing is very much interfered with. As soon as the uterus begins to descend, the breathing becomes freer, and the pit of the stomach again becomes visible; but now the uterus presses upon the pelvis, like a heavy burden, and the female feels as if her hips would come apart. The small of the back is par- ticularly affected by the presence of the child's head against the internal PREPARATION FOR CONFINEMENT. 635 surface of the sacrum, which sometimes feels bruised and numb, in con- sequence. HOME TREATMENT. One month before child-birth take 4 oz. Castor Oil, 4 oz. Brandy. Mix them together and bathe the hips, bowels, and back two or three times a week, rubbing the mixture well in with the hand. Another sign of impending parturition is the frequent and anxious urging to urinate, caused by the increasing pressure upon the bladder by the descending uterus. The last and most reliable sign of parturition is the appearance of the first labor pains, which may set in a few days pre- vious to the act of parturition, but which, generally, are not felt until a few hours before the event. THE BOWELS. If the bowels have been constipated, an artificial evacuation previous to delivery, may be obtained by a lavement of luke-warm water repeated with a small quantity of linseed or sweet oil, when necessary from a fail- ure in the first attempt to obtain the desired effect. Injection.—If of luke-warm water simply, inject about a pint; if the addition of oil be necessary, to a pint of water add two tablespoonsful of the oil; shake them well together in a bottle, or other closed vessel, and inject the mixture. PREPARATION OF THE BED FOR LABOR. If the means allow, the confinement bed had better be arranged a few days previous to confinement, since at the last moment something might be forgotten, or a needful article might be wanting, because the hurry and anxiety of finding things are both unpleasant and injurious to the patient. The best thing for a patient to lie upon, is a simple mattress, which should be slightly raised toward the head. The nates (hips) should be raised upon a cushion about a hand high, which may be covered with oil cloth or rubber cloth, or any common cushion may be used for the purpose, the object of which is to raise the body so as to procure the necessary space for an examination, and for the reception of the infant. The bed should be arranged so that every part of the body, from the nates to the head, is supported. The body being thus supported, the following rules may be observed in regard to the thighs and legs: It is better to have the space between the thighs and the foot-board of the bed just long enough so that the feet of the patient may press firmly against the foot-board ; but if the space should prove too much, a foot-bench may be placed between the bed and the feet, so that she can press against it without drawing up the knees. It is sometimes necessary to have a cord or sheet attached to the foot of the bed, which the female may hold in her hands during the pains, for the hands are often spasmodically contracted during the pains, and it affords the patient great relief to hold something firmly in the hands at such a time. Holding another person's hands, likewise affords relief to the patient. Persons frequently arrange the confinement-bed by the side of the 636 DISEASES PECULIAR TO WOMEN. regular bed, into which they are lifted soon after the act of parturition is accomplished. However, those who do not find it convenient to prepare a separate couch, must protect the mattress by some old cloths, or oil or rubber cloths may be placed under them, to prevent the fluids lost by the mother and child from soaking the mattress. Even after parturition, it is best to leave the oilcloth under the patient, for the flow of blood con- tinues quite freely for a feAV hours after labor. After preparing the bed for confinement, we will now consider— FALSE PAINS. False pains sometimes precede labor but a feAV hours—but in many cases comeonsome days, or even weeks, before delivery, and chiefly differ from labor pains in these respects: they usually begin at the upper part of the womb, are seldom felt in the back, do not extend so greatly around the lower part of the body as the true pains, are either on all the time or appear with great regularity, and do not cause the womb to become firm and hard, Avhile the true pains do. They are chiefly confined to the belly with sensibility to touch and movement, and in fact are A'ery annoying. False pains can sometimes be distinguished from true ones by sitting over a vessel of warm water after which, if false, they will frequently abate, and if labor, they will continue with more regularity or strength, TREATMENT. Bryonia is indicated when there are pains in the loins resembling a dragging weight, much inaeased by motion with pains in the abdomen, pre- ceding those in the back. This remedy is more particularly indicated Avhen the above symptoms have been excited by a fit of passion or by taking cold. Dose: Of a solution of six globules to four teaspoonsful of Avater give a teaspoonful. If soon after the administration of the first dose an aggravation of the pain ensues, pause until two or three more par- oxysms have occurred ; and if these succeeding pains prove to be of diminishing intensity or frequency, do not repeat the dose until re- lapse threatens. On the other hand, if no improvement is the result, repeat the dose after an interval of three hours, and so on if the proper time for the expected time for labor is not nearly due—dis- continuing immediately on relief or change. Nux vomica.—When the exciting cause seems to be constipation or mental irritation or too luxurious mode of living, stimulants or spirituous liquors, etc. Dose: As directed for Bryonia. Pulsatilla.—Abdominal pains and pains in the loins resembling those from continued stooping, or the pressure of a tight bandage attend- ed with painful dragging and aching in the thighs, constipation or relax- ation, mildness of temper or great sensibility; particularly when these pains seem to have arisen from indigestion brought on by rich indiges- tible food. Dose: As directed for Bryonia. LABOR. 637 PARTURITION, OR LABOR. During the first pains of the female, she may remain dressed and out of bed, because a certain unrest drives her from place to place, and it would not be best to confine her to her bed. But all things should be made ready; the attending physician should be sent for; warm water should be at hand; and in some convenient place in the sick room (all in one place), the infant's linen bandages, and little strips of linen, should be kept all ready ; also, a pair of scissors and two pieces of string, each about one-half a yard long ; the strings may either be tape, about a quar- ter of an inch wide, or cord of sufficient size and strength suitable for ty- ing the cord attached to the infant; a little fresh lard, or oil, some soap and pins, should also be at hand. Besides the attending physician and nurse, a friend may, likewise, be present in the sick room (if requested by the patient), in order to comfort and quiet the sufferer. But all superfluous persons, such as callers and children, must be kept away. If the pains become stronger, the female should lie down. Perhaps by this time the water may break, which nffiy take place with a feeble report. A young woman who has never borne any children, should be warned of this event, so as not to get frightened by the suddenness of the occurrence. Nothing should be done, by irritating the neck of the womb, dilating the mouth of it, or by any other artificial means, to hasten the moment of delivery. This is the business of Nature, who knows best when the right time has come for ushering the child into the world. Every arti- ficial interference is contrary to law, and is more hurtful than useful. Of course, these remarks apply only to natural labor. In preternatural la- bor, or those requiring mechanical means, the conduct of the attending physician depends entirely upon his or her own tact and knowledge. The parturient female may adopt any position that is most comfort- able to her—on the side or back, Avith her limbs stretched out or raised ; but she must not bear down during a pain, until the right time for it has come. Premature bearing-down may result in distressing weakness of the womb; for not only the child, but the whole organ, is pressed by such untimely efforts. No bearing-down should be resorted to until the mouth of the womb is dilated so that the infant's head is protruded at least half its length. At this period, the patient may assist Nature by holding the breath and bearing-down during a pain, with her head bent forward (never backward, lest she should give rise to the formation of Goitre). Du- ring the passage of the head through the soft parts, the perineum (bridge between the front and back passage) must be properly supported, lest rup- ture might take place; at each pain, the attendant should place the palm of the hand against the perineum without, however, making any press- ure against it, until the perineum remains hard and globular, even be- tween pains. At this season, the patient may contribute a great deal to a rapid and successful delivery by a suitable position of the body. As soon as the head shows a tendency to pass through the vulva, the patient should remain quietly on her back, with her feet firmly pressed against the foot-board, and legs extended and stretched apart a comfortable dist- 638 DISEASES PECULIAR TO WOMEN. ance. At this stage, all bearing-down may cease, lest a too rapid delivery of the head should rupture the perineum. After the head is born, and the shoulders are still Avithin the vagina, a short pause generally takes place, which must not be broken by any improper pulling on the head which may give rise to fatal dislocation of the vertebrae. Supporting the head Avith one hand, the abdomen may be gently rubbed with the other, in case the pains should not come on again with sufficient speed. The patient may now rest assured that, by assisting the remaining efforts of Nature, delivery will soon take place. Occasionally it has happened that parturient females, while com- pressing the teeth during a hard pain, have broken off a portion of the tooth, or haA'e lost the whole of it; therefore, it is always best to have a handkerchief or napkin placed near her, which she may crowd into her mouth as soon as the pain is approaching, or if she should be surprised too suddenly, one of her attendants must do this office for her. THE PLACE OF THE ACCOUCHEUR (PHYSICIAN) AT THE BEDSIDE. As soon as the labor pains assume an expulsive character, the attend- ant should place himself or herself by the side of the bed where they can use the right hand most convenient, and should not leave the bed-side of the patient. We may assist the female, either sitting or standing, ac- cording as is most convenient. The patient should not be uncovered, as it is entirely unnecessary to expose the patient's person, and is also risk- ing the chance to take cold, which, at this time, would be very injurious. As soon as the little one makes its appearance into the world, it may be uncovered enough so that it may be wiped off with a soft cloth, Avhich may be placed convenient for the purpose, but the mother need not be exposed, even at this time. THE CARE OF THE CHILD DURING LABOR. Immediately after the expulsion of the head we should feel with one finger about the child's neck to see if the cord is around it; in case it should be, a slight traction on the cord may loosen it from the placental end, so that it will slip over the child's head, leastwise will keep it from choking or strangling it. When the head is born it should be carefully supported from the clots and other discharges from the uterus, patiently waiting for the work of nature to complete the delivery. After the expulsion of the child, it is better to turn its back to the mother and let her covering fall between the child and herself, thus at the same time bringing the child to our full view and completely protect- ing the mother from cold and exposure. A soft cloth should now be used to wipe the child's face, eyes, and mouth. It usually cries lustily as soon as it is born, but it should be permitted to lie undisturbed for some four or five minutes, or until breathing is established. The cord should then' be tied about three inches from the child and again about an inch further along the cord and then cut between the two places. The child should then be wrapped in a blanket and handed to a nurse to wash. After it has been properly washed and thoroughly dried a piece of raw cotton or cotton batting the size of the palm of the hand should be laid on LABOR. 639 the abdomen just aboA-e the navel, the remnant of the cord laid on it with its cut end pointing upward—the cotton being arranged so as to embrace the base of the cord—and another piece of cotton of the same size placed over the cord, the whole being kept in place by the usual belly band. THE ATTENTIONS TO THE WOMAN AFTER LABOR. After the child has been handed to the nurse the next care of the at- tendant is to look after the delivery of the placenta (after-birth); untilit is removed and the uterus is firmly contracted there is more or less danger of flooding. In most cases there is a short suppression of the pains im- mediately after the expulsion of the child, after which the pains return in a diminished degree and the after-birth usually becomes detached and either lies free in the vagina or is expelled without the vulva. If it should not be outside the vulva a very slight traction of the cord a little upward and outward, taking hold close up to the person, will be all that is neces- sary to disengage it after which it should be carefully scooped up and placed in a vessel ready for its reception. The woman should then be made comfortably dry and a soft dry cloth should be applied to the vulva. She should then be straitened out a little in bed and in all respects made as comfortable as possible, both mind and body, must be kept in a state of perfect repose; everything which may tend to arouse the excitability of the patient, such as talking, noise, strong light, and odor must be carefully avoided and the rooni be kept at a moderate temperature. GENERAL MANAGEMENT, DIET, ETC. In the first place we would most severely disapprove of administering stimulating and even spirituous beverages after delivery, which, far from possessing a strengthening property, tend only to excite the whole ner- vous system. As a usual thing for some time after parturition, nature calls for but little nourishment; it should be given only, and when the womanherself, expressly feels the need of it, and then let her partake of such nourishment as she particularly craves, (unless it should consist of rich meats, pastries, and vegetables which create gases in the stomach and bowels); however, we must allow nature to pursue her own course which, as a general thing, prescribes but little nourishment for the first five or six days after delivery, and thereby avoids the necessary calling of the bowels into action, which state of constipation (if it may be so called) is ordained for the wisest purposes and attended with the most beneficial results; the balance of the system is kept up by the passing off of effete matter in the shape of increased perspiration, etc. Then we cannot sufficiently condemn the use of physics, which only tend to promote irritation and occasionally aid in bringing on puerperal fever and other evil consequences. In many cases this artificial relaxation also interferes with the proper secretion of milk. After the fourth or sixth day nature generally acts spontaneously. When it appears neces- sary to afford mechanical assistance we may do so by application of warm friction to the abdomen, or the employment of a lavement as directed to evacuate the bowels before confinement. When a costive state of the 640 DISEASES PECULIAR TO AVOMEN. bowels continues so long as to cause inconvenience, the appropriate medi- cine may be selected and administered according to the directions for constipation of pregnant females. AFTER PAINS. These pains, which frequently annoy the patient so much, especially if she be of highly nervous sensibility, and deprive her of the necessary rest, ought, under such circumstances to be subdued as soon as possible; by means of the folIoAving remedies good results will certainly follow. TREATMENT. Arnica employed internally, and also externally as a lotion, Avhen there is a sore feeling all through the patient as if from a bruise. The pains are not very seA'ere, but there is a bruised sore feeling with pressure on the bladder and retention of urine. Dose:—Internal. Six pills every two hours commencing immediate- ly after the delivery. Application—externally. To four table- spoonsful of tepid water add fifteen drops of the concentrated Tincture of Arnica and apply to the parts. Chamomilla should be administered an hour after the second dose of Arnica when the after pains still continue to a severe extent and the patient is highly excitable and sensitive. It is sometimes beneficial to alternate the two. Dose: Six pills repeated if necessary after the lapse of an hour from the first dose, then pause three hours and so on. Nux vomica should be employed Avhen the after pains are very severe and there is a continual inclination to relieve the bowels when ly- ing down, but passing away when rising accompanied Avith inclination to cramp in different parts of the body. Dose: As directed for Chamomilla. Pulsatilla is to be preferred when the pains are protracted and the patient is of a mild, tearful disposition, but sensitive and easily alarmed about herself; the pains become worse towards evening. Dose: Six pills as directed for Chamomilla. Secale is indicated in feeble, thin and delicate women when the pains are more particularly of a pressing or forcing nature similar to labor pains. Dose: As directed for Chamomilla. FLOODING. With respect to the treatment of flooding or excessive discharge of blood as incidental to delivery, will require exactly the same medical and general treatment as is given in the article on miscarriage, page 630, and hemorrhagia page 641. It is to be remembered, however, that while in flooding after labor at full term, the application of cold to the abdomen is allowable in severe cases, while the tampon or plug is not to be resorted to. DURATION OF CONFINEMENT. 641 It may be mentioned in addition, that pressure made upon the womb through the relaxed walls by clasping it with one or both hands equally and forcibly, but yet gently and without roughness, very frequently arrests the hemorrhage with great promptness. RETENTION OF URINE. SPASM OF THE BLADDER. During the passage of the child's head out of the womb it is sometimes pressed against the bladder with so much force, that it causes an inflam- mation and irritation of this organ. The best remedy is Arnica. Next to Arnica Cantharis or Nux Vom. Dose: Four pills every half hour, especially if the urine passes off drop by drop and the discharge causes pain. It may be well to apply warm cloths or other warm applications to the parts, for the Avarmth will have a relaxing tendency. INCONTINENCE OF URINE. An incapability of retaining the urine is, on the other hand, another not unusual sequel of protracted or severe labor. TREATMENT. The employment of Arnica, internally and externally, as advised un- der the head of " After Pains" at page 640, is, in the majority of cases, sufficient to overcome this Aveakness. When it fails to accomplish this object, the folIoAving remedies should be had recourse to: Pulsatilla is frequently successful in remedying the defect in from two to four days. Dose: Six globules three times a day for tAvo days. Belladonna may be given, if, in one or two days after the last dose of the foregoing medicine has been given, only partial relief has ensued. Dose: As directed for Pulsatilla. DURATION OF CONFINEMENT. Strict attention should be paid to cleanliness and ventilation of the lying-in chamber. EA'erything that produces an offensive odor should be promptly removed from the room, and a draught of air should be al- lowed to pass through the room (not, however, across the patient's bed). The parts should be bathed daily with lukewarm water so lonar as the discharge continues ; this should be performed under tlie bed-clothes. The patient should make no exertion during the first three or four days, or at least until the proper secretion of milk ; after that time, she may be carefully moved from the bed to a couch, long enough for the bed to be aired a little. After the tenth day, she may sit up, out of bed, for a short time, if she is able, which may be lengthened, gradually, from day to day, as she gains strength. Thus, too, she may begin to walk, little by little until she gradually grows stronger and more accustomed to exer- cise. ' In summer, she may ride out during the third week ; and in win- ter, during the fourth week, all things being favorable. 41 642 DISEASES PECULIAR TO AVOMF.N. CHAPTER XXXII. DISEASES FOLLOWING CONFINEMENT. SECRETION OF MILK. This is one of the most interesting and remarkable changes occurring during the lying-in period. While the child is still in the uterus, all that pertains to the mother unites to affect its nourishment, groAvth and devel- opment there. Suddenly all this is interrupted, the child is expelled from the little Avorld within, and has to find nourishment elsewhere. Nature intends it to be supplied, as before, from the maternal blood, though through the medium of the mammary glands. The reaction upon the or- ganism, from this change from the uterus to the breast, causes what is called milk fever, in consequence of which there results a disturbance in the system, more or less well marked, according to the obstacles to be overcome. In some cases appear chills, fevers, headaches, and a great variety of pains and suffering; while in others this period is passed without any of the above mentioned disturbances. As a general thing, all the disturb- ances incident to the coming of the milk, are less when the child is applied to the breast as soon after delivery as is practicable. Much advantage is gained, both to the mother and child, by this method, since it serves to lessen the suffering of one from hunger, and the danger of the other from fever. SUPPRESSION OR SCANTY SECRETION OF THE MILK., It is of vast importance that the natural operations of the organism peculiar to this condition proceed with regularity. Among these the se- cretion of milk takes a prominent position, and its sudden suppression is apt to be followed by internal and local inflammation, flow of blood to the head, hot and cold flashes, etc. The use of the following remedies should be employed according to their indications. TREATMENT. Pulsatilla should be promptly employed in cases of sudden suppose sion of the secretion of milk, whatever cause has occasioned it; and this- medicine will frequently be found sufficient to restore the natural flow of milk. Dose: Four pills repeated every four hours (or every eight in very mild cases) until change. Bryonia is to be preferred when there is oppression at the chest or stitchiug pains in the chest or side, or more particularly if the suppression can be traced to some sudden mental emotion or to catching cold. Dose: As for Pulsatilla. Chamomilla should be selected, if the patient be particularly irritable and excitable, and the suppression be followed by intense flushing of heat or burning heat of the hands and face either with crimson flush or alter- nate flushing and paleness or one cheek red and the other pale. ' Dose: As for Pulsatilla. SECRETION OF MILK. 643 Belladonna should be given in cases in which the suppression is characterized by: redness of the face and general symptoms of congestion of the head, breasts feel^heavy and appear red and the redness running in streaks over them; sensitiveness to noise, light, or touch. Dose: As for Puis. Aconite should be given if active feverish symptoms, such as hot, dry skin set in, and, under such circumstances will remove the whole disor- dered condition Avith promptitude. Dose: Four pills every two hours. EXCESSIVE SECRETION OF THE MILK. GALACTORRHCEA Occasionally, on the other hand, it happens that too abundant a secre- tion takes place, causing distention of the breasts with spontaneous flow of milk keeping the breasts constantly Avet. Relief from such an uncom- fortable state may be obtained by the appropriate remedy according to the indications beloAv. The function of lactation being one purely physiologi- cal and provided for in the economy of suitable forces. Under the stimulus of maternal instinct and affection most women enjoy perfect health during its continuance. Many indeed are never so well as when giving suck to their children. Under the influence of this process, there arises a greater activity of all the functions at the same time and also a greater strength of appetite and corresponding energy of the digestive powers. The process of conversion of food is unusually rapid, the excess going to form milk. Where a greater amount is thus found than is required the system becomes gradually exhausted, even in health. This over-production may be due simply to excess of vitality, while it may result from the efforts of nature to supply the required material support even under difficulties. The fol- lowing remedies will be found beneficial as the indications appear. TREATMENT. Aconite may be taken as a precautionary measure when there is high febrile action of the whole system and we are ignorant of the exciting cause. Dose: Take four globules repeated at intervals of four hours, until the frequency of the pulse is diminished and the skin becomes moist. Rhus tox frequently proves of much service where febrile symptoms arise from distention of the breasts induced by an excessive secretion and indications of what is generally termed milk-fever (which, however, fre- quently arises from other causes.) Dose: Three globules every six hours until amelioration or change. Calcarea Carb. should be employed in cases in Avhich excessive distention of the breasts, spontaneous emission of milk and loss of flesh oc- cur without any marked and active fever symptoms—or after the previous employment of Aconite or Rhus., when the fever symptoms have been allayed. Dose; Six pills as directed for Rhus. 644 DISEASES PECULIAR TO AVOMEN. Phosphorus is of especial value in cases of this kind when there are marked signs of a tendency to consumption and emaciation takes place rapidly. Phosphorus is yet further indicated when there are sensations as of a rush of blood with oppression at the chest and sometimes even short, dry, hacking cough. Dose: Three pills as directed for Rhus. PERSPIRATION AFTER DELIVERY. The increased perspiration which takes place after child-birth is, as be- fore mentioned, a substitute for the suspended action of the alimentary canal, consequently its sudden suppression is unavoidably followed by an injurious result and not unfrequently followed by fever. Exciting Causes. Exposure to cold or a sudden chill or applying damp linen or clothing not well aired, are the most frequent causes. TREATMENT. Dulcamara should be promptly administered when the perspiration has been checked by a chill, and in such cases a single dose will often re- store the action of the skin and prevent further injurious consequences. Dose: Four pills repeated, if the^e be a degree of effect after the lapse of three hours, but if no evident reaction should have occurred, pro- ceed with the next remedy. Bryonia is to be administered when extreme oppression at the chest is present, or when there is a feeling of soreness and aching in all the limbs aggravated by movement. Dose: As directed for Dulcamara. Sulphur should be employed after the foregoing medicines in cases in which such treatment is insufficient and there is more especially intense heat of the skin and distress. Dose: As directed for Dulcamara. EXCESSIVE PERSPIRATION. On the other hand an excessive perspiration is equally as harmful; it is chiefly injurious from the extreme debility and high susceptibility of taking cold which it occasions. It is generally brought about by keeping the room at too high a temperature, the use of too many bed-clothes or by stimulating beverages. TREATMENT. Our flrst care should be tire removal of the exciting causes after which, if it still continues excessive, the following remedies may be employed. China should be employed if the perspiration be of an exhausting character and attended with great debility. Dose: Six globules every three hours. Acidium Sulphukicum is to be preferred when the perspiration is excessively profuse Avhen lying still, but is diminished when moving about. Dose; As directed for China. MILK AND PUERPERAL FEVERS. 645 MILK FEVER. The secretion of milk is considered an operation of nature and not one that requires medical aid for its regulation; but occasionally women suffer some slight uneasiness for a few clays following confinement; and when any of the below mentioned group of symptoms present themselves, the affection is known by the name of Milk Fever. Symptoms. Shiverings and heat terminating in perspiration ; the pulse is at first weak, changing to various phases, (sometimes quick and frequent), at others soft and regular; and in some instances these symptoms are attended with a drawing pain in the back extending to the breast, a disagreeable taste in the mouth, thirst, oppressive breathing, anxiety, head- ache, etc. Exciting Causes—are neglecting to put the infant to the breast suffi- ciently early, which allows the absorption of the milk into the circulation, mental emotions, fright or anger, and excessive talking. TREATMENT. Nature herself, if not disturbed by improper treatment, will in most cases suffice to restore the equilibrium of the system; should the affection become aggravated we may dread the setting in of puerperal fever. Aconite must be employed in all instances where considerable fever is present, and will usually remove all the symptoms. Dose; Gi ve four globules repeated after the lapse of three hours if ne- cessary. Pulsatilla will will be found particularly useful in severe cases, especially Avhen caused by taking cold and appearing more like a rheuma- tic affection and have the general symptoms of milk fever. Do.se; As directed for Aconite. Belladonna is very useful in particular cases in which complications with very severe disturbance of the brain, or when inflammatory action in the breast may supervene. Dose: Three globules repeated at intervals of four hours, until a de- gree of improvement sets in, and then at intervals of six hours. Rhus is also of considerable service when extreme fullness, tension and painfulness of the breasts, with excessive secretion of milk, attend the case. Dose: As directed for Belladonna. CHILD-BED FEVER. PUERPERAL FEVER. This trouble is of so grave a nature that it is with reluctance that we approach the subject. Where it is at all possible, we would advise a skilled physician to be employed. As this work, however, Avill enter some home where no physician can be procured, it has been thought judicious to treat of the disease at sufficient length to be available in cases of emergency. Symptoms.—This disease assumes various types and degrees, and has received various names. Usually the disease begins on the second, third, fill} DISEASES PECULIAR TO AVOMEN. or fourth day, although in some cases it even appears later, as late even as the eighth or ninth. It somtimes begins Avith a distinct chill, and again there may be only slight chilliness, imperfect and merely noticed. The pulse is very rapid, full and soft. In some cases there is neither pain, dis- tention nor tenderness of the abdomen; while in others the pain is very acute, the distention enormous, and the tenderness exquisite. Profuse SAveating is a very common and distressing accompaniment of this disorder; the sweating of puerperal fever does not diminish the amount of urine, nor abate the quickness of the pulse. An intolerable thirst prevails, and the patient drinks immense quantities of whatever fluid she may be allowed. Dark spots appear on the wrists or other parts of the body. At first, the lochia may be unaffected; they may be even increased in quantity, but more commonly they are entirely suppressed. As the dis- ease advances, usually about the third day, diarrhoea and vomiting may supervene. The patient becomes listless and languid, losing all interest in surrounding circumstances, and even in her child, and the expression of her face indicates anxiety and great prostration ; or, on the other hand, she may be unduly excited, nervous and tremulous. If the disease pro- gresses in spite of treatment, delirium commonly supervenes. Rattling of the breathing, Avith enormous distention of the abdomen, are usually regarded as fatal symptoms. As the disease advances, the womb, the peritoneum and other organs, and tissues of the abdomen become involved in the prevailing inflamma- tion. The flrst symptoms of this disease are similar to tliose of " milk fe- ver,'' but the distinction is to be made by the fact of absence of pain, and more particularly by absence of tenderness in the abdomen. Causes.—This disease may result in consequence of a chill occasioned by a draught of air, or other cause, or from the use of damp or wet linens, or it may be occasioned by violence; or again, it may be impossible to assign any reason for its occurrence ; in which case we are led to believe that it is due to infection, or arises in consequence of some lurking taint or predisposition of the system. TREATMENT. Aconite should be employed at first being indicated by the feeble con- dition, and by other circumstances; and will in very many instances, when promptly administered, particularly in those cases of a more simple form, serve to dissipate the entire disordered condition, and restore harmony to the system in an almost magical manner. Dose: Give four globules every hour, or half hour, according to the severity of the symptoms. It, at the end of twelve hours, the symp- toms have abated, the intervals may be extended two or three hours. Belladonna should be administered when the pain is violent and cramp-like, coming on suddenly and ceasing as suddenly, with swelling of the abdomen; or the pains are forcing, as if the contents of the abdomen would be forced out; sensitiveness of the belly to the touch, she cannot even bear the jar of the bed; redness of the face and eyes; headache; dry mouth, with red tongue; sleeplessness and restiveness; delirious; suppres- CHILD-BED FEVER. 647 sion of the lochia or escape of red and fetid blootl; the breasts are red and inflammed, or swollen and empty. Dose: As directed for Aconitum. Hyoscyamus may be used in some cases of a similar nature to that indicative of Belladonna, but where the disease has been developed by mental emotions and is characterized by spasmodic symptoms, jerks and twitches, delirium, throwing off of the bed-clothes and desire to be uncov- ered, etc., it is more particularly indicated. Dose: As for Aconite. Bryonia will be found useful in cases in which the abdomen is swollen equally and is sensitive to the touch; violent splitting headache the pains are aggravated by the slightest motion; sitting up or even rais- ing the head causes nausea and fainting, great thirst with desire for cold drinks; the patient is irritable or restless and apprehensive as to the results of her sickness. Dose; As for Aconite. Rhus tox. is suitable when the fever is .of a low typhus grade ; the patient is very restless, constantly tossing about. The lochia is again tinged Avith blood or clots of blood are discharged ; aching soreness and stiffness of the limbs ; the tongue is red. Dose: As for Aconite. Mercurius is indicated by dejected expression of countenance ; great thirst; constant flow of saliva; lancinating, boring or pressive pains in the belly; profuse sweat which does not relieve; mucous or bloody diarrhoea or ineffectual desire for stool; very offensive wind; thesymptorns are usually aggravated at night. Dose: Give four pills every two hours until improvement or change. Nux vomica is suitable at the commencement when the lochia has been suddenly arrested by some mental emotion such as vexation; fre- quent desire to urinate, with pain, scalding, and burning; heaviness and burning in the abdomen; pain in the small of the back, worse in the morn- ing; frequent and ineffectual urging to stool; despondency; sleeplessness or else dreaming frightful dreams; the symptoms are usually aggravated early in the morning. Dose: As directed for Mercurius. COLOpYNTH will be found valuable when the abdomen is greatly dis- tended and the pains are unbearable, being of a sharp, cutting or lancin- ating character, which cause the patient to draw the thighs up as close to the belly as possible; diarrhoea with colicky pains aggravated or excited by eating or drinking. Dose: As for Aconite. Chamomilla is useful for cases in which the breasts are flaccid and without milk; diarrhoea; pains in the abdomen like pains of labor; general heat with redness of the face, or one cheek is red and the other is not; great agitation, impatience and nervous irritability. Dose: As for Mercurius. Arsenicum will prove valuable Avhen there are great anguish; sudden 648 diseases peculiar to avomen. prostration; sunken countenance with a sallow complexion; extreme rest- lessness and anguish with fear of death ; sleeplessness; dry and parched lips; great thirst with desire to drink but little at a time; burning heat in the abdomen; feeble and intermittenr pulse with coldness and desire to be covered. Dose: As for Aconite. Secale is good where there is strong tendency to putrify; the dis- charge is pus-like and offensive. Dose; As directed for Mercurius. Diet and Regimen.—The most absolute repose of mind and body should be secured; all noise should be shut out, the room darkened and a moderate temperature maintained; the room should be well ventilated, so as to have the air changed without admitting a cold draught. Purification of all aliment must be enforced and the thirst allayed by small quantities of cold water which should be iced in summer or when vomiting is present. If the lochia is suppressed flannels wrung out of warm water may be applied to the external genitals, or a tepid injection may be thrown into the rectum, if there be great constipation; but it must be a small quan- tity that the bowels may not be much disturbed. The infant should be re- moved and fed on cow's milk and water until the patient is out of danger. LOCHIAL DISCHARGE AND IRREGULARITIES. By the detachment of the placenta from the inner sides of the womb, the parts are left open, and for some days after confinement the vessels dis- charge blood; in six to eight days this changes to serum, and finally to a white purulent mucus. This is the lochial discharge. In most cases it lasts from two to three, Avhile in others it continues several weeks. In cases where it becomes suppressed suddenly, it needs medical attention, also when profuse and long continued. Causes.—Profuse and protracted lochial discharge may be frequently traced to sitting up too soon after confinement, or to keeping the room too Avarm, or to mental emotions. Treatment.—If, after nine days, the discharge continues profuse, con- taining pure blood, whereby an unnatural state is indicated, one or more of the following medicines may be required : FOR EXCESSIVE DISCHARGE. Bryonia is to be preferred when the discharge is of a deep red color, and is attended with internal burning pain in the region of the womb. Dose: Six globules, three times a day. Nux Vomica is usually required when a chill or the use of stimulants has produced the mischief, and the patient is affected with severe pains in the back, and a constant and fruitless urging to stool. Dose: As for Bryonia. Calcarea is most particularly indicated when troublesome itching of the parts is experienced; or when the discharge is protracted, and occurs in women of full habit. Dose: As directed for Bryonia. diarrhcea of lying-in women. 649 Silicea should be employed when pure blood flows with the lochial discharge every time the infant is placed at the breast. Dose: As directed for Bryonia. SUPPRESSED DISCHARGE. Pulsatilla.—When the lochial discharge is suddenly suppressed— which it sometimes is from a variety of causes—and from this cause pu- erperal fever is threatened to ensue, the danger may frequently be warded off by the administration of this medicine. Dose: Four pills eA'ery four hours. Aconite will generally suffice if promptly administered when the sud- den suppression is caused by fright, and is attended with febrile symptoms. Dose : Four globules every hour until relief. Dulcamara will be found beneficial when the suppression is caused by exposure to damp or cold. Dose: As for Pulsatilla. Belladonna. Where sudden suppression is followed by congestion of the brain, Avith flushed face, delirium, etc. Dose: As for Aconite. OFFENSIVE DISCHARGE. Carbo-veg should be administered, if the discharge becomes thin, and offensive. Dose: Six pills four times a day. Kreosote or Secale should be given twelve hours after the sixth dose of Carbo-Veg, if the discharge should still continue offensive. Dose: As for Carbo-Veg. DIARRHOEA OF LYING-IN WOMEN. Diarrhoea at this time is to be looked upon as a serious occurrence and immediate means must be employed for its correction by proper reme- dies. Dulcamara is generally indicated by the cause of the trouble being a check of the naturally increased perspiration from a chill. Dose :■ Four globules administered every three hours. Phos. acid is most effectual for the treatment of painless and almost involuntary evacuation. Dose: As directed for Dulcamara. Antimonium Crud. is generally sufficient when the evacuations are thin and watery and offensive. The tongue is coated white. Dose: As for Dulcamara. Rheum is to be preferred in cases which, in addition to the indications afforded for the last-named remedy. The evacuations and the body emit a sour smell. Dose: As for Dulcamara. 6-50 DISEASES PECULIAR TO AVOAIEN. Phosphorus should be employed in very obstinate cases when the discharge is watery and almost painless. Dose : As for Dulcamara. Veratrum should be given if the discharges are very profuse and watery attended Avitb much pain, chilliness, coldness of the surface and cold sweat on the face. Dose: As for Dulcamara. For cases in which neither of the medicines above mentioned have the desired effect consult the " Article on Diarrhoea " page 280. WEAKNESS AFTER DELIVERY. We frequently find our patient very weak after delivery, especially if there has been considerable loss of blood, for which the following remedies will prove effectual. TREATMENT. China ranks flrst of all and will generally be found efficient in restor- ing the vital energies ; especially when there has been considerable loss of blood or very profuse sweating. Dose: Give six pills every three hours for the first two days, after that give twice daily. Aconite should generally be given at first when there is nervous weakness attended with great restlessness and want of sleep. Dose. As for China. Sepia. This remedy is indicated when there is a painful sensa- tion of emptiness at the pit of the stomach. Icy coldness of the feet and hands; the urine deposits a very hard crusty sediment; flushes of heat and loss of appetite. Dose: Six pills once in six hours. Sulphur. Weak fainting spells coming frequently during the day; feels A'ery faint and weak from eleven to tweh'e every morning; flushes of heat; cold feet; heat on top of the head. ABDOMINAL DEFORMITY—PENDULOUS ABDOMEN. Abdominal deformity is more common to those women who haA'e borne many children, or to those who present a disposition to corpulency. It may be caused by wearing tight stays, which have a tendency to relax the abdominal muscles, and increase the existing disposition to this affec- tion; or it may take place in consequence of a strain upon the muscles of the belly during pregnancy. accessory measures. An elastic bandage laced at the back, and exerting an equal pressure over the whole of the abdomen may be worn with advantage. In some cases where there is a tendency to this affection, particularly in corpulent persons, we may soon after delivery have recourse to mechanical aid by BREAST DISEASES. 651 transfering the support of the abdominal muscles to the shoulder, by the aid of a properly constructed apparatus; but Ave must in the strongest man- ner object to this, or any other pressure being exercised upon the abdom- inal region during pregnancy, as such a measure is obviously calculated to entail injurious consequences upon the offspring. Diet and Regimen. Spare diet and regular exercise must in all cases be observed. SORE NIPPLES. In a previous chapter I have shown the necessity of preparing the nip- ples for their new function. In spite of all care, however, the nipples sometime becomes sore three, four or six days after confinement, especially if the skin is very fine and delicate. This is a most distressing affection, because of the cracks opening whenever the child takes held to suck. If the nipples are too short, the shield before mentioned should be worn be- tween the interval of nursing. In case however the nipples should be insufficient, or their tenderness remain in spite of treatment, nursing may yet be accomplished by using a proper shield, or artificial teat, numerous and excellent varieties of which may be procured. It is well to bathe the nipples with Avarm water and milk, or with borax water, as soon as the babe is done nursing, being sure to wash the breasts as soon as it is ready to nurse again. Arnica employed internal and externally, this remedy will very of- ten obviate all further inconvenience, if used at the onset. Dose: (Internal): Four pills three times daily. Application (exter- nal): To a half teacup-full of water add fifteen drops of concen- trated Tincture of Arnica Avith which a small strip of linen may be wet and applied to the nipple, this may be repeated three times a day. Chamomilla. The nipples are much inflamed, and are very tender, she can hardly endure the pain of nursing; she feels irritable and cross with impatience. Dose: Four pills three times daily. Sulphur should be given, if after nursing the nipples smart and burn badly, they chap badly about the base and bleed. Dose: Six pills night and morning. INFLAMMATION OF THE BREASTS. One of the greatest obstacles to nursing an infant is inflammation of the breasts. The breasts become red and inflamed, occasionally suppurating in some parts which open, and discharge, while others still remain hard, and inflamed, which either end in suppuration, or in the formation of hard lumps. Causes which produce this disorder are numerous. Anything which may operate as an exciting cause to disturb the local secretion, such as fright, passion, cold, etc; though it not unfrequently arises without being able to trace it to any particular origin. Inflammation of the breasts fre- quently arises from not applying the infant to the breast soon enough 652 DISEASES PECULIAR TO AVOMEN. after its birth; and occasionally from a sudden cessation of suckling caused by the death of the infant, or from disinclination of the child, to suck, or from other reasons. When the milk is copiously secreted, and either from inability on the part of the child, or from the obstruction of the milk tubes, or from deficiency of the nipple, the milk cannot be freely drawn in the natural way, every effort should be made Avithout loss of time to secure this end by such other means, as may be possible. Sometimes the breast may be drawn by another child, or by a friend, or by young puppies. The proper remedy should be selected, and faithfully administered in order as rapidly as possible t .• remove all difficulty. In cold Aveather the breast should be warmly protected. If the inflammation is caused and kept up by a tender and ulcerated state of the nipples, let these be particularly attended to, in accordance with the directions already given. (For further particulars see Mastitis, page 384). TREATMENT. Aconite. When a chill in dry cold air has been the exciting cause, and there is high fever prevailing. There is fear, anxiety, and restless- ness, thirst for cold water, etc. Dose: Six pills every hour until the fever moderates. Belladonna. When the breasts feel heavy; there are red streaks running like radii from a central point; she is occasionally chilly, a dull and stupid feeling prevails. It is well to alternate Aconite with this remedy. Dose: Four pills every two hours. Bryonia. Her breasts have a stony heaviness in them, they are hot, hard, and painful, but not very red. She feels sick when first sitting up in a chair and still more sick on standing up, rough dry lips, thirst, and consti- pation , stools dry looking as if burnt, she feels worse when moving, and wishes to keep still. Dose: As for Belladonna. Phosphorus. Inflammation of the breasts, threatening ulceration with cutting or stitching pain. Hectic fever and night sweats, deep ulcers with blue appearance. Dose: Six pills every six hours. Sulphur. The inflammation runs in streaks from the nipple, suppu- ration profuse, Avith chilliness in the fore part of the day, and heat in tlie after part. Some piles in complication. The breasts feel hot. She has night sweats, flushes, or heat, weak and faint spells, irresistible hunger at II A. M. Dose: Six pills every twelve hours. Another treatment of gathered breasts, which has never been known to fail, if employed as soon as threatened, is this: take of chloroform and glycerine equal parts. As the substances are of unequal weight, the vial containing them should be thoroughly shaken, the mixture quickly applied, and the part covered with oiled silk, or something equally impermeable, to prevent too rapid evaporation. TREATMENT AFTER BIRTH. 653 Jr*ai*t Fourteenth. TREATMENT OF INFANTS. CHAPTER XXXIII. TREATMENT AFTER BIRTH. As soon as the child is born it should be Avrapped in a soft woolen cloth, it first being warmed, as care should be taken to gradually inure the infant to the temperature of the surrounding atmosphere. The skin should then be gently washed with a little Avarm Avater; or it may be annointed with lard, using a little fine toilet or castile soap in • the water Avith Avhich it is Avashed, but care must be used in the first washing lest it should get chilled. It is best only to Avash part of the body at a time keep- ing the other parts protected. After washing the skin ought to be dried im- mediately to avoid the risk of taking cold. The child should be bathed every day, gradually loAvering the temperature of the water after weaning. The best time for bathing is in the morning soon after being taken out of the bed. I Avish I could impress every mother with the importance of dressing their infants in a more suitable manner. The practice of bandaging and swathing the tender bodies of their infants and loading them Avith a superfluity of clothing, which, by its weight and length presses upon the loAver extremities and is frequently the cause of deformity and weakness in after life, and moreover causes rupture of both navel and groin. STILL-BORN CHILDREN. SUSPENDED ANIMATION. Causes—in many cases arise from difficult parturition, pressure of the cord around the child's neck, natural debility arising from some scrofu- lous or syphilitic taint of either or both of the parents; or from accumu- lation of mucus in the nose and throat; or, if delivered Avith forceps, it might be caused by an injury from them; or again, it is caused by too sudden alteration of temperature, the action of the lungs not having com- menced . - TREATMENT. From whatever cause the apparent death or suspended animation of the child should result, no time should be lost in making proper efforts to establish respiration. Mechanical Means to be employed is to immerse the child sudden- ly into cold Avater, or better still, cold or even iced water should be 654 TREATMENT OF INFANTS AND CHILDREN. poured over it. In some apparently lifeless children pouring cold water on the head and letting it run down over the body establishes the circula- tion and respiration; the child should then be wrapped in woolen blankets until quite restored. Of course, in all those cases where the breathing is prevented by an accumulation of miicus in the throat and nose, such measures should be employed as to remove such obstructions. Should these methods fail, the one of which a description may be found in the article on '' Apparent Death from Suffocation,'' Avill have to be re- sorted to. Should this method fail, the lungs may be directly filled and respiration may be excited by an adult placing his or her mouth directly over the mouth of the child, closing the child's nostrils betAveen the thumb and forefinger of his hand and bloAving air into the child's lungs, and, Avhen filled, by gradually and carefully compressing the Avails of the chest, emptying the lungs again. This should be repeated again not oftener than from ten to fifteen times in a minute. This artificial respiration, and all other methods employed to restore suspended animation, should be persevered in for some time, life having returned after the lapse of an hour from judicious and careful treatment. Medicinal Treatment. — If the child should still continue to breathe feebly and imperfectly after animation has been restored, the fol- loAving remedies may be resorted to. Aconite if the child is hot, purple-hued, pulseless, and breathless or nearly so. Dose: Two pills on the infant's tongue. Belladonna. The face is very red and the eyeballs are greatly in- jected. Dose: As for Aconite. China if the face is pale, the infant small and of a delicate frame and in cases Avhere the mother has had profuse hemorrhage. Dose: As for Aconite. Opium is good if improvement takes place slowly and the face is livid and bluish. Dose: As for Aconite. SWELLING OF THE HEAD. Immediately after birth the head of the infant appears more or less swollen; this in most cases is but a trifling affection and will disappear of itself; medicinal treatment may sometimes be required. Arnica or Rhus will usually be sufficient to hasten the swelling to subside; when it is very extensive it is necessary to resort to external ap- plication of the same remedies. Dose: Two pills repeated again in twelve hours. Application—external: To four tablespoonsful of water add six drops of the tincture and apply this lotion to the part, repeating the oper- ation after the lapse of twelve hours. RUPTURE OF INFANTS. 655 If there should result an ichorous discharge and caries of the bone and prostration. Calcarea will in many cases produce a eure. Dose: Tavo pills every second day. Silicea is useful if the trouble yields sloAvly to Calcarea to finish the cure. Dose: Two pills as for Calcarea. RUPTURE IN INFANTS. NAVAL RUPTURE. Hernia or rupture may be developed before birth and a predisposition to this affection may be observed in children Avhose parents are similarly affected. The mechanical treatment of naval rupture is as follows:— Take a piece of lint or soft cloth just large enough, when folded five or six times to cover the rupture effectually, then press in the protrusion and keep it reduced with the hand until the compress is rightly adjusted and secured in its position by means of two strips of adhesive plaster placed over the compress in the form of a cross. Another compress may be made by taking a button-mold about an inch or an inch and a quarter in diameter and cover it Avith a piece of soft linen ; apply and secure it the same as the before mentioned compress, or by a bandage made of suitable form to secure it properly. This disease being frequently brought on by violent fits of crying, to Avhich delicate children are subject, the bandage may be worn for some time after the cure as a precautionary measure against its return. It is best to administer a remedy or remedies in order to assist the mechanical measure, and in nearly every case Avhether subsequent treat- ment be required or not. Nux vomica may be looked upon as a medicine of primary import- ance. Dose: Two pills every morning and evening. Aconite.—This remedy is suitable when the infant feels hot and is restless; in that case it is best to give it in alternation Avith the Nux. Dose: Two pills in alternation with the Nux every six hours. Chamomilla is sometimes of service; more particularly Avhen the infant is very fretful and the motions of the boAvels be too relaxed and of an unhealthy color, or if there be evidence of griping in the bowels. Dose: As for Nux. Sulphur is also of great service after any of the previous remedies in obstinate cases when there has been partial improvement, but the treatment prescribed has been insufficient to complete the cure. It is also good for the treatment of soreness of the navel, remaining after the liga- ture has fallen off, or even before this takes place, Dose; As for Nux, 656 TREATMENT OF INFANTS. Silicea should be given four days after the fourth dose of Sulphur in cases of soreness of the navel in which no decided'improvement has been effected by the last named medicine. Dose: As for Nux. RUPTURE IN THE GROIN. All the remedies just enumerated are just as good in those cases of rupture in the groin, which are occasionally met with. WHEN MAY THE CHILD BE PUT TO THE BREAST? Even before delivery the breasts secrete a milky fluid ; the genuine milk is only secreted after delivery. In some instances it has been the custom to draw off this first milk and feed the child in the meantime on catnip tea or chamomile tea, cracker water, or thin soup, etc. Nothing can be more irrational or inhuman. Nothing is more calculated to expel the meco- nium, (the excrementitious matter discharged from the bowels of a new born infant), than the first milk, Avhich has a slightly loosening effect up- on the child's bowels. It is evident that nature has designed it so, else why should the milk be secreted and the child created with a desire to suck as soon as born V After having a few hours rest the mother may take a little nourishment, if she should desire it. After this, the child may be put to the breast; if the mother should feel rested before, and the child should desire, it can nurse before, and at all events do not let more than twelve hours elapse before letting the child nurse. If the child was born in the evening or night, it need not be put to the breast before morning, especially if the mother sleeps; often both mother and child sleep till morning, but if it should Avake and become restless, it may be fed on a few teaspoonsful of water and milk, of equal parts, sweetened. OBSERVATIONS ON THE SUCKLING OF THE INFANT. Conquist, whose opinion in this respect we perfectly indorse in his " Outlines of Mhfwifery," remarks: " Unless very peculiar urgent reasons prohibit, a mother should sup- port her infant upon the milk she herself secrets. It is the dictate of rea- son, of nature, and of common sense. Were it otherwise, it is not probable that so abundant a supply of suitable food would be provided to meet the wants of an infant when it enters upon a new course of existence. It is difficult to estimate the mischief resulting from infants being de- prived of their natural nourishment; for, however near the resemblance may be between food artificially prepared and breast milk, still reason and observation demonstrate the superiority of the latter to the former. As a further inducement, it should be remembered that medical men concur in the opinion, that very rarely does a constitution suffer from secreting milk; whilst the health of many a woman is most materially improved by the performance of the duties of a nurse. Presuming that the laudiible determination is formed to indulge the CHOICE OF A NURSE, AND HER DIET. 657 child with that nutriment which is designed for its support, it becomes necessary to state that unless very strong objections should exist, twelve hours should never elapse before the infant has been put to the breast. Instinct directs it what to do, and the advantages of allowing it to suck soon after birth are many and important, both to the mother and child. By this commendable practice the patient is generally preserved from fe- ver, from inflamed and broken breasts, and from the distressing and alarming consequences resulting from those complaints. If the breasts should not have secreted milk previous to delivery, the act of suckling will encourage and expedite the secretion. Thus the mother will be saved from much of the pain connected with distended breasts, besides which, if the infant be not put to the nipple until the breasts become full and tense, the nipple itself will sometimes almost dis- appear on account of its being stretched, and without much and effectual labor on the part of the child, it cannot be laid hold of; and even then the pain endured by the mother is exquisitely severe, and not unfrequently the cause of sore nipples." THE CHOICE OF A NURSE. For those who cannot give suck to their own children, the selection of a nurse is of great importance, and the medical attendant ought generally to be consulted, ahd the following points merit particular attention: She should be of sound constitution and of good health, of full and mod- erate plumpness, with a fresh complexion, and clear eyelids, free from any appearance of redness, scurfiness or thickening. She should be thoroughly exempt from glandular enlargements, and possess deep red lips without cracks, sound Avhite teeth, and Avell-formed, moderately firm breasts, with nipples free from excoriation or appearance of eruptions; the child of the nurse is one of the best criterions to judge by—its being plump and healthy is a great point in her favor. We should also endeavor to discover if she is free from any hereditary taint; she should, moreover, be of a mild' patient and equable temper, not irritable, or disposed to fits of passion, or nervous; of regular and temperate habits, and fond of children. She ought also to be about the same age, and to have been delivered about the same time, or, at least, within three months of the same period as the mother; with respect to age, we must, of course, avoid extremes. A woman, hav- ing given birth to a child very late in life, should choose a nurse several years her junior, and fully qualified for her duties; the reverse of the rule applies to extremely young mothers. DIET DURING NURSING. As regards the nurse's diet, it should be simple and easily digested, and she ought to live upon a proper proportion of animal and vegetable food. Nature generally provides for the increased call upon her powers by sup- pression of the menstrual discharge, and a moderate increase of appetite, which may be safely indulged; but all food of a highly concentrated, heavy description, is injurious, causing the milk to become unsuited to the delicate digestion of the infant; the best guide, in the majority of cases, is 42 658 TREATMENT OF INFANTS AND CHILDREN. the regular Homcepathic regimen, which may be consulted with advan- tage. Reference must, however, be had to constitution; thus, a strong woman of full habit will not require much animal food, and will have, generally speaking, a plentiful supply of good milk, if she drink nothing but gruel, barley water, toast water, cocoa, tea, etc.; whilst, on the other hand, a woman of somewhat delicate constitution and languid circulation, will want more nourishing food, milk, etc. But Ave cannot too strongly repudiate that too prevalent but deeply er- roneous idea that Avomen, during the period of sucking, necessarily require stimulants to keep up their strength; under this impression, both wine and malt liquors,—and, among the latter, more particularly porter,—are frequently resorted to. Porter is not only injurious, from its stimulating properties, but the deleterious effect Avhich the different ingredients com- posing it produce upon the milk, forms one of the most prolific causes of the many evils that attack infancy. We shall conclude this part of the sub- ject with a single quotation from a well-known medical Avriter:— " There is an evil too generally prevalent, and most pernicious in its con- sequences on individuals and society, and by no means confined to mothers in the lowest classes of the community, which cannot be too severely rep- robated ; it is the wretched habit of taking wine or spirits to remove the languor present during pregnancy and suckling. It is a practice fraught with double mischief, being detrimental both to mother and child. The relief afforded is temporary, and is invariably followed by a degree of lan- guor which demands a powerful stimulus, which at length weakens, and eventually destroys the tone of the stomach, deteriorates the milk, and ren- ders it altogether unfit to supply that nutriment Avhich is essential to the existence and welfare of the child." SUPPLEMENTARY DIET OF INFANTS. Unfortunately, some mothers do not possess sufficient milk for the prop. er nourishment of their offspring; if this arises merely from a deficiency in the secretion, and the woman is in other respects healthy, we must have recourse to supplementary diet to make up for the diminished quantity of the natural nutriment. Goat's, ass's, and coav's milk are excellent substi- tutes, especially the latter, diluted with one-third of water; goat's milk be- ing apparently objectionable from its peculiar aroma. The milk, therefore, of the cow ought, when possible, to be obtained, and, if given undiluted, to be boiled,—cow's milk being generally considered too heavy, Avhich boiling in a great measure obviates; it ought also to be slightly sweetened, so as to resemble as closely as possible that of the nurse, and should, moreover, be about the same temperature, say from ninety-six to ninety-eight degrees, —a point less regarded than it should be, and easily determinable by the thermometer. If any constitutional taint exist in the mother, the sooner the child is transferred to another breast, the better for both parties; and if a nurse be not procurable, the above will generally prove sufficient nour- ishment until the front teeth appear, Avhich is a clear indication that the digestive organs are prepared for more solid food; if, however, the milk diet appears to disagree with the infant, we may give thin water gruel, or mix a little thin arrow-root, rusk, or well toasted bread in water, to which SUCKLING AND WEANING* 659 the milk may be afterwards added; such alterations in diet are, however, but rarely required. We may here observe that no portion of the milk ought to be retained for a subsequent meal, from the quickness with which it becomes sour; the same remark applies to any of the above preparations, in which milk forms the principal ingredient. In the cow's milk, at first diluted as above prescribed, we may, after two or three weeks, gradually diminish the quantity of the water, as the diges- tive organs become stronger; but we cannot too stringently press the point, that, where it is at all practicable, the child ought to derive as great a portion of its nutriment as possible from the breast, no food being able efficiently to supply the place of that which nature intended for it at its birth. When it is necessary to give supplementary nourishment, a sucking-bot- tle ought to be used, as the best imitation of nature, in. giving the food slowly; particular care being take a to observe the utmost cleanliness. The child ought, in feeding, to be kept in a reclining, not supine position, as the latter frequently causes it to incur the risk of suffication; and when it evinces disinclination to its food, no more should be offered. The child should be accustomed to take its nourishment from each breast alternately; as, if this precaution be not adopted, inflammation is likely to arise in the breast not used, and the child is apt to become crooked, from being always retained in the same position. The physician is frequently asked hoAV often the child ought to be ap- plied to the breast; the best rule on this point is, to give the breast when the infant desires it, and to withdraw it when the child appears satisfied. As the infant increases in strength, it may be easily accustomed to regular hours. It should not be permitted to " lie at the breasts " during the night; which is a most pernicious practice for both mother and child. DURATION OF SUCKLING—WEANING. The period of suckling ought seldom to last longer than forty weeks ; but in this we must be guided^ in a great measure, by the constitution of the infant; weak, ill-conditioned children, in whom teeth are long in making their appearance, it has been recommended to continue at the breasts for eighteen months, or even a longer period. Weaning ought, in fact, to be regulated by the constitution both of mother and child. The full development of the front teeth, which in healthy children is from nine to ten months, but in delicate or scrofulous constitutions is delayed for several months later, has been considered the best indication of wean- ing; but this is by no means an unexceptionable rule. If the strength of the mother appears unequal to the task, and the supply of milk begins to fall off, the child may be gradually weaned, even before the teeth appear; still, even when the supply is ample, and the mother and child are appar- ently strong, a continuance of suckling beyond the tenth month is gen. erally injurious alike to parent and child. Weaning should not take place suddenly, but the infant should be gradually accustomed to other food, and a less frequent administration of 660 TREATMENT OF INFANTS AND CHILDREN. the breast, until entirely weaned; the time to commence this gradual course is upon the first appearance of the front teeth, so that the weaning may terminate with their full development; thereby the secretion lessens by degrees, preventing all evil consequences of swollen or inflamed breasts, and the child also becomes quietly reconciled to the deprivation. Weaning ought not, however, to take place, if the child suffers con- siderably from the irritation of teething, or any acute infantile disease. When, however, it is found absolutely necessary to Avean, the above precautionary measures should be observed, both Avith respect to the mother and child. FOOD OK THE INFANT. After the child has been weaned, its nourishment should generally consist of the same simple food as before mentioned. The transition to a more substantial diet ought to be extremely gradual and guarded, and no material alteration made until after the appearance of the eye-teeth. SLEEP—SLEEPLESSNESS. From the inability of the infant itself to maintain a proper degree of warmth, it should sleep by its mother's or nurse's side, for at least the first six weeks, particularly during Avinter or early spring. Care must be taken not to overburden it with bedclothes, and to place it in such a position as to prevent it slipping under them, and thereby becoming exposed to the risk of breathing a vitiated atmosphere, or even of suffocation; after six or eight weeks, when the organism becomes stronger, and able to pre- serve a proper degree of natural warmth, a seperate bed or cradle will be more conducive to the health of the infant; this change of arrangement AA'ill be found beneficial to both parties—to the child, from its breathing a purer air ; and the mother, being freed from the necessary watchfulness and restlessness consequent upon the child sleeping with her, will enjoy better health, and be more likely to secrete good and nutritious milk. Moreover, sleeping in the same bed with an adult, and particularly with an old person, is somewhat detrimental to the health not only of infants, but even of children. As to the length of sleep allowed to the infants, the chief business of the first months of its existence being sleep and nourishment, we may safely leave the point to nature, and not attempt to coerce the inclinations of the child; if the infant is lively on waking, we may conclude it has not slept too much ; and as it increases in vigor, and is able to endure longer intervals of wakefulness, we may proceed (recollecting that night is the proper period for sleep), so to regulate its habits of taking its food and rest, as to accustom it to an uniform system, and particular hours. Chil- dren, up to two years of age, require rest during the day, and the nurse ought to endeavor to get them into the habit of taking it in the forenoon; for, if it be taken in the afternoon, it generally interferes with the night's sleep. Whether by night or day, we must carefully exclude both light and noise from the nursery; for although they may be insufficient to arousethe SLEEPLESSNESS. 661 infant, still they cause its sleep to be disturbed and unrefreshing, and, by acting upon the nervous sensibility, predispose the child to COnAyulsions~ or spasmodic attacks from slight accidental causes. It is true that, during the first month, the infant sleeps immediately on leaving the breast, and no evil consequences ensue; but it must be borne iivmind, that it takes but a little at a time, and milk is at that time \visely adapted to its delicate digestion; but as the secretion''becomes' richer, and suited to the increasing power of those organs, it is injurious to put the child asleep immediately after a full meal, for its rest is"then unquiet and disturbed, from the process of digestion being interfered' with, more particularly when the nurse foolishly endeavor to force1 na-" ture, by resorting to the baneful practice of rocking. Nothing causes greater annoyance and even anxiety to the mother, than a disposition to Avakefulness on the part of her infant!. A healthy child should always be prepared for its rest at the usual hours; if, in- stead of going to sleep, it appears restless, fretful, and disinclined for its accustomed rest, it is an evident indication of some derangement of the child's general health; frequently, through ignorance, nurses, instead of attending to this Avarning voice of nature,—which by the sleeplessness of the infant demands appropriate relief,—endeavor to stifle it, and some- times, to free themselves from a little temporary annoyance, administer opiates, often in the form of "carminatives," "soothing syrups," which in- duce an unfreshing slumber, and not unfrequently a deep stupor, mistaken for sleep, while the original evil still continues to make head against the vital poAver. This baneful practice has not only been the ruin of many constitutions in after life, but to it, conjoined with improper diet* stimulating or unwholesome drinks, quack medicines, together with the highly erroneous practice of a frequent administration of laxatives, in in- fant maladies, a considerable number of diseases and even deaths are annually attributable. Every mother should not only caution her nurse against the use of opiates, but use her utmost vigilance to detect any breach of her injunctions, Avhich should be visited with the immediate discharge of the person so offending; for she must be truly unfitted for such an important trust, who, after being warned of its injurious ten- dency, will persevere in a practice placing in jeopardy the life of her infant charge. TREATMENT. Amongst the homoeopathic remedies which have been found the more generally useful in removing restlessness and sleeplessness in children, the subjoined deserve especial notice. Coffea is very efficacious when the child seems unusually lively, rest- less, and wakeful; but will commonly fail to answer its purpose when the nurse is in the daily habit of taking coffee as a beverage. Dose: Two globules, dry, at night and morning. Opium may be substituted for Coffea when the nurse is in the daily habit of taking coffee, and is especially indicated if the face of the child looks red. Dose: As for Coffea. 662 TREATMENT OF INFANTS AND CHILDREN. Chamomilla will do good when the child is tormented with flatu- lence, and distention of the bowels, and appears to suffer from colic, indicated by drawing up the legs, screaming, etc. Dose: As for Coffea. Aconitum is preferable to any of the preceding, when there is general febrile heat and great restlessness. Dose; Two globules, dry, on the tongue, three times each day. ADDITIONAL PARTICULARS. The reader should further consult, if necessary, the general article on " Sleeplessness,'' and that on " Crying, Wakefulness, and Colic of Infants," in the subsequent pages. EXERCISE. For the first six or seven months the great business of nature seems to be the proper development of the infant frame, and particularly of the respiratory, and digestive organs. During this period, also, the cartilage is gradually forming into bone, and the infant's delicate muscles are acquir- ing power and strength. We find, however, that consciousness is yet indistinct, and the infant evinces no anxiety to indulge in voluntary motion, the muscles of the neck and back not possessing sufficient power to support the head, or to keep the body in an erect position; for this rea- son, children during this period should, Avhen carried in the arms, be kept in a reclining position, so as to avoid an undue pressure upon the spinal column; a neglect of this precaution, and a premature carrying of the infant in an upright position, is a too frequent cause of deformities of the spine, and derangement of the functions in after life. As its powers gradually develop, the infant seems inclined to exercise them, and evinces a desire to sit upright, which we may safely indulge, taking care not to overtask its strength by keeping it sitting up during the greater part of the time it is awake. A careful attention to nature in this, as in all other cases, is the best guide. The practice of dandling the child in an upright position, seems rather to proceed from the pleasure of indulging the feeling of parental affection, than from any benefit the child can, by any possibility, be expected to de- rive from it; in fact, it is highly injurious, even at a rather more advanced period, as exciting a premature involuntary exercise of the muscles, and consequent deformity. The act of respiration bringing into play a great variety of muscles, occasional crying seems sufficiently active exercise dur- ing this period. In mild spring and summer weather the child may, under favoring circumstances, after the first fortnight has elapsed, be carried out into the air for a quarter of an hour at a time, and the period of exercise grad- ually increased; in fact, if the weather be fine, it can scarcely be too much in the open air. Should its birth occur in winter, advantage may be taken of a fine day, after it is a month or five weeks old, as the frame is grad- ually acquiring the power of generating heat; but, at the same time, great RETARDED STRENGTH OF THE LIMBS. 663 care must be taken to prevent its catching cold; and should the child exhibit the slightest sign of being affected by the atmosphere, the practice of carrying it out of doors should be immediately discontinued, and it should be carried up and down in a well ventilated room, the nurse moving it quietly in her arms from side to side. Many children are lost through a foolish idea of making them hardy, by accustoming them to endure cold; this can occur only through ignorance; for nature, in very early infancy, does not possess sufficient energy of reaction to overcome the power of a sudden or long-continued chill. We may recommend an occasional gen- tle friction of the hand over the body and limbs, which materially assists in the promotion of the circulation of the blood, and will, in unfavorable weather, serve, in some measure, as a substitute for exercising the infant out of doors. The practice of assisting children to walk, or of exciting them to a premature exercise of their powers, is highly reprehensible, causing, in many cases, curvature of the limbs, the bones not being yet sufficiently formed to bear the burden imposed upon them. By allowing nature to act, the infant's power Avill become more gradually, but at the same time more fully developed; its carriage will be more firm and erect, and its limbs straight and well formed ; moreover, it will walk with greater con- fidence and independence by the expiration of the first year, than tliose who haA'e been taught to walk by the assistance of the nurse, leading- strings, or mechanical inventions. RETARDED STRENGTH OF THE LIMBS. TREATMENT. Calcarea carb. is, in the majority of cases, the appropriate medi- cine when the child continues to be feeble, and any attempt to walk, or the capability of sustaining an erect position, is unduly procrastinated. Dose: Tavo globules every morning, the first thing, fasting for four days (unless some condition requiring other treatment should sooner arise); then pause eight days, after Avhich repeat the course as be- fore ; then pause again for three weeks, and repeat the course once more. But if within three weeks after completion of the third course no very apparent change should have taken place, consider the following medicines. Silicea or Sulphur may be required after the previous employment of Calcarea, when the last named medicine has been productive of no very apparent improvement, more particularly if the child manifests a gener- ally feeble or scrofulous habit, and is affected with enlargement of joints or tendency to curvature of the bones, or rickety affections. Dose: Of the remedy selected, give two globules, as directed for Cal carea. 664 DISEASES OF INFANCY. CHAPTER XXXIV. DISEASES OF INFANCY. INFLAMMATION OF THE EYES. OPTHALMIA. New born infants and older children are subject to Purulent Opthul- mia or inflammation of the eyes. This disorder is always more or less serious, for, unless speedily cured the inflammation may result in ulcera- tion and the contents of the eye-ball be discharged, causing permanent deformity as well as hopeless blindness. The first indication of the disease is generally the eyelids becoming glued together during sleep, with redness and SAvelling externally. The Causes are sudden exposure to the light of day, to cold, or the glare of a lamp or fires. Many cases of inflammation of the eyes occur in babes whose mothers are affected with leucorrhcea, therefore we must conclude a discharge from the genitals of the mother is a very frequent cause of opthalmia in newborn infants; or it is sometimes epidemic; and no doubt many children who are what is commonly called " born blind," owe their misfortune to the neglect of proper precaution, in many cases the external indications of this affection being so slight as to escape obser- vation. For additional particulars see page 179. TREATMENT. Aconite should be administered as soon as we become aware of the existence of this evil; a feAV doses will generally be found sufficient to subdue this affection in all mild cases. Dose: Two pills every four hours. Belladonna. The eyes look very red; cannot bear the light; open- ing the eyes only when in a dark place. This remedy is good to alternate with Aconite. Dose: As for Aconite. Sulphur. There are pimples, more or less over the body ; the eyes seem to itch very much. This remedy should be selected when we have reason to suppose the constitution of one or both of the parents is affected. A little breast milk applied to the affected eyes of an infant often affords speedy relief. Dose: Two pills repeated every twelve hours. HICCUP. This affection, though in itself of slight importance, frequently causes a consideraole degree of uneasiness to the young mother. It generally arises from exposure of the body, even in a warm room, to the atmospher- ic air, even during the operation of dressing and undressing the new born child. COLD IN THE HEAD. 665 Wrapping the infant warm in bed, or better still, applying it to the breast will generally lead to a cessation of the affection ; should it, how- ever, continue, the administration of a small quantity of white sugar as much as will cover the end of a teaspoon, dissolved in a teaspoonful of water Avill frequently effectually remove the evil. Nux vomica. Two pills placed in the mouth of the infant will arrest the trouble if the other advice should fail. ALLOPATHIC TREATMENT. Hiccup is generally relieved by a sudden arrest of the attention, as by a reproof or a sudden expression of great surprise. Hot cloths wrung out of warm or hot water may be continually applied, or a mustard and flaxseed poultice laid over the region of the diaphragm. The common in- ternal remedies are cold water, snow, pounded ice, or ice cream. Ano- dyne and antispasmodic drugs are useful in this as in other coughs. A combination of Chloral, Bromide of Potassium with or without an opiate is generally effectual. Take of Hydrate of Chloral and Bromide of Po- tassium and Bicarbonate of Potash one scruple, Paregoric two drams, Peppermint Water sufficient to make two ounces. Mix. Dose: A teaspoon half full, to a dessertspoonful every two or three hours. Obstinate cases will require professional advice. SNUFFLES, OR COLD IN THE HEAD. CORYZA. Snuffles or cold in the head is one of the earliest and most common affections of the young infant. It consists of an inflammation of the mu- cous lining of the nose. The first that is known of it is, that the infant's nose is stopped up so as to hinder its breathing, hindering it in the action of sucking by not allowing the breath to pass through the nostrils, oblig- ing the infant to release the nipple in order to breathe, causing it to become fretful and irritable. While this state continues, it has its influence against the infant's thriving, both by hindering it from taking a sufficient amount of nour- ishment and by annoying the breathing of the child so as to disturb its sleep. When the nose is dry while administering a remedy, to remove the evil, relief may be obtained by oiling the nose on the outside and by using a feather or camel's hair pencil on the inside. Fresh lard, goose grease, cream, or a little breast milk will often afford grateful relief. TREATMENT. Aconite. This remedy, if administered at first when there are febrile indications, will often cut short an attack of coryza. Dose: Two globules every two hours. Nux. The trouble is worse at night, particularly toward morning or in the morning. Through the night the nose is very dry. Dose: As for Aconite. Euphrasia. Profuse fluent discharge and acrid discharge from the eyes ; the eyes are much involved. Dose: As for Aconite. 666 DISEASES OF INFANCY. Chamomilla. Where there is watery or mucous discharge ; the child is quieted by carrying it up and down the room. One cheek red the other pale. Dose: As for Aconite. Pulsatilla is indicated by thick green or yelloAV bloody matter like discharge from the nose attended with frequent sneezing. Worse towards evening. Dose: As for Aconite. ALLOPATHIC TREATMENT. Cold in the head generally requires but little more than maintaining an equable temperature for a few days, when it naturally subsides. It is, necessary to keep the nostrils open that the child may nurse. For this purpose the nostrils may be moistened Avith glycerine applied with a camels' hair pencil. Nurses are in the habit of provoking sneez- ing by dropping milk into the nostril, so clearing it out, and smearing the nose Avith Olive or Almond Oil. A very useful application when the discharge tends to continue, is Tannin fifteen grains, Fluid Extract of Belladonna twenty drops, Glycerine two drams. Mix, and apply with a a camels' hair pencil two to four times a day after first cleansing the nos- tril with a camels' hair brush and warm water. If the discharge is offen- sive a solution of one or two grains of Permanganate of Potash to the ounce should be used to cleanse the nostril. In chronic cases the above mixture of Tannin may be used alternately with the dry powder or a so- lution of Alum, five grains to the ounce, may be employed. If the disease depends on scrofula, the following mixture may be given: Take of Iodide of Potassium sixteen grains, Pyrophosphate of Iron ten grains, Avater sufficient to make a solution, Syrup of Peppermint sufficient to make two ounces. Mix. Dose: A teaspoon half full, to a teaspoonful, three times a day. Or three to five drops of the syrup of the Iodide of Iron may be given. CRYING AND WAKEFULNESS OF NEW BORN INFANTS. COLIC. Occasional crying of new-born children is a wise provision to bring the respiratory organs into play, and to expand the chest. When, however, the crying becomes excessive and threatens to prove injurious, we must in the first place endeavor to discover its origin, which Avill frequently be found in some derangement in the infant's dress, a wet diaper or tight band- age, or perhaps it may feel thirsty and would like to be refreshed by a little cold water. Care and love will easily detect the cause of the child's cries, and a good, true mother will scarce ever lose her patience at such times. Sleeplessness is often caused by similar circumstances ; the chil- dren sometimes lie with their heads too high, or they are too warm, or they are sometimes affected by nursing their mother when she is in a nervous and excited condition ; all these things must be considered. CRYING AND WAKEFULNESS. 667 TREATMENT. Belladonna Avill frequently be found sufficient to remove the evil, when no exciting cause or guiding symptoms of disease present them- selves, and the infant is peevish and irritable, affected with incessant whimpering and wakefulness, or prolonged fits of crying. The infant's face looks somewhat flushed. Do.se; Tavo pills every three hours, until relief or change. Chamomilla is of very great service, when the child appears to have griping pain (colic), indicated by drawing up the limbs, contortions of the body and face ; or when there is a yellowish, greenish water discharge from the bowels, the child Avants to be carried all the time. Dose; As for Belladonna. Coffea cruda will generally prove beneficial, when the child is ex- ceedingly wakeful and bright, may be somewhat fretful or not. Dose: As for Belladonna. Aconite should be employed when there is in addition to the above mentioned symptoms considerable dry heat of the skin, with extreme restlessness. Dose: As for Belladonna. Nux vomica Avill usually succeed in restoring ease, when flatulent colic, accompanied with A'iolent fits of crying, drawing up of the legs, and a costive state of the bowels, appears to be the cause of the disturb- ance. Dose: As directed for Belladonna. Pulsatilla is very suitable when the derangement arises from over- loading the stomach, or improper food, and the crying, or wakefulness, is accompanied with colic, wind and diarrhoea of stools, with no two that look alike. Dose: As for Belladonna. ALLOPATHIC TREATMENT. Crying, when not dependent on hunger, fright, willfulness, or peev- ishness, is generally dependent on dyspeptic colic. These are loud and may be long. Whimpering, moaning, painful cries, depend on inflammatory or ex- hausting diseases. The smothered cry depends on true or false croup. The treatment, therefore, will have reference to the causitive conditions. The use of soothing syrups is not free from danger, as they contain a se- cret amount of Morphine, which is an unsafe drug to give to children. Simple restlessness may be relieved by two to five-grain doses of Bromide of Potassium, dissolved in syrup. When necessary to give an anodyne, it is best to give Paregoric ; the doses of which is on the printed label, suited to the age. It can be given with the Bromide of Potassium, or an equal amount of Tincture of Hy- oscyamus. But rather than by any drugs, should relief be obtained by correcting whatever derangement causes the crying. 668 DISEASES OF INFANCY. Colic may be temporarily relieA-ed by a dose of Paregoric suited to the age, given at suitable intervals of from half an hour to longer intervals, until the pain is relieA'ed. Warm cloths or poultices, over the abdomen, are useful. The principal treatment consists in correcting the derange- ment of the stomach and boAvels. Irritation from unsuitable milk is a frequent cause, as is noticed at the period of menstruation during lacta- tion ; the occurrence of another pregnancy, violent mental emotions, hard, exhausting labor, errors of diet, or some other causes which render the breast milk unsuitable. These causes suggest their own change. If the amount or quality of the breast milk is insufficient, the trouble will be relieved by proper artificial feeding. An excess of acidity in the stomach, as shown by sour eructations (belchings), sour and greenish stools, scattered, sometimes, Avith lumps of undigested material, call for alkalies sufficient to correct these symptoms. The best is Bicarbonate of Soda, in doses of one or two grains, or teaspoonful doses of Lime Water, given often enough to correct the sourness (acidity). Two to five grain- doses of Pepsin, with an equal quantity of Bismuth may bo given three or four times day. The regulation of the diet to the exact wants of the system, is the most important part of the treatment. This will have to be accomplished somewhat by experiment. The milk for artificial, as tested by litmus paper, should be alkaline, and not used until sufficient lime Avater or soda is added to make it so. It should be perfectly fresh, and kept on ice to prevent any decomposition (souring), or if this is impossible, and it can- not be freshly milked each time it is used, scalding will help to keep it, and is, in this case, permissible. The juice of lean meat may frequently be given, instead of milk, with advantage, or raw lean beef, chopped fine and ground in a mortar, and strained through a sieve, may be salted or sweetened and fed a tea- spoonful at a meal. It will frequently be digested when milk Avill not. In older children, the treatment will be the same for the relief of pain. If the irritating matter is not removed by a free, loose stool, a tea- spoonful or a dessertspoonful of Castor Oil (mixed with an equal quanti- ty of inodorous Glycerine, and flavored with a couple of drops of Oil of Wintergreen or Cinnamon, to make it palatable), should be given. VOMITING OF MILK. SOUR STOMACH. FLATULENCE. The infant, the same as the adult, is subject to attacks of indigestion, and the disorder in the one case bears a certain similarity to that in the other. Though vomiting in every case is by no means the result of indi- gestion, for Avhen the stomach is simply overloaded or rather overfilled, it relieves itself of the excess by vomiting, and this act takes place with little effort and no suffering, the process of digestion still going on undis- turbed. When indigestion, colic, constipation or diarrhoea arises from impro- per food, in babies raised by hand—that is, from food which evidently does not agree with the child's stomach—or even from unwholesome ma- VOMITING OF MILK. 669 ternal milk, we will frequently have to encounter many difficulties before we can select a suitable article of food that Avill agree Avith the delicate digesth'e apparatus of the babe. We should endeavor to make a good choice of food; and if, having done so, Ave find that the choice has been a mistake we should try again, not despairingly, but remembering always that what is one baby's food is another baby's poison. TREATMENT. Ipecac. There is much sickness of the stomach the more constant the; nausea, the more certain will Ipecac relieve; the stools look fermented. Dose: Two pills, repeated after a lapse of four hours. Chamomilla. The child is very irritable and fretful, must be carried all the time; distress after nursing; sleepless starting and jerking Avhile asleep ; stools smell like rotten eggs and are green, chopped, or consist of Avhite and yellow mucus. Dose: As for Ipecac. Arsenicum. The food is thrown up as soon as taken into the sto- mach, and passes off through the bowels undigested; the stools are offen- sive; much crying during and after nursing, or as soon as the child begins to take food. Emaciation and restlessness. Dose: As for Ipecac. Nux vom. is indicated when vomiting of milk is attended Avith flatu- lence, constipation, uneasiness or irritability of temper. Dose: As for Ipecac. Bryonia. Should be given the second dose of Nux after the lapse of four hours, if the symptoms mentioned in the last remedy have not entirely yielded to its action. Dose: As for Ipecac. ALLOPATHIC TREATMENT, Flatus Avill be relieved by alkalies, given as above, and care regarding food. Vomiting, except as a symptom of serious disease, and not simply a regurgitation from over-distention of the stomach, Avill be relieved by the same means occurring from over-distention, the infant should be given a little less of that article of food at a time. With infants at the breast, it is generally of no consequence. FLATULENT .DISTENTION OF THE STOMACH AND BOWELS. Gentle friction Avith the palm of the hand Avhich has been previously warmed, will often give grateful relief. It is best to begin at the lower right side of the bowels, passing the hand gently up the right side as high as the stomach, then across and down the left side and so on. At the same time the following remedies should be employed. Nux vom should be employed at the onset for children of a spare, meagre habit, or who are more subject to a costive condition, Dose: One pill every two hours. 670 diseases of infancy. Pulsatilla is to be preferred if the children are of a relaxed habit or who are subject to discharge from the eyes and eyelids; or particularly when diarrhoea is present. Dose: As directed for Nux. Chamomilla should be administered four hours after the third dose of Nux or Pulsatilla, if no permanent relief should have resulted ; and more especially if convulsions or diarrhoea be developed as attendant symptoms. Dose: As directed for Nux. Diet. The diet must at the same time be attended to and altered if of an indigestible nature and the suspected cause of the mischief. MILK CRUST. CRUSTA LACTEA. MILK SCAB. Description and Symptoms. This eruption occurs in children Avhile nursing, and more commonly Avhile teething, and appears to be much closely connected Avith that process. It commonly commences on the cheeks, and forehead, by the breaking out of a number of small yellowish pustules, (pimples) croAA'ded together upon a red surface. These pustules excite great itching, and are quickly broken, discharging a viscid fluid that dries, forming greenish-yellow scabs; the scabs are frequently rubbed off but form again; fresh crops of pustules appear around the scabs which quickly extend to the scalp, and even the face. The eruption appears behind the ears and patches will sometimes appear also, upon the neck and breast. The discharge from the pustules is caught by the hair upon the head, and forms into small irregular friable masses, Avhich may resemble the bruised yolk of a hard boiled egg. The pustules or achores as the small superficial ulcers which they form upon the skin are sometimes called, have an irre- gular form, contain a straw-colored fluid, rest upon an inflamed base, and are succeeded by a thin brown or yelloAvish scab. There is much irrita- tion, heat, and itching; the discharge is very profuse, and with so much itching that it is easily rubbed off, leaving the surface raw and excoriated. Whenever this discharge is brought in contact with the skin—in the face, Avhere it trickles down upon the breast, where it falls, and upon the backs of the hands, violently used by tlie child to rub with—it proves so acrid as to produce there a fresh eruption. The same is true even of the arms of the nurse upon which the child rests its head at night. The itching and burning acridity of the eruption, and discharge are much worse at night. All external application should be voided, with the exception of a little sweet cream or olive oil, which has sometimes proved very grateful. Ev- erything should be carefully avoided which would have a tendency to drive this eruption in, since it might result in some more serious trouble. TREATMENT. Aconite should ahvays commence our treatment, Avhen Ave find ex- cessive restlessness and excitability produced by this affection, and when the skin around the parts is red, inflamed and itching. Dose: Tavo pills repeated every tAvo hours. Viola Tricolor. As soon as the beneficial effect has resulted from PPTH.E—THRUSH. 671 the administration of Aconite; and six hours after the last dose of that medicine, it Avill be well to proceed with the remedy under consideration, which, in the simple and uncomplicated form of the disease, is often suf- ficient to effect a cure. Dose: Tavo globules every night and morning. Calcarea. Eruptions, with thick scabs and yelloAV pus underneath. Stools having a chalky appearance. Sometimes the eruption appears in the form of a ring-worm. Dose: Two globules every morning. Graphites should be given Avhen a transparent, glutinous fluid ex- udes. Avhich causes the crusts to fall off; the eruption appears more par- ticularly on the chin and behind the ears; emits a fetid odor, and itches. intolerably. Dose: As directed for Viola Tricolor. Arsenicum is indicated Avhen the eruption is very dry and scaly and causes destruction of the hair. Dose: As directed for Viola Tricolor. Rhus Tox Avhen the scalp is considerably affected ; thick scales ; a bright edge of inflammation surrounds every portion of the eruption and there is much itching, particularly at night. Dose: As for Viola Tricolor. Sulphur Avhen the eruption extends more or less over the whole body, with much itching; although the main affection appears on the head. Dose: As directed for Calcarea. Sepia. Eruption very moist; almost constantly discharging pus- like matter. The child often jerks its head to and fro, seemingly from the itching. Dose: Two pills eA'ery evening. APIITILE. THRUSH. The thrush often attacks the infant in tbe^second week, and is char- acterized by the mouth and tongue being covered with minute whitish blisters, which arc rubbed off by the action of sucking. A succession of these vesicles is constantly taking place as long as the disease lasts, and if not checked, becomes confluent and sometimes present an ulcerated ap- pearance or form a thin, white crust which generally lines the Avhole cavity of the mouth, and in severe cases, extends to the throat and even throughout the stomach and bowels. The affection, although of itself neither malignant nor dangerous, frequently causes not only considerable suffering to the child by prevent- ing it from suckling, but great pain and inconvenience to the mother by being communicated to the nipples and causing excoriations, etc, 672 DISEASES OF INFANCY. TREATMENT. Chamomilla. When the child exhibits much uneasiness and must be carried all the time, this remedy will prove more beneficial. Dose: Two pills eA'ery three hours. Mercurius is to be recommended when there is more than usual moisture in the mouth. There is inflammation in the whole cavity of the mouth ; the gums have ulcers on them. DOse: Two pills to be taken every four hours. Carbo veg. The mouth is very hot, the tongue almost immovable, and a sort of bloody saliva escapes occasionally. Dose: The same as for Mercurius. Sulphur. The child does not take its usually long sleep ; it awakens often and the same symptoms prevail, even after taking the other reme- dies. Dose: As for Mercurius. Bryonia. The mouth seems unusually dry with thirst; dry lips, rough and cracked ; the child does not like to take hold of the breast, but when once in its mouth and moistened, and it is fairly at work, it nurses well. Dose: The same as for Chamomilla. EXTERNAL APPLICATIONS. The mouth should be carefully washed after nursing with a soft old linen rag dipped in tepid water or in water containing a small quantity of Borax and Honey in solution. Pure molasses applied by means of a piece of old linen or muslin or by the finger, constitutes one of the best healing washes where one seems to be needed. ALLOPATHIC TREATMENT. Thrush : A good digestion and regularity of the bowels, should be secured. The nourishment of the child is generally insufficient, so that in cases of weakly infants, additional feeding is necessary. A little new creamy milk, the juice of lean meat or freely ground lean beef may be given. For local use, awash of lime water, a solution of Chlorate of Potash or Borax is appropriate. If ulceration occurs, the popular Golden Thread lea and Borax may be used. Sulphurous Acid two drams in an ounce of water, may be ap- plied with a linen mop. Other remedies are given on page 216, in the treatment of Stomatitis. CONSTIPATION. Even very young infants are sometimes affected with constipation; in fact, during the first two months of infantile life, constipation is frequent, while diarrhoea is comparatively rare. This may be occasioned by some hereditary predisposition, and be maintained by the constantly imparted influence of a costive habit on the part of the nursing mother. In the medical treatment of the constipation of infants, recourse must CONSTIPATION OF INFANTS. 673 always be had to the cause. If this be found in the nursing mother, the proper remedies should flrst be administered to her. Should there be any. thing in her diet which may be capable of rendering either her or her child constipated, this should also be attended to. With scarcely a single excep- tion, cases of costiveness in nursing infants will be found dependant upon the influence of diet, hereditary and constitutional weakness and inaction of the bowels or actual derangement of the liver. MECHANICAL MEASURES. Before proceeding to enumerate the remedies, we may observe that an injection (lavement) of tepid water, or of some milk and water, may occasionally be used, if necessary to remove the obstruction of feces; or, a suppository consisting of a small strip of paper or linen, spirally twisted and lubricated with oil, may be introduced by a gentle rotary movement. If these means should fail at flrst, they should be repeated after the lapse of a feAV hours. Rubbing the stomach and bowels frequently in the course of the day Avith a warm hand sometimes assists the means employed. In order to overcome the constitutional tendency, it will be well to use the appropriate remedies. MEDICINAL MEANS. Nux vom. when the stools are large and difficult or small, frequent and painful, with disturbed or restless sleep, frequent efforts to evacuate the stool without effect. Dose: In ordinary cases give two pills morning and evening for tAvo days, then pause two days. Bryonia is suitable if the stools are very dry, as if burnt, and of a dark color: dry lips and mouth, and there is alteration of constipation and diarrhoea. This is a good remedy to alternate with Nux Vom. Dose: As for Nux Vom., or Avhen alternate with Nux Vom., give Bryonia in the morning and Nux Vom. in the evening. Calcarea Carb. is to be preferred when the stools are of a whitish or a clay color. Dose: As for Nux Vom. ALLOPATHIC TREATMENT. Constipation is best relieved by injections of soap and Avater or cold water. I have known teaspoonful doses of Olive Oil to relieve constipa- tionin infants Avithout being followed again by constipation. Syrupof Rhu- barb in doses of half a teaspoonful to a teaspoonful and a half may be used. Fluid Extract of Senna in doses of ten to thirty drops in syrup is gener- ally an effectual remedy in constipation. Change in the diet which will overcome costiveness is called for. To this end fruit is indicated. It may be raw or cooked. If hard feces have lodged in the rectum (lower bowel) which the in- jections do not remove, they should be broken down by the finger or removed with the handle of a spoon. In older children free exercise should be taken; in cities the systema- tic use of gymnastics may be useful. Cold wet packing of the abdomen 43 674 DISEASES OF INFANCY. often succeeds. Exercise, cool bathing and a diet Avith plenty of fruit will probably relieve. The Fluid Extract of Senna may be given, and for continued use Tincture of Nux Vomica and Belladonna will establish the habit of a regular stool. Take of Tincture of Nux Vomica and Tincture of Belladonna each two drams, Syrup of Orange Peel four drams. Mix. Dose: One to tAventy drops once a day according to the age of the child. DIARRHOEA OF INFANTS. Infantile diarrhoea constitutes one of the most frequent, and serious of all diseases that occur in infancy and childhood. Of itself alone diarrhcea does not often prove directly fatal, but its long continuance seriously weakens the patient, and endangers the health, and it constitutes more- over a very grave complication of other forms of disease. Causes of diarrhoea are various; the introduction into the stomach of inappropriate indigestible food; the deranged condition of the mother's milk induced by mental emotions, improper diet, or other causes on the part of the mother; fright, and exposure of the infant to cold; and the im- proper use of laxatives, etc., may be enumerated as being the most frequent exciting causes of this disorder. It is Avell to notice closely as to the symptoms. A healthy infant at the breast, passes on an average from three to six motions in twenty four hours; but in some instances the evacuations are more frequent, yet with- out in any degree affecting the health of the child; in such cases then, there ought to be little or no interference, so long as the stools remain free from fetor, possessing merely the slightly acid smell, peculiar to un- natural indication. When, however, the stools become green, and watery, or yellow and watery, brown and frothy, as if fermented, mixed Avith phlegm or mucus, or consisting entirely of mucus, emit an offensive odor, and are generally preceded or accompanied by signs of suffering, it be- comes necessary to have recourse to remedial aid. TREATMENT. Aconite should be employed when the skin is hot and dry; and the child is restless; stools watery and often of a dark color; after the fever has subsided the diarrhoea will usually disappear also. Dose: Give two pills every hour, until the fever abates, then grad- ually lengthen the time. Antimonium crud. When the tongue is coated white, and there is some nausea and watery discharges; sometimes there are hard lumps of feces with the water. Dose: Four pills every four hours. Chamomilla is almost indispensible in bowel complaints, when the following symptoms are present: redness of the face or of one cheek, hardness and fullness of the belly, attended by severe colic; constant cry- ing and drawing up of its legs, wants to be carried. Its discharges smell like rotten eggs. Dose: Tavo pills every two hours. DIARRHCEA OF INFANTS. 675 Arsenicum is suitable when there is much exhaustion and rapid ema- ciation ; stools undigested, offensive, and painful immediately after taking nourishment; stools and vomiting at the same time. Dose: The same as for Chamomilla. Bryonia. Diarrhcea from hot weather, or is aggravated by the re- turn every hot spell of weather. Dose: The same as for Chamomilla. Calcarea Carb. is particularly suitable for children who have larger heads and open fontanelles; the head perspires much so as to Avet the pil- low far around. Muscles soft and flabby. Do.se: As for Antimonium Crud. Carbo-Veg. should be administered when Bryonia fails. Pose: As for Bryonia. Pulsatilla is suitable for diarrhoea arising from indigestion, or from a chill. The stools are very changeable, no two alike, and are usually worse at night. Dose: As for Chamomilla. Ipecac is particularly good Avhen there is much nausea and vomiting, or almost constant nausea; the stools are frequent. This remedy is particularly indicated at the time of weaning, or when food disagrees. Dose: As for Chamomilla. Mercurius is characterized by the following symptoms: much pain before the stool, great relief afterwards; stools frothy, slimy, bloody or dark green, Avith much straining. The child's legs and thighs are cold and clammy, particularly at night. Dose: As for Antimonium Crude. Belladonna. When the child is very drowsy, half asleep and half aAvake, much moaning. Dose: As for Anti. Crud. Podophyllum should be employed Avhen the diarrhoea is worse in the morning, stools green or watery, or which may be quite natural, only too frequent. This is particularly good when there is falling of the boAvel. Dose: As for Anti. <'rud. Sulphur is particularly good for children who have delicate parents. Much redness around the anus, eruption of pimples upon the skin; or, if the child, after getting better, under other remedies, always gets worse. Dose: As for Anti. Crud. Veratrum alb. Much exhaustion after every passage, Avith cold sweats upon the forehead, or upon the skin in general. Dose: As for Chamomilla- ALLOPATHIC TREATMENT. For treatment of the diarrhoeas of children, see Chapter XIII, p. 279. 676 DISEASES OF INFANCY. CHOLERA INFANTUM. summer complaint. This is a special form of bowel complaint, which requires special notice. This disease very often proves fatal, even under the best of treat- ment, since it appears usually in the latter part of the summer, when the young infant's system is already somewhat exhausted by the previous heat; when the air is impure and the weather sultry, or Avarm and damp and seems to spring up as an epidemic from some atmospheric miasm Avhich is little less than malignant. In this, the worst form of infantile diarrhoea, all the symptoms seem equal in intensity and the disease runs a very rapid course. Children under tAvo years are most liable to at- tack. Vomiting and diarrhoea form the most noticeable symptoms. The stomach is so irritable that it rejects immediately and sometimes with great A'iolence, everything that it receives. At first the matter vomited consists of the ordinary contents of the stomach, but this does not continue long, as the malady advances the matter vomited is tinged with bile and presents a greenish hue. The discharge from the bowels usually consists of a colorless or some- times greenish; inodorous and watery fluid; occasionally Avith shreds of mucus mixed with it. The stools are usually discharged without effort— sometimes unconsciously—or are squirted out as though thrown from a syringe. Frequently there is considerable pain with straining, the infant manifesting its sufferings by a whining, plaintive cry, by restlessness and by draAving up and extending its limbs. As the disease advances vomit- ing becomes spontaneous and the matter ejected resembles that passing from the bowels, while the number of stools increase. Sometimes there is a sudden lull in the whole force of the disease or the diarrhtea may abate and the vomiting continue or the opposite. There is extreme languor and prostration and generally very rapid emaciation ; which conditions, together with the vomiting- and the diarrhoea as above described clearly and unmistakably point to cholera infantum. As the disease progresses, the discharges from the bowels become still more frequent, are passed involuntarily, and are usually more profuse, resembling dark-colored dirty water or " washings of meat," and are very offensive; emaciation becomes extreme; the eyes are languid and dull, or hollow and glassy, and the child takes no notice of surrounding objects or persons ; the lips are dry and shrivelled. In many cases, the child lies in an imperfect doze, with half-closed eyes, and entirely insensi- ble to external impressions. The abdomen frequently becomes distend- ed, and hard, or is sunken or flacid. Frequently, in fatal cases, the child falls into a complete state of stu- por, and convulsions ensue. It not unfrequently happens, particularly in children predisposed to affection of the brain, that in an early stage of the disease, the brain becomes involved, and the child dies Avith all the symptoms of inflammation of the brain. Favorable Symptoms are: an abatement of the fever, and the CHOLERA INFANTUM. 677 gradual restoration of an even temperature, with decreased frequency of the pulse; cessation of vomiting, and decrease in the number of evacua- tions, Avith a gradual return of the stool to a more natural condition and appearance; natural and peaceful sleep; desire for food; and a general im- provement in the appearance of the child, together with a return of playfulness. TREATMENT. Much of what has been said under the head of Treatment, in the pre ceding article on "Diarrhoea of Infants'' (page 674), may be made available in selecting the remedy suited to a case of cholera infantum, and that article should be, therefore, carefully consulted. The subjoined medicines, however, are those most freciuently called for in the treatment of the disease under consideration, and are approved as of the utmost efficacy when carefully seletecd for the individual case. Aconitum is very frequently indicated, and should be given, in cases in which there is febrile excitation, manifested by acceleration of the pulse, heat and dryness of the skin, and thirst. Under such circumstances it often happens that Aconitum, when promptly administered, not only re- moves the febrile indication, but, as well, cuts short the entire disease, and very promptly aids in restoring the babe to health. Dose : Two globules dry, on the tongue, every one or two hours, accor- ding to the severity of the symptoms, until manifest improvement or change. If a favorable change should result, however slight, at once lengthen the intervals between the doses to two, three, or four hours, as the case may be, according to the existing condition, and finally cease giving medicine upon the exhibition of marked and decided amelioration and improvement. Should, however, no evidence of improvement be manifested after the sixth dose, or should symptoms indicative of some other remedy sooner occur, proceed at once to the administration of another and better indicated remedy. Arsenicum is suited particularly to cases in which there is great weakness from the first, so that the child does not care to hold its head up ; there is much thirst, while drinking induces vomiting and stool; vomiting and purging occur at the same time, and greatly exhaust the child ; the child has a pinched and distressed look, and is very restless) which restlessness, together with the other symptoms, groAV worse after midnight; coldness of the hands, feet, etc. Dose: In every particular as directed for Aconitum. Ipecacuanha should be given when the stools, which are very fre- quent, have a fermented appearance, or resemble greenish Avater; and Avhen, more particularly, nausea and vomiting predominate, the child seeming to be sick at its stomach, almost constantly. Dose: In every particular as directed for Aconitum. Chamomilla Avill frequently prove useful in the early stages of some cases, particularly if the child be suffering from the irritation incident to dentition ; it is more particularly indicated by the presence of griping, «7H DISEASES OK INFANCY. colicky pains, Avitb greenish stools ; fretfulness and crossncs.-., with de- sire to be carried. Dose. Tavo globules dry, on the tongue, every three hours, until manifest improvement or change. Verateum is required in eases in which the purging and vomiting are almost constant and simultaneous, and are excited by even the small- est quantity of nourishment or drink ; motion even excites nausea ; there is very great prostration, with coldness of the face and extremities, and cold sweat forming on the forehead, and an almost imperceptible pulse. Dose: As directed for Aconitum. Segal?: is indicated by a chain of symptoms very similar to those pointing to Veratrum, but is more particularly indicated by paleness of the face, with sunken eyes, dry heat of the body, restlessness, and sleep- lessness. Dose: An directed for Aconitum. Pouophallum should be given in cases in which the dejections have an exceedingly offensive odor, and are passed most frequently in the morning; the child moans during sleep, lying with half-closed eyes, and rolls its head from side to side. Dose: In all respects as directed for Aconitum. Mercurius should be given, particularly at the commencement, if there be much colicky pains, which are relieved by the purging, the stools being slimy or bloody ; or, when there is a great deal of perspiration, par- ticularly on the thighs. Dose: As directed for Aconitum. Croton tig. should be administered in cases in which the stool is forcibly expelled, as though forced frcm a syringe,—one gush and it ceases. Dose: As directed for Aconitum. Belladonna is required in some cases, particularly if there be great heat of surface, with flushed face, and evidences of a tendency to conges- tion of blood to the head; the child is very thirsty, drinks hurriedly, and thrusts its hands constantly into its mouth. Dose: As for Aconitum. Calcarea carb. will prove valuable in cases in which the stools are whitish and Avatery, and haA'e a sour smell, as does the matter vomited ; there is great emaciation, while the abdomen is bloated; the face has an old, Avrinkled look ; the extremities are cold. It is especially adapted to scrofulous children, with retarded dentition, or Avhere the case has be- come chronic. Do.se: Two globules, dry on the tongue, repeated eA'ery four hours, until manifest improvement or change. Sulphur may be called for, in cases similar to those indicative of Calcarea. It should be giA'en, likewise, in cases where the patient, hav- ing got better, relapses, and this process is again repeated, so that the case seems to linger, and has a tendency to become chronic. Dose: As directed for Calcarea. CHOLERA IN FANT U >!. 679 Bryonia, Nux-vomica, may be called for in the treatment of this malady, in its earlier and later stages. For discriminative indications for their use, consult, under the beading of each medicine, respectively, the article on " Diarrhoea of Infants." • Diet and Regimen. Very little nourishment will be taken by an infant suffering from cholera infantum. Breast-milk should constitute its chief source of food and drink, in cases in which the child suckles; but in other cases. hoAvever, great care must be taken to avoid giving any- thing that can add to the irritation already existing in the stomach and boAvels. Pure dilute milk, boiled and SAveetened, or thin, Avell-boiled oat- meal gruel, Avill afford sufficient food and drink. Water may be given in small quantities, if it does not excite vomiting ; in Avhich latter case, the infant may be permitted to suck small pieces of ice from time to time, if its lips be parched and dry, or a small piece of ice may be enclosed in a linen rag, and the child allowed to suck at it. Every effort should be made to sustain the natural warmth of the body, particularly of the ab- domen and lower extremities, by the application of warmed Avoolen cloths ; but the resort to the application of cloths Avrung out of hot spir- its, or claret wine, or other poultices, is highly objectionable, and should not be resorted to. ALLOPATHIC TREATMENT. In the Cholera of infants, if vomiting and purging have not emptied the stomach and boAvels of their irritating contents, as shown by undiges- ted substances in the stools or vomited matter, an emetic of three or five grains of Ipecac should be given in Avater, or a purge of three grains of Calomel should be given. The latter should be assisted in its operation by an injection of Avarm Avater. If no indigestible matter is noticed, neither a purge nor an emetic should be given, but no time should be lost n stopping the discharges. This is best and soonest clone with Opium. One drop of Laudanum may be given with a teaspoonful of Chalk Mix- ture or three grains of Sub-Carbonate (or Nitrate) of Bismuth in a tea- spoonful of Lime Water. This may be given every hour to a child a year old. To those younger Paregoric should be given instead of Laudanum. If neither Bismuth and Lime Water nor Chalk Mixture are at hand, the opiate should be given with a grain or tAvo of Bicarbonate (baking) Soda. The object is to diminish the discbarges from the stomach and bowels and improve their character. When the discharges are checked or the child begins to be stupid the opiate should be discontinued or given less frequently. When the vomiting has ceased, if the boAvels continue mov- ing, if the child is not inclined to be stupid an injection of tAvo to five drops of Laudanum may be given Avith half a teaspoonful of milk in a small hard rubber syringe. If the child is nursing it should be confined Avholly to the breast, and then only alloAved to draw small quantities at a time. If the breast milk is rejected it can be allowed lean meat finely minced, pounded in a mor- tar and strained, Avhich may be seasoned Avitb salt. The white of eggs 680 DISEASES OF INFANCY. mixed Avith Avater and rendered alkaline with Bicarbonate of (baking) Soda, five to ten grains, is frequently well digested. The raw meat juice and Avhite of egg are of great use Avhen there is great prostration or ema- ciation. If the pulse weakens or collapse threatens stimulants should be freely given. Brandy or Bourbon Whisky is best suited. The dose is fifteen or twenty drops to a teaspoonful given with the milk, meat, or egg, and can be repeated at intervals varying from one to four hours. Stimulants are generally indicated early. Rice or barley water can be drunk ; small lumps of ice may be al- lowed . A warm poultice over the stomach Avill be beneficial. Great heat of the skin will require cool sponging. If the skin is cool or cold a warm bath of 100° to 104° will be beneficial. Sometimes Cholera infantum is caused from ill nourishment. In these cases the acute symptoms are relieved by Opium as above directed, and better nourishment completes the cure. When the disease occurs from the effects of heat Bromide of Potassium is highly serviceable and is thought by some to be generally applicable. Take of Bromide of Potash two scruples, Mucilage of Gum Arabic two ounces. Mix. Dose: From fifteen drops to a teaspoonful. Five grain doses of Cerium, an eighth of a drop of Creosote, or Car- bolic Acid in water, are useful in relieA'ing the vomiting. Continued diar- rhoea will call for astringents as directed for that disease. Anaemia (thin blood) will require tonics, such as: Take of Citrate of Iron and Quinine ten to fifteen grains, Orange Water and Peppermint Water each an ounce. Mix. Give a teaspoon half full three or four times a day. If the cause of the disease is malarial, one or tAvo grains of Quinine ought to be given at the first intermission. CHAFING; EXCORIATIONS. Excoriation, soreness, or chafing, frequently occurs in those parts of the skin of infants Avhich are either rubbed together in the natural move- ments of the limbs, or liable to be fretted by friction of the diaper or other articles of clothing. Thus the groins, the surface between the geni- tals, and the thighs, behind the ears, under the arms, and even the folds in the neck of fleshy children, may become the seat of these excoriaj tions. Such tenderness of the skin is due, in the first place, in a great part, at least, to taint in the constitution ; and for its complete removal will require therefore a suitable remedy. Against this affection cleanliness is the best preA'entive. TREATMENT. Chamomilla will be found speedily effective if the child cries much and requires to be carried continually up and cIoavii the room. Dose: Four globules night and morning. ASTHMA MILLARIS 681 Mercurius. The excoriation is much worse at night; it is very raw and bloody; the child does not sleep much. Dose: As for Chamomilla. Calcarea carb. will be suitable for very fat and flabby children. Dose: Two pills in the evening. Graphites will be found useful when the affected parts discharge a quantity of transparent glutinous fluid, especially behind the ears and between the thighs. Dose: As for Calcarea Carb. Sepia. The skin is very delicate; the least injury tends to ulcera- tion. Dose: As for Calcarea Carb. Sulphur. There is much itching of the skin in general and of the parts affected. Dose: As for Calcarea Carb. A most valuable application to the excoriated parts of infants is to take green tea and pulverize it to a fine powder and apply the same as any powder. ALLOPATHIC TREATMENT. Protecting the chafed or excoriated skin from irritation, will provide for its cure. If the trouble is caused by the discharges from the bowels or bladder, the napkin should be immediately removed and the child cleaned. These discharges must be rendered unirritating by giving Bi- carbonate of Soda, in doses of one or two grains, sufficiently often to ac- complish the result. The raw surface on the skin may be dusted by starch, flour, Oxide of Zinc or Calomel, or the Benzoated Oxide of Zinc Ointment, may be applied. ASTHMA MILLARIS. Attacks children between two and eight (seldom infants at the breast or full grown persons), is very similar to Croup. The attack almost always sets in in Avinter, in consequence of a cold; first at night, suddenly without any distinct premonitory symptoms, and sets in at once with the most \Tiolent symptoms of suffocation without any rattling or wheez- ing. The pulse is hurried and small. If cough sets in it is short, rough, without gagging or expectoration ; the voice is hoarse, deglutition, diffi- cult. However, the child does not complain of a local obstacle in swal- lowing or breathing or of pain in the larynx or trachea, but of a dull pain or spasmodic drawing throughout the chest, as if caused by suffocating vapors. Slight spasms and change of color are noticed. A general ere- thism of the circulation and nervous system, scanty and pale urine hav- ing a sAveetish odor. The patient is suddenly roused with a fearful look and an expression of anxiety in the altered features. The voice is •iS2 DISEASES OF INFANCY. deep, barking, hollow sounding, husky, very seldom wheezing or crowing. During the convulsive movements of the chest the labored inspirations of the chest are suddenly followed by a noisy expulsion of the air. The face becomes dark-colored, the eye becomes staring and protruded, the veins of the neck and temples sAvell. If the attack does not destroy life it ends in a few hours with sneezing, eructations and A'omiting. The breathing becomes easier, the peculiar sound disappears and amid a general subsi- dence of the symptoms the child falls into a quiet slumber from Avhich it aAvakes exhausted and desponding. Generally a second attack sets in the following night, more A'iolent than the former Avitb increasing fever. The danger of suffocation is greater, the face and lips become mottled blue, the shoulders are raised, and all the muscles of the thorax are violently Avorked. The face becomes more and more distorted, the nostrils dilate, the pulse becomes very rapid and intermits ; the patient tosses about, is covered with cold or lukewarm perspiration, feces and urine are passed involuntarily, but the consciousness is undisturbed ; finally the patient dies of suffocation amid convulsions. Only a few children survive more than one attack and death almost ahvays sets in during the third or fourth attack. The attacks never terminate with expectoration. Asthma Millaris cannot Avell be confounded with croup, if we remem- ber that in croup the larynx is always tender to pressure, and that the patients bore their heads into the pillow, whereas in this disease the child sits erect and does not complain of pain in the larynx, but of spas- modic constriction of the chest. In croup the breathing is fine and crow- ing ; in asthma millaris it is deep and hollow. If the disease is speedily recognized subsequent attacks may be aA'er- ted and the present attack modified and alleA'iated by one of the following remedies. TREATMENT. Ipecacuanha. Sudden paroxysms of suffocation at night Avith a sensation of violent constriction in the chest, short and anxious inspira- tions and sudden and jerking expirations, pale, bloated face with blue margins around the eyes ; peevish mood. Sanbucus nigra. Sudden starting up from sleep Avith a shriek, anxiety and trembling, sudden, Avheezing inspirations which sometimes intermit, deep, IioIIoav rough A'oice, bluish puffiness of the face and hands protruded eyeballs with the mouth half open. Anxious tossing about; heat without thirst, hurried and tremulous pulse, torpor and copious, mostly cold, sweat. On comparing these indications Avith the symptoms of the disease, it is readily seen tbat Ipecac is only given to advantage in the beginning of the attack, and if the attack attains to its full deA'elopment Sambucus has to be given. If the attack should set in again during the night fol- lowing, nothing can be expected of this agent, and it will be advisable to give Arsenicum. All these remedies haA'e to be giA'en in the form of a Avatery solution—a dose eA'ery fiA'e or ten minutes. SWELLING OF THK BREASTS.—ATROPHY. 683 Other varieties of Asthma can be most frequently controlled by Ar- senicum. For Asthma caused by the inhalation of sulphur, we give Pulsatilla. Asthma, caused by a fit of anger, or a cpld, ean be best relieved by Chamom. or Nux-vom, the latter being more particularly indicated by a vehement disposition. For Asthma caused by the inhalation of stone dust, in the case of stone-cutters, sculptors, etc., we give Calc. Carb., Silic. or Sulphur. Calc. Carb. is a main remedy for chronic Asthmatic complaints, with disposition to draw a long breath, and sensation as if the breath were arrested betAveen the shoulder blades. The distress is relieved by raising the shoulders. Mere stooping causes the breath to give out fre- quent paroxysms of dry cough, at night especially. SWELLING OF THE BREASTS. These organs in infants—more especially female infants—sometimes become swollen and hard, Avhich is often the result of the absurd and Avicked practice on the part of nurses, of squeezing them, under the erroneous opinion that if the milk is not squeezed out of them, they will not perform their proper functions in after life. This practice is a cruel one, and very often brings about the state of affairs it is intended to pre- vent, for by squeezing the gland inflammation, swelling, and perhaps suppuration and destruction follow and the breast is rendered useless and the source of a great deal of trouble and suffering in after life. TREATMENT. Aconite should be given; if there be much fever at the outset this remedy may dispel the whole difficulty. Dose: Two pills every six hours. Arnica. The breasts are merely hard with no apparent inflamma- tion, or if the redness has not appeared. Dose: The same as Aconite. Belladonna if the breasts are very red and run in streaks to the adjoining parts. Dose: As for Aconite. Bryonia when the breasts are quite hard and of a pale red color. Dose: As for Aconite, Chamomilla. The child is very fretful; the breasts are very tender to the touch. Pose: As for Aconite. Hepar sul will be useful if the matter or pus has already formed. Dose: As for Aconite. ATROPHY—EMACIATION -MARASMUS. General Causes. Emaciation of Infants and children usually arise from a predisposing constitutional cause, Which frequently becomes de- 6S4 DISEASES OF INFANCY. veloped during the irritation of teething, or is called into activity by in- appropriate or unhealthy nourishment, either from the breast, or in the form of supplementary diet, at an earlier period ; or again, and, unfor- tunately, not unusuaUy, it is engendered or developed, and rendered more complicated, and almost incurable, at a somewhat more advanced age, by the pernicious habit of a free and reiterated use of mercurial pre- parations, in the vain hope of bringing about a healthy state of the pri- mary organs of digestion, when these have become deranged by repeated infractions of appropriate rules, as to diet and general habits. The man- ifestation of worms, and the usual attendant symptoms of invermination, and the enlargement and induration of the mesenteric glands, are fre- quent, antecedent, occasional causes of the disease. TREATMENT. Sulphur is appropriate in almost all cases at the commencement of the treatment, when the disease has become fairly developed, or occurs in scrofulous children, but is more especially indicated by the following symptoms : Craving appetite for food and drink, watches eagerly for the cup or spoon, and clutches at them, thrusting everything into its mouth; enlargement of the glands in the groin or armpits; slimy, excoriating di- arrhoea, or obstinate constipation; pale complexion, sunken eyes ; jump- ing, starting, and screaming; restless sleep. Dose: Three globules every morning, the flrst thing, for ten days, unless decided change or new symptoms should sooner occur; then pause five days, after which the course may, if still indicated, be repeated as before, and so on, until decided amelioration or change. Calcarea should either be employed at the onset, or after the pre- vious administration of Sulphur (as just directed), if the following symp- toms be more especially predominant, or should supervene; or if, again, Sulphur should not have been productive of apparent improvement within eight days after the completion of the second course. The indicative symptoms are: great emaciation, with craving appetite; enlargement and induration of the mesentric glands and of the belly; great weakness, clayey evacuations, a dry and flabby skin ; too great a susceptibility of the nervous system; large, open fontanels; profuse sweat about the head ; cough with rattling of mucus. Dose: Three globules, as directed for Sulphur. Chamomilla is chiefly required when the following symptoms occur: Frequent screaming, with drawing of the legs towards the stomach; hardness and fullness of the belly; great restlessness and feverishness ; acidity; flatulence, frequent purging, the stools being of a deep grass- green, or very yellow color, or whitish, yellow and frothy, sometimes re- sembling beaten eggs, and of an offensive odor, often like that of rotten eggs ; occasional sickness, the matter vomited being more or less of a bil- ious description ; thirst; want of appetite; frequent change of com- plexion . Dose: Three globules thrice a day. Pulsatilla is indicated when less restlessness and peevishness pre- vail than under Chamomilla, and little or no thirst, with complete loss of ATROPHY—EMACIATION. 685 appetite; or, on the contrary, voracious and inappeasable hunger, with acid or other disagreeable risings; or disposition to vomiting the contents of the stomach ; frequent papescent stools of a greenish, bilious descrip- tion ; or Avatery, slimy evacuations, at times of a light or whitish color; the child is ahvays better in the open air. Dose: As directed for Chamomilla. antimonium c. may be had recourse to, twelve hours after the last aose of the preceding remedy, if no improvement has resulted; or this remedy may be preferred, from the commencement, if the child cannot bear to be looked at, or touched by any one; or if its tongue be covered with a thick, white coating. Dose ; As directed for Chamomilla. Ipecacuanha is usually a most useful medicine, Avhen nausea or copious and frequent vomiting form more prominent features in the case than purging; or, when there is both vomiting and purging; the substance ejected from the bowels being chiefly of a greenish-yellow color, and often bearing a resemblance to matter in a state of fermentation. Dose: As directed for Chamomilla. Mercurius is required when the evacuations from the bowels are very frequent, but generally scanty and slimy, and usually attended Avitb distressing straining; or greenish, sour-smelling, or fetid; also when small white ulcers make their appearance on the inner surface of the lips and cheeks, or on the tongue, etc.; Avhen, with less flatulency, most of the symptoms mentioned under the head of Chamomilla are present; or, and more particularly, when the patient is affected with enlarged joints and glands, and distorted limbs---provided always these latter symptoms haA'e not been induced, or at least materially aggravated by the abuse of Calo- mel, or other mercurial preparations, under allopathic treatment—this medicine is also of much efficacy. Dcjse: As directed for Sulphur. Nux vomica. The interposition of constipation, or alternate states of costiveness and relaxation, with fickle, variable, or entire loss of appe- tite ; regurgitations or vomiting, flatulency, acidity, excessive irritability of temper, great feebleness, soreness of the mouth, or formation of small white, ulcerative specks or spots, are all indicative symptoms for the em- ployment of this remedy. Dose: As directed for Chamomilla. Bryonia. Vomiting occurs almost immediately after eating ; consti- pation ; the child always feels cold; the lips are dry and parched, and the mouth is dry. Dose: As directed for Chamomilla. Arsenicum is one of the most important remedies; it is indicated by dryness of skin, which resembles parchment; hollow eyes; desire to drink often, but little at a time; excessive agitation and tossing, especially at night; short sleep, interrupted by jerks; colic, with relaxed stools of greenish, brownish, or blackish color, or evacuations containing indiges- ed food ; night sweats; extreme prostration; pale, waxy appearance. Dose; As directed for Sulphur. RSfi DISEASES OT INFANCY. Baryta carb. is indicated by enlargement of the gland of the nape of the neck; tenderness of the belly, with tumefaction and induration r.f the abdominal glands; continual desire to sleep; great indolence, and aversion to exertion and amusement; dysenteric or loose stools, some- times containing thread-worms. Dose: As directed for Sulphur. Acidum nitricum is chiefly required in cases which have been devel- oped or exacerbated by the abuse of mercurial preparations; the bones and joints being SAvoUen and tender, the mouth and gums more or less inflamed and sore, the mesenteric and other glands much enlarged ; the bowels confined, or much relaxed, and attended Avitb straining. Dose: As directed for Sulphur Phosphorus is more or less useful, in cases with protracted and de- bilitating Avatery diarrhoea, and when the mesenteric glands are diseased 7>o6'e: As directed for Sulphur. Belladonna is to be preferred Avhen the preA'ailing symptoms and conditions are as follows: eapriciousness and obstinacy; nocturnal cough Avith rattling of phlegm ; enlargement of the glands of the neck ; unquiet sleep ; precocity of intellect; (blue eyes and fair hair.) Dose: As directed for Chamomilla. China is required for excessive emaciation; voraciousness; diarrhoea at night, or frequent, Avhite, papescent motions, or evacuations of undi- gested matter ; frequent perspirations, especially at night; great debility and languor; uurefreshing sleep. Dose: As directed for Chamomilla. China is more particularly required when the patient suffers from worms ; or for wetting of the bed. insatiable appetite, etc. Dose: As directed for Chamomilla. Rhus should be selected, when there is slimy or sanguinous diar- rhoea; debility, and excesshe languor, with constant desire for the re- cumbent posture ; great restlessness; the symptoms are all aggraA'ated after midnight. Dose: As directed for Chamomilla. Diet and Regimen. When the disease is manifested in infants at the breast, recovery will, in many cases, take place on the substitution of a good nurse of sound constitution, or of appropriate artificial feeding-- such as goat's milk, or, sometimes, weak broths—for the faulty nutriment which has originated the disease. But Avhen the child is of scrofulous constitution, and glandular enlargements, etc.. have become deA'eloped, the addition of regular and appropriate medicinal treatment is required. Again, Avhen the affection has been engendered by improper food, in children who are being reared by the hand, or who are past the age of infancy, if the progress of decay is not too far adA'anced, and no organic disease be developed, a cure may, as in the former case, be accomplished by the correction of the main source of all the mischief. The improper food ought, therefore, to be at once withdrawn, or the quantity reduced, DISEASES of infancy. fiS7 if that has been too great. Coal's milk or cow's milk, Avhich has previ- ously been boiled and diluted (one part of water to about three of good milk), and. occasionally, chicken broth, or, to children of more advanced age, farinaceous food, generous beef tea, or mutton broth, free of fat, may be substituted for food of a more solid or indigestible nature Avitb which the child has been dieted. Pure air and regulated exercise are also of great importance. ALLOPATH1C TREATMENT. Atrophy. A full discussion of the treatment of infantile atrophy (Avasting aAvay) Avould require considerable space. It may briefly be said to be caused by lack of proper nourishment. If the child is at the breast the amount of breast milk is insufficient, or its quality poor, or, from acci- dental causes, it is absolutely harmful. In the latter case, the child should be raised by a Avet nurse, Avhich is preferable, or weaned; in the two former cases, it ought to be raised by a Avet nurse, or artificially fed, in addition to the food it gets from the breast. For artificial feeding, milk is most suitable. The milk should be daily tested Avith litmus paper, and if it is alkaline, /. e., turns red litmus paper slightly blue, it may be sweetened a little) and diluted as further directed and given to the baby, without further preparation. If it is not alkaline. sufficient Lime Water or Bicarbonate of Soda should be added to render it so. Previous to a mouth old, one-half water should be added to the milk; at a month old, only a quarter part water should be added. A little cream should be, also, added to make up for the water. After four months, milk may be gh'en plain, except that it should be rendered alkaline if not naturally so, Avith Lime Wafer or Soda. Milk is the food for chil- dren. A child a month old should take a quart of milk a day prepared as aboA'e; but not oA-er a quarter of a pint at a time Cow's or goat's milk should be treated as above. If possible, the animal should be fed on grass and should have only pure water to drink and subject to no confinement. If the child should continue to Avaste after being suitably fed as aboA'e directed, other foods may be given as directed in the dyspepsia of infants treated Avith colic. Cod Liver Oil may also be given in doses of ten drops in the first place, gradually increased to a teaspoonful. The tonic effect of Iron Quinine is of service. Take of Citrate of Iron and Quinine fifteen grains; Syrup of Orange Peel and Peppermint Water each an ounce. Mix. Dose: From fifteen to thirty drops three times a day. Pepsin of Lactated Pepsin in doses of two to five grains, after feeding or nursing, may be advantageous, or Liquid Pepsin (Shelter's formula) may be tried as an aid to digestion. 6s8 REPERTORY. F*ai-t Fifteenth. CHAPTER XXXV. THE REPERTORY. This Repertory is to be used in selecting a remedy to remove some disease, or symptom of disease from the system. It can be almost as well ustd when you do not know any name for the trouble, as when you do, having only to learn all of the symptoms you can, both those that can be seen and those which can only be felt, and arranging each symptom on a line by itself, you proceed to find each symptom in the Repertory and then note on the slip of paper you have your symptom down on, on the same line with each symptom the abbreviated names of the remedies that appear in this full faced black type. If you do not find any of that type following your symptom, take the remedies appearing in italics, and if none of them, then the Roman or common type. Full Faced type indicates remedies which are known to be the most certain to cure that symptom. Italic type indicates remedies that are good but not so good as those in full faced type. Roman, or common type, are used for remedies having a very general reference to the symptoms which they follow. Here is an example of a case of scarlet fever arranged and the remedy selected: 1. Throat (Pharynx) Redness of page, 26.. 2. Throat Swelling, page 26............... 3. Urine Red, (Scanty) page 81........... 4. Palate Redness of, page 25........... 5. Headache as if Head Avould burst, p. 6. 6. Delirium, page 2....................... 7. Skin Red Burning, page 122........... 8. Scarlet-Rash, page 124................. Aeon. Bell.. Can.. Ars... Bell. Bell. Chi. Bry Merc. Ign... Carbv Apis. Bry. Bell. Bell. Calc. Ars... Bell.. Bry. Op... Bry.. ux MIND AND DISPOSITION. 3 Natr. mur. N. vom. Puis. Sep. Sil. RAGE: Aeon. Agar. Ars. Bell. Camph. Cann. Canth. Cham. Coc- cul. Croc. Cupr. Drosera. Hyosc. Opium. Petr. Plumb. Ruta. Sec. corn. Strain. Veratr. SHAMELESSNESS: Hyosc. N. vom. Op. Stram. Verat. WANDERING OF THE MIND: Aeon. Arn. Aur. Bell. Caust. Cham. Cocc. Croc Hell. Ign. Kali. Natrum mur. Phosph. Ph. ac. Plat. Sep. Stann. Sulphur. Verat. WEAKNESS OF MLND: Bar. Bell. Mental Derangements. ANGER, also with vehemence: Cham. —with fright. Aeon. —with feeling of coldness: Ars. —with subsequent ill-humor: Bry. —with silent grief: Ign. —Avith irascible mind: N. vom. —with pushing away that Avhich one holds in one's hand: Staphis. —Avith mental derangement: Vera- trum. ANXIETY AND FRIGHT. —Avith joyful surprise: Coff. —with subsequent starting during sleep: Hyosc. —f olloAved by grief or spasms: Ign. —followed by anxiety or nocturnal pains: Merc. —with fear, heat of the head, and spasms: Op. —followed by mental confusion: Plat. —followed by diarrhoea: Puis. —Avith suffocative fits and blueish face: SamD. —with involuntary stool and icy coldness: Veratr. GRIEF. —caused by mortification and fol- loAved by mental confusion: Bell. —with shame and suppressed anger: Ign. —with nocturnal anxiety and com- plaints : Merc. —followed by spasms: Op. —Avith emaciation, drowsiness, and morning-sAveats: Ph. ac. GRIEF, with apprehensions for the future and day-droAvsiness: Staph. HOMESICKNESS. —with flushed face and sleepless- ness: Caps. —Avith noctural anxiety and sweat: Merc. —Avith emaciation and morning- sweat, drowsiness: Ph. ac. JEALOUSY. —Avith vehemence and delirium: Hy- osc. —insane, with distrust: Lach. Defects of Memory. FORGETFUL : Aeon. Alum. Anac. Arn. Ars. Bar. Bell. Colchic. Coceul. Digit. Hell. Hyosc. Ign. Laches. Lye Natr. mur. Petr. Phosph. Plat. Rhus. Rhododend. Sec. corn. Silic. Spig. Staph. Stram. Sulph. Veratr. Viol. odor. MEMORY, involuntary: Hyosc. —quick: Aeon. Coff. Hyoscyam. Lach. Op. Viol. odor. —defective: Acem. Anac. Arn. Bell. Bryon. Calc. Camph. Cocc. Clraph. Hyosc. Puis. Sep. Spigel. Strain. Sulph. Veratr. —feeble: Aeon. Alum. Ambr. Anac Ars. Aur. Bell. Bryon. Calc. Caust. Coleh. Cupr. Dig. Wraph. Hep. Hyosc. Ign. Lye. Natr. mur. Op. Plat, Pulsat. Rhus. Sep. Spigel. Staph. Stram. Salph. Veratr. —loss of: Bell. Canrph. Con. Hyosc Nat. mur. Op. Strain. Veratr. MEMORY, decrease of: Anac Ars. Aur. BeU. Hell. Hyosc. Op. Stram. Veratr. 4 MIND AND DISPOSITION. UNFORTUNATE LOVE. —Avith thoughts of suicide: Aur. —Avith jealousy and loquacity: Hy- osc. —with silent grief: Ign. —Avith desponding mood: Lach. —Avith emaciation and morning- sweat : Ph. ac. —Avith unmerited mortification: Staph. WRATH. —Avith cries, lnemoptisis, palpitation: Arn. —Avith loss of consciousness or delir- ium : Bell. —with flushed cheeks, thirst: Bry. —hot SAveat about the head, spasms: Chain. —thirst, vomiting of bile, chilliness heat: Nux vom. —laughter, Aveeping, anxiety: Plat. —with internal chilliness, no thirst, but dizziness: Puis. —on account of unmerited humilia- tion, Avhole body sore: Staphis. Mental Derangement. FOREBODINGS OF DEATH. —Avith foretelling of the day of death: Aeon. FOREBODINGS OF DEATH, Avith anxiety and restlessness: Bell. —alternating Avith fits of rage: Stram. HYSTERIA AND HYPOCHON- DRIA, —Avith anxiety, disposition to sui- cide: Aur. —caused by suppression of the sexu- al instinct: Con. —Avith fitful mood, sleeplessness: Ign. —of those who lead a sedentary life and revel at night, Avith consti- pation : N. vom. —after unmerited insults, Avith flatu- lency: Slaph. —with tremulous and excessive sensi- tiveness: Valer. RAGE, —timorous. Avith frightful spectra: Bell. —amorous, Avith shameless gestures: Canth. —Avith haughty manners and spasms: Cupr. —with furious jealousy: Hyosc. —with amorous tenderness and jeal- ousy: Lach. —silent, Avith religious melancholy: Lye. —with frightful visions, alternating Avith stupor: Op. —censorious, with trembling and spasms: Plat. —raving, Avith frightful spectra: Strain. —av. Avicked imprecations: Veratr. SUICIDE, DISPOSITION TO, —Avith amorous fancies: Ant. crud. —Avith nocturnal anguish and despair: Ars. —w. religious melancholy: Aur. —av. anxiety, restlessness, frightful spectra: Bell. SUICIDE, DISPOSITION TO, Avith silent anguish, fear of death: Puis. —with stupefaction of the head, rest- lessness: Rhus. SOMNAMBULISM, —Avith prediction of the clay of death: Aeon. ^Avith intense fancy, and dullness of feeling: Op. —Avith clairvoyance, increased sensi- bility: Phosph. Vertigo. According to its nature. GENERALLY: Aco. Am.br. Arn. Be".!. Bry. Calc Camph. Cann. Curb. veg. Cic. Cocc Coff. Cupr. Dig. Graph. Hell. Hep. Ipec. Merc. HEAD. 5 Mosch. Lye Natr. Natr. mur. j Nitr. Nitr. ac. N. voin. Op. Petr. Phosph. Ph. ac. Plat. Puis. Rhus. Sec. Com. Spic. Staph. Stram. Stann. Sulph. Thuj. Verat. Zinc. AS IF FALLING : Aeon. Arn. Ars. Cann. Cham. Cic Con. Croc. Hep. Ign. Ipec. Nitr. ac. N. vom. Op. Puis. Sec. cor. Sil. Spig. Sulph. Staph. Stram. AS IF FALLING BACKWARD: Bry. Camph. Chin. N. vom. Ph. ae. Rhus. Spig. Stram. AS IF FALLING SIDEWISE: Arsen. Cann. Caust. Con. Euphr. N. vom. Puis. Staph. Sulph. AS IF FALLING TO RIGHT SIDE: Aeon. Ars. Calc. Rhus. Ruta. AS IF FALLING TO LEFT SIDE: Aur. Bell. Spig. Zinc. AS IF FALLING FORWARD: Arn. Caus. Cic. Cupr. Ferr. Graph. Natr. mur. Petr. Ph. ac. Puis. Rhus. Sil. Spig. Sulph. TURNING: Aeon. Arn. BeU. Bry. Calc. Carb. veg. Caust. Chel. Cic. Cocc. Croc. Cup>r. Ferr. Merc. Mur. ae. Natr. mur. N. vom. Ph. acid. Puis. Rhod. Rhus. Sep. Sil. TURNING IN A CIRCLE: Aconit. Bell. Bry. Calc. Caustic. Cic. Con. Ferr. Hell. Kali. Merc. Nux. vom. Op. Puis. Rhus. Sep. Staph Veratr. Internal. MENINGITIS: Aeon. Arn. Bell. Bry. Camph. Canth. Crotal. Cupr. Glonoin. HeU. Hyos. Laches. I Vertigo. With accompanying ailments. ANXIETY: Ignat. Op. Rhus. Rho- dod. ERUCTATIONS: N. vom. EYES, gauzy before: Laur. Sabin. COLIC : Coloc. Petr. Spig. Stram. DEAFNESS : N. vom. Puis. DIM SIGHT: Stram. DIARRHCEA: Cham. Stram. CHILLINESS : Cocc. Plumb. Rhus. Veratr. FAINTING: Bar. Bryon. Canth. Chamom. Croc. Hep. Ign. Laur. N. vom. Plat. Sabad. HEAT: Aeon. Arg. Bry. Croc. Ign. Laur. Led. Merc. Nux vom. Puis. Stram. HEADACHE: Aur. Bar. Calc. Con. Canth. Cupr. Ferr. Graph. Hep. Ign. Lach. N. vom. Puis. Strain. NAUSEA: Aeon. Ant. crud. Arg. Arn. Bar. Bell Bry. Chin. Coff. Calc. Coccul. Ferr. Hyosc. N. vom. Puis. Petr. Phosph. Sil. Spig. NOSE, BLEEDING: Aeon. Ant. crud. Sulph. OBSCURED VISION: Aeon. Arg. Bell. Canth. Cham. Cic. Croc. Dulc. Ferr. Hyosc N. vom. Natr. mur. Nit. ac. Op. Puis. Phosphor. Merc. Sec. cornut. Stram. Sulph. PALE FACE: Puis. SWEAT: Rhus. —cold: Ign. Veratr. VOMITING: Calc. Graph. Hyosc. YAWNING: Agar. Petr. Mercur. Op. Phosph. Stram. (See general Index). CONCUSSION OF BRAIN: Arn. Bell. Cic. Merc. Ph. ac. Sep. I. HEAD. 8 HEAD. HYDROCEPHALUS. —acute: Aeon. Bell. Bry. Hell. Merc. Op. Sulph. —chronic: Ars. Hell. Sulph. HEADACHE. ! Sensations as if the brain were distended: Bell. Caps. —like a band around the head: Aeon. Carb. veg. Mer cur. Nitr. ae. Plat. Spig. Sulph. BEATING: Aeo. Ars. Asar. Aur. Bell. Bryon. Calc. Caps. Carb. veg- et. Caust. Cham. Cocc. Hyosc. Ign. Ipec. Lijeopod. Nitr. ac. Phosph. Puis. Rhus. Sep. Silic. Sulph. Ve- ratr. —as if the brain were moved: Aeon. Ars. Bell. Bry. Croc. Kali. Bheum. Spig. —rush of blood: Aeon. Amhr. Ant. crud. Arn. Asa f. Bar. Bell. Bry. Camph. Cann. Canth. Chin. Coff. Calc. Carb. veg. Caust. Coloc. Dig. Ferr. Graph. Hell. Hyosc. Ign. Iod. Kali. Lach. Lye. Merc. Natr. Nitr. ac. Nux vom. Op. Plumb. Pulsat. Phosph. Rhus. Sep. Sil. Sulph. Spong. Staph. Stram. Thuj. Voter. Veratr. —boring: Ant. crud. Bell. Arg. Calc. Cocc. Chin. Dulc. Hepar. Ipec. Ign. Plat. Staph. Phosph. ac. Bhoclod. Sep. Sil. Spig. Strain. Sulph. —as if bruised: Aeon. Ars. Aur. Camph. Cham. Chin. (off. Euphr. Hell. Ignat. Ipec. Phosph. Nux vom. Puis. Rhus. /Sep. Veratr. —as if it would burst: Ant. crud. Asar. Bar. BeUad. Calc. Caps. Cham. Chin. Coff. Con. Ign. Natr. mur. Nux vom. Phosphor. Rhus. Sep. Sil. Spig. Spong. Sulph. —burning: Aeon. Arn. Bell. Bry. Cupr. Hell. Ipec. Merc. Natr. N. vom. Phosph. Ph. ac. Rhus. Sec. corn. Spig. Staph. Stann. Veratr. —buzzing: Canst. Cocc. Phos. Sulph. Veratr. —crawling: Aconit. Arn. Bar. Cocc. Hyosc. Puis. Rhus. Sulph. Thuj. —digging: Agar. Aur. Bar. Bry. Dulc. Ign. N. vom. Spig. —drawing: Aeon. Aur. Bell. Calc. Carb. veg. Cham. Cina. Coloc. Cupr. Didc. Graph. Hell. Lye. Ipec. N. vom. Nitr. ac. Petr. Plat, Puis. Rhus. Sep. Sil. Sulph. Veratr. DULL HEADACHE: Antimon. crud. Bry. Calc. Carb. veg. Chin. Camph. Coee. Coff. Dulc. Hell. Ign. Natr. mur. Ph. ac. Plat. Puis. Veratr. Zinc. HEAVINESS OF HEAD: Aeon. Arn. Asa f. Agar. Alum. Ars. Bell. Bry. Camph. Cann. Chain. Chin. Cic. Coceul. Coff. Croc. Cupr. Calc. Carb. veg. Caust. Con. Digit. Dulc. Dros. Euphr. Ferr. Hell. Hyosc Ign. Ipec. Kali. Lye. Merc. Natr. mur. Nitr. acid. N. vom. Opium. Petr. Plumb. Puls- at. Phosph. Ph. ac Plat. Sabin. Spig. Spong. Staph. Stram. Silic. Stann. Sulph. Thuj. Veratr. HAMMERING: Calc. Chin. Coff. Lach. Natr. mur. Phosph. Sil. Sulph. HEAT : Aconit. Alum. Arn. Bell. Bry. Calc. Canth. Caustic. China. Coff. Dig. Dros. Dulc. Euphr. Hell. Hyosc. Ign. Ipec. Lycop. Merc. Natr. mur. Nitr. ac. N. vom. Petr. Phosphor. Plumb. Puis. Rhus. Sep. Sil. Stann. Stram. Sulph. HEMICEANIA: Asar. BRY. Chin. Coloc Ign. Ipec. N. vom. Rhus. Sep. AS AFTER INTOXICATION: Bryon. Merc. Natr. mur. Puis. JERKS: Amhr. Bell. Bry. Calc. Dig. Mur. ac. *Natr. mur. N. vom. Puis. Petr. Phos. Spic. Spong. Sep. Stann. Thuj. Voter. SIMPLE PAIN: Aeon. Ars. Bar. Bell. Calc. Canth. Carb. veg. Chin. Cocc. Croc. Cupr. Hell. Hyosc. Iod. Lach. Lijeop. Merc. Mur. ac. Natr. c. Natr. mur. Nitr. Nux vom. Op. Ph. acid. Plumb. Puis. Rhus. Sep. Sil. Spig. Stram. Sulph. Yaler. AS FROM A NAIL (clavus:) Aeon. Agar. Coff. Hep. Ign. N. vom. Ruta. Thuj. PRESSING ASUNDER: Aeon. Bar. Bell. Bry. Calc. Ign. Lye. Merc. Natr. mur. Nitr. Nux vom. Sep. Sil. Spig. Stann. Staph. PRESSING TOGETHER: Alum. Asa foet. Bry. Calc. Cina. Cocc. Graph. Hell. Phosph. ac. Sil. Staph. PULSATING: Bell. Bryon. Chin. Petr. Phosph. Puis. Rhus. Sulph. PRESSURE : Aeon. Ambr. Arg. Arn. Asaf. Asar. Anac. Ars. Aur. Bell. Bryon. Calc Caps. Cham. Chin. Cic. Cina. Cocc. Coff. Croc. Dig. Hell. Hyosc. Iod. Ign. Ipec. Lach. Merc. Mur. ac. N. vom. Natr. carb. Natr. mur. Nitr. ae. Petr. Pulsat. Phosphor. Phosph. ac. Plat. Spig. Sep. Sil. Stann. Staph. Sulph. Voter. Zinc. ROARING: Aur. Ferr. Graph. Phosph. Sulph. STINGING: Aeon. Ambr. Arg. Arn. Asa f. Alum. Ars. Bar. Bell. Bov. Bry. Canth. Caps. Chamom. Chin. Cic. Calc. Caust. Con. Dulc. Ferr. Hep. Ign. Ipec. Natr. mur. N. vom. Petros. Phosph. Plumb. Puis. Ph. ac. Rhus. Sabad. Selen. Staph. Sep. Sil. Sulph. Thuj. STUPEFYING: Anac. Ars. Ant. crud. Arn. Bell. Bov. Cann. Cic. Cina. Calcar. Hyosc. Ign. Mur. ac. 7 Phosph. Natr. earb. Nitr. Ph. ac. Plat. Ruta. Sabad. Sepia. Stann. Staph. Verb. Zinc TEARING: Alum. Ambr. Anac. Ant. crud. Arg. Arn. Asar. Bell. Bry. Calc. Camph. Canthar. Caps. Carb. veget. Caust. Cham. Chin. Cocc. Coff Coloc. Con. Ign. Ipec. Lycop. Mur. ac. Natr. mur. N. vom. Ph.ac. Puis. Rhus. Sil. Spig. Sulph. TWITCHING: Arn. Bell. Bry. Carb. veg. Caust. Chin. Ign. N. vom. Ph. ac. Staph. Sulph. VIBRATING: Lye. Nitr. ac. Nux vom. Sil. Stann. According to the Part of the Head FRONT PART OF THE HEAD: Aeon. Alum. Ambr. Anac. Antim. arud.Arg. Arn. Arsen. Asa foet. Asar. Aur. Bar. Bell. Bry. Camph. Calc. Cann. Canth. Caps. Carb. veg. Caustic Cham. Chin. Cicc. Cina. Cocc. Coff. Colch. Coloc. Con. Croc. Cupr. Dig. Dros. Dulc. Euphr. Ferr. Graph. Hell. Hyosc. Ign. Iod. Ipec. Kali. Lye. Merc. Natr. mur. Nux vom. Op. Phosph. Plat. Plumb. Puis. Rhodod. Rhus. Sabin. Samb. Sep. Sil. Spig. Spong. Staph. Stann. Sulph. Veratr. Zinc. TEMPLES : Aeon. Agar. Alum. Ant. crud. Arg. Arn. Asaf. Asar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Chamom. Chin. Cina. Cocc. Con. Cupr. Dig. Euphr. Hell. Hep. Ign. Lach. Nitr. ac. Op. Phosph. Phos. ac. Rliertm. Rhus. Rhodod. Sabin. Spig. Spong. , Stann. Staph. VERTEX: Aeon. Ambr. Ant. crud. Arg. Am. Asa f. Aur. Bell. Bry. Cann. Canth. Caps. Caust. Chin. Cina. Cocc. Coff. Coloc. Con. Croc. 8 Cupr. Ferr. Graph. Hell. Ign. Iod,. Ipec. Lach. N. vom. Phosph. Ph- ac. Plat. Sabin. Samb. Sep. Sil. Spig. Spong. Stann. Staph. Strain. Sulph. Thuj. Veratrum. OCCIPUT : Aeon. Ambr. Arg. Arn. Asa f. Asar. Aur. Bar. Bell. Bry. Calc. Camph. Conn. Canth. Caps. Carb. veg. Chin. Cic. Coff. Colchic. Croc. Cupr. Dig. Dros. Hell. Hy- osc. Ign. Ipec. Lye. Mercur. Moscli. Nitr. Nux Vom. Op. Petr. Plat. Puis. Rhus. Sabin. Samb. Spig. Spong. Staph. Stann. Sulph. Thuj. RIGHT SIDE: Aeon. Alum. Ant. crud. Arg. Arn. Asa f. Bell. Bry. Camph. Canth. Caust. Chin. Cin. Coceul. Colchic. Croc. Dig. Dros. Graph. Hep. Ign. Kali. Lach. Lye. Nux vom. Phosph. Ph. ac. Plumb. Puis. Rhus. Sabad. Sabin. Sil. Spig. Spong. Sulph. Thuj. LEFT SIDE: Aeon. Ambr. Ant. crud. Argent. Arn. Asa f. Asar. Aur. Bell. Bry. Calc. Camph. Cann. Caps. Carb. veg. Chin. Cic Cin. Cocc. Coloc. Croc. Cupr. Dig. Dulc. Dros. Euphorb. Ferr. Hell. Hyosc. Iod. Lach. Merc. Nitr. Nitr. ac. Nux vom. Plumb. Puis. Petr. Plat. Rhodod. Rhus. Sabin. Samb. Sec. cor. Sep. Spigel. Spong. Staph. Stann. Sulph. Veratr. External. BLOTCHES: Ant. crud. Ars. Aur. Hep. Natr. mur. Nux vom. Phosph. Sil. Thuj. BLOATING: Ars. Sulph. BOILS : Bell. Rhus. Arn. BURNING: Arn. Ars. Bar. Bell. Bry. Caps. Carb. veg. Coloc. Dulc. Dros. Graph. Phosph. Plat. Sabad. Sil. Spig. Spong. Staph. Stann. Sulph. Veratr. CHILLINESS: Bar. Calcar. Carb. veg. Dulc. Kali. N. vom. Ph. acid. Spig. Staph. Veratr. COLDNESS: Agaric. Alum. Bar. Calc. Phosph. Ph. ac. Rhod. Ve- ratr. —feeling of: Asar. Cann. Lach. Ve- ratr. DRAWING: Agar. Bar. Bell. Calc. Canth. Chin. Ignat. N. vom. Ph. ac. Puis. Rhus. Staph. ERUPTION: Anac. Ars. Aur. Bar. Calc. Carb. veg. Cic. Con. Graph. Hep. Kali. Mere. Natr. mur. Petr. Rhus. GNAWING: Caps. Dros. Thuj. HAIR FALLING OUT: Ambr. Ant. crud. Ars. Aur. Bar. Bell. Calcar. Canth. Carb. veg. Caust. Con. Ferr. Graph. Hep. Ign. Iod. Kali. Lye. Merc. Natr. mur. Nitr. ae. Petr. Phosph. Plumb. Sec. cor. Sep. Sil. Staph. Sulph. HAIR AS IF PULLED: Aeon. Alum. Arn. Bar. Bry. Canth. Kali. Lye. Mur. ac. Nitr. Phosph. Ph. ac. Rhus. HERPES: Alumina. Graph. Petr. Rhus. ITCHING: Agar. Alum. Arg. Arn. Ars. Asar. Aur. Bar. Bell. Bry. Calc. Caps. Carb. veg. Caustic. Chin. Conium. Dros. Graph. Hep. Kali. Merc. Lye. Mur. ac. Natr. mur. Petr. Phosphor. Puis. Rhod. Rhus. Ruta. Sabad. Sep. Sil. Spig. Staph. Sulph. Thuj. Veratr. Zinc. LICE: Oleand. Sabad. Staph. Fine Comb. PAIN AS IF CONTUSED: Arn. Ipec. Rhus. Ruta. PAINFULNESS : Arsen. Bell. Calc. Caust. Hell. Merc. N. vom. Rhod. Rhus. Thuj. PIMPLES: Ars. Bar. Bell. Kali. Mur. ac. Natr. c. Petr. Rhus. Sil. Zinc. EYES. 9 SCALES ON THE SCALP: Cal- car. Phosph. Rhus. Staph. SCURFS: Ars. Bry. Calc. Ferr. Graph. Hep. Lye. Merc. Natr. mur. Petr. Rhus. Ruta. Sil. Staph. Sulph. AS IF THE SKIN ADHERED: Arn. SWEAT: Bar. Bell. Bry. Calc. Cham. Chin. Coloc. Ipec. Graph. Hepar. Nux vom. Merc. Natr. mur. Nitr. ac. Op. Petr. Phosph. Phosph. ac. Plumb. Puis. Rheum. Rhus. Ruta. Sec. corn. Sep. Silic. Spig. Sulph. Valer. STINGING: Agar. Alum. Ant. cr. Arn. Asa f. Aur. Bar. Bell. Canth. Caust. Chin. Digit. Hep. Iod. Kali. Visual Power. AMAUROSIS: BeUad. Calc. Cann. Chin. Cocc. (Con.) Dig. Dulc. Hy- osc. (N. vom.) Mercur. Nitr. ac. Phos. Plumb. Puis. Rhus. Ruta. Sec. corn. Sil. Spig. Stram. Sulph. —incipient: Aurum. China. Caust. Dulc. Hyosc. Natr. mur. Puis. Sulph. BLINDNESS: Ant. crud. Phosph. Sil. Veratr. BLURRED: BeU. Bry. China. Dros. Graph. Hyoscyam. Lycopod. Natr. mur. Sil. Stram. CATARACT: Baryta. Cann. Caust. Conium. Euphr. Hyosc. Nitr. acid. Op. Puis. Ruta. Sil. Sulph. DAZZLING: Con. Dig. Dros. Ign. Kali. Lye. Mere. Nitr. ac. Ph. ac. Sil. Stram. Sulph. GLAUCOMA: Phosph. HEMERALOPIA: Bellad. Dig. Hy- osc. Merc. Veratr. Natr. mur. Nitr. ac. Phosph. Phos. ac. Sabad. Spigel. Staph. Sulph. Thuj. Veratr. SWELLING: Ars. BeU. Cham. Caust. Cup. Dig. Euphorb. Op. Phosph. Puis. Rhus. Sep. Strain. Sulph. TEARING: Agar. Alum. Ambr. Bar. Bell. Cede. Digit. Graph. Lycop. Merc. Natr. Rhus. Ruta. Sabin. Sep. Staph. TENDENCY TO COLD: Kali. Natrum mur. TINGLING: Aeon. Arn. Arsen. Carb. veg. Ferr. N. vom. Rhod. Sabad. Spig. TREMBLING OF HEAD- Cic. Coc. Ign. ILLUSIONS OF COLOR: —pale: Dig. —blue: Bellad. Stram. Sulph. Zinc. —checkered: Euphorbium. Kali. Nitr. Sulph. —colored streaks: Con. —fiery yeUow: Ph. ac. —yellow: Ars. Canth. Dig. Kali. Sulph. Santon. —gold-colored: Bell. Hyosc. —green: Dig. Merc. —red: BeU. Cann. Con. Croc. Dig. Hep. Hyosc. Spig. Stram. Sulph. —black: Caps. Chin. Cic. Cocc. Merc. Phosph. Staph. —white: Cann. Dig. Kali. Ph. ac. —halo around the light, many-col- ored: Bell. —gray: Phosph. Sep. —green: Phosph. Sep. Zinc. —bright: Calc. —ruin-bold: Nitr. —red: Bell. —black: Phosph. III. EYES. 10 EYES. ILLUSIONS OF SIZE, SHAPE, DISTANCE. —seeing double: Agar. Aur. Bel'. Cic. Digitalis. Euphorb. Graph. Hyosc. Nitr. acid. Merc. Petr. Pals. Secale corn. Sulph. Veratr. —seeing things half: Aur. Calc. Lye. Mur. ac. Natr. mur. VISION, false: Hyosc. —larger: Hyosc. Staph. —brighter: Camph. Hyosc. N. vom. —smaller: Hyosc. —slanting: Stram. —confused: Strain. OPTICAL ILLUSIONS OF THINGS NOT PRESENT: —flashes: Croc. Natr. Spig. —flashes, black: Staph. —gray covering: Phosphor. Sil. —thr-ads: Con. —feathers: Calc. Lye. Natr. Natr. mnr. Spig. —fire: Bar. Bell. Bry, Dig. Dulcam. Natr. mur. Ph. ac. Spig. Staph. Stram. Yeratr. —spots, dark: Calcar. Carb. veg. Caust. Con. Dig. Kali. Lye. Natr. mur. Nitr. ac. Petr. Phosph. Sec. corn. Sep. Sil. Sulph. —gauze: Asa f. Alum. Ars. Aur. Bryonia. Caust. Cina. Croc. Drosera Euphorbium. Euphr. Hyosc. Ign. Lye. Natr. mur. Opium. Petr. Phosph. Plat. Rhod. Rhus. Sabin. Sec. corn. Sep. Stram. Sulphur. Thuj. —sparks: Arsenic. Aur. Bar. Bell. Bry. Calcarea. Caust. Coloc. Croc. Dig. Dulc. Kali. N. vom. Op. Petr. Sii. Spig. Veratr. —cobwebs: Agar. Caust. —figures: Camph. Samb. —mist: Aeon. Agar. Alumina. Ambr, Arg. BeU. Bry. Cann. Caust. Croc. Dig. Graph. Kali. Merc. Natr. mur. Ph. ac. Plat. Plumbum. Puis. Ruta. Sec. corn. Spig. Staph. Stram. Sulph. —point: Calc. Con. Dig. Kali. Merc. Natr. mur. Nitr. ac. N. vom. Petr. Phosphor. Sulph. —halo around light: Slajih. LON(;-SIGHTED : Alum. Bell.Brj. Calc. Caustic. Con. Dros. Hyosc. Lye. Natr. mur. N. vom. Petr. SU. Spigelia. Sulph. AS IF THINGS WERE MOVING: Bell. Con. Cic. Euphr. Hyosc. Ign, Mere. Sabad. Stram. PHOTOPHOBIA : Aeon. Alum. Am. Ars. Bellad. Bry. Camph. Cham. China. Cic Cina. Coff. Con. Croc. Euphras. Graph. Hell. Hep. Ign. Kali. Lycopod. Merc. Mur. ac. Nitr. ac. N. vom. Ph. ac. Puis. Sep. Sil. Sulph. SQUINTING: Alumina. Bellad. Hy- esc. Puis. Sec. corn. SENSITIVENESS: Aeon. Antim. crud. Bell. Chin. Coff. Hell. Ign. N. vom. Spig. SHORT-SIGHTEDNESS: Agar. Anac. Calcar. Carb veg. Chin. Con. Euphr. Graphites. Hyosc. Natr. mur. Nitr. ac. Phos. Ph. ac. Plumb. Puis. Ruta. Stramon. Valer. Thuj. STARING AT ONE POINT: Cicu- ta. Cocc. Ruta. Strain. VIBRATIONS: Arsen. Bell. Calc. Carb. veg. Caust. Cham. Con. Dig. Graph. Hell. Ign. Lye. Mur. ac. N. vom. Petr. Phosph. Ph. ac. Pulsat. Sec. corn. Sep. Staph. Sulph. VISION, sudden blackness of: Aeon. Alum. Arg. Ars. Asa feet. Atrc. Aur. Bell. Bry. Calc. Carb. veg. Caust. Canth. Caps. Cham. Cic. Cina. Croc. Dros. Dulcam. Ferr. Graph. Hepar. Hyosc. Lye. Merc. Natr. mur. Nitr. Nitr. ac. N. vom. Op. Phosph. Plumb. Puis. Sabin. EYES. 11 Sec. cor. Staph. Stram. Sep. Sulph. VISION, dim: Alum. Bellad. Cham- om. Chel. Rheum. Ruta. Sabad. —pale: China. Croc. Dros.Petr. Puis. Rhus. Sil. —obscured: Aeon. Agar. Arn. Ars. Asar. Aur. Bar. Bell. Bryon. Calc. Camph. Caps. Caustic Chain. Cic. Con. Cupr. Dig. Dros. Euphr. Ferr. Hyosc Iod. Kali. Lye. Nalr. mur. Nitr. ac. Nux vom. Op. Phosphor. Plat. Pulsat. Ruta. Sil. Spig. Strain. Sulph. Thuj. —vanishing of: Agar. Bell. Calc. Cic. Con. Hep. Hyosc. Merc. Natr. m. Nitr. N. vom. Op. Phosph. Puis. Sec. corn. Spig. Staph. Stram. Veratr. —Aveak: Asar. Agaric. Alum. Ars. Bar. Bell. Calc. Can. Caps. Carb. veg. Chin. Con. Croc. Dros. Graph. Hep. Iod. Lye. Hyos. Ign. Natr. mur. Nitr. ac. Petr. Phosph. Ph. ac. Plumb. Rhus. Ruta. Sec. corn. Sep. Sil. Staph. —obscuration of: Ang. Cann. Caps. Chel. Chin. Nitr. ac. Op. Plumb. Puis. Sulph. —ulcers on: Euphr. Ruta. DRYNESS: Agar. Asa f. Asar. Bar. Bell. Bry. Caust. Croc. Euph. Kali. Lye. Natr. mur. Nux vom. Phosph. Pals. Spig. Staph. Sulph. Veratr. DISTORTION: Aeon. Arnic. Ars. Bell. Bry. Camph. Canth. Cham. Cic. Cocc. Cupr. Hell. Hyosc. Opium. Petr. Plat. Plumb. Pulsat. Sec. corn. Spig. Stan. Stram. Sulph. Veratr. ECCIIYMOSIS: Am. Cham. Nux vom. Plumb. EYE-GUM. Agar. Alum. Calcar. Caust. Cham. Chin. Con. Dros. Euphorb. Graph. Hep. Lye. Nitr. ac. Phosph. ac. Sil. Spig. Sulph. EYES, blood Aoavs from: Cham. Euphr. N. vom. Ruta. —gum: Euphr. Ign. Puis. FUNGUS H.EMAT: Apis. Bell. Calc. Lye. Sep. Sil. GLAZED: Bell. Cocc. Croc. Op. Ph. ac. Spig. HCEMORRHAGE: Bell. Cham. Euphr. N. vom. INFLAMMATION: Aeon. Ambr. Apis. Am. Ars. Bar. Bell. Bry. Calc. Camph. Canth. Carb. veg. Cham. Chin. Coloc Con. Cupr. Dig. Dulc. Euphras. Euphorb. Ferr. Graph. Hep. Hyosc. Ignat. Ipec. Kali. Lye. Merc. Natr. mur. Nitr. ac. N. vom. Opium. Phosph. Ph. ac. Plumb. Puis. Rhus. Sep. Sil. Spig. Staph. Sulph. Veratr. LACHRYMATION: Aeon. Agar. Alum. Ambr. Anac. Arn. Ars. Asar. Bar. Bell. Bry. Calc. Camph. Canth. Caps. Carb. veget. Caust. Chelicl. Chin. Cina. Coff. Coloc. Con. Croc. Digit. Euphr. Fer. Graph. Hell. Hep. Ign. Kali. c. Lach. Lye. Merc. Natr. mur. Nux Sensations. In the eye-halls and eye generally. AGGLUTINATION: Alumina. Bell. Bry. Calcar. Carb. veg. Caustic. Croc. Euphorb. Hep. Ign. Kali. Lye. Nat. mur. Nitr. ac. Nux voin. Phosph. Plumb. Pulsat. Rhus. Ru- ta. Sep. Silic. Stann. Staph. Sulph. Thuj. BURNING : Aeon. Agar. Alum. Ars. Arn. Aur. Asa f. Bar. Bell. Bry. Calc. Canth. Col. Con. Caps. (ham. Chin. Cic. Croc. Dig. Dros. Ferr. Graph. Hell. Ign. Kali. Lye. Mur. ac. Nitr. ac. Nux vom. Phosph. Plumb. Pulsat. Rhod. Rhus. Ruta. Sep. Sil. Spigel. Spong. Staph. Stram. Sulph. Thuj. CORNEA, spots on: Apis. Ars. Aur. Calc. Can. Chel. Con. Euphr. Hep. Lye. N. vom. Sep. SU. 12 EYES. vom. Op. Petr. Phosph. Ph. ac. Plat. Puis. Rhodod. Rhus. Ruta. Sabadilla. Seneg. Sep. Sil. Spig. Spong. Stan. Staph. Strain. Sulph. Valer. Veratr. Zinc LACHRYMATION, smarting: Aeon. Bell. Calc. Carb. veg. Con. Dig. Euphr. Graph. Lycop. Natr. mur. Phosph. ac. Rhus. Sabin. Spig. Staph. Sulph. LOOKS, anxious: Strain. —staring: Aeon. Arn. Bryon. Camph. Canth. Cic. Cina. Cocc. Cupr. Hell. Hyosc. Nux vom. Op. Sec. corn. Spig. Strain. Veratr. —disturbed: Camphor. Cupr. Op. Sec. corn. Stram. Verat. —Avild: Cupr. Hyosc. Opium. Sec. corn. MOTIONS, convulsive: Canthar. Cham. Cupr. Hyosc. —involuntary: Spig. Stram. PAIN, simple: Aeon. Ariiic. Bar. Bell. Bry. Calc. Canth. Carb. veg. Cin. Croc. Dig. Euphr. Petr. Phosph. Plat. Plumb. Pulsat. Rhus. Ruta. Sabin. Sep. Sil. Spig. Stann. Staph. Veratr. PELLICLE ON EYES : Cann. Eu- phras. Puis. Ruta. PRESSURE, outward: Jicon. Asa feet. Asar. Aur. Calc. Camph. Cann. Canth. Con. Hell. Ign. N. vom. Rhus. Spig. Staph. —nvward: Agaric. Anac. Aur. Bry. Calc Caust. Kali. Ph. acid. Spig. —as from a foreign body: Ambr. Anac. Arn. Ars. Asa f. Aur. Bar. Bell. Calc. Caps. Carb. veg. Caust. China. Cina. Cocc. Con. Croc. Ferr. Hyosc. Ign. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sep. Sil. Spig. Stann. —together: Arg. Sabin. Verat. PROTRUDED: Aeon. Arn. Ars. Aur. Bell. Canth. Caps. Cin. Cocc. Con. Cupr. Hep. Hyoscyam. <)p. Rhus. Spigel. Spong. Staph. Stram. Verat. PUPILS, dilated: Aeon. Agar. Anac. Arn. Ars. Asa f. Aur. BeU. Calc. Camph. Canth. Caps. Caust. Chin. Cina. Con. Croc. Cupr. Dig. Dros. Hell. Hep. Hyosc. Ign. Ipec. Mur. ac. Nitr. ac. Nux vom. Petr. Ph. ac Plumb. Pulsat.Sec. corn. Spig. Stann. Staphys. Strain. Veratr. Zinc. —contracted: Aeon. Agar. Anac. Arn. Ars. Aur. Bell. Calcar. Camph. Canthar. Capsic. Chain. Chin. Cic. Cina. Cocc. Croc. Dig. Dros. Hell. Hyosc. I^n. Mur. ac. Natr. carb. Ph. ac. Plumb. Puis. Sec. corn. Staph. Stram. Stann. Sulph. Thuj. Veratr. —immovable: Aeon. Baryt. Bell. Cham. Chin. Cupr. Dig. Ferr. Hyosc. Op. Plumb. Seneg. Spig. Strain. —suddenly dilating and contracting: Bar. PUS: Ars. Bry. Euphorb. Hep. N. vom. Ruta. RUSH OF BLOOD TO EYES: Aur. Bell. Plumb. Sep. Spii;. SMARTING: Ambr. Agar. Alum. Ars. Bell. Bry. Calc. Canth. Carb, veg. Caust. Chin. Con. Croc. Droser. Euphr. Graph. HeU. Hep. Kali. Lye. Merc. Mur. ac. Nitr. ac. Nux Mtm. Phosph. Ph. ac. Rhus. Sep. Sil. Staph. Sulph. Thuj. Val. SPARKLING: Aeon. Bell. Bryon. Hyosc. Op. Strain. SPOTS ON EYES: Euphr. Nux vom. Puis. Ruta. SQUINTING: Alum. Bell. Hyosc. Puis. Sec. corn. SUNKEN: Ambra. Camph. Chin. Cic. Cupr. Dros. Ferr. Hyosc. Op. Sec. corn. Spong. Staph. Veratr. SWELLING: Ars. Bry. Carb. veg. EYES. 13 Hep. N. vom. Phosph. Plumb. Rhus. Ruta. Strain. Sulphur. ULCERATION: Ambr. Arn. Calc. Caps. Cham. Lye. Phosphor. Sil. Sjjong. Staph. Sulph. VEINS ENGORGED : Aeon. Ambr. Spig. VEINS, red: Euphr. WHITES, blueness of: Veratr. WHITES, yelloAvness of: Aeon. Ambr. Ant. crud. Arsenic. Bell. Bry. Canth. Cham. Chin. Cocc. Con. Ferr. Ign. N. vom. Op. Phosph. Ph. ac. Plumb. Puis. Rhus. Sep. Sulph. —without lustre : Asa f. Asar. China. Ferr. Hyosc. Merc. Ph. ac. Sabin. Veratr. In the eye-broies. DRAWING: BeU. Caust. Dros. Hell. ■ Rhus. ERUPTION: Cuprum. Kali. Selen. Sil. Spong. Stann. Thuj. FALLING OF LASHES : Agaricus. Plumb. Selen. ITCHING: Agar. Alum. Caust. China.J.S'c/cn. Silic. Spigelia. Sulph. SWELLING: Kali. TWITCHING: Caustic. Kali. Zinc. WARTS: Caust. At the eye-lids. (u. signifies upper, 1. lower lid; r. right, 1. left; where these signs are wanting, both lids are meant.) EYE-GUM: Dros. Ferr. Rheum. Rhus. Staph. AGGLUTINATION: Aeon. Agar. Bell. Bry. Calc. Causticum. Cham. Con. Dig. Drosera. Euphr. Ferr. Graph. Ign. Kali. Mur. ac. Natrum. mur. Nux vom. Phosphor. Plat. Puis. Rhus. Sep. Silicea. Spigel. Staph. Stramonium. Sulph. Veratr. BLUENESS: Dig. BURNING: Ambr. Asar. Ars. Bell. Bry. Caps. Con. Graphit. Kali. Nux vom. Ph. ac. Rhus. Seneg. Spig. Stann. ECCHYMOSIS: Apis. Arn. INFLAMMATION: Aco. Apis. Ars. Bell. Bryonia. Calc. Carb. veg. Caust. Cham. Dig. Euphr. Hep. Hyosc. Ign. Lye. N. vom. Pulsat. Rhus. Sep. Spig. Spong. Staph. Stramonium. Sulph. Thuj. Veratr. ITCHING: Ambr. Ars. Bellad. Bry. Calc. Camph. Carb. A'eg. Caustic. Cocc. Drosera. Euphorb. Euphrasia. Lye. Nux vom. Phosph. Rhus. Spong. Staph. Sulph. Veratr. —u.: Bar. Carb. an. Cin. ('roe. Sil. Staph. —1.: Caust. Lach. Petr. Ruta. PARALYSIS: Bellad. Cocc. Nitr. ac. Rhus. Sepiae. Spig. Stram. Ve- ratr. PIMPLES: Hep. Lye. Petr. Rhus. Sulph. —u.: Hep. —u. r.: Canth. Lye. —u. 1.: Chel. —1.: Natr. mur. Seneg. —1. 1.: Alum. SMARTING: Camph. Carb. veg. Caust. Ign. Rhus. Spig. —u. r.: Rhus. —u. 1.: Aur. SPASMS. Alum. Ambr. Bell. Croc. Hyosc. Rhododendr. Sep. Sil. STYES: Ambr. Apis. Digit. Ferr. Lye. Puis. Rhus. Sep. Stann. Staph. SWELLING: Aco. Arn. Ars. Bar. Bell. Bry. Calcarea. Caust. Cham. Euphr. Ferr. Hyosc Ign. N. vom. Phosphor. Pulsatilla. Rhus. Ruta. Sen. Spong. Strain. Sulph. Valer. —u.: Aco. Asar. A^r. c. Sep. Sil. Sulph. —1.: Ars. Aur. Bell. Bry. Croc. Dig. Lach. Op. Ph. ac Rhus. Sep. AS IF SWOLLEN: Aconitum. Croc. Rhus. Valer. 14 EAKS. TETTER: !by. Rhus. Sep. ULCERATION: Coleh. Croc. Ign. Lye, Nux vom. Phosph. Puis. Rhus. Silicea. Spig. Staph. Stram. —1.: Colch. Natr. mur. In the canthi. (Corners of the eye ABSCESS, int.: Bry. AGGLUTINATION: Phosph. Staph BLUEISH, int.: Aur. Sassap. BURNING: Alum. Stann. Staph. —int.: Agar. Asar. Aur. Bar. Bell. Calc. Graph. Hell. Natr. mur. Phosph. Ph. ae. Rhodod. —ext.: Carbo anim. Cina. Kali. Sep. Spig. Stront. Sulph. EYE-GUM: Agar. Ant. crud. Calc Caust. Coff. Dig. Euphr. Graph. Ipec. N. vom. Staph. Thuj. —ext.: Chin. Euphorbium. Ipec Sabad. Staph. —int.: Agar. Euphras. Helleb. Rhus. Sil. Staph. FISTULA LACHRYM: Calc. Chel. Petr. Pulsatilla. Ruta. Stann. Staph. GUM: Natr. mur. INFLAMMATION: Aco. Alum. Ars. Cham. Euphr. Ign. N. vom. Phosph. Puis. —int.: Agar. Merc. —ext.: Calc. STYE: Puis. Sep —int. r.: Natr. mur. ITCHING: Arg. Arn. Calc. Caust. Cina. Hell. Hyosc. Natr. mur. Plat. Puis. —hit: Bellad. Caust. Con. Lye. Nitr. ac. Nux vom. Pulsatilla. Ruta. Sep. Staph. LACHRYMATION: Petr. Silicea. Thuj. PRESSURE, as from a foreign body, 1.: Agar. Bar. Con. Ignat. Nitr. ac. PUS: Cham. Cina. Graph. N. vom. Puis. Staph. SMARTING: Carb. veg. Mur. ac. N. vom. Sep. Sil. —int.: Con. Graph. HeU. Kali. N. vom. Puis. Staph. —ext.: Camphora. Ign. N. vom. Sulph. IV. EARS. On the Ears. BORING: Alum. Aur. Baryta. BeU. Caust. Euphr. Helleb. Plat. Plum- bum. Sil. Spigel. Stann. DISCHARGE, of blood: Bryonia. Cic. Graph. Mercurius. Petr. Phosph. —of pus: Alum. Aur. Bellad. Bov. Calc. Caustic Kali. Lye. Merc. Petr. Pulsat. Sep. Sulph. —humor: Asa foet. Caust. Mereur. Natr. mur. Phosph. Sep. ERUPTION: Agar. Bar. Cic. Chin. Kali. Petr. Phosphor. PulsatiUa. Sep. Sil. Spongia. Sulph. —behind the ears: Antim. crud. Canth. Chin. Puis. Sabad. Staph. EAR-WAX, liquid: Merc. —blood-red: Con. —hard: Selen. Soft water. —pappy: Lach. —deficient: Calcar. Carb. veg. —increased: Agar. Calc. Con. Selen. Sep. Sil. HEAT: Aeo. Alum. Ars. Asar. Bel- lad. Bry. Calc Cantharis. Capsic. Carb. veg. Chin. Hep. Ignat. Kali. Mere. Natr. mur. Petr. Ph. ac. Puis. Sabin. Sep. Sil. ITCHING: Agar. Alum. Ambr. EARS. 15 Ant. cr. Arg. Bar. BeU. Calc. Carb. veg. Caust. Coloc. Con. Caps. Graph. Hep. Ign. Kali. Lycop. Mur. ac. Natrum mur. Nitr. ae. Nux vomica. Petr. Phosphor. Phosphor, ac. Plat. Pulsat. Rhod- od. Rhus. Sambuc. Selen. Sep. Sil. Spigel. Stann. Sulph. ITCHING of external ear: Arg. Spig. —of lobule: Argent. Sabadilla. Ve- ratr. INFLAMMATION: Aeon. Bryon. Kali. Lye. Merc. N. vom. Ph. ac. Puis. Sil. Spong. PAROTID GLANDS, pains on: Arg. Bry. Cham. Chin. Cocc, Hyosc. Ign. Ml'i-c Phosphor. Puis. Rhus. Sabad. —pressure: Merc —inflammation: Chamom, Rhus. —swelling: Bar. BeU. Bry. Carb. veg. Chamom. Chin. Cocc. Con. Dulc. Hyosc. Ign. Men: Nitr. ac. Phosph. Puis. Rhus. Sepia*. ,S77. Sulph. —hardness: Rhus. —painfulness: Puis. —stitches: BeU. China. Con. Ign. Nitr. ac. Pulsat. Sep. Sulph. STITCHES: Alum. Ant. cr. Arn. Ars. Bar. Bell. Bry. Calc Cann. Canth. Capsic. Carbo. Areg. Caust Chamom. China. Colch. Coloc dm. Dros. Dulc Ferr. Graph. Hell. Hep. Ign. Ipec. Kali. Lycopod. Merc. Natr. mur. Nux vom. Petr. Platin. Plumb. Ph. ac Puis. Rhodod. Sep. Sil. Spigel. Spong. Stann. Staph. Sulphur. Yeratr. Zinc. SWELLING: Ant. crud. Calcarea. Caust. Kali. Lycop. Merc. Natr. mur. Nitr. ac. Ph. ac. Puis. Rhus. Sep. Silic. Spong. Zinc. ^ TEARING: Aconit. Agar. Alum. Amhr. Anac. Arn. Aur. Bar. Bel- lad. Camph. Cantharis. Capsic Cham. Chin. Carbo. veg. Caust. Con. Cupr. Dros. Dulcam. Graph. Hyosc. Kali. Lye. Merc. Mur. ac. Nitr. ac. N. vom. Plat. Plumb. Ph. av. Pulsat. Stann. Spigelia. Sulph. /inc. —behind the ears: Alumina. Ambr. Arg. Bar. Belladonna. Canth. Caps. Plumb. Rhus. Sep. Sil. TENESMUS : Ambr. Anacard. Arn. Ars. Asar. Bell. Carb. veg. Caustic. Coloc. Conium. Chain. Cina. Colch. Croc. Dros. Dulc Hell. Kali. Lye. Merc. Irfur. ac Nitr. ac. N. vom. Phosph. Plat. Puis. Rhodod. Rhus. Sabad. Sep. Spig. Spong. Stann. Sulph. Thuj. ULCERS: Alum. Camph. Kali. Merc. Puis. Ruta. Spongia. Stann. Hearing. DEAFNESS: Ambr. Ant. crud. Arn. Plumb. Puis. Sec. corn. Veratr. FLUTTERING: Bell. Cupr. Merc. Plat. Spig. GRO'ANING: Puis. Sabad. HEMORRHAGE: Bell. HAMMERING: Spig. HARD HEARING: Ambr. Anac. Ant. crud. _Im.Arsen. Asar. Aur. Bar. Bell. Bry. Calc. Caust. Cham- om. Chin. Cic. Coccul. Croc. Dulc. Dros. Craph. Hyosc. Ign. Iod. KaU. Lye. Merc Natr. m. Nitr. ac. Petr. Phosph. Ph. ac. Puis. Ruta. Sabad. Sec. cor. Sep. Sil. Spig. Spong. Stram. Stann. Sulph. Veratr. —to human speech: Ars. Phosph. HUMMING: Aur. Bell. Bryon. Caust. Con. Laches. Lycop. Natr. mur. N. vom. Puis. Sabad. Sep. Spig. Sulph. 16 Illusions of Hearing. ROARING: Aeon. Ambr.,int. crud. Arn. Ars. Asar. Aur. BeU. Bryon. Calc. Cann. Carb. veg. Caust. Cic. Cocc. Colchic. Con. Graph. Ignat. Kali. Lye. Merc. Nitr. ac. N. vom. Op. Phosph. Ph. ac. Plat. Puis. Rhus. Sec. corn. Sep. Sil. Staph. Su'ph. Thuj. Veratr. INTOLERANCE OF MUSIC : Aeon. Cham. Coff. Ign. Viol. od. REPORTS: Graph. Kali. Natr. c. Rhus. Sabad. Sil. Staph. Zinc. RINGING: Alum. Arsen. Calc. Clemat. Kali. Lycop. Phosph. Rhod. Sil. Sulph. Valer. Zinc. RUSHING: Aur. Bar. Bell. Cocc Con. Cham. Dulc. Kali. Natr. mur. Nux vom. Puis. Rhodod. Stann. RIN( iING : Aeon. Agaric. Anac. Arn. Ars. Asa f. Aur. Bar. BeU. Bry. Calc. Camp. Cann. Canthar. Carb. veg. Caustic. Cham. Chin. Cic. On the Nose. BLACK PORES : Nit. ac. Sulph. BLOOD BLOWN FROM THE NOSE: Agar. Alum. Ambr. Ars. Asar. Bar. Canth. Caps. Caust. Dros. Graph. Hep. Kali. Lach. Lye. Natrum mur. Nux vom. Petr. Phosph. Phos. ac. Puis. Sep. Silic. Sulph. BOILS: Alum. Carb. an. Arnica. BONE-PAIN: Aur. Hyosc. Lach. Merc. CANCER: Aur. Calcar. Sep. Sulph. COLDNESS: Arn. Bellad. China. Dros. Ign. N. vom. Plumb. Veratr. DISCHARGE OF PUS : Aur. Cina. Lach. Phosph. ac. Puis. Con. Dulc. Graph. Kali. Ignat. Lye. Merciir. Natr. mur. N. vom. ()p. Petr. Plat. Ph. ac. Puis. Rhus. Sep. Silic. Stann. Staph. Sulph. Veratr. SENSITIVE HEARING, excessive: Anac. BeU. Carb. veg. Coff. Graph. Ign. Lye. Nux vom. Phos. Ph. ac. Sep. Sulph. SENSITIVENESS TO SOUND: Aco. Bell. Chin. Coff. Colch. Con. Ign. Iod. Merc. Natr. carb. Nitr. ac. N. vom. Ph. ac. Puis. Sil. Spig. Zinc. SENSITIVENESS TO MUSIC: Aeon. Cham. CofT. Ign. WHIZZING: Aeon. Agar. Alum. Anac. Arn. Ars. Asar. Aur. Bar. BeU. Bry. Calc. Canth. Carb. veg. Caust. Chamom. Chin. Cupr. Ferr. Hep. Kali. Lye Merc. Natr. mur. Nux vom. Op. Petr. Phosph. Puis. Rhod. Ruta. Sec. com. Sep. Spig. Sulph. Verat. Zinc. DULL: Anac. Calc. Caps. Carb. an. Ipec. Kali. Nux vom. Puis. Rhodod. HEMORRHAGE: Aeon. Cann. Conium. Choc. Led. Rhus. Sabin. INFLAMMATION: Agar. Arnica. Ars. Aur. Bellad. Cann. Canth. Lach. Merc. Natr. mur. Plumb. Rhus. Sulph. ITCHING: Agar. Alumina. Arn. BeU. Bov. Calc. Carbo veg. Caust. Cannab. Caps. Coloc. Con. Chel. Chin. Cina. Kali. Lye. Hell. Ign. Laches. Merc Mur. ac. Nux vom. Platina. Plumb. Phosph. Phosphor. ac. Santon. Sambuc. Selen. Seneg. Sep. Silic. Spig. Staph. Zinc. NOSE BLEED: Aconit. Agaric. N< V. NOSE. FACE. 17 Alum. Ambr. Ant. crud. Arg. Am. Ars. Bar. Bell. Bry. Calc. Cann. Canth. Caps. Carb. veg. Causti- cum. Cham. Chin. Cina. Coff. Colch. Con. Croc. Cupr. Dig. Dros. Dulcamara. Ferr. Graphit. Hep. Hyosc. Ipec. Kali. Lach. Lycop. Merc. Mosch. Natr. mur. Nitr. ac. N. vom. Petr. Phos. Ph. ac. Pulsat. Rhod. Rhus. Ruta. Sabad. Sabin. Sambuc. Sassap. Secale corn. Seneg. Sep. Silicea. Spong. Stan- num. Sulphur. Thuj. Veratr. POLYPI: Teucr. mar. SCURFS IN NOSE : Alumina. Ant. cruel. Arn. Aur. Bry. Canth. Cham. Cic. Cocc. Hepar. Hyosc. Ignat. Kali. Lachesis. Merc. Nux vom. Ph. acid. Puis. Selen. Sil. Spigelia. Staph. Thuj. —under the nose: Bar. Kali. Smell. SMELL, of blood: Sil. —sensitive • Aeon. Aur. Bar. Bell. Cham. Chin. Cocc. Colch. Graph. Kali. Lycop. N. vom. Phosph. Plumb. —putrid: Aur. Bellad. Calc. Merc. Sulph. —fine, extremely: Aeon. Agar. Aur. Bell. Chin. Cocculus. Coff. Con. N. vom. —of lime: Sulph. —of foul cheese: N. vom. —deficient: Anac. Bell. Hep. Hyosc. Nat. mur. Op. Plumb. Pulsat. Ruta. Sec. corn. Sep. SU. Zinc. —catarrhal: Graph. Merc. Puis. Sulph. —fetid: Belladonna. Phosph. Sep. SWELLING: Arn. Ars. Aur. Bell. Bry. Calc. Cann. Canth. Caust. Cham. Chel. Cocc. Lye. Mere. Natr. mur. Nitr. ac. Phosphor. Ph. acid. Puis. Rhus. Sep. Spigelia. Stann. Stram. Zinc. SWELLING OF BONES: Aur. TETTER: Rhus. Spig. TWITCHING: Agar. Arnica. Aur. Caps. Con. Hyoscyam. Plat. Puis. ULCERATED NOSTRILS: Anac. Ant. crud. Arn. Aur. Bell. Bryon. Calc. Cham. Cocc. Graph. Hep. Hyosc. Ign. Lach. Lye. Merc. Natr. mur. Nitric acid. N. vom. Phosph. Phosph. ac. Puis. Sep. Spig. Stann. Staph. Zinc. —exter. nose: Puis. WARTS: Caust. VI. FACE. Color and. External Ap- pearance. ACNE ROSACEA (red pimples): Arsenic. Cann. C. an. Veratr. —blue: Aco. Ars. Asar. Bryon. Camph. Cham. Cic Cina. Con. Cupr. Dros. Hyosc. Ign. Ipecac Mercurius. Op. Samb. Spongia. Stramon. Veratr. —margins around eyes: Anac. Arsen. Calcar. Cham. China. Cina. Cocc. Cupr. Graph. Hep. Ignat. Ipecac. Kali. Lach. Lycop. Merc. Phosph. Phosph. acid. Rhus. Sabad. Sabin. Sec. corn. Staph. Stram. Sulphur. Veratr. -brown, changing to: Bryon. Hyosc. Iod. Op. Sec. corn. Stram. -bloated: Aco. Arnic. Aur. Bar. Bell. Bry. Cham. China. Cina. Cocc. Cupr. Dig. Dros. Dulcamara. 18 FACE. Ferr. Hyosc. Ipec. Kali. Led. Lye. Merc. Natr. c. Nux vom. Op. Phosph. Plumbum. Rhus. Sep. Spig. Spongia. Staph. Strain. COMPLEXION, changing: Aco. Bell. Bov. Capsic. Cham. Chin. Cina. Crocus. Hyosc. Ign. Led. Opium. Natr. c. Phosph. Ph. ac. Veratr. Zinc. —jaundiced: Aeon. Ambra. Ant. cruel. Arn. Ars. Bry. Calc. Causticum. Canth. ('ham. Chel. Chin. Cina. Con. Croc. Ferr. Graph. Hell. Hep. Ign. Jod. Kali. Lye. Merc. Natrum. mur. Nitr. ac. N. vom. Op. Petr. Plumb. Puis. Rhus. Secale corn. Sep. Spigelia. Veratr. —shining: Aurum. Plumbum. Rhus. Selen. —sallow: Bryon. Carb. veg. Ferr. Merc. Phosphor. Sec. corn. —sickly: Anac Bryon. Calc. Canth. Caust. Chin. Cina. Colch. Cupr. Kali. N. vom. Plumb. Phosph. Ph. ac. Puis. Rhus. Sec. corn. Silicea. Spigel. Stann. Staph. Sulph. Ve- ratr. Zinc. ^red: Aeon. Arg. Arnica. Ars. Bar. Bell. Bryon. Calcar. Camph. Cann. Canth. Capsic. Caustic. Cham. China. Civ. Cina. Cocc. Coff. Croc. Cupr. Drosera. Euphr. Dig. Du'c. Ferr. Hyosc. Hep. Ign. Ipec. Laur. Lye. Merc. Mur. ac. Natr. c. N. vom. Op. Petr. Phosph. Plat. Plumb. Puis. Rhus. Ruta. Sabad. Sabina. Sep. Sil. See-ale cornut. Spigel. Spong. Siannum. Stramon. Sulphur. Thuj. Veratr. Zinc. red and bluish: Aco. Bell. Bry. Hep. Merc. Opium. Phosphor. —red, burning cheeks: Aeon. Arn. Bellad. Bry. Cannab. Caps. C. an. Cham. China. Cina. Cocc. Coffea. Dulc. Hell. Ign. Kali. Lycop. Merc N. vom. Op. Plat. Sabad. Samb. Stann. Stra,m. Valer, —red on one side: Aeon. Am. (aim. Canth. Cham. Chin. Ign. Ipec. N. vom. Pulsat. Rheum. —red, erysipelatous: Bellad. ("Cal- car.) Camphor. Cham. Lach. Rhus. Ruta. Stram. —sallow: Arsen. Bry. Canth. Chin. Cic. Euph. Ferr. Hyosc. Ignat. Ipec. Merc. Natr. mur. Nux vom. Op. Plumb. Phosph. Sec corn. SU. EYES, sunken: Ambr. Arsen. Cal- car. Camph. China. Cic. Cupr. Coloc. Dro.s. Ferr. Hyosc. Jod. Lye. Nitr. ac. Op. Phosphor. Ph. acid. Sec. corn. Spongia. Siannum. Staphys. Sulph. Verat. FEATURES, altered: Ars. Bellad. Camph. Canth. Chamom. Colch. Rhus. Sjiig. Veratrum. FRECKLES: Calc. Kali. Lye. Natr. c. Phosph. PALE: Aconitum. Ambr. Anac. Arn. Ars. Bell. Bry. Calc Camph. Cann. Canth. Caps. Carb. veg. Cham. China. Cic. Cina. Coloc. Con. Cocc. Cupr. Dig. Euphorb. Euphr. Ferrum. Graphit. Helleb. Hyosc. Ign. Jod. Ipec. Kali. Laches. Led. Lye. Merc Nux vom. Op. Plum- bum. Pefcr. Phos. Ph. ac. Puis. Rhus. Sabin. Sec. corn. Sep. Sil- icea. Spigelia. Spong. Stann. Stram. Sulph. Teuer. mar. Veratr. Zinc SPOTS, yellow: Calc. Hell. Lye. Natr. c. Phosph. Sepia. —red: Alumina. Ambr. Bellad. Canth. Croc. Lye Merc Nux vom. Op. Phosph. Sabadilla. Samb. Sil. Sulph. Zinc. —Avhite: Ars. Merc. Natr. c. SWELLING: Alum. Ars. Bell. Bry. Calc. Canth. Carb. veg. Chamom. Dulc. Graph. Hell. Hyosc. Kali. Lycop. Natr. mur. Nitr. ac Op. Petr. Phosph. Rhus. S^nnh. Sep. Stram. FACE. 19 Sensations. In the face generally. BLOTCHES: Antim. crud. Canth. Cic Hell. Lach. Led. N. vom. Op. Puis. Viol. tr. BOILS: Alum. Arn. BeU. Bry. Chin. Laur. Led. BONES, inflammation of: Staph. —swelling of: Sil. Spig. —pains of: Asa f. Caps. Chel. COLDNESS : Asar. Camphor. Canth. Cham. Cina. Dros. Hyosc. Ign. Ipecac. Rhus. Veratr. CONVULSIONS: Bell. Calcarea. Camphora. Canth. Cham. Cupr. Dig. Ipec. Phosphor. Rheum. Stram. Sulph. CRAMPY FEELING : Bellad, Cina. Cocc. Dig. Dulc. Hyosc Kali. Nitric acid. Platina. Rhus. Spongia. Stannum. Thuj. Va- leriana. CRUSTA LACTEA: Ambr. Arsen. Bar. BcUad. Bry. Hep. Ledum. Mercur. Rhus. Sassap. Staph. Viol. tr. ERUPTION : Alum. Anac Ars. Aur. Bar. Calcar. Carb. veg. Cauat. Chamom. Cic. Colch. Coloc. Con- ium. Dulc. Graph. Kali. Lachesis. Led. Lye. Merc. Natr. mur. Petr. Plumb. Ph. ac. Rhus. Sep. Silic. Stann. Staph. Veratr. Viola, tr. —on the lips: Aco. Ant. cr. Am. Bar. Bell. Bov. Bry. Cann. Canth. Caps. Caustic Chin. Coloc. Con. Dulc. Hep. Hyosc Ignat. Ipec. Kali. Led. Mur. acid. Nux vom. Rhus. Samb. Scill. Spigelia. Spong. Staphys. Sulphur. Veratrum. Zinc. —around the mouth: Ant. crud. Bar. Bov. Calc. Carbo veget. Cocc. Graph. Petr. Phosphor. Ph. ac. Rhod. Rhus. Sep. Sil. Staph. Veratr. Zinc. —around the ears: Ant. crud. Mur. ac. Petrol. Phosphor. Sulph. —on the forehead: Agar. Ambr. Ant. crud. Arn. Baryta. Bov. Calc Canthar. Carbo veget. Chamom. Clem. Coccul. Euphorb. Hell. Hep. Led. Mur. ac. Natrum mur. Rheum. Rhod. Rhus. Sep. Sil. Staph. Sulph. ERYSIPELAS: Rhus. Bell. FEELING OF COLDNESS: Am. Bar. Merc Mosch. Phosph. Plat. Rhod. Ran. seel. FLASHES OF HEAT: Ambr. Arnica. Asa feat. C. an. Coec. Graph. Lye. Nitr. acid. Petr. Sulph. Teucr. mar. Thuj. Valer. HEAT: Aeon. Agar. Alumina. Ambr. Anac Arn. Ars. Asaf. Asar. Bar. Bellad. Bov. Bry. Calc. Camph. Cann. Canthar. Caps. Carbo veget. Caust. Cham. Chin. Cina. Cocc. Coffea. Coloc. Con. Croc. Cupr. Digital. Drosera. Dulcam. Euphr. Ferr. Graphit. Hell. Hepar. Hyosc. Ign. Ipec. Kali. Led. Lye. Mere. Mur. ac. Natrum mur. Nitr. ac. Nux vom. Op. Petr. Platina. Plumb. Phos. Ph. ac. Puis. Rheum. Rhod. Rhus. Ruta. Sabad. Sabina. Samb. Sassap. Senega. Sep. Scill. Sil. Spig. Spong. Stann. Staph. Stram- ov . Tar. Thuj. Veratr. Viol. tr. HERPES: Bar. Bov. Calc. Carbo veg. Caustic. Chel. Graph. Led. Natr. c Nitr. ac. Pet. Phosph. Rhus. Sabad. Sep. Sil. —on the cheek: Ambra. Anac. Bar. Bov. Bryon. Caustic. Merc —on the chin : Bov. Chel. N. vom. —on the lips (cold blisters): Rhus. —on the temples: Alum. ITCHING: Agar. Alumin. Ambr. Arg. Arnic. Asa f. Aur. Bry. Bov. Calc. Caps. Carbo veg. Caustic. Clem. Coloc. Con. Dulc. Graph. 20 FACE. Kali. Lach. Lye. N. vom. Opium. Petr. Phosph, Ph. ac. Plat. Plumb. Rhus. Ruta. Sabadilla. Sabin. Sas- sap. Sep. Sil. Sulph. Veratrum. Zinc MUSCLES, twitching of: BeU. PROSOPALGIA: Aconit. Alumina. Asa f. Aur. Bar. Bell. Bry. Calc. Caps. Chin. Cina. Colch. Coloc. Con. Daph. Graph. KaU. Lye. Mur. ac. Nitr. ac. Nux vomica. Phosph. Sep. Spigelia. Stann. Staph. Valer. Veratr. Verb. PULSATIONS: Agar. Cann. Cham. Clem. Croc. HeU. TEARING: Agar. Alum. Ambr. Arg. Aur. Bell. Bry. Calc. Carb. veg. Chel. Cina. Colch. Con. Daph. Dig. Dulcam. Euphorbium. Graph. Kali. Led. Lye. Merc. Mur. ac. Natr. c. Nitr. ac. Phosph. Plumb. Rhus. Sassap. Senega. $ej)ife.Stilig. Spigelia. Spong. Staph. Sulphur. Thuj. Teucrium mar. Zinc. PIMPLES: Agar. Ambra. Ang. Ant. crud. Arsen. Bar. Bellad. Bov. Calc. Caps. Carbo veg. Caust. Cocc. Con. Drosera. Graph. Kali. Lye Natrum mur. Nux vom. Nitr. ac. Petr. Phos. Ph. a<: Rhus. Sassap. Sep. Sil. Sulph. Stann. Staph. Ye- ratr. Zinc. —around the eyes: Calc. Hep. Ign. Merc. Petr. Sil. Staph. Sulph. —on the cheeks: Ant. crudum. Arn. Calc. Canth. Carbo veg. Canst. Cham. Cina. Dulcam. Hyosc. Nux vom. Phosphor. Sassap. Sabina. Sep. Staph. Valer. Veratr. —on the chin: Ambr. Antimon. crudum. Bellad. Calc. Canth. Caust Cic. Clem. Con. Dros. Dulc Hep. Hyosc. Lye. Nitr. ac. Nux vom. Rhus. Sabina. Sil. Spigelia. Spon.c Sulphur. Thuj. Veratr. SENSATION OF HEAT: Am. Asa f. Bar. Bell. Bry. Camph. Croc. Dros. Euphr. Ipec. Merc. Nux vom. Petr. Platina. Rheum. Rhus. Ruta. Sabadilla. Spong. Stramom. Thuj. SPASMS: Ambr. Carbo vegetab. Camph. Cann. Cham. Cocc. Cupr. Dig. Hep. Op. Sepise. Stram. STITCHES : Agar. Arg. Asa f. Asar. Aur. Bar. Bry. Calad. Canth. China. Cocc. Con. Dig. Graph. Ign. Kali. Lye Mere. Natr. mur. Nitr. ac. Petr. Phosph. Plat. Plumbum. Rhod. Rhus. Sabad. Sabin. Sep. Sil. Spigelia. Spongia. Staph. Stann. Sulph. Thuj. Veratr. Verb. SWEAT: Aeon. Ambra. Arg. Arn. Ars. Asa f. Bell. Bry. Calc. Camph. Cann. Capsic. Carb. veg. Cham. China. Cina. Coccul. Coff. Con. Croc. Cupr. Dulc Drosera. Hell. Hep. Hyosc. Ignatia. Ipic. Laur. Led. Lycop. Mere. Natr. mur. N. vom. Op. Petrol. Plat. Pulsat. Rheum. Rhus. Sambucus. Sassap. Sep. Spong. Staph. Stram. Stann. Sulphur. Thuj. Valer. Veratr. —cold, on the forehead: Bry. Cin. Cupr. Ipec. Rheum. Veratr. TENSION: Aconit. Alum. Arn. Asa f. Aur. Bar. Bry. Calc. Canth- aris. Chel. Colch. Con. Euphorb. Laurocer. Led. Lye. N. vom. Petr. Platina. Phosph. Ph. ac Pulsatilla. Rheum. Rhus. Sabad. Samb. Sep. Spong. Veratr. Verb. Viol. od. THROBBING: Arn. Bellad. Calc. Sabad. Staph. TITILLATION: Bed. Cann. Coloc. Laur. Phosph. ULCERS: Ars. Bry. Merc VESICLES: Alum. Ant. cr. Bar. Cantharis. C. an. Caust. Euphorh. Graph. Nitric acid. Petr. Plumb. Phosph. Rhus. Sepise. Silicea., Sulph. Valer. Zinc. FA( WARMTH, feeling of: Asa foet. Asar. Cann. Cantharid. Chin. Cocc. Coff. Croc. Laur. Phos. ac. Puis. Samb. Seneg. Valer. On the lips. (u. signifies upper lip; 1. lower lip, and c. cor- ner of the mouth.) BLACK: Aconit. Bryon. Chin. Mer- cur. Phosph. acid. Veratr. BLUE: Agar. Ars. Caust. Cina. Con. Cupr. Dig. Op. Phosph. Stramon. Veratr. BLISTERS, bloody: Natr. mur. Bry. Ign. Ph. ac Plat. —u.: Kali. Rhus. —1.: Ars. Bry. Rhus. BURNING: Agar. Anac Arnica. Ars. Bry. Caps. C. an. Chin. Hyosc. Kali. Merc. Muriatic ac. N. vom. Phosph. Rhod. Rhus. Sabad, Sulph. Thuj. —u.: Ant. crud. Bar. Caustic Daph. Graph. Merc. Natr. c. Rlius. Sa- bad. Sep. Spigel. Staph. Veratr. —1.: Asa f. Bar. BeUad. Bov. Bry. Clem. Daph. Graphit. Kali. Phosph. Phosphor, acid. Sabad. —c. • Arn. Coloc. Daph. Dros. Natr. c. Zinc. CANCER: Ars. (Bryon.) Clem. Con. Sil. CHAPPLNG : Alum. Arn. Bry. Calc. Caps. Carbo veg. Cham. Chin. Colch. Croc. Ign. Nux vom. Phos. Pulsatilla. Staph. Veratr. Zinc. —u.: Caust. Natr. mur. Sab. Selen. —1.: Cham. Chin. Daph. Dros. Graph. Natr. mur. Nux vom. Phosph. Ph. ac Puis. CONTRACTION: Calc. Sec. corn. DEAD NESS, u.: Calc. DISTORTION: Bellad. Graphit. Nux vom. Sec. corn. DRY: Aco. Agar. Alum. Ambr. Anac Arn. Ars. Bar. Bell. Bry. Calad. Cann. Canth. C. an. Cham. China. c& 21 Con. Croc. Cycl. Dros. Graphites. Hyosc. Ign. Mere. Mur. ac. Nux vom. Phosph. Plat. Puis. Rhodod. Rhus. Stram. Thuj. Veratr. Zinc. —u.: Amm. Plat. Sulph. —1.: Daph. Merc Sabin. ERUPTION, vesicular: Alumina. Canth. Laur. Natrum mur. Rhus. —u.: Amm. mur. Ars. Carbo veg. Cic. Con. Graph. Hell. Laur. Mur. ac. Plat. Seneg. Sil. Stront. Valer. —1.: Aur. Bell. Bry. Carbo veg. Clem. Kali. Laur. Mur. ac. Natr. mur. Phos. Plat. Rhodod. Sassap. Sepia. Staph. Sulph. —c : Caust. Daph. Laurocer. Seneg. GLANDS, indurated: Con. Sulph. Zinc. —ulcerated: Ign. HEAT: Ambr. Arn. Bell. Canth. Carbo an. Daph. Hep. Sep. HERPES : Anac Ars. Rhus. Sep. —u.: Phosph. Sep. —1.: Sep. —c.: Carbo veg. Phosph. Sep. PALE : Ferr. Kali. Lye. Valer. PEELING OFF : Alum. Bell. Canth. Caps. Cham. Con. Daphne. Nux vom. Platina. Plumb. Puis. —u.: Sulph. —1.: Daph. Kali. Natrum mur. PIMPLES: Cann. Caps. China. Dulc. Hyosc. Ipec. Kali. Mur. ac. Nux vom. Rhus. Spong. —u.: Aco. Ant. crud. Arn. Bell. 6alc. Carbo veg. Capsicum. Caust. Dig. Kali. Led. Lycop. Nux vom. Rhus. Sassap. Sep. Scill. Silicea. Staphys. Thuj. Zinc —1.: Bell. Bry. Calc Capsic Caust. Ign. Merc. Mur. acid. Natrum c. Rhus Samb. Sil. Spig. —c.: Antim. crud. Bar. Bellad. Calc. Cann. Canth. Caustic. Coloc. Phosph. Rhod. Rhus. Veratr. PRESSURE, u.: Sulph. ac —1.: Valer. 22 face. RHAGADES: Arn. Bryonia. Cann. Caps. Croc. Ign. Plat. Puis. —u.: Agar. Kali. Natr. mur. Ph. ac- Sabad. —1.: Bry. Cham. Nux vomica. Puis. Plat. Sulph. —c.: Ant. crud. Merc. ROUGH: Anac. Calc. Mur. acid. Plat. —u.: Calc. Sulph. —1.: Merc. Natr. mur. SCURFS: Ars. Bar. Bryon. Cann. Cham. Ign. Mur. ac N. vom. Staph. Sidph. —u.: Ars. Cic. Kali. Mercur. Petr. Sil. Staph. Sulph. —1.: Alum. Calc. Natrum mur. Ph. ac. Sulph. —c.: Calc. Graph. Ign. Sil. SPASM: Ambr. BeUad. Caust. Kali. Merc. Plat. SWELLING: Arn. Alum. Aur. Bell. Bry. Carbo veg. Caps. Chin. Dig. Natr. mur. Opium. Rhus. Stram. —u.: Argent. Bar. Bell. Bov. Canth. Carbo veg. Con. Daph. Graph. Hep. Kali. Lye Merc. Natr. mur. Nitr. ae. Petr. Phosph. Rhus. Staphys. 8H*Sulph. Thuj. Zinc. —1.: Alum. Asa f. Calc Caust. Daph. Lye. Mur. ac Natrum mur. Puis. Sep. Sil. TREMBLING: Strain. Sulph. —1.: Arn. Con. TWITCHING: Arsenic Cham. Dulc. —u.: Carbo veg. Natr. c Plat. Sabad. Thuj. Zinc. —1.: Bry. TUBERCLES: Bell. Caust. Con. Sep. Sil. Sulph. —u.: Arsenicum. Bar. Graphit. Magnes. c. —1.: Ign. Sep. —c.: Bry. Stront. ULCERATION, c: Calc. ULCERS: Ars. Bellad. Capsic. Cham. Chin. Cic. Con. Dulc. Graph. Natr. mur. Nitr. ac. N. vom. Staph. Sulph. —u.: Caps. Caust. Daph. Kali. Merc. Staph. —1.: Bry. Caps. Ign. Lye Merc. Nux vom. Phosphor. Phos. ac. Puis. Sep. Sil. Staph. Zinc. —c: Arn. Bell. Graph. Hep. Ign. Merc. Nux vom. Natr. mur. Phosph. Sil. Zinc. Lower jaw and articulation of the jaw. BONE, swelling of: Sil. CONTRACTION: Nux vom. Puis. Stann. CRAMP : Alum. Asa feet. Asar. BeU. Chamom. Cocc. Colch. Ignat. Kali. Merc. Mur. ac. N. vom. Plat. Rhus. Spig. Spong. Stann. Sulph. —in the joint: Aeon. Arnica. BeU. Bry. Calc. Camph. Canthar. Cic. Colchic. Con. Hyosc Ign. Laur. Merc. N. vom. Op. Phosph. Plat. Plumb. Rhus. Sec. corn. Spig. Strain. Sulph. Verat. CRACKING: Nitr. acid. Rhus. Sa- bad. DEPRESSION: Op. DISLOCATION: Ign. Petr. Ph. ac. Rhus. Staph. PAIN, arthritic: Caust. —crampy: Digit. Plat. Sassap. Spong. Stann. PRESSURE: Ambr. Arn. Asar. Aur. Bry. Chin. Coff. Cupr. Dros. Ign. Led. Phosph. Sabin. Sassap. Spig. Veratr. RIGIDITY: BeUad. Caust Cocc. Euphr. Graph. Hyosc. Merc. Nux vom. Petr. Sassap. Sep. Thuj, SWELLING: Aeon. Arn. Ars. Staph. Veratr. TEARING: Agar. Anac. Arn. Aur. Bar. BeU. Bov. Bry. Canth. Carb. anim. Chin. Cocc. Coff. Colch. Droser. Graph. Laur. Mercur. Nux TEETH ANn GUMS. 23 vom. Phosphor. Plumb. Puis. Sas- sap. Spig. Stann. Sulph. TWITCHING: Arn. BeU. Bryon. Canth. Chin. Cina. Con. Ign. Rhus. Sabin. Valer. Chin. BURNING: Anac. Ant. crud. Bov. Canth. Caust. Rhus. Spong. COLDNESS: Veratr. CRAMP: Bell. DRAWING: Caust. Cupr. HERPES: Bov. Chelid. Natr. mur. Nux vom. Sil. ITCHING: Alum. Con. Dig. Kali. Lye. Natr. mur. Op. Phosph. Plat. Puis. Sassap. Scill. Spig. Stront. Sulph. Zhic NUMB FEELING: Asaf. Plat. PIMPLES: Ambr. Anac Ant. cr. Bell. Calc Canth. Caust. Cic. Clem. Con. Dros. Dulc Graph. Hyosc. Lye. Mere. N. vom. Nitr. ac. Rhus. Sabin. Sassap. Sil. Spig. Spong. Sulph. Thuj. Veratr. Zinc. PUSTULES: Merc. Oleand. Sabin. Zinc. SWELLING: Carb. veg. TEARING • Aur. Caust. Plat. ULCERS: Hep. VESICLES: Hep. VI. TEETH AND GUMS. Teeth. BLACK: Ignat. Merc Plumb. Sep. Staph. BLEEDING: Ambr. Bar. Graph. Phosph. Ph. ac Sulph. Zinc. BRITTLE: Lach. Plumb. Sabad. SUiph. DECAY : Amm. Carb. an. SU. DULL: Agar. Caps. Nitr. acid. Puis. Spong. Staph. FALLING OUT: Ars. Bry. Merc. N. vom. Plumb. Sec corn. FETID: Calc Carb. veg. Daph. Graph. Kali. GRITTING: Aeon. Ant. crud. Ars. Bar. Bellad. Canth. Caust. Chamom. Cic. Coff. Con. Hyosc. Ign. Merc. Plumb. Sec. corn. Sep. Strain. Veratr. HOLLOW: Asar. Calcar. Daph. Hyosc Plumb. Phosph. Sabad. Selen. Sep. Sil. Staph. LOOSE: Aeon. Arn. Bry. Camph. Cham. Chin. Cocc. Hyoscyam. N. vom. Op. Puis. Rheum. Rhus. Staph. Veratr. MUCUS ON TEETH: Alum. Arn. Bov. Bry. Cham. Daph. Iod. Plumb. Selen. SMOOTH: Phosph. Selen. TEETHING: Aeon. Arn. Bryon. Chamom. Cic. Cina. Coff. Cupr. Hyosc. Ign. Ipec. N vom. Op. Puis. Rhus. Stram. TOOTHACHE, see Index. YELLOW: Iod. Lye. Nitr. ac. Gums. BLUE: Sabad. BLEEDING: Agar. Alum. Ambr. Ang. Bar. Bellad, Bov. Calc. Carb. veget. Caustic Con. Euphr. Graph. Iod. Kali. Lycop. Merc. Natr. mur. Nitr. ac. N. vom. Phosph. Ph. ac. Ruta. Sep. Staph. Sulph. Zinc BURNING: Bell. Chamom. Merc. Mur. ac. N. vom. Petr. Puis. Rhus. Sep. CORRODED: Merc. Staph. FISTULA : Calc. Canth. Caust. Natr. mur. Petr. Puis. Sil. 24 GROWTHS: Staph. HEAT: Bell. Lye. INDENTED: Merc. INFLAMED: Bov. Iod. Natr. mur. N. vom. Petr. Phosph. Sil. PALE: Carb. an. Merc. Nitr. acid. Plumb. Sabin. Staph. PUTRID: Ambr. Nux. vom. Staph. RECEDING: Bov. Carb. veg. Graph. Merc. Natr. carb. Phosph. Ph. ac. Rhus. Sep. Staph. REDNESS: Carbo an. Iodine.Merc. Nitr. Sep. SENSITIVE: Amm. Ang. Arsen. Carbo veg. Caust. Natr. mur. Phosph. Puis. SPONGY: Ang. Bry. Graph. Merc. N. vom. Staph. SCURVY: Cic. N. vom. Staphys. (See Index.) nil. Buccal Cavity. APHTHAE: Bry. Caust. Cham.Chin. Ipec. Merc. Nitr. ac. Nux vom. Sulphur. Sulph. ac. BLISTERS: Ambr. Anac. Canth. Calc. Caps. Jod. Merc. Nitr. acid. Phosph. Spong. Staph. Thuj. BLUE: Cic Merc. BLEEDING: Bell. Canth. Manein- nella. MillefoJ. BURNING: Asa f. Asar. BeUad. Bov. Carbo veget. Cantharis. Cham. Cupr. Mere. Petr. Phos. Plumb. Spong. Sulph. Veratr. BREATH, sour: Nux vom. —bad. Aeon. Ambr. Arn. Agar. Aur. Bar. Bell. Bry. Camph. Canth. Capsic. Calc. Carbo anim. Carbo veget. Cham. Chin. Croc Digital. Ferr. Graphit. Kali, c Hyosc. Ign. SUPPURATION: Canth. Caust. Lach. Merc. Petr. SWOLLEN: Alum. Amhr. Ang. Bar. Bellad. Bism. Bov. Calc. Carbo an. Carbo veg. Caps. Caust. Cham. Chin. Cocc. Graphites. Hep. Hyosc. Jod. Kalie. Lach. Lye. Merc. Mur. ac. Natr. mur. N. vom. Nitr. ac Petr. Phosph. Plumb. Puis. Sabin. Sep. Sil. Spig. Spong. Staph. Sulph. TUBERCLES: Caust. Phosph. ac. Plumb. Staph. ULCERATED: Alum. Aurum. Bov. Calcar. Kali. Kali bichr. Lye Merc. Millef. N. vom. Phosph. Sabin. Stann. Staph. Zinc. VESICLES: Bellad. Calc Canth. Daph. Nux vom. Petr. Sep. Staph. WHITE: Merc. Staph. Ipec. Merc. N. vom. Petr. Plumb. Puis. Sepise. Spigel. Strain. Sulph- ur. Zinc. DRYNESS : Aco. Ambr. Amm. Ars. Aur. Antim. crud. Am. Asa f. Asar. Bar. Bell. Bry. Calc. Carbo veg. Cann. Canth. Capsic Cham. China. Cina. Cocc. Coffea. Colch. Croc. Ferr. Hyosc Ign. Ipec. Kali c. Kali bichr. Lye. Mur. ae. Merc. Natrum c. Nitr. Nitr. ac. N. vomica. Petr. Phosph. Phosph. ac. Rhod. Plumb. Puis. Sabad. Sassap. Seneg. Sep. Sil. Spig. Stram. Sulph. Thuj. Veratr. Zinc. FOULNESS: Arn. Ars. Aur. BeU. Bov. Bryon. Capsic. Carb. veg. Chain. Chin. Crotal. Graph. Hyosc. Iod. Merc. N. vom. Nitr. ac. Puis. Rula. Sabin. Spigelia. Staph. GROWTHS: Staph. MO 47 MOUTH. 25 HEAT: Amm. Calc. Camphora. Carbo veg. Cham. Mercur. Natr. c. Phosph. Plumb. Sil. Sulph. INFLAMED: Aeon. Bismuthiun. Brom. Calad. Canth. Colch. Ign. N. vom. Veratr. ROUGH: Carbo veg. Caustic Cina. Cocc. Dig. Ipec Millclol. Ph. ac. SKIN DETACHED: Merc SWELLING: Ainin. Causticum. Canth. Merc. Sep. Zinc. TRISMUS: Calc. Con. Phosphor. Sulph. ULCERS: Arg. Graphites. Kali bichr. 3Ierc. Natr. mur. Nitr. ac, N. vom. Opium. Petr. Phosph. Plumb. Sepioe. Sil. Staph. Zinc. Palate. BLISTERS: Iod. Nux vom. Nitr. ac. Phosph. Spig. BURNING: Carbo veget. Camph. Cann. Canth. Caustic Cocc Mur. ac. Phosph. Phosph. ac. Rhodod. Seneg. Spig. Staph. Thuj. DRYNESS: Camph. Cann. Cina. Cocc. Hell. Merc. Nux vom. Op. Plumbum. Samb. Sepise. Staph. Stram. Sulph. Yeratr. INFLAMMATION: N. vom. PEELING OFF: Amm. Euphorb. REDNESS : Ars. Bell. Canth. SMARTING: Carbo veget. Coloc. Canth. Cham. China. Kali c. Merc. Seneg. Zinc. SORE: Daph. Nitr. ac. Phosph. acid. STINGING: Bar. Camph. Caust. Coloc. Ign. Kali c. Phosphor. Staph. Zinc. SWELLING: Apis. Ars. BeU. Caps. Chin. Merc. Natr. mur. N. vom. Seneg. Stram. ULCERS: Apis. Aur. Kali bichr. Merc. Natr. mur. Nitr. ac. Ph. ac. Sil. WHITE: Merc. Pharynx. (Compare Larynx.) APHTH.E : Spong. Staph. BALL, hysteric: Calc. Causticum. Graph. Ign. Kali e. Natrum mur. Plumb. Sep. Sil. Sulph. Valer. BURNING: Aco. Alum. Amm. Ars. Arn. Asa feet. Bellad. Calc. Camph. Cannabis. Canth. Carbo veg. Caus- ticum. Chain. Cocc Con. Digital. Dros. Euphorb. Graphites. Hyosc. Iod. Merc. Nitr. ac. N. vom. Petr. Phosphor. Puis. Rhod. Sabad. Seneg. Stram. Sec. corn. Spongia. Sulph. Veratr. CONTRACTION: Aco. Alum. Arg. Ars. Asa feet. Bellad Calc. Caus- ticum. Chin. Cic. Daph. Hyosc Merc. Natrum muriat. Phos. Sabad. Stram. Sulph. Veratr. CROUP, gangrenous: Ars. Chin. —membraneous: Aco. Broin. Cham. Dros. Hep. Iodine. Phosph. Samb. Spong. —disposition to: Lycopod. Phosph. DEGLUTITION DIFFICULT: Aconit. Arg. Arn. Asar. Bell. Bry. Calc. Canth. Carbo vegetab. Cham. Chin. Hyosc. Ign. Ipec. Kali bichr. Mere. Natr. mur. Nitr. Nux vom. Op. Phosph. Ph. ac. Puis. Pyro c Sabad. Spong. Stramon. Sulph. Thuj. —desire for: BeU. Caust. Con. Ipec. Merc. Seneg. Sabad. Thuj. —painful: Aeon. Alum. Arg. Ars. Asa f. Bar. Bell. Bry. Calc. Camph. Canthar. Caps. Carbo veg. Causti- cum. Cham. China. Cocc. Coffea. Croc. Ferr. Graph. Hell. Hep. Ign. Ipec. Kali c. Lycopod. Merc. Natr. mur. N. voni. Petr. Phosph. Ph. ac. Puis. Rhus. Ruta. Sabad. Sabin. 26 MOUTH. Sep. Seneg. Sil. Spig. Staph. Strum. Sulph. Zinc. DRYNESS : Agaric. Alumina. Ambr. Anac. Ant. crud. Ars. Asa f. Bar. BeU. Bry. Calad. Calc. Canth. Caust. Cham. Cocc. Colch. Cupr. Hyosc. Ign. Ipec Kali c. Lye. Mere. Mur. ac Natr. mur. Nitr. ac N. vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sabad. Sabina. Sec. corn. Sepiye. Sil. Spongia. Stann. Staph. Strain. Thuj. Sulph. INFLAMMATION: Aeon. Agar. Apis. Alum. Arg. Ars. Bar. Bell. Bry. Canth. Caps. Cham. Con. Euphorb. Iod. Lach. Lye Mercur. Petr. Phosph. Ph. ac. Puis. Ruta. Seneg. Sep. LUMP IN THROAT: Ambr. Ant. crud. Arn. Ars. Bell. Calc. Caust. Croc Hep. Mercur. Natr. m. Plumb. Sabad. Sab. Sep. PARALYSIS : Aco. Bell. Coco. Ipec. Plumb. Sep. AS IF A PLUG IN THROAT: Amm. Bar. Chamom. Crocc. Ferr. Hep. Ign. Merc. Mur. ac. Natr. mur. Nux vom. Sep. Sulph. REDNESS: Aco. Alum. Apis. Bell. Canth. Merc. Nitr. ac. Spong. ROLLING OF DRINKS, audible: Cuprum. Laur. ROUGH: Aeon. Ambr. Antim. crud. Arg. Ars. Bar. Bryon. Carbo veget. Caustic. China. Coccul. Dros. Euphr. Graph. Hep. Hell. Hyosc. Ign. Ipec. Mur. acid. Natr. c. N. vom. Phosph. Ph. ac. Plat. Plumb. Rhod. Rhus. Sabad, Sassap. Sen- ega, Spong. Stann. Staph. Sulph. Thuj. Veratr. SCRAPING : Alum. Anac. Arg. Ars. Bry. Carbo an. Cocc Croc Dros. Dulcam. Kali c Hyosc. N. vom. Puis. Rhus. Sabad. Stann. Thuj. Veratr. SMARTING: Ambr. Carbo veget. Dros. Hyosc. N. vom. Ph. ac Sep. SORE THROAT, chronic: Ammon. Arg. Bar. Bov. Dulc Lach. Lye. Nitr. Pulsatilla. Rhus. Zinc. —in measles: Carbo veg. HEAT: Bellad. Cham. Duicam. Euphr. Ferr. Hyosc. Iodine. Mer- eur. Natrum c. Nitric ac. Phosphor. Rhododend. Sepise. Stram. SPASM: Alumina. Carbo veget. Caps. Con. Dig. Graph. Ipec. Phosphor. Sassap. Sepise. Stram. Sulph. Veratr. SWELLING: Aeo. Arg. BeUad. Bry. Carbo animalis. Cham. Chin. Hep. Hyosc. Iodine. Ign. Lye. Merc. Petr. Spig. Stann. Sulph. AS IF SWOLLEN: Veratr. ULCERS : Arg. Calc. Iod. Ign. Merc. Nitr. ac. UVULA INFLAMED: Apis. Bell. Brom. Millefol. Mercur. Ruta. Zinc. —elongated: Caps. Chel. Croc. Plat. Sabad. Sulph. —swoUen: Bell. Calc. China. Coff. Dulc. KaU bichr. Lycop. Merc. N. vom. Pulsatilla. Sabad. Seneg. Sil. Sulphur. Zinc. Saliva. FRONT OF MOUTH: Bell. Calc. Camph. Canth. Chamom. Cic. Cocc Cupr. Hyosc. Ign. Laur. Op. Plumb. Sec. corn. Strain. Veratr. —bloody: Cantharis. Hyosc. Pyro- carb. Sec. cornut. Strain. MUCUS, bitter: Arn. -bloody: Alum. Amm. Bism. Iod. Lye. Mercur. Phosphor. Sec corn. Selen. Sulphur. Strain. Thuj. Zinc. —foul: Bellad. Bov. Calcarea. Carbo veg. Cham. China. Sep. Zinc. —yelloAv: Bry. Spig. —gray: Arg. —green: Carbo vegetab. Colch. Natr. mur. Plumb. Zinc. MoutH. 27 —salt: Alum. Amm. Bovista. Graph. N. vom. Phos. Rhus. Sulph. —sour: Plumb. —sweetish: Asar. —tasting badly: .Merc. —smelling badly : Chin. Ignat. Puis. Rheum. —viscid: Alum. Ambr. Anac Ant. crud. Arg. Asar. BeU. Bry. Camph. Caps. Chamom. Coff. Dulc Euphr. Iod. Ign. Merc. Nux vom. Phosph. Ph. ac. Plumb. Pulsat. Rhus. Samb. SALIVATION : Ant. crud. Agar. Alum. Apis. Bellad. Broui. Bry. Camph. Canth. Cham. Chin. Cocc. Colchic. Con. Cyc Dros. Dulc. Euphr. Ferr. Hed. Hyosc. Ign. Iod. KaH c Ipec. Merc. Nitrum ac. Nux A'om. Op. Phosph. Plumb. Puis. Rhus. Strain. Veratr. SALIVA, bitter: Arn. Ars. Merc. Thuj. —frothy: Ant. crud. BeU. Bry. Cam- phora. Canth. Cic. Cocc Ign. Ipec. Phosph. Plumbum. Sil. Sabin. Sec: com. Spigelia. Strain. —watery: Asarum. Camphora. Colch. Dig. Dros. Hell. Iod. Ipec. Lach. Nux vom. Phosph. Plumb. Staph. —increased flow: Aeon. Alum. Arg. Asar. Bar. BeU. Bov. Brum. Bry. Calc. Camph. Canth. Carb. veget. Caustic.'Cham. Chin. Cocc. Colchic Dros. Dulc. Graph. Hell. Hep. Hyosc. Ign. Ipec. Merc. Natr. mur. N. vom. Phosph. Pulsat. Rhus. Sep. Spig. Spong. Staph. Strain. Sulph. Veratr. Tongue. BLACK: Ars. Chin. Op. Sec. corn. BLOTCHES: Apis. Dros. Lycop. Phosph. BLISTERS: Amm. Arg. Ars. Apis. Bar. Bell. Brom. Bry. Calc. Canth. C. an. Caust. Cham. Chin. Croc. Graph. Hell. Kali carb. Mur. ac. Natr. mur. Nitr. ae. N. vom. Phosph. Puis. Sabad. Sep. Spig. Spong. Staph. BLUE: Ars. Dig. Lach. Mur. acid. Sabad. BURNING: Aeon, Alum. Argent. Ars. Asar. Bar. Bell. Bry. Calc. Canth. Carb. an. Caust. Chin. Coff. Coloc: Croc. Graph. Hyosc. Ign. Kali carb. Merc. Natr. mur. Op. Phosjdi. Ph. ac. Plat, Plumb. Rhodod. Sabad. Spig. Spong. Sulph. Veratr. CANCER: Apis. Ars. COATED, brown: Arsen. Bell. Bry. Carb. veg. Crotal. Mancin. Plumb. Sabin. Sec. cor. Sulph. —yelloAv: Aeon. Alum. Arn. Ars. BeUad. Bry. Cann. Chamom. Chin. Cocc. Kali bichr. Lach. Merc. Nitr. acid. Sabad. Sabina. Senec. Stann. Zinc. —like a crust: Chin. —like fur: Merc Puis. —frothy: Plumb. —slimy: Aeon. Agar. BeU. Canth. Chamom. Chin. Cina. Ignat. Merc. Nitr. Nux vom. Phosph. Plumb. Puis. Sec. com. Sep. Sil. Stann. —dirty: Aeon. Ant. crud. Arn. Chin. —blackish: Ars. Bry. Merc. Sec. corn. —Avhite: Aeon. Agar. Alum. Anac. Ant. crud. Ars. Asar. Arn. Bell. Bryon. Calcar. Canth. Cann. Carb. veg. Cham. Chin. Cina. Croc. Dig. Euphr. Ign. Ipec. Merc. Mur. ac. Nat. mur. Petr. Phosph. Plumb. Puis. Rheum. Rut. Sabad. Sabin. Sassap. Selen. Seneg. Spigel. Staph. Sulphur. Veratr. Zinc. CRACKS : Bar. Calc Ign. Merc CRACKED : Bar. BeU. Bryon. Calc Chain. Chin. Plumu Ph. ac. Sec. corn. Spig. 28 MOUTH. DRY: Aeon. Ambr. Arn. Ars. BeU. Bry. Calc. Canth. Carb. veg. Caust. Cham. Cocc. Coff. Con. Dulc. Kali carb. Lye Hell. Hyosc. Ipec. Lach. Merc. N. vom. Op. Phosph. Ph. ac. Plumb. Puis. Rhus. Sep. Staph. Stram. Sulph. Veratr. Zinc. HEAT: Aeon. BeUad. Canth. Carbo veget. Plumb. Pulsat. Stram. Sulph. HEAVY: Anac. BeU. Calc. Carb. veget. Merc. Mur. ac. Natr. mur. Plumb. N. vom. Ruta. INDENTED: Merc. INFLAMMATION: Aconit. Arn. Canthar. Cham. Nux vom. Plumb. PAPILL.E, erect: Croc. Oleand. —inflamed: Bell. PARALYSIS: Aeon. Bar. Core. Crotal. Dulcam. Ipec Hyosc. Laur. Mur. a<: N. vom. Op. Rhus. Rut. Sec cor. Stram. PEELING OFF: Spig. RAXULA: Ambr. Calc. Natr. mur. Nitr. ac Staph. RED: Cham. Veratr. ROUGHNESS: Aeon. Alum. Bar. Calc. Carb. veg. Cocc Dulc Graph. Hyosc. Merc Phosph. Sep. Stram. Sulph. SMARTING: Aeon. Am. Arsen. Asar. Bell. Cham. Chin. Coloc. Croc. Dros. Ign. Ipec Natr. mur. Op. Sep. Sulph. Zinc. SORE: Agar. Ars. Canth. Cic. Dig. Kali c. Lye Merc Mur. acid. Natr. mur. Nitr. ac Op. Sen. Sil. SUPPURATION: Canth. Mancin. SWELLING: Anac Apis. Ars. Bell. Bryon. Calad. Chin. Cic. Dig. Dros. Glonoin. Hell. Mere. Natr. mur. Plumb. Pyroearb. Ruta. Sabad. Sec. Sil. Stram. Veratr. TONGUE PROTRUDED: Aco. Plumb. TREMBLING: Bell. Phos. ac. Stram. TWITCHES: Sec. corn. ULCERS: Amm. Apis. Arsen. Canth. Chin. Cic. Dros. Kali bichr. Lye. Mur. ac. Mere Natr. mur. Nitr. ac Op. —at the edge of tongue: Caust. Merc. Nitr. ac Thuj. —under the tongue: Lye. WHITE: Arsen. Canth. Coloc. Hell. Kali carb. Nitr. ac Nux vom. Op. Petr. Phosphor. Puis. Sep. Sulph. Veratr. WITHERING: Veratr. Speech DUMB: Cicuta. Pyroearb. Stram. SPEECH, impeded: Aeon. Anac. Arg. Am. A is. Bell. Bry. Calc. ('ami. Canth. Carb. veg. Caust. Cocc Conium. Dulc Hyosc Pjn. bye. Merc. Mur. ac. Natr. mur. N. vom. Op. Plumb. Petr. Phos- phor. Sec. cor. Spong. Stann. Strain. Sulph. Veratr. Zinc. —hurried: Aeon. Bry.'Hep. Merc. —stuttering: Cocc Stram. —slow: Thuj. —low tone: Bell. Canth. Chamom. Chin. Hep. N. vom. Op. Sec. corn. Staph. —nasal: Bry. SPEECHLESS: Arn. Ars. Bar. Bell. Bryon. China. Con. Crotal. Cupr. Hyosc. Lye Merc Mur. ac. N. vom. Op. Phosph. Plumb. Puis. Ruta. Sec. corn. Stram. Veratr. STUTTERING: Aco. Arn. Bell. Cham. Euphr. Hell. Opium. Sec. corn. Stram. Verat. STAMMERING: Euphr. VOICE, clear: Chin. Secale corn. Spong. Stram. Veratr. —Ioav: Ant. crud. Canth. Ign. Nux vom. Op. Puis. Secale corn. Spong. Veratr. APPETITE. 29 -indistinct: Bry. Cann. Cocc. Hyosc. Sec. corn. Stram. Veratr. -loss of: Antimon. crud. Cann. Dros. Hyosc Lach. Plumb. Ruta. Spong. Veratr. II APPETITE. LOSS OF APPETITE: Aco. Agar. Alumina. Ant. crud. Arg. Am. Ars. Bar. Bell. Bry. Calc Canth. Carbo vegetabil. Caustic. Cham. China. Cic. Cocc Coff. Colch. Con. Croc. Cupr. (yd. Dig. Dros. Dulc. Ferr. Graphites. Hell. Hep. Hyosc. Ign. Ipec. Lach. Lye. 3Ierc. Natr. mur. Nux vom. Op. Phosphor. Plat. Puis. Rhodod. Rhus. Ruta. Sabad. Sec. corn. Sep. Sil. Spigel. Spong. Stann. Staph. Sulph. Thuj. Veratr. Zinc AVERSION TO BEER: BeU. Cham. China. Cocc. N. vomica. Phosph. Spig. Spong. Stann. Sulph. —to brandy: Ign. Merc. —to bread: Con. Ign. Lycopod. Natl", mur. Nitr. ac. Nux vom. Phosph. Ph. ac Puis. Rhus. Sep. Sulph. —to broAvn bread: Kali e. Lye. N. vom. Puis. Sulph. —to solid food: Ferr. Mercur. Staph. —to fat food: Ars. Bell. Bry. Calc. Carbo veg. Drosera. Hell. Hep. Merc. Natrum mur. Petr. PuIsatUla. Psorin. Rhus. Sep. Sulph. —fish: Graph. Zinc. —meat: Alum. Arn. Ars. Aur. Bry. Calc. Carbo veget. Causticum. Ferr. Graph. Ign. KaU bicher. Lye. Mercur. Mur. ac. Natr. mur. Nitr. ac. N. vom. Op. Petr. Plat. Puis. Rhus. Sabad. Sepiae. Sil. Sulph. Zinc. —broth: Arn. Ars. Belladonna. Graph. Rhus. —vegetables: Hell. —coffee: Bellad. Bry. Calc. Carbo veget. Cham. China. Coff. Dulc Lye: Merc. Natr. mur. N. vom. Phosphor. Rhus. Sabad. Spig. —to milk: Arn. Bell. Bryon. Calc. Carbo veg. Cina. Ign. Natr. c Nux vom. Phosphor. Pulsat. Sep. Sil. Stann. Sulph. —sour tilings: Bellad. Cocc. Ferr. Ign. Nux vom. Ph. ac Sabad. Sulph. —salt things: Carbo veg. Graph. Selen. —sweet things: Ars. Caust. Graph. Merc. Nitr. ac Phos. Sulph. Zinc. —to Avater: BeUad. Brom. Bryon. Canth. Caust. China. Lye Natrum mur. N. vom. Strain. —to Avine: Ign. Lach. Merc. Rhus. Sabad. Sulphur. DESIRE FOR BEER: Aeon. Bry. Calc. Causticum. China. Cocc Graph. Lach, Merc. Natr. c. N. vom. Op. Petr. Ih. av. Pulsat. Rhus. Sabad. Spig. Spong. Sulph. Zinc. —bitter things: Dig. Natrum mur. —brandy: Aeo. Arg. Ars. Bov. Bry. Calc. China. Cic. Hep. Mur. ac N. voin. Op. Puis. Selen. Sep. Spigel. Staph. Sulph. Sulph. ac —bread: Ars. Bell. Bov. Ferr. Hell. Ign. Natr. m. Plumb. Puis. Staph. —bread and butter: Ferr. Ign. Merc. —something refreshing: Carbo an. Caust. Cocc. Phosph. Ph. ac. Pulsat, Rheum. Valer. 30 TASTE. —for fat food: Nitr. ae. Nux vom. —for meat: HeU. Sulph. —liquids: Ferr. Merc. Staph. Sulph. —pastry: Plumb. —.smoked things: Caust. —vegetables: Alum. Magnes. carb. —cucumbers: Ant. crud. Veratr. —herrings: Nitric ac Veratr. —cheese: Ign. —coffee : Ars. Aur. Bryon. Capsicum. China. Colch. Con, Mosch. Selen. —chalk: Nitr. ac. N. vom. —sweet things: Amm. Calcar. Carbo veg. Chin. Ipec Kalic. Lye. Natr. c. Nux vom. Petr. Rheum. Rhus. Sabad. Sulph. —farinaceous: Sabad. —milk: Anac. Am. Aur. Boa-. Bry. Calc Chel. Mercur. Natr. mur. Nux vom. Ph. ae. Rhus. Sabad. Sabina. Sil. Staph. —fruit: Alum. China. Ignat. Puis. Sulph. ac. Veratr. —juicy: Ph. ac. —salt: Calc Carbo veg. Caust. Conium. Nitric acid. Phosph. A'e- ratr. —sour: Antim. crud. Arn. Ars. Bry. C. an. Cham. China. Con. Dig. Hep. Ign. Kali c Lach. Phosph. Puis. Sabin. See. com. Sep. Strain. Sulph. Veratr. —Avheat bread: Aur. —warm food: Cycl. Ferrum. Lye. —wine: Aco. Arg. Bov. Bryon. Calc. Chin. Cic. Hep. Lach. Pulsat. Sep. Spigelia. Staph. Sulph. BAD EFFECTS OF FOOD OR DRINK: see Index. TASTE, bitter: Aconit. Alum. Ant. crud. Arg. Am. Ars. Aur. Bar. Bell. Bov. Bry. Calcar. Canth. HUNGER: Agar. Alum. Antim. crud. Arg. Ars. Aur. Bellad. Bryon. Calc. Canth. Carbo veg. Cham. China. Cina. Cocc Coff. Graph. HeU. Hyosc Ign. Lye. Merc Mur. ac. Natr. mur, Nux vom. Op. Petr. Phosphor. Plat. Plumb. Puis. Rhus. Sabad. Secale corn, Sep. Sil. Spong. Staph. A'eratr. —Avithout appetite : Ars. Bellad. Bry. Calc. Chin. Dulc. HeU. Ign. Lye Natr. mur. Nux vom. Op. Puis. Rhus. Sil. Sulph. A'eratr. —canine: Ars. Bryon. Calc. Cham. Chin. Cina. Cocc Graph. Hell. Hy- osc. Iodine. Lye. Natr. mur. N. vom. Op. Phosph, Puis. Rhus. Sep. SU. Spig. Sulph. Veratr. THIRST: Aeon. Ant. crud, Arn. Ars. Bell. Bryon. Calc. Canth. Carb. veg. Caust. Chum. Chin. Cina. Coffea. Crocus. Crotal. Cupr. Dros. Dulc Ferr. Hep. Hyosc Ign. Kali bichr. Merc. Natr. mur. Nux vom. Plumb. Rhus. Sec cornui. Silic Stram. Sulph. Veratr. —loss of: Ambr. Apis. Arsen. Bellad. Camph. Canth. Chin. Con. Hell. Hep. Lycop. N. mosch. Oleand. Op. Ph. ac. Puis. Rhus. Sep. Spig. Spong. Staph. —with aversion to drinks: Am. Bell. Canth. Caust. Hyos. Lach. Lye. Natr. mur. Nux vom. Rhus. Samb. Strain. —none, but desire to drink: Ars. Camph. Cocc: Coloc: Graph. Man- cm. Phosph. Carb. veg. Cham. Chin. Cocc. Coff. Croc. Cupr. Dig. Glonoin. Hyosc Ign. Ipec. Kali o. Lye. Merc. Mur. X. TASTE. ERUCTATIONS. 31 ac. Natr. mur. Nitr. ac. Nux vom. Op. Petr. Phosph. Pulsat. Rhod- odend. Rhus. Sabad. Sabin. See. corn. Sepias. Silic Spong. Staph. Stram. Sulph. Veratr. —of food: Ars. Bryon. Camph. Chin. Ferr. Hell. Hep. Ign. Ph. ac. Puis. Sabin. Staph. Stram. —of blood: Alum. Ars. Canth. Ferr. Ipec. Kali carb. Rh us. Sabin. Zinc. —burnt: Bryon. Cyclam. Laur. Puis. ,SW//. Sulph. —of pus: Dros. Merc Natr. carb. Puis. —nauseous: Bry. Chel. N. vom. Puis. A'aler. —earth: Caps. Ferr. Hep. Merc. Puis. —flat: Agar. Alum. Ant. crud. Ars. Asaf. Aur. BeU. Bry. Caps. Chin. Coloc. Dig. Dulc. Euphorb. Ign. Ipec Natr. mur. Op. Ph. ac. Puis. Rhus. Sec. corn. Stann. Staph. —foul: Aeon. Arn. Ars. Aur. Bellad. Bry. Cham. Con. Cupr. Ign. Kali carb. Lycop. Merc. Mur. ac. N. vom. Ph. ae. Puis. Rhus. Spig. Staph. Veratr. —of foul eggs: Aeon. Arn. —bilious: Aeon. Bry. Cham. Puis. ATeratr. —of cheese: Chin. —chalky: Ign. Nux mosch. —insipid: Aeon. Alum. Ars. Bell. Bry. Caps. Chin. Euphras. Ign. Kali c. Op. Petr. Phosph. Sabin. Spig. Stann. Staph. A'aler. —salt: Alum. Ars. Bar. Bell. Calc. Carb. veg. Chin. Coff. Croc. Iod. Merc. Puis. Rhodod. Sulph. —sour: Aeon. Alum. Ars. Aur. Bar. Bell. Calc Canth. Caps. C. an. Con. Chamom. Chin. Cocc Crotal. Graph. Ignat. Kali c. Kali bichr. Lye. Merc Nitr. ac. Nux vom. Pyroearb. Phosph. Puis. Rhus. Sep. Sil. Sulph. —slimy: Alum. Arn. Arsen. Bell. Cham. Chin. Cocc. Dig. Hell. Hep. Lye. Merc Nux vom. Petr. Phosph. Ph. ac Rhus. Sep. Sulph. —sAveetish: Alum. Aur. Bell. Bry. Canth. Chin. Coff. Croc Cupr. Ferr. Kali c Lye Merc N. vom. Phosph. Plat. Plumb. Puis. Sabad. Spong. Sulph. Zinc. —offensiA-e: Ars. Brom. Bry. Calc. Canth. Chin. Cocc. Dros. Ign. Merc. Natr. mur. Nux vom. Phosph. Pulsat. Sep. Spig. Stann. Sulph. Zinc. —lost: Alum. Anac. Ant. cr. Bell. Bry. Cede. Hyosc. Ipec Kali c Lye- Merc Natr. mur. Rhodod. Sec. corn. Sep. Silic. Stram. Sulph. Ve- ratr. XI. ERUCTATIONS. ERUCTATIONS, bitter: Alum. Ar- nica. Ars. Bar. BeU. Bry. Cham. Chin. Calc. Carb. veg. Cocc Droser. Hyosc. Ign. Kali carb. Lye. Merc. Mur. ac. N. vom. Phosph. Pulsat. Sil. Spong. Stann. Sulph. Veratr. —foul: Aeon. Arn. Bellad. Brom. C. an. Cocc. Merc. Mm-, ac. N. vom. Phosph. Puis. Sep. Sulph. —after eating: Antim. crud. Bellad. Bry. Camph. Canth. Chin. Cina. Cocc. Coff. Crotal. Euphr. Ferr. Graph. Ign. Natr. mur. Phosph. Pulsat. Rims. Sil. Sulph. Thin. —bilio;-.r.: .Arn. Bryon. Cocc. Dros. 32 HEARTBURN AND REGURGITATION. N. vom. Puis. Spong. A7eratr. -hot: Mancin. -spasmodic : Ferr. Nux vom. Phosph. Ruta. -loud: Ant. crud. Caust. Con. Kali c. Petr. Phosph. Plat. Puis. -empty: Aeon. Agar. Alum. Ambr. Ant. crud. Arn. Ars. Bar. BeU. Bryon. Calc. Cann. Canthar. Carb. veg. Caust. Coloc Con. Chamom. China. Cocc. Coff. Colchic Croc Dulc. Euphorb. Graphit. Hell. Iod. Ign. Ipec. Kali c Lye. Merc. Millefol. Natr. mur. N. vom. Phosphor. Plumb. Plat. Rhus. Ruta. Sabad, Sabin. Sep. Sil. Spig. Spong. Staphis. Veratr. -sour: Ambr. Arsen. Bar. BeU. Bry. Calcar. Carb. veg. Cham. Chin. Con. Dros. Dig. Graph. Ignat, Kali e. Kali bichr. Lye. Mercur. Natr. mur. N. vom. Op. Posph. Puis. Sabin. Sil. Stann. Sulph. Sulph. ac Zinc. —fetid: Bism. Cocc. Merc. N. vom. Sulph. Thuj. —incomplete: Am. BeU. Canth. Cina. Cocc. Con. Hyosc. Millefol. Natr. mur. Ph. ac. Rhus. Sabad. —suppressed: Aconit. Alum. Ambr. Bar. Bell. Calc. Canthar. Caustic. C. an. Cocc. Con. Hyosc Ign. Kali carb. N. vom. Phosph. Plat. Plumb. Puis. Sulph. —repulsive: Asa f. Cina. Nat. mur. Ph. ac. Plumb. XII. HEARTBURN, REGURGITATION. HEARTBURN: Agaricus. Alumina. Ambr. Ant. crud. Arg. Arn. Bar. Bell. Calc. Capsic. Carbo veg. Caust. Cham. Chin. Croc. Crotal. Con. Dig. Dulc. Ferr. Graph. Iod. Ign. Lye Merc. Natrum mur. N. vom. Petr. REGURGITATION, bitter: Arnica. Bar. Bry. Dros. Ign. Nux vom. Phosph. Puis. Rhod. —of blood: Canth. Chin. Merc N. vom, —salt: Arn. Lye ATeratr. —sour: Alum. Calc. Con. Dros. Nux vom. Petr. Plumb. Puis. Rhus. Sabin. Spong. Zinc. —of food: Antim. crud. Arnica. Bell. Bry. Camph. Canth. Carbo veget. Cham. Dulc Ferr. Ign. Lye. Merc. Nux vom. Phosph. Plumb. Puis. Sep. Sulph. —of Avater; Aco. Arg. Arn. Bar. Bryon. Cann. Caust. Cina. Hep. KaU c Merc Nux vom. Petr. Phosph. Plumb. Puis. Suljih. ae. RISING: Alumina. Bellad. Calc. Chin. Phosph. Pulsat. Rhus. Sabad. Stann. —hot: Asa f. Canth. Carbo veg. Cic. Coffea. Croc: Dulc Hell. Merc. Nux vom. Plat. —cold: Veratr. —sweet: Aco. Chin. Plat. Merc. Stann. —burning: Arsenic. Bov. Calc. Carbo veget. Croc. Hep. Hell. Lye. Nux vom. Phosph. Sabina. Secale corn. Sep. Sil. Staph. Sulph. Thuj. Verat. Zinc. WATER-BRASH, bitter: Chehdon. Graph. Nux mosch. Sulph. —sour: Bell. Calc. C. an. Con. Natrum c. Sulph. —general: Ant. crud. Arsenic Bry. Carbo veg. Chin. Cina. Cocc, NAUSEA AND VOMITING. 33 Graph. HeU. Ign. Kali e. Lye Merc. Nux vom. Staph. Sidph. -more fully: Aco. Alum. Ars. Bar. Bryo. Calc. Canth. Carbo veg. Caustic. Cic. Cina. Cocc. Dros. Ferr. Hep. Ign. Kah c. Lye. Natr. mur. Nitr. ac. Nux vom. Petr. Phos. Puis. Sabad. Sep. SU. Spig. Staph. Sulphur. Veratr. -with shuddering: SU. -with hiccup: Aconit. Agar. Alum. Ant. crud. Arg. Ars. Asar. Bar. BeU. Bov. Bry. Calc. Cann. Canth. Carbo veg. Causticum. Cham. Cic. Cina. Coco. Coff. Colchicum. Con. Cupr. Dig. Dros. Dulcam. Euphr. Euphorb. Graph. Iod. Kali c. Merc Natr. mur. N. vom. Op. Phosph. Pulsat. Samb. Sep. Spong. Staph. Stram. Sulph. Veratr. XIII. NAUSEA, VOMITING. LOATHING: Aco. Ant. crud. Arg. Am. Asar. Bar. Bell. Bry. Canth. Cham. Chin. Cocc. Colch. Cupr. Digit. Dulc. Ferr. Hep. Ign. Ipec. Kali c Merc Nux vom. Op. Phosph. Plumb. Puis. Rhod. Se- cale corn. Sep. SU. Spigel. Stram. Sulph. ac iAUSI A, generaUy: Aco. Alum. Ant. crud. Arg. Am. Ars. Bell. Bry. Calc Cann. Carbo veg. Caus- tic Cham. China. Cocc. Coff. Con. Croc. Cupr. Dig. Dros. Dulc Glonoin. Hep. Ign. Ipec. Kali c. Lye. Mosch. Mercur. Mancin. Natr. mur. Nux vom. Petr. Phosph. Ph. ac. Puis. Rhus. Ruta. Sabacl. Sep. Sil. Staph. Sulph. Veratr. —in the chest: Aco. Bry. i Ac. Mere. Nux vom. Rhus. Sec. crtrn. Staph. —in the throat: Aco. Ars. Bell. China. Cocc. Coffea. Cupr. Cycl. Ferr. Merc Ph. ac. Puis. Rhus. Spig. Stann. Staph. Sulph. Valer. —in the stomach: Aconit. Arn. Asar. Cale'Cann. Cantharis. Cham. Chin. Cic. Cocc Croc. Cupr. Hell. Ipec. Kali carb. Lye. Merc. Natr. mur. Nux vom. Phosphor. Puis. Rhus- Sil. Sulph. Veratr. —in the abdomen: Bell. Bry. Cocc. Cupr. Hell. Hep. Puis. Rheum. Samb. Sil. Staph. QUALMISHNESS: Aco. Arnica. Ars. Bar. Bellad. Bry. Calc. Caps. Carbo veg. Caustic. Cham. China. Cina. Coffea. Croc Digit. Euphr. Hep. Ign. Ipec. Kah c. Lye. Natr. c. Nitr. ac: Nux vom. Petrol. Phos- phor. Plat. Pulsat. Rhus. Sabad. Sil. Staph. Sulph. Thuj. Veratr. Zinc. RETCHING: Aco. Ant. crud. Arg. Arn. Ars. Asar. Bell. Bryon. Canth. Chin. Cocc. Cupr. Dig. Dulc. Glonoin. Hyosc. Ipec. Lye Natrum. mur. Plumb. Pulsat. Sabin. Secale corn. Sulph. Veratr. VOMIT, inclination to: Aeon. Ant. crud. Arg. Arn. Ars. Aur. Asar. Bell. Bryon. Cann. Canth. C. veg. Cham. China. Cocc. Coffea, Croc. Cupr. Dig. Ferr. Graph. Hep. Hyosc Hell. Ign. Iod. Ipec. Kali bichr. Lye Merc. Mur. ac. N. vom. Op. Plat. Plumb. Puis. Pyro carb. Rhus. Sabina. Secale corn. Sep. 31 NAUSEA AND VOMITING. SU. Spig. Spong. Staph. Stram. Sulph. Thuj. Veratrum. —anxious: Aco. Calc. Caustic. Kali c. Lach. Lye Nitrum ac. Plumb. Sabad. A'OMITING, generally: Antim. crud. Arg. Arn. Arsen. Asar. Bar. Bell. Bryon. Calc. Camph. Cann. Can- th eir. Caps. Cham. Chin. Cina. Cocc. Coffea. Colch. Con. Cupr. Dig. Dros. Dulc. Euphorb. Ferr. Graph. Hell. Hep. Hyosc. Ipec. Iodine. Kali c. Lach. Lye Mer- cur. N. vom. Phosph. Ph. ac. Op. Plumb. Puis. Ruta. Sabin. Sec. corn. Sep. Sil. Sulph. Veratr. Zinc. —bitter: Bryo. Cann. Canth. Cham. Chin. Cocc. Cupr. Ipec. Sec. corn. Sep. Sil. Sulph. Thuj. Veratr. —bloody: Aco. Arn. Arsenic. Bry. Camph. Cann. Canth. Chin. Cupr. Dros. Ferr. Hyosc. Ipec. Lye Nux vom. Op. Plumb. Pulsat. Rhus. Sepise. Stann. Areratr. Zinc. —of brown substance: Arsenic. Bism. —bUious: Aeon. Ant. crudum. Ars. BeU. Bism. Bryo. Camph. Cann. Canth. Chain. Colch. Con. Cupr. Dig. Dros. Dulc. Hyosc. Ipec-. Iodine. Kali bichr. Lye Merc. Natr. mur. N. vom. Phosph. Puis. Sab. Sec. corn. Sep. Sil. Stann. Strain. A'eratr. Zinc. —yeUow: Arsen. Bryon. Cann. Colchic Iod. Ipec. Plumbum. Veratr. —yellow-green: Arsen. Bryon. Dulc. Ipec A'eratr. —of drinks: Ant. crud. Dulc. Ipec. —green: Aco. Ars. Asar. Bry. Cann. Chamom. Crotal. Cupr. Digitalis. HeU. Hep. Hyosc. Ign. Ipec. N. vom. Op. Plumb. Pulsat. Stram. Veratr. —violent: Cupr. Ipec Veratr. —green-blackish: Plumb. Petr. Phosph. —of urine: Op. —of faeces: Bry. N. vom. Op. Plumb. —sour: Ars. Asar. Bellad. Calc. Canst. Cham. Chin. Cocc. Ferr. Graphites. Hep. Ipec. Lye Nux vom. Op. Phosph. Psorin. Pulsat. Sabin. Secale cornut. Stann. Stram. Sulph. Veratr. —frothy: Veratr. —of mucus: Aeon. Ant. crud. Ars. Bar. Bell. Bry. Cann. Chain. Chin. Cocc. Cupr. Dig. Dulc. Fen-. Graphit. Hep. Hyosc. Ign. Ipec. Lye Merc. N. vom. Pulsat. Phosph. Sec. cornut. Sil. Stram. Sulph. Veratr. —of food: Antim. crud. Arn. Ars. BeU. Bryon. Calc. Canth. Chamom. Chin. Cina. Cocc. Coffea. Coloc. Dig. Dros. Ferr. Graphites. Hyosc. Ign. Ipec. Kali bichr. Kali c. Lach. Lycop. Merc. N. vom. Op. Phos. ac. Plumb. Puis. Pyro carb. Sabin. Sep. Sil. Stan. Sulph. Veratr. —fetid: Cupr. Ipec. Plumb. Sec. corn. Veratr. —Avatery: Asar. Bry. Cannab. China. Cupr. Dros. Ferr. Hyosc Ipec, Pulsat. Strum. Veratr. —black: Ars. Calc. Camphora. Chin. Hep. Ipec. Lye. Manciii. Nux vom. Op. Petr. Phosph. Plumb. Seealc corn. Stram. Sulph. Sulph. ac, Veratr. —of Avorms: Aco. Anac. Ars. Cina. Coff. Ferr. Hyoseyam. Merc. Na- trum mur. Sabad. Secale corn. Sil. Spigelia. Veratr. 35 XIV. STOMACH AND PIT OF STOMACH. 1. Stomach. ACIDITY: Con. Graph. Sil. Sulph. acid. Zinc. AS IF BLOATED: Alum. Bellad. Bov. Chin. Con. Croc. Dulc Ferr. Hell. Iod. Kali bich. Lye Nitr. ac. Nux mosch. Op. Petr. Phosph. Sab. Stann. Zinc. BURNING: Aeon. Ambr. Arg. Ars. Asa f. Bar. Bell. Bry. Calad. Cal- car. Camph. Canth. Caps. Carb. veg. Chin. Cic. Colch. Con. Croc. Digit. Euphorb. Graphit. Ignat. Iod. Nux vom. Petr. Phosph. Phosph. ac. Sabad. Sec. cornut. Sep. SU. Sulph. —at the pylorus: N. vom. CANCER: Ars. Lye. N. vom. —as if something alive in it: GVoc. COLD: Ars. X. vom. Puis. Veratr. COLDNESS: Alum. Arsen. Bar. Caps. Con. Graph. Ign. Natr. mur. Phosph. Sabad. Sulph. Sulph. ac CONSTRICTION: Aco..Hum. Bry. Bellad. Calc Carb. veg. Chin. Con. Cocc Euphorb. Lycop. Nux vom. Phosph. Plumb. Sil. Sulph. CONTRACTION OF PYLORUS: Ars. Euphorb. Ign. Nitr. ac. Nux vom. Phosph. Zinc CRAMP: Ars. Ambr. Ant. crud. Arn. Asa feet. Bar. Bellad. Brom. Bry. Calc. Carb. veg. Caust. Cha- mom. Chin. Cocc. Con. Cupr. Dig. Euphorb. Ferr. Hyosc. Iod. Ign. Ipec. Kali carb. Lye. Merc Natr. c. Natr. mur. N. vom. Petr. Phosphor. Plumb. Puis. Psorin. Sabad. Sec. corn. Seneg. Sep. Sil. Stann. Staph. Sulph. Sulphur, acid. Thuj. Valer. Veratr. CRAMPY PAINS: Arn. Caust. Eu- phorb.- Ign. Kah carb. Nux vom. Puis. CUTTING: Alum. Antim. cr. Ars. Asa f. Calc. Cann. Canth. Chel. Digit. Kedi carb. Petr. Phosph. Stann. Sulph. EMPTY FEELING: Alum. Bar. Bry. Carbo veg. Caust. Chin. Dig. Graph. Ign. Ipec. Iod. Kali c. Kali bichr. Lye Mur. ac. Natr. mur. N. vom. Petr. Phosph. Platin. Plumb. Rhus. Sep. Veratr. FLATULENCE, feeling of: Arnica. Ars. Croc. N. mosch. FULLNESS, feeling-of: Aco. Alum. Arn. Asa f. Asar. Bar. Bov. Calc. Canth. Carb. veg. Cham. Chin. Cocc. Ferr. Hell. Iod. Kali c. Ign. Lach. Lye. Merc. N. vom. Opium. Petr. Phosphor. Puis. Rhus. Sa- bina. Sepiae. Silicea. Stann. Sulph. Sulph. ac. Valer. GRIPING: Caustic. Euphorb. Graph. Natr. carb. Phosph. Sil. Stann. HEAT: Aco. Ars. Camph. Canth. Cocc. Con. Digit. Euphorb. Mur. ac. Plumb. Phos. Sulph. INFLAMMATION: Aco. Ant. cr. Arsen. Bell. Bry. Canth. Chin. Cic Colchic. Hyosc. Ipec. Nux vom. Phosph. Plumb. Puis. Sabad. Sec. cor. Stram. Veratr. MOVEMENTS : Cocc. Cupr. Iod. PINCHING: Argent. Arn. Asar. Bry. Canthar. Con. Croc. Dulcam. Hell. Nitr. ac. Rhus. Sep. Stann. Sulph. PRESSURE: Aeon. Agar. Ambr. Ant. crud. Arn. Anac Asa fret. Asar. Ars. Bar. BeU. Bov. Bryon. Calc. Canth. Carb. v. Caust. Cham. Chin. Cic. Cocc. Coloc. Con. Crotal. Cupr. Dig. Ferr. Hell. Hep. Ign. Ipec. Iod. KaU c. Lye. Mercur. 36 STOMACH AND PIT OF STOMACH. Mur. ac. Natr. mur. Nux vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sabin. Sec. corn. Sep. Spigel. Spong. Staph. Stram. Sil. Stann. Sulph. Veratr. PRESSURE AS FROM A STONE : Aco. Alum. Arn. Ars. Bar. Bry. Calc. Carbo veget. Cham. Dig. Ferr. Kah c. Merc. N. vom. Op. Puis. Sephe. Sil. Staph. Sulph. RUMBLING: Arn. Arsen. Croc. Graph. KaU c. Natr. c. Phos. Ph. ac. Sep. Stann. Zinc. TEARING: Arn. Ars. Puis. WEAK DIGESTION: Bar. Bryon. Calc. Canth. Carbo an. Caust. Con. Chin. Cuprum. Dig. Graph. Hyosc. Ign. Lye Merc. Natr. c. N. vom. Op. Petr. Phosph. Pulsat. Ruta. Valer. Veratr. Zinc. WRENCHING: Arn. Calc. Carbo veg. Caust. Chin. Cocc. Lye N. vom. Petr. Phosph. Puis. Sulph. Sulph. ac. 2. Pit of Stomach. ANXIETY: Ars. Bry. Calcarea. Cann. Canth. Cham. Chin. Cic. Con. Ferr. Ign. Mercur. N. vom. Pulsat. Sabad. Sabina. Sec. corn. Stram, Stann. Sulph. BURNING: Ambr. Ant. crudum. Arg. Ars. Bry. Caps. Cham. Kali bichro. Mancin. Merc. Natr. mur. Nux vom. Phosphor. Pyro carb. Sec. corn. Sep. Sil. Veratrum. Zinc. CONSTRICTION: Agar. Alumina. Asar. Calc. Carbo veg. Digit. Dros. Kali c Merc. Natrum mur. Plat. Rhus. Sulph. Zinc. CRAMP: Hyosc. Kali c Nitric ac. Phosph. CUTTING: Anac. BeUad. Bryon. Cann. Digit. Kali c Mercur. Nitr. Phosphor. Sulphur. Valer. DIGGING : Arn. Chin. Cina. Kahc. Natr. mur. Phos. Sabad. Sulph. GNAAVING: Glonoin. OPPRESSION: Ars. Ant. crudum. BeU. Bry. China. Cocc. Hyosc. Platina. Plumb. Rhus. Sec. corn. Staph. PRESSURE: Aeon. Anac Arn. Ars. Asar. Aur. Bar. Bellad. Bry. Cnjis. Carbo veget. Caust. Cham. China. Cocc. Cupr. Dig. Graphites. Hell. Hyosc. Ign. Ipec. Kali c. Lye Merc. N. vom. Natrum mur. Petr. Phosph. Plat. Puis. Rhod. Rhus. Sec. com. Sep. Spig.iStann. Staph. Sulphur. Valer. Veratr. PULSATIONS: Asa f. Cann. Cic Iod. Merc. Puis. Rhus. Thuj. SENSITIVENESS. Alumina. Arn. Bry. Camph. Canth. Carbo vege- tabilis. Cupr. Ferr. Hell. Hyosc. Kali e Natrum c. Nux vom. Sec. cornut. Spong. Stann. Veratr. STITCHES: Aconit. Anac. Arn. Bar. Bell. Bryon. Calad. Canth. Caps. Chel. China. Cocc. Coff. Cupr. Dig. Dulc. Euphr. Graphit. Ign. Iodine. Ipec. Kali e Natrum mur. Phosph. Pled. Plumb. Puis. Rhus. Sabin. Sep. Sil. Spig. Staph. Stann. Sulph. Zinc. SAVEAT: Bell. Nux vom. Secale corn. SWELLING: Ars. Aur. BeUad. Bryon. Calc. Cham. Cic. Coff. Ferr. Hell. Kali c. Lye. N. vom. Natr. mur. Op. Sabina. THROBBING : Arn. Ars. Asa f. Bell. Cann. Carbo veg. Cham. Cic. Dros. Ferr. Ipec. Phos. Puis. Rhus. Sep. Sulph. TENSION : Aeon. Anac. Arsenic Bry. Cham. Cocc. Dros. Dulc. Hep Kali c. Lycop. Mercur. Pulsat. Phosphor. Rheum. Sabin. Staphy- sag. Stann. Sulph. Veratr. XV. HYPOCHONDRIA. (L. Signifies region of the liver; ,s\ region of spleen; B. both sides.j BURNING : Aco. Alum. Bryon. Crotal. Ign. Mur. ac. Phosph. Phosph. ac. Plat. Secale corn. Sulph. —,S'..- Cann. Chel. Graph. Ign. Seneg. Spig. —B.: Laur. Kali carb. Mercur. Sulph. CONSTRICTION, L: Aco. Asa f. Asar. Dros. Ign. DISTENTION, L: Arn. Bryon. Lye Merc. Sep. —>S'.: Merc Natr. e Nitr. ae —B.: Calc. Cham. Ign. FLATULENCE: Cham. Chin. Colch. Ign. Nux vom. Puis. Veratr. HARDNESS, L.: Arn. Bryon. Calc. Cann. Graph. Merc. Mur. niagn. —S.: Iod. INFLAMMATION, L.: Aco. Bell. Bry. Canth. Cham. Cocc. Ignat. Merc. Nux vom. Puis. Sec. corn. —S.: Aeon. Ars. Dros. Ferr. N. vom. Plumb. —B.: Aco. Canth. Nux vom. PRESSURE, L.: Aco. Ambr. Arn. Ars. Asa f. Bar. Calc. Carbo veg. Camphor. Chamom. Chin. Cocc. Con. Graph. Ign. Iodine. Kali c. Lycop. Merc. Mur. magn. Natr. mur. X. vom. Petr. Phosph. Ruta. Sabad. Sabina. Sepise. Stann. Staph. Sulph. Veratr. Zinc —S.: Alum. Arn. Asa f. Bell. Camph. Cann. Chin. Con. Ign. Lycop. Mur. ac. Natrum mur. Petr. Plat. Rheum. Rhodod. Rhus. Sassap. Sepiae. Stann. Zinc. —i>\. Aco. Alum. Arn. Asa f. Camph. Caps. Cham. Chin. Cocc. Con. Ign, N. vom. Ph. ae Rhodod. See corn. Spong. Staph. Veratr. Zinc. STITCHES, L: Aco. Agar. Alum. Arn. Asa ./'. BeU. Bov. Bry. Calc. Camph. Canth. Carbo veget. Caust. Chin. Cocc. Con. Dulc. Graphites. Hyosc. Ipec. Iod. Kali c Laur. Lye Merc. Mosch. Mur. ae Natr. c. N. vom. Phosphor. Platina. Plumb. Psorin. Rhus. Sep. Sil. Sabad. Spig. Spong. Sulph. Zinc. —8.: Aco. Agar. Am. Arsen. Aur. Bar. Bry. Caust. Chin. Glonoin. Hep. Ignat. Ipec. Mur. ac. Na- trum mur. Ph. ae Plumb. Rhodod. Selen. Spig. Sil. Sulph. SWELLING, L.: Cann. China. N. mosch. —S.: Ign. N. mosch. Ruta. —B.: Aco. Alum. Arn. Arsenic. Bry. Canth. Chin. Ferr. Ipec Phosph. Plumb. Pulsat. Sil. Spig. TENSION, L.: Ars. Brom. Bry. Calc. Carbo veg. Causticum. Ferr. Lye. N. voin. Sulph. Veratr. —S.: Camph. Con. Mere Rhus. Zinc. —B.: Aco. Ant. crud. Asa f. Calc. Chain. Chin. Conium. Ferr. Hell. Lye X. Vom. Op. Puis. Staph. Veratr. WARMTH, feeling of: Sabad, XVI. ABDOMEN. Sensations. ALIATE, as of something: Cann. Croc. Hyosc. Ign. Merc. Plumb. Spong. Thuj. BALL, ascending: Aeon. Ignatia. Plumb. BLOATING: Aeon. Alum. Am- bra. Antim. crud. Arg. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc Canth. Capsicum. Carbo an. Carbo vegetal). Caust. (ham. Chin. Cic. Cina. Cocc. Coloc. Con. Croc. Cupr. 38 ABDO iMEN. ( Dulc. Euphorbium. Euphr. Ferr. Graphit. Hell. Hep. Hyosc. Iod. Ign. Ipec. Kali c. Lachesis. Lye. Merc. Mur. ac. Natr. mur. N. vom. Op. Petr. Phosph. Phos. ac Plati- na. Plumb. Pulsat. Rheum. Rhod. Rhus. Ruta. Sabina. Sec. cornut. Sep. Sil. Spigel. Spong. Stannum, Staph. Stram. Sulphur. Thuj. Valer. Veratrum. Zinc BOUNDING, as of something: Croc. BRUISING PAIN: Asa feet. Aur. Camph. Cann. Cina. Coccul. Coloc Con. (Ferr.) Hell. Hep. s. c. Ign. Nux vom. Op. Phos. Pulsa- tilla. Samb. Sep. Staph. Stram. Sulph. Valer. Veral. BURNING: Aco. Alum. (Ambr.) Arg. Arn. Ars. Asa f. Bell. Bry. Camph. Canth. Caps. Carbo vegetab. Caust. Cham. Coccul. Coloc. Cuprum. Euphorb. Euphr. Graphites. Ipec. Kali c. Laches. Merc. N. vom. Phosph. acid. Plat. Plumb. (Puis.) Rhus. Sabad. Sabin. Sec. cornut. Sep. Sil. Spigelia. Spong. Stann. (Thuj.) Veratr. COLDNESS: Alum. Ambr. Ars. Kali c. Merc. Phos. Plumb. Ruta. Secale cornut. Sulphur. Zinc. CLOTHES TOO TIGHT, as if the: Nux vom. CRAMPY FEELING: Ambr. Arsen. Carbo veget. Coccul. Coloc. Con. Graj)h. Phosph. Ph. ac. COLIC: Aco. Alum. Arn. Arsen. Asa f. Aur. Bar. Bry. Camphora. Cann. Canth. Cham. Chin. Cocc. Coff. Coloc. Con. Cupr. Digit. Euphorb. Ferr. Hell. Hep. snlpli. Hyosc. Ign. Iod. Kali c. Mur. ac. N. vom. Op. Plumbum. Puis. Ruta, Secale corn. Staph. Strain. A'eratr. CONTRACTION: Arg. Aur. Bell. Calc. Carbo an. Carbo veget. China. Coccul. Coloc. Con. Dig. Euphorbium. Ferr. Graph. Hep. sulph. Ignatia. Ipec. Kali c. Lach. Lycop. Nitric acid. N. vom. Petr. Phosphor. Ph. ac. Platina. Plumb. Rheum. Rhus. Sabad. Sabin. Sec. corn. Sep. Spig. Sulph. Thuj. CRAMPS: Alum. Ambr. Arsen. Aur. Bell. Bryon. Caustic. Chamom. Chin. Coccul. Coff. Con. Cupr. Digitalis. Euphorb. Ferr. Hep. sulph. Hyosc. Ign. Ipec. Iodine. Kali c. Mosch. Mur. ae N. vom. Plumb. Pulsat. Rhus. Sec. corn. Spong. Stann. Staph. Stramon, Thuj. Valer. Veratr. CREEPING: Asa f. Carbo veget. Caust. Chin. Plat. Stann. Zinc CUTTING: Alum. Ambra. Ant. crud. Arg. Arn. Ars. Asa f. Bar. (Bell.) Bryon. Calc. Camph. Canth. Carbo an. Carbo veg. Caust. Chain. Chin. Cina. Coccul. Coff. Coloc. Con. Croc. Cupr. Dig. Dros. Dulc. Graph. Hep. sulph. Hyosc. Ignat. Ipec. Iod. Lach, Lye. Merc. Mur. ac Natr. mur. Nitr. ac. X. vom. Op. Petr, Phosph. Ph. ac. Plat. Plumb. Puis. Rheum. Rhus. Sabad. Sabin. Selen. Sepiae. Sil. Spig. Spong. Staph. Sulphur. Valer. Verat. Zinc. DIGGING: Alum. Arn. Ars. Asaf. BeU. Calc. Cina. Coloc. Con. Dig. Dulc. Graph. Kali e Phosph. Phosph. ac. Rheum. Rhod. Rhus. Sabadilla. Sep. Spig. Spong. Stann. Valer. DRAAVING: Aco. Ars. Asa feet. Bar. Bry. Calc. Camph. Cann. Caps. Carbo veget. Chamom. Chin. Cic. Coccul. Conium. Cupr. Dros. Graph. Hep. s. c Hyosc. Ign. Iod. Lye Nitrum ac. N. vom. Op. Plat. Plumb. Puis. Rheum. Rho- dod. Rhus. Ruta. Sabin. Sep. ABDOMEN. 39' Spig. Stann. Staph. Stramon. Thuj. Valer. Veratr. DROPSY: Aeon. Ambr. Aim. Ars. Bry. Camph. Canth. China. Dulc. Ferr. Hell. Kali c. Lye. Mere Nux vom. Spong. DYSENTERIC PAIN: Arn. Bryon. Rhus. EMPTY FEELING: Ant. crudum. Arn. Carbo veg. Caust. Cham. Cina. Cocc. Coloc. Croc. Dulc. Euphorb. Kali c Lach/Merc. Mur. ae. N. vom. Phosphor. Pulsat. Rhus. Sabad. Sep. Stann. Zinc. FLATULENCE, moving about: Ant. crud. Bell. Bry. Cann. Canth. Caps. Carbo an. Caust. Chin. Cina. Coff. Croc. Dig. Euphorb. HeU. Hep sulph. N. vom. Plat. Plumb. Pulsat. Sabad. Stann. Staph. Sulph. FULLNESS: Alum. Ant. crudum. Arn. Ars. Asa f. Aur. Bar. Calc. Camph. Cann. Canth. Cham. China. Cic. Coffea. Coloc Con. Croc Dig. Ferr. Graph. Hell. Hyosc. Ignatia. Kali c. Lye. Mur. ac. Natrum mur. N. vom. Phosph. Phos. ac. Plat. Plumbum. Pulsat. Rheum. Rhod. Rhus. Sil. Spig. Spong. Stann. Sulphur. Thuj. ATaler. Zinc. GURGLING: Alum. Ambr. Asaf Carbo veg. Cham. Croc. Dig. Graph. Hell. Lye Merc. Nux vom. Ph. ac. Plat. Plumbum. Sep. Stann. Valer. Zinc. GRIPING: Aconit. Bell. Cham. Coloc. Con. Hep. s. Ipec. N. vom. Phosph. Pulsat. Sil. Stann. —colicky: Bry. Canth. Euphorb. Plumb. Ruta. Sil. * HARDNESS: Alum. Ars. Beuid. Calc. Caps. Caustic. Cham. China. Coloc. Con. Cupr. Ferr. Graphit, Hep. sulph. Hyosc. Kali c: Mere Phosph. Plumb. Puis. Sec. corn. Sep. Sil. Sulphur. Valer. Veratr. HEAT: Bellad, Bryon. Calcarea. Camph. Canth. Carb. an. Carbo veg. Cic: Cina. Digit. Euphorb. Graph. Ipec. Lye. Phosphor. Plumb. Ruta. Sil. Spong. Stann. Sulph. Zinc. HEAA1NESS: Ambr. Asa f. Aur. Bell. Camph. Ferr. Graph. Hell. (Ipec.) Mere N. vom. Op. Puis. Rhod. Rhus. Sec. corn. Sep. Staph. INACTIVITY: Champhor. Cham- om. Kali c. Nux vom. Op. Staph. INDURATION S : Ch ina. Lycop. Plumb. INFLAMMATION: Aeon. Arsen. Bellad. Bryon. Canth. Cham. Chin. Cic. Ipec. N. vom. Phosph. Plumb. Puis. Rhus. Sabina. Spongia. Stram. A'eratr. LABORLIKE-PAIN : Aco. Asa. feet. Aur. Camph. Carbo vegetab. Cham. Cina. Coff. Cupr. Ferr. Hyoscyam. Ign. Ipec. Kali c. Nux vom. Op. Puis. Rhus. Sabina. Sec. corn. LARGE: Antim. crud. Calc. Caust. Coloc. Hep. sulph. Kali e Sep. Staph. Thuj. LEAD-COLIC: Hyoscyamus. Op. Stram. MOVEMENTS, internal: Coloc. Croc. Cupr. Dig. Iod. Nux vom. Thuj. Valer. Veratr. NAUSEA : Bryon. Cic. Coccul. Croc. Cupr. Hell. Ipec. Rheum. Ruta. Samb. Silic Stannum. Staph. PAIN, diarrhceic: Ambr. Antim. crud. Arg. Asaf. Bar. Bellad. Bry. Calc. Canth. Carbo an. Carbo veg. Cham. Chin. Coff. Dig. Graph. Hell. Ign. Kali e Merc. N. vom. Nitr. ae Op. Petr. Phosph. Plat. Pulsat. Rhod. Rhus. Sabin. Sec. corn. Sep. Spigel. Staph. Vera- trum. Zinc. 40 ABDOMEN. —simple: Aco. Ant. crua. Arg. Ars. Bar. BeU. Bryon. Calc. Canth. Carbo veg. Causticum. Cham. China. Cic. Coloc. Con. Cupr. Dros. Euphorb. Euphr. Graphit. Hell. Hyosc Ign. Ipec. Iod. Kali c. Lye. Merc. Nitr. ac. Nux vom. Op. Petr. Phosph. Plat. Plumb. Puis. Rheum. Rhus. Ruta. Samb. See. corn. Sep. Sil. Spig. Stann. Sul- phur. Areratr. Zinc. PINCHING: Alum. Ant. cr. Ars. Asa f. Aur. Bar. BeU. Bry. Calc. Cann. Canth. Carb. v. Caust. Chamom. Chin. Cic. Cina. Cocc. Coloc. (Coff.) Croc. Cupr. Dig. Dros. Dulc Euphr. Graph. Hell. Hep. Hyos. Ign. Ipec. Kali c. Lye. Merc. Mur. ac. Natr. mur. Nitr. ae N. vom. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rheum. Rhus. Rut. Sabad. Samb. Sep. Silic Spigel. Spong. Stann. Staph. Sulph. Valer. Veratr. Zinc. PRESSURE: Aeon. Alum. Ambr. Antim. crud. Arg. Arn. Ars. Asa f. Aur. Bell. Bry. Calc. Camph. Caps. Carb. v. Chin. Cina. Cocc. Coff. Coloc. Con. Croc Cupr. Dig. Ferr. Hep. Ign. Iod. Kali c. Lye Merc. Mosch. Mur. ac. Nitr. ac. N. vom. Opium. Petr. Phosph. Plumb. Pulsatilla. Rheum. Rhus. Ruta. Sabad. Sabin. Samb. Sep. Sil. Spig. Staph. Valer. Veratr. Zinc. —outwards: Aeon. Asaf. Bell. Cann. Dulc. Kah carb. Lye Mercur. Nitr. acid. Nux vom. Rheum. Thuj. —inAvards: Bry. Bell. Rheum. Zinc. —as from a stone: Cupr. Hyosc. N. vom. Op. Puis. Sabad. PRESSING: Alum. Argent. Chin. Coff. Coloc Euphr. Ign. Iod. Plat. Pulsat. Ruta. Sulph. Thuj. Valer. Zinc. PULSATION: Alum. Calc. Lycop. Merc. Zinc. QUALMISHNESS : Bar. Calc Carb. veg. Ipec. Phosph. Plat. Rho- dodend. Spong. ATeratr. RING AROUND NAVEL, as if: Puis. SENSITIVENESS: Aconit. Arn. Bry. Canth. Cham. Cic. Coff. Dulc. Mosch. Pulsat. Secale cornut. Stram. Araler. Veratr. SHOCKS: Am. Cannab. Platina. Stann. SORE PAIN: Aeon. Alum. Ars. Bar. Bellad. Calc. Carb. veg. China. Cic. Coloc. Con. Croc. Euphorb. Kali c. Natr. mur. Nux vom. Phosph. Sep. Stann. Sulph. Zinc. STITCHES : Alum. Ars. Asa f. Bell. Bryon. Calc. Cann. Canthar. Caps. Caust. Cham. China. Cina. Coccul. Con. Croc. Cupr. Dig. Ferr. Graph. Hell. Ign. (Ipec.) Kali carb. Merc. Nitr. ac. Nux vom. Phosph. Phosph. ac. Plumb. Puis. Rhodod. Ruta. Sabad. Sep. Spig. Stann. Staph. Sulphur. Thuj. Veratr. Zinc. SAVELLING: Aeon. Ant. crud. Ars. Bryon. Cann. Canth. Cham. Chin. Coloc. Con. Kali carb. Op. Plumb. Sec. corn. Sulph. TEARING: Alum. Arn. Ars. Aur. Bry. Calc. Canth. Carb. an. Carb. veg. Caustic. Cham. Chin. Coccul. Coloc. Con. Dig. Hell. (Ign.) Ipec. Iod. Kali carb. Lye. Merc. N. vom. Phosph. Plumb. Pulsat. Rhus. Ruta. Samb. Sil. Spig. Stram, Thuj. Veratr. Zinc. TENSION: Aeon. Alum. Ambr. Ant. crud. Arn. Ars. Asa f. Bar. Bell. Calc. Caps. Carb. an. Carb. veg. Chin. Coloc. Graph. Hyosc. Ign. Iod. Lye. Nitr. ae N. vom. Opium. Petr. Plat. Plumb. Pulsat. Rheum. Rhododend. Sec. corn. Sep. Sil. Spong. Stann. Staph. Stram. Sulph. Thuj. ABDOI TWITCHING: Aur. Canth. Caust. Chin. Coff. Con. Dig. Graph. Ign. Kalic. Phosph. Rhus. THROBBING: Arn. Cann. Canth. Chin. Dulc Ign. Kali c. Op. Plat. Selen. ULCERS: Cupr. Plumb. ULCERATIVE PAINS: Cann. Chin. Coccul. Cupr. Dig. Hell. Merc Nitr. ac. Rhus. Sabad. Sep. Stann. UNEASINESS: Calcar. Dulc. Eu- phorb. Ipec. Kali c Nitr. ac. Phosph. Plat. Sabin. Sep. URGING: Asa f. Bell. Calc Carb. veg. Coloc Dig. Dulc Graph. Ign. Iod. Kali carb. Phosph. Puis. Sep. Thuj. WARMTH: Canth. Caps. Cina. Coff. Iod. Ipec. N. vom. Phos. Sabin. Sec. corn. WEAK FEELING: Aeon. Carb. an. (Ferr.) Ign. Phosph. Platina. Rhodod. Sen. Stann. Zinc. WRITHING: Alum. Ars. Asa f. Bryon. Calc. Caps. Cina. Con. Dros. Dulc. Mere Plat. Plumb. Rhus. Ruta. Sabad. Sabin. Silic Staphys. Valer. Veratr. Region of the Abdomen. ABDOMEN, loAver: Alum. Ambra. Ant. crud. Arg. Arn. Arsen. Asa f. Aur. Bar. BeU. Bry. Calc. Camph. Cann. Canth. Caps. Carbo an. Carb. veg. Caust. Cham. Chin. Cic. Cina. Coccul. Coff. Coloc. Con. Croc Cupr. Dig. Dulc Ferr. Hell, Hepar. Hyosc. Ign. Iod. Kali c. Lye. Merc. Natr. mur. Nitr. ac. N. vom. Phosph. Ph. ac. Plat. Plumb. Puis. Rheum. Rhod. Rhus. Ruta. Sabad. Sabin. Sambue Sep. Silic. Spigel. Spong. Stann. Staph. Sulph. Thuj. Valer. A'eratr. Zinc. —sides of: Aconitum. Alum. Ambr. men. 41 Antim. crud, Arg. Arn. Ars. Asaf. Aur. Bar. Bell. Bry. Calc Cam- phor. Cann. Canth. Caj)s. Carb. an. Carb. v. Caust. Cham. Chin. Cina. Coccul. Coff. Croc. Dig. Dros. Dulc. Euphorb. Ferr. Graphit. Hell. Hep. s. e Hyosc Ign. Ipec. Iod. Kalic. Lye. Mercur. Mosehus. Natr. mur. Nitr. ac. N. vom. Opium. Petr. Phosph. PSat. Plumb. Puis. Rheum. Rhodod. Rhus. Ruta. Sabad. Samb. Sep. Sil. Spig. Spong. Stann. Staph. Sulph. Thuj. Valer. Zinc. EPIGASTRIUM: Aco. Ambr. Ant. crud. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carbo veg. Caust. Chamom. China. Ciiia. Coccul. Coloc Con. Croc. Cuprum. Dig. Dros. Dulc Euphr. Hell. Hep. sulph. Hyosc. Ignat. Ipec. Iod. Kali c. Lycop. Mercur. Mosch. Mur. acid. Natr. mur. N. vom. Op. Petr. Phosph. Ph. ae Plat. Plumb. Puis. Rhodod. Rhus. Sabad. Samb. Sep. Sil. Spig. Spong. Stannum. Staph. Sulph. Thuj. Valer. Veratr. Zinc. LUMBAR REGION: Aeon. Ambr. Ant. crud. Arg. Arn. Aurum. Asa f. Calc. Cann. Canth. Carbo an. Carbo veg. Cham. China. Cina, Coccul. Coloc. Dig. Euphorb. Ign Iod. Kali c. Lye. Merc. Nitr. ac. Nux vom. Plumb. Pulsatilla. Rheum. Rhus. Ruta. Sab. Sec. corn. Sep. Spig. Spongia. Staph. Sulph. Thuj. Valer. Zinc. UMBILICAL REGION: Aco. Alum. Ambr. Ant. crud. Arn. Asa f. Bar. Bell. Bry. Calc Cann. Canth. Caps. Carbo an. Carbo veg. Causticum. Cham. Chin. Cina. Coccul. Coloc Con. Dig. Dulcam. Graph. Hep. sulph. Hyosc Ignat. 42 CATARRH. Ipec. Iod. KaU carb. Merc. Mosch. Mur. acid. Nux vom. Op. Phosph. Ph. ac. Platina. Plumb. Pulsat. Rheum. Rhod. Rhus. Ruta. Sabina. Sep. Sil. Spigel. Spongia. Stann. Staph. Sulph. Thuj. Valer. Veratr. Zinc. XVII. CATARRH. Sensations. CATARRH: Alum. Ambr. Antim. crud. Arg. Asa f. Ars. Bar. BeU. Bry. Calc. Camphor. Canth. Caps. Carbo vegetab. Caust. Chin. Cina. Coccul. Coloc Cupr. Dros. Euphorb. Euphr. Graphit. HeU. Ign. Iod. Kali c Lach. Lye. Merc N. vom. Natrum mur. Nitric acid. Petr. Phosphor. Ph. ac. Plat. Plumb. Puis. Rhod. Rhus. Selen. Sep. Sil. Spig. Spong. Stannum. Staph. Sulph. Thuj. Veratrum. Zinc. —on one side: N. vom. Puis. —alternately fluent and stopped: Nux vom. Puis. —in the day time: N. vom. CATARRH, generally: Aeon. Am. Camph. Coccul. N. vom. Puis- Sabad. CATARRHAL FEVER: Aeon. Bellad. Bryon. Camph. Cham. Coff. Graph. Hep. s. Mercur. Nitric ac. N. voin. Rhus. Sabad. Sep. Spig. CATARRHAL DISCHARGE DE- LAYED: Calc. CATARRHAL FEELING: Ambr. Ant. crud. Arg. Bry. Cann. Carbo an. Carbo veg. Cic. Coff. Ign. Ipec. Merc. Mur. ae Nitr. ae Phosph. Sabin. Thuj. CORYZA: Aeon. Alum. Ambr. Ars. Bar. Bellad. Bry. Calc. Camphor. Cann. Capsicum. Carb. an. Carb. veg. Caust. Cham. China. Coff. Con. Cupr. Dig. Dulc. Graphites. Hep. sulph. Ign. Ipec. KaU c. Lye. Mosch. Mur. ac. Natr. mur. Nitr. ac. N. vom, Op. Petr. Phosph. Plat. Pulsat. Rhod. Sabin. Samb. Sep. Sil. Spig. Spong. Stannum. Sulph. Thuj. Zinc. —on side: Nux vom. —of infants: Samb. —evening and morning: Nux vom. DRY NOSE: Ambr. Bar. Bellad. Bry. Calc. Canth. Cic. Con. Dulc. Graph. Hyosc. Ignat. Ipec. Lye. Merc. Mur. acid. Natr. mur. Nitr. ac. (Nuxvom.) Petr. Phosph,Rhod. Sep. Sil. Spig. Sulphur. Veratr. Zinc. DRY NOSE, without being stopped: Sep. —upper nostrils: Sabad. —front nostrils: Spig. MUCUS FROM THE NOSE, dis- charge of: Cham. Euphorb. Phos. Rhod. —arrest of discharge: Euphorb. Ph. ae Rhod. NASAL MUCUS FROM THE POSTER. NARES, corrosive. Ars. Nux vom. Nitr. ac. Sil. —smarting: Ars. Sulph. ----without catarrh: Rhus. Sabad Selen. Spig. ----involuntary: Rhus. —bloody: Ambra. Bar. Canth. Caps. Caust. (Coccul.) Cupr. Graph. Kali c. Lach. Lycop. Merc. Natr. mur. Nitrum ac. N. vom. Petr. Phosph. Ph. ac. Puis. Sabad, Sep. Sil. Spig. Sulph. Thuj. CATARRH. 43 —burning: Arsen. Pulsat. Sulph. —thick: Alum. Ant. crud. Bar. Calc. Graph. Mur. ac. Natr. mur. Nitr. ac. Puis. Sabad. Selen. Staph. Sulph. —thin: Canrph. Capsic Rhus. Staph. —transparent: Sabad. —purulent: Calc Cina. Con. Graph. Lach. Merc. Puis. ----and yeUow: Calc. Cicuta. Con. Sidph. —gelatinous: Selen. —yellow: Cic Puis. Selen. —yeUoAV-green: Natr. Phosph. Puis. Sabad. ----and bloody: Sep. —yeUowish: Alum. Ant. crud. Bar. BeU. Graph. Nitr. ac. Puis. Spig. ----and watery : Sep. —greenish: Puis. Spig. —clear: Sabad. —in little lumps: Selen, —acrid: N. vom. Spig. ----pus: Merc. — —Avater: Ars. Lach. Lycop. Mur. ae N. voin. Sil. —odor of catarrh: Puis. —suppressed: Spong. —fetid: BeUad. ( ale Caustic.Graphit. Hep. s. Lye Mercur. Nitr. ac. Puis. Sep. —indurated: Bryon. Lach. Sep. Staph. —increased: Arg. Bar. Calcar. Canth. Carbo veg. Cic Cina. Coff. Con. Euphr. Graph. Iod. Lach. Mur. ae Nux vom. Petr. Phosph. Plat. Rhod. Rhus. Sabad. SciU. Selen. Sil. Zinc. —watery: Alum. Bellad. Carbo an. China. Coff. Con. Graphit. Ign. Iod. Lach. Mercur. Mur. ac. N vom. Phosphor. Plumb. Rhus. Staph. Sulph. —white: Spig. —tenacious: Alumina. Canthar. Graph. Sabad. Sep. Spig. SNEEZING: Alum. Ambr. Ant, crud. Arg. Arn. Ars. Asa f. Bar. Bellad. Bov. Bry. Calc. Cann. Canth. Carbo animalis. Carbo veg. Caust. Chin. Cina. Coccul. Con. Croc. Dros. Dulc. Euphorb. Euphr. Graph. Hell. Hep. sulph. Iod. Ipec. Kali c. Lach. Lye Merc. Mosch. Mur. ac. Natr. mur. Nitric acid. N. vom, Petr. Phosph. Rhod, Rhus. Ruta. Sabad, Sepiie. Sil. Spigel. Spong. Stannum. Staph. Sulph. Thuj. Veratr. Zinc —troublesome: Phosph. Sulph, —racking: Sabad. —violent: Aconit. Bar. Capsic Chin. Mere Rhus. Sabad. —vehement: Cina. Puis. Rhus. Sabad. Valer. Veratr. —spasmodic: Rhus. —after tingling in nose : Ambr. Car- bo veget. Dros. Mur. acid. Nitr. ac. Puis. Spig. Zinc. —painful: Aeon. Dros. —Avithout catarrh: Alum. Ars. Calc Carbo veg. Caust. Cic. Con. Dros. Euphorb. Hyosc. Iod. Lye. Mer- cur. Nitric acid. Phosph. Stann. SL . Zinc. —dry: Chin. —excessiA'c: Bry. Merc. Sil. —suppressed: Aconitum. Alum. Carbo veg. Caust. Cocc. Natr. mur. Plumb. Sil. Zinc —desire for: Ambra. Carbo veg. Mur. ac. Phos. Sil. Sulph. Zinc. ----ineffectual: Canth. Carbo veg. Caust. Euphorb. Hell. Lye Phosph. Plat. Plumb. Sil. SNIFFLING: Sep. STOPPAGE OF NOSE: Alum. Ambra. Ant. crud. Arg. Aur. Bar. Bell. Bry. Calcarea. Carbo veg. Caustic. Cham. Chin. Cic. Cina. Con. Digit. Graph. (Ign.) Iod. Kali c. Lach. Lye. Merc. Mosch. Natr. mur. Nitr. ac. N. vom. Op. A CATARRH. Petr. Phosph. Plumbum. Puis. Rhod. (Rhus.)Samb. Sep. Sil. Spig. Stann. (Staph.) Stram. Su^dt. Thuj. Zinc. —behind: Staph. —in front: Arg. Spig. —in one nostril: Ignat. Sabad. Staph. —as from a leaf high up: Ignat. Mur. ac —feeling of: Plumb. Strain. —by ulceration every night: Lycop. Accompanying Ailments. ABDOMEN, burning on: Carb. v. —rumbling in : Phosph. —stitches in : Carb. veg. BACK-ACHE: Kali carb. CHEEKS, redness of one half: Cham. N. vom. STUPEFACTION: Hell. CHEST, simple pain in: Aconit. Bry. Caust. —roughness: Carb. veg. Sulph. —stitches: Mere —pain, as if flying to pieces: Cina. Sil. —constriction of: Phosph. CHILLINESS: Caust. Graph. Sidph. —and heat altern.: Graph. COLIC: Calc. —aching: Aeon. Canth. COUGH: Bell. Cupr. Nitr. ac. N. vom. Sul pit. —desire to, in throat: Petr. Sep. Sulph. DIARRH03A: Sep. DRAAYING IN THE ARMS: Sep. DRY LARYNX: N. vom. DRY MOUTH: N. vom. DROWSINESS: Cham. N. vom. Petr. DULL FEELING IN HEAD: Cham: Hell. DYSPNC3A: Sep. EARS, buzzing in the: Rhodod. Sep. —pains in the : Arn. Lach. Puis. EYES, paiu in the: Sep. —red: Veratr. —weeping: Alum. Carbo veget. Chin. Euphr. N. vom. Staphys. A'eratr. —lids, red: Sabad. —closed by gum : Caust. —smarting in the corners of: Carb. veg. FACE, bloated: N. vom. Staph. j —hot: N. vom. Rhodod. FEVER CHILL: Bry. Caps. Cha- mom. N. vom. Puis. Spong. I —heat: Spig. HEAD, burning in: Calc HeU.Lye. N. vom. Phosph. —simple pain in: Aeon. Byron. Calc Caust. Chin. Cic. Cina. Euphr. Graph. Hell. Kalie Lach. Lye Nitr. ae N. vom. Phosph. Puis. Rhodod. Sep. Spig. Thuj. —stitches: Sabad. —cloudiness: Staph. —contraction: Sabad. —dull: Chin. Dulc. Euphr. Hell. Lye Phosph. Rhodod. HOARSENESS: Ars. Caust. Kali carb. Nitr. ac N. vom. Puis. Spig. HOT HANDS AND FEET: N. vom. —at night: Lye LANGUOR: Graph. Sep. LIMBS, pains in the: Calc. Caust. Ipec. —distortion of: Phosph. LIPS, corrosive: Cann. —chapped: Chamom. Hell. Staph. —itching: Hell. LOSS, of appetite: Phosph. —of smell: Arn. Cina. Coccul. Hell. N. vom. Puis. Rhod. Sabad. Spig. Staph. —of taste: Puis. Sabad. NAUSEA: Graph. NOSE, sensitive: Calcar. China. N. vom. —burning: (Arn.) Puis. —inflammation: Lycop. Merc. Stann. BREATHING, 1 —biting in the: Carb. veg. Euphorb. —ulceration: Cham. —SAvelling: Bry. Cham. Puis. Rhus. Spig. —heat: N. vom. —itching: Nux vom. Sabad. Spig. ----under the nose: Hell. —titillation: Capsic Carb. veg. Nux vom. Puis. Sabad. Seji. Staph. —scraping: N. vom. —soreness: Lach. Nux vom. Puis. Spig. —sore pain: China. Nitr. acid. N. vom. Staph. NOSTRILS, ulcerated: Bry. Calc. Coccul. Ign. Lye. Merc Petr. Puis. PHOTOPHOBIA: Puis. SICK FEELING ALL OVER: Phosph. Sensations. ASTHMA: Aco. Ant. crud. Arn. Ars. Asa f. Aur. Bell. Bry. Ca'c. Capsic. Carb. anim. Carb. veg. Cham. Chin. Cic. Cina. Coccul. Coloc Con. Cupr. Dig. Dros. Euphorb. Euphras. Ferr. Graphit. Hyosc. Ignat. Ipec. Iod. Kali c. Lye. Merc. Mur. ac. Natr. mur. Nitr. ac. Nux vom. Op. Petr. Phosph. Plat. Plumb. Puis. Rheum. Rhod. Ruta. Sabin. See. cor. Sep. SU. Spic.|(Spong.) Stann. Staph. Sulph. Thuj. Veratr. Zinc. —spasmodic: Aconitum. Ambr. Caust. Cham. Chin. Coffea. Cupr. Ferr. Ipec. Kali c. Mosch. N. vom. Op. Puis. Samb. Veratr. BREATHING, moaning: Ipecac. (See also: groaning.) —Anxious: Aeon. Arn. Ars. Bellad. Bryo. Camph. Cham. Coff. Ferr. ISPIRATION. 45 SLEEPLESSNESS: Ars. SUBMAXILLARY GLAND, pains in the: Graph. THKrHS, drawing in the: Sep. THIRST : Cham. Graph. Lye THROAT, inflamed: Phosph. —creeping in: Kali e —simple pain in: Nux vom. —feeling of roughness: N. vom. Nitr. ac. Phosph. Rhodod. THROAT, stitches in: Nitr. ae —scraping in: N. vom. —mucus in: N. vom. TOOTH-A CHE: Chin. Lach. UPPER LIP, inflamed: Lye URINE, flow of: Veratr. VERTIGO : Chin. N. vom. WHINING- MOOD: Puis. Spig. YAWNING : Bry. Cupr. Hell. Hep. s. Ign. Ipec. N. vom. Op. Phosph. Plat. Plumb. Puis. Rhus. Samb. Secale corn. Spig. Spong. Staph. Strain. Thuj. —intermittent: Camph. Op. —wheezing: Cham. China. Nitr. ae —noisy: Aeon. Chin. —hurried: Ipec. Samb. —labored: Aco. Ign. Spong. —hot: Aco. Ant. crud. Bry. Brom. Cham. Coffea. Ferr. Natrum mur. Platina. Rhus. Sabad. Sulph. —cold: (Carbo vegetab.) Chin. Rhus. —cooling in trachea: Arn. —panting: Arn. Camph. Cupr. Ipec Nitr. ae. Op. Phosph. Sil. Spong. Stann. —smaU: Bell. —spasmodic: Puis. —slow: Aconit. Camph. China. Cic. Hyosc. Ign. Nux vom. Op, Spong. Staph, XVIII. BREATHING, RESPIRATION. 46 BREATHING, RESPIRATION. —loud: Aco. Cina. Op. Veratr. —Ioav : Ign. —deficient: Bell. Camph. Can- tharis. Caustic. Cic Coccul. Dig. Ferr. Hell. Ign. Ipec. Iod. Merc Nux vom. Platina. Puis. Rhus. Spig. Spong. Stann. Staph. Veratr. —faint: Chin. Nitr. ac. Opium. Phosph. A'eratr. —wheezing: Calc. —piping: Alum. Ambra. Cann. Cham. China. Cina. Cocc. Coloc. Hep. sulph. Iod. Kalic. Lye. Natr. mur. Nux vom. Phosph. Plumbum. Sabad. Samb. Sep. Spong. Sulph. —having an odor: Ars. Aur. Natrum mur. Nitr. acid. Petr. ----pungent: Dros. ----foul: Arn. Arsen. Aur. Bry. Cham, Chin. Graph. Iod. Nitr. ac. Puis. Ruta. Sabin. Sep. Spig. ----like milk : Spong. ----sour: (Cham.) Nux A'om. ----like sulphur: Nux vom. ----fetid: Aco. Ambr. Am. Aur. Bar. Bellad. Bryo. Camph. Canth. Caps. Carbo animal. Carbo vegetab. Cham. Chin. Croc. Ferr. Graph. Hyosc. Ign. Ipec. Kali e Merc. X. vom. Petr. Plumb. Puis. Rheum. Sej>. Spig. Stann. Strain. Sulph. Zinc. BREATHING, short: Aeon. Alum. Arn. Ars. Asa f. Aur. Bar. BeU. Bry. Calc. Camph. Cann. Canth. Carbo veg. Caust. Cham. Chin. Cic. Cina. Coccul. Coffea. Coloc. Con. Cupr. Digit. Euphorb. Eu- phrasia. Ferr. Hepar. sulph. Hyosc Ign. Ipec. KaU carb. Lycop. Merc. Natr. mur. Nitr. ac. N. vom. Op. Petr. Phosph. Plat. Plumbum. Puis. Rhod. Rhus. Ruta. Sabad. Sabina. Samb. Sec. corn. Sep. Sil. Spig. Spong. Stann. Stram. Sulph. Veratr. Zinc. —heavy: Aco. Alumina. Arg. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carb. veg. Caust. Chin. Cic Cina. Coccul. Con. Croc. Cupr. Dig. Dros. Euphr. Ferr. Graph. Hell. Hep. s. Hyosc Iodine. Kali c. Lye. Merc. Nux vom. Op. Phosph. Ph. ae Plat. Plumb. Pulsat. Rhod. Rhus. Sabad, Sec. corn. Selen. Sep. Sil. Spig. Spong. Stann. Staphysag. Strain. Sulph. Thuj. Araler. Veratr. —deep: Ant. crud. Arn. Aurum. Bell. Bry. Camph. Cann. Caps. Cham. Chin. Cic. Dig. Dros. Hell. Hep. sulph. Ign. Ipec. Kali c. Merc. Mosch. Mur. ac. X. vom. Op. Phos. Plat. Plumbum. Rhus. Selen. (Sil.) Spong. Stann. —disposed to draAV along: Croc. Cupr. HeU. Lach. Mosch. Rhus. Sabin. Selen. Stram. BREATH, stoppage of: Asa feet. Bell. China. Cic. Coff. Dros. Mosch, Opium. Pulsat. Ruta. Zinc. —incarceration of: Aco. Arn. Bar. Bellad. Bryon. Calc. Camph. Cann. Canth. Capsic. Carbo an. Cina. Cocc. Croc Cupr. Dros. Euphr. Ipec. Kali carb. Mosch. Natr. mur. Nitric ac. Op. Phosph. Plat. Plumb. Puis. Rhus. Ruta. Sabin. Sep. Sil. Spig. Spong. Staphys. Stram. Sulphur. Veratr. BREATHING, oppressed: Aconit. Alum. Ambr. Ant. crudum. Arg. Arn. Ars. Asaf. Aur. Bar. Bellad. Bryon. Calc. Camph. Cann. Canth. Caps. Carbo an. Carb. veg. Caust. Cham. Chin. Cina. Coccul. Coff. Coloc. Con. Croc Cupr. Digitalis. Dros. Dulc. Ferr. Graph. Hell. Hep. sulph. Hyosc. Ignatia. Ipec. Iod. Kali e. Lycop. Mere Mosch. Mur. a<: Natr. mur. Nitric ac N. vom. Op. Petr. Phosph. Phos. ac. BREATHING, RESPIRATION. 47; Plat. Plumo. Puis. (Rheum.) Rhod. Rhus. Ruta. Sabad. Sabina. Samb. Sec. corn. Sepias Sil. Spig. Stann. Staph. Stram. Sulph. Thuj. Valer. Veratr. Zinc. EXPIRATION, bloAring: Chin. —sIoav : (Arnica.) Camphora. Cham. Chin. Hell. Ign. —quick: Chin. Ign. Stram. —sniffling: Rhus. —difficult: Ipec. —strong: Caps. Chin. INSPIRATION, slow: Ferr. Ignat. Op. Staph. Stram. —stertorous: Nux vomica. Op. Puis. Rheum. —quick: (Arnica.) (Camphora.) Cham. Ign. —difficult: Chin. Cina. Coccul. Ferr. Ign. Staph. Veratr. —like urine: Graph. —rattling: Aeon. Arn. Bell. Bry- Calc Cann. Carbo an. Caust. Cham. Chin. Cina. Croc Cupr. Ferr. Hyosc. Ipec Lye. Op. Petr. Samb. Sepise. Spong. Stannum. Stram. —hiccuping: Asa f. Op. Sec. corn. —stertorous: Bellad. Cham. Chin. Coccul. Cupr. Hep. sulph. Ign. KaU c. Natr. mur. Nitric acid. Nux vom. Op. Petr. Sep. Stannum. Strain. Sulph. —painful: Aeon. Arn. Arsenic. Bry. Chin. —quick: Aeon. Asa f. BeU. Bryon. Cupr. Dig. HeU. Hep. s. Ign. Ipec. N. vom. Op. Samb. Secale cornut. Spong. Stram. Veratr. ■—sniffling: Arn. China. Nux vom. Rhus. Sabin. ^sighing: Ant. crud. Capsicum. Chin. Coccul. Op. Secale corn. Selen. Stram. EXPIRATION, groaning: Bell. Bry. Cham, Cina, Coccul, Cupr, Ign. Kali c. Mur. ac. Nux vom. Op. Sec. corn. Strain. —inequal: Coccul. Ignat. Ipec. Op. Sec. corn. —imperceptible: Veratr. —irregular: Bell. —'interrupted: Aeon. Cham. Cic, Cina. Cupr. Ignat. Op. Puis. Phosph. —suppressed; Cupr. SUFFOCATING FITS: Aeon. Ant:. crud. Ars. Bell. Bryon. Camph.. Cann. Causticum. Cham. Chin.. Coccul. Coff. Con. Cupr. Digit.. Hep. sulph. Hyosc. Ignat. Ipec. Lach. Mosch. Nux vom. Op, Plat. Plumb. Puis. Rhus. Sabad- Samb. See corn. Spong. Staph.. Sulph. Veratr. Causes of the Impeded. Respiration. ABDOMEN, flatulence: Capsic Cham. Ign. —unpleasant feel: Ars. —simple pain : Arn. Bry. Ign. Ruta. —SAvelling: Bry. —pinching: Rhus. Spig. —cutting: Puis. —weight like a stone: N. vom. —stitches: Croc Dros. Mosch. Nux vom. Puis. Ruta. —fullness: Cann. Caps. Cham. Chin. Phosph. —compression: Staph. —crying: Cupr. Rhus. Samb. —simple pain in: Stannum. —jerks in: Calc. ANXIETY: Aco. Arnica. Croc. N. vom. Puis. Rhus. Ruta. Valer. Veratr. —fits of; Ars. Lye Stann. ARMS ABOVE THE HEAD, rais- ing the: Cupr. BACK-ACHE: Arg. Cann, Lach, Ruta. Sep. (Staph.) —dislocation-pain in: Petr. 48 BREATHING, RESPIRATION. —simple pain in: Puis. Selen. ■—stitches in: Nux vom. Pids. BLADDEB, stitches in: Aur. BREATHING, nasal: Puis. CHAGRIN: Ars. Cham. CHEST, oppression in: Aconit. Arn. Cann. Cic. Cin. Coccul. Coff. Dros. Ign. Merc. N. vom. Puis. Rhus. Sabad. Spigel. A'eratr. -pressure in the: Argent. Arn. Asaf. BeUad. Camph. Cann. Caust. Cham. Chin. Cic. Ign. N. vom. Rheum. Ruta. Sabad. Samb. Spig. Staph. Stram. A'aler. —spasm in the: Petr. —empty feeling: Stann. —faintness in the: Stann. —heaA'iness in the: Plat. —tension in the: Mere Mur. ac —stitches in the: Aur. Carbo veg. Merc Stann. -—fullness in the : Sep. —contraction in the: Sep. —as if oppressed by a load: Rheum. Sabad. Spig. —ulcerative pain: Staph. —throbbing in: Asa f. —spasms in: Asa foet. Cupr. Plumb. —pressing in: Ign. Veratr. —mucus in: Cina. —pain generally: Selen. —Aveightin: Cann. Ign. Rhus. —tension in: Cann. Cic. Coccul. Puis. Rhus. Staph. —stitches in: Aeon. Arg. Asaf. Bry- on. Canth. Caps. Chin. Dros. Plumb. Ruta. Spig. Staph. Veratr. —shocks in: Cann. —fullness in: Aeon. Ant. cr. Caus. Puis. Ruta. A^eratr. —as if bruised: N. vom. —draAving in: N. vom. —contraction in: Arn. Asa f. Can- thar. Cujisic Chin. Coccul. Cupr. Hell. Ipec Moselius. N. vom. Op. Spig. Staph. Ver.ilr. COUGH; Ars. Bry. Coccul. Cuprum. Dros. N. vom. Petr. Rhus. Sil. Spig. Veratr. —dry: Cupr. Ipec. N. vom. Rhus. Sep.. CRAMP, in left side: Merc. DREAMS, anxious; Graph. —as from dust: Ipec EPIGASTRIUM, pain in: Arsenic. Coccul. Hell. Pulsat. Sep. Staph. FLATULENCE: Cham. Nux vom. Puis. HEAD, dull: Sep. —ache: Arn. HEART, stitches in the: Cham. Petr. (Puis.) —region of, pain in the: N. vom. (Puis.) HYPOCHONDRIA, swelling in: Cham. Ign. —pain in: Chin. Puis. Staph. LARYNX, mucus in: Chin. Cupr. —contraction: Sabad. Spong. LIVER, pain in: Sep. LUNGS, Aveak: Stann. MORTIFICATION: Ign. Staph. NAPE OF NECK, drawing and stinging in: Sep. NAUSEA: Rhus. Samb. NOSE, dry: Canth. ODORS, strong: Phosph. PALPITATION OF HEART: Spig. RECTUM, stitches in: Sulph. RIBS, pains under the: Sep. RISING, from abdomen: ATaler. SCAPULAE, pressure in: Rhus. —pressure when leaning against: Sep. —stitches: Puis. Sep. —dislocation-pain: Petr. —drawing: Rhus. Ruta. STITCHES IN RIGHT SIDE: Graph. SPLEEN, pain in: Ruta. —stitches in: Arn. STOMACH, anxiety in pit of: Can- nab. Ferr. Sabad. Strain. —pressure in pit oi: Arn. Bry. Camph. Chamom. Chin. Cic Coc- cul. Helleb. Hyosc. Ignat. Mosch. Nux vom. Rhus. Samb. —cranqi in pit of: Sulph. —simple pain in pit of: Arnie Cina. Helleb. N. vom. Pulsat. Ruta. Sabad. —feeling as if SAvoUen in pit of: Rhus. —stitches in pit of: Chin. Phosph. Spig. —warmth in ditto: Bry. —digging in ditto: Chin, —griping: Phosph. —pain in: Caps. Cham. Rhus. —fullness in: Chin. Coccul. LIKE VAPORS OF SULPHUR: Croc. Mosch. Character of the Cough. COUGH, in general: Aco. Ambr. Bell. Calc. Cann. Cantharis. Caps. Carbo an. Carbo veget. Causticum. Cham. Chin. Cina. Coccul, Coloc. Con. Digital. Dros. Ferr. Euphorb. Graphites. Hep. s. Ignat. Iod. Ipec. Kali e Lye. Mercur. Mur. ac. Natr. mur. Nitric ac. Op. Petr. Phosph. Phos. ae Plumb. Puis. Rhus. Ruta. Sabin. Sep. Sil. Spig. Spong. Staph. Sulph. —Avith expectoration: Ambr. Ant. crud. Arg. (Arn.) Ars. Asa f. Bell. Bry. Calc. Carbo veg. Caust. Cham. China. Cic. Cina. Con. (Croc) Dros. Euphorbium. Euphr. Ferr. Graph. Hepar s. Ipec. Kali c. Lye. Ale re N. vom. Natrum mur. Petr. Phosph. Ph. ac. Plumbum. Puis. Rheum. Rhus. Ruta. Sabad. Sabin. Secale cornut. Selen. Sep. Sil. Spigelia. Spong. Staph. Stront. Sulph. Ve- ratr. —Avith easy expectoration: Argent. Euphr. Plumb. Puis. Staph. m. 4!) TRACHEA, obstacle in: Cannab. Spong. —tickling-: Rhus. —mucus in: Cupr. Ruta. Veratrum. —contraction of: Canth. Ipec. Puis. THROAT, as if larger: ATeratr. —scraping in: Sabad. —like a plug: Spong. —constriction: Canth. N. vom. Puis. Veratr. —rising in: Cann. Stann. —like a foreign body in: Cic. —mucus in: Aur. —dryness: Petr. —constriction : Cham. Coccul, THROAT-PIT, constriction in: Rhus. —with difficult expectoration: Ambr. Ars. Aur. Bry. Camph. Cann. Canth. Caust. Cham. Cina. Dros. Euphr. Hyosc. Ign. Iod. Kali c Nux vom. Phosph. Plumb. Puis. Sep. Stann. Staph. Sulph. Zinc. —Avithout expectoration: Aconit. Alum. Ambr. Antim. crud. Arn. Ars. Asa feet. Bar. Bellad. Bry. Calc. Cann. Canth. Caps. Carbo an. Carbo veg. Caust. Cham. China. Coff. Coloc. Con. Croc. Cupr. Digit. Dros. Euphorb. Ferr. Graphit. Hell. Hep. s. Hyosc. Ignat. Iod. Ipec. Kali e Lycop. Mur. ac Merc. N. vom. Op. Petr. Phosph. Phos. ac. Plat. Plumb. Pulsat. Rheum. Rhod. Rhus. Sabad. Sep. Sil. Spi- gel. Spong. Stann. Sulphur. Veratr. Zinc. —anxious: Aeon. Cina. Coff. Rhus. —fatiguing: Cocculus. Crocus. Ipec. N. vom. Rhus. —barking: Dros. Spong. -dull: Arsen. Bar. BeU. Carbo \'eg. XIX. COUGH. 50 COtJGH. Euphorb. Hep. s. Kali c Lye Petr. Phosph. Sep. —close: Asaf. Bry. Chamom. Coc- cul. Sabad. —rocking: Antim. crud. Ipec. Puis. Rhus. —suffocative: Aco. Bry. Cham. Cupr. Ipec. Op. Spigilia. Spong. —violent: Ambra. Cina, Con. Hep. s. Ign. Ipec. Mere N. vom. Phosph. Ruta. Sabad. Spig. Spong. Stann. —hoarse: Aco. Ambr. Asa f. Brom. Chin. Cina. Drosera. Samb. Spong. Veratr. —hollow: Aco. (Bell.) Caust. Cina. Euphorb. Hepar sulph. Ign. Ipec. Opium. Phosph. Sambucus. Spig. Spong. Veratr. —hacking: Aeon. Alum. Ars. Cann. Canth. China. Coffea. Coloc Cupr. Dros. Euphorb. Hell. Hyosc. Kali c. Natrum mur. Op. Phosph. Plumb. Rhus. Stann. Sulph. Thuj. ----and dry: Alum. Arg. Am. Ars. Bell. Canth. Capsic. Carbo an. Caust. Cina. Con. Graph. Ign. Phosph. Sabad. Sabin. Sulph. Veratr. Zinc. —irritating: Coff. Ign. —spasmodic: Aconit. Ambr. BeU. Bry. Carbo veg. Chin. Cina. Con. Ferr. Hyosc. Ignatia. Ipec. N. vom. Phosph. Plumbum. Puis. Sep. Sil. Staph. —short: Aco. Alumina. Arg. Arn. Ars. Aur. Bell. Canth. Carbo vege- tabilis. Caust. Coff. Euphorb. Ign. Ipec. Merc. Mur. acid. Nux vom. Natr. mur. Phosph. Platina. Puis. Rhus. Sabad, Spigel. Spong. —scraping: Nux vomica. Puis. Sabad. —deep: Ambra. Ars. Drosera. Hep, s. Petr. Phos. Samb. Spong. Stann. Veratr. —unceasing: Cupr. Droser. Hyosc. Ipec. —titillating: Alum. Arn. Asa f. Calc. Canth. Caust. Chamom. Chin. Con. Hyosc. Iod. Kali. Merc. Nux vom. Natrum mur. Nitric ac. Phosph. Rhus. Stann. Staph. —with vomiting: Alumin, Arg. Ar- sen. Asa f. Aur. Bry. Calc. Carbo an. Carbo veget. Cina. Coccul. Coff. Dig. Dulc. Iod. Nitric ac. Phosph. Plat. Puis. Rhus. Spong. Stann. Staphys. Zinc. —whooping: Aeon. Ambra. Am. Ars. BeU. Byron. Cham. China. Cina. Con. Cupr. Dros. Euphr. Hep. s. Hyosc. Ign. Ipecac. Kali c. Mosch. Mur. ac. N. vom. Opium. Phosph. Puis. Rhus. Ruta. Sep. Spong. Sulph. ATeratr. Expectoration. ACRID: Puis. BITTER: Ars. Cham. Drosera. Ni- tric ae Puis. BLOODY: Aeon. Alum. Am. Ars. Bell. Bry. Calc. Canth. China. Cina. Con. Croc. Cupr. Daph. Dig. Dros- era. Dulc. Ferr. Hepar sulph. Hy- osc. Iod. Ipec. (Kali c) Lye. Merc. Mur. ac Nitric ac Op. Phos. Plumb. Pub. Rhus. Sabad. Sabina. Sec. corn. Selen. Sep. Sil. Staphys. Stram. Sulphur. Zinc. BLOOD, broAvn: Bry. Rhus. —thick: Cupr. —thin: Ferr. Sabin. —coagulated: Arn. Bryonia. Canth. Nux vom. Nitric acid. Puis. Sep. —bright-red: Am. Cantharis. Chin. Dros. Hyoscyam. Rhus. Sabad. Sa- bina. Sep. Sil. —frothy: A'::. Dros. Ferr. —black: Arn. Canthar. China. Croc. Nux vom. Nitric acid. Puis. BILIOUS- Puis. TASTING OF OLD CATARRH: Ignat. Puis. Sulph. Zinc COOL: Cann. Phosph. (Sulph.) COPIOUS: Alum. Bry. Caust. Cic. COTJ GH. 51 Cina. Dros. Euphr. Ferr. Graph. Kali e Lye. Puis. Sep. Sil. Stan- num. Sulph. HAYING A FOUL TASTE: Cal- carea. Carbo veg. Cham. Cupr. Ferr. Phosph. Pulsat. Sepise. Stann. Zinc. FROTHY: Op. Phosphor. Plumb. Sil. GRANULAR: Chin. Phosphor. Sep. GLOBULAR: Thuj. GRAY: Ambra. Lycop. Sepiaa. Thuj. GREEN: Ars. Cann. Carb. veg. Ferr. Hyosc Lycop. Puis. Sep. Stann. Tmj. INDURATED: Iod. INODOROUS: Arg. LEVER-COLORED: Puis. HAVING A METALLIC TASTE : Ipec. MUCUS, bloody: Alum. Am. Ars. Bry. Chin. Con. Dros. Ferr. Iod. Ipecac. Opium. Phosph. Sabin. Sec. corn. Selen. Sil. Spong. Zinc. —transparent: Ars. China. Sil. —yclow: Bry. Dros. Puis. —gray: Ambr. —blackish: Lye -dry: Bry. Plumb. —white: Ambr.Argent. Cina. Phosph. Rhus. Sep. Spong. —tenacious: Antim. crud, Ars. Bell. Bryon. Cann. Canth. Carbo veget. Caust. Cham. Coccul. Euphr. Iod. N. vom. Phosph. Puis. Ruta. Samb. Sep. Staph. Veratr. Zinc. HAWKING UP OF MUCUS: (See Larynx.) NAUSEOUS: Dros. (Puis.) PURULENT: Bell. Calc. Chin. Con. Dros. Ferr. Lycop. Kali c. Natr. mur. Phos. Ph. ac. (Puis.) Ruta. Sep. Sil. Staph. Zinc. SALT : Alum. Ambr. Ars. Bar. Cann. Carbo veg. (Drosera.) Graph. Lye. Phos. Puis. Sep. Stann. Sulph. SOUR: Calc. Phosph. Ph. ae SLIMY: Alumina. Ambr. Arg. Ars. Aur. Bar. Bell. Bryo. Cede. Caps. Caust. Chamom. Chin. Cina. (Croc) Digit. Euphr. Ferr. Hep. s. Hyosc. Iod. Ipec Merc. Mur. acid. Natr. mur. Op. Phosphor. Plumb. Puis. Rheum. Rhod. Rhus. Sabin. Sec. corn. Selen. Sep. Sil. Spigelia. Spongia. Stann. Staph. Sulph. Zinc. HAVES G A BAD SMELL: Arsen. Calc. Stann. — — taste: Ars. Stann. LIKE STARCH: Arg. Bar. SWEETISH: Calc. Ferr. Nux vom. Phosph. Stann. TASTELESS: Arg. TENACIOUS: Alum. Ars. Carbo veg.Caust.Dulc Iod. Kalie Phosph. Sep. S!ann. Zinc. THICK: Arg. Ipec. Lye. Phos. Stann. Sulph. Zinc. TITILLATING: Caust. LIKE TOBACCO : Puis. TUBERCLES, brownish: Phos. ATSCID: (Rhus.) AVATERY: Arg. AVHITISH-YELLOW: Lyc.Phosph. ae YELLOW: Ars. Bryo. Calc. Dros. Ign. Lye Phosphor. Puis. Sep. Spong. Stann. Staph. Thuj. Exciting Causes. AS FROM THE ABDOA1EN: A'e- ratr. BY OPEN AIR: Ars. Lye Phosph. IN — — : Bry. Coccul. Ipecac. N. vom. (Rhus.) Spig. BY GETTING ANGRY: (Cham.) FROM ASCENDING : Arg. N. vom. BY BARING ONE SELF: N. vom. BY DRAAVLNG A LONG BREATH: Dulc. Hep. s. BREATHING : Bellad. Coloc. Dulc. Graphit. Hepar sulph. Natr. mur. I Sulph. 62 COUGH. BY BENDING IN THE CHEST: Phos. acid. AFTER CHAGRIN: Aco. Bry.. IN COLD AIR: Aco. Br.,. Carbo veg. Hepar sulph. Phosphor. Spong. BY TAKING COLD: Bryo. Cupr. Dros, Ipec. Op. N. vom. Rhus. FROM TAKING COLD : Carbo veg. Dulc. Hep. s. Petr. Phosphor. BY CONTRACTION OF ABDO- MEN: Dros. BY GETTING COOL: Arn. Rhus. AFTER CRYING: Am. AFTER DRINKING: Aeon. Ar- senic. Bry. Coccul. Ferr. Hep. sulph. Lye N. vom. Op. (Phosph.) FROM DRINKING COFFEE: Capsic. Cham. Coccul. Ign. N. vom. FROM DRYNESS: Puis. BY FEELING OF DRYNESS: Mere AFTER EATING: BeU. Bryon. Chin. (Dig.) Ferr. N. vom. Opium. (Puis.) Ruta. Staph. Zinc. WHEN EATING: Carbo vegetabil. Coccul. (Puis.) Sep. BY EMOTIONS: Aeon. Arn. Bry. Cham. Nux vom. Op. Rhus. Staph. AFTER ERUCTATION: Staph. BY EXPIRATION: Cann. N. vom. AS FROAI FEATHER-DUST: Bellad. Calc. Cina. Ign. BY HEAT OF BODY : (Aco.) BY GETTING HEATED : Aco. Bry. Ipec. N. vom. Thuj. AS FROAI A HAIR ON THE TONGUE: Sil. HYPOCHONDRIA, irritation in: Thuj. —inspiration : Cina. Croc. Iree. Puis. ----deep: liry. Cina. Ipec. IRRITATION, generally: Aconit. Alum. Arg. Arn. Ars. Asaf. Bar. Bellad. Bryon. Calc. Cann. Carbo an. Carbo veget. Caust. Cham. China. Cina. Coccul. Coloc Con. Croc. Dig. Euphorb. Ferr. Graphit. Hepar s. Hyosc. Ignat. Iod. Ipec. Lye. N. vom. Nitric ac. Petr. Phosph. Pulsat. Rhodod. Sabin. Sep. Sil. Spig. Stann. Staph. Sul- phur. Thuj. Zinc. A'eratr. BY AN IRRITATION IN THE LARYNX: Aco. Alum. Arn. Ar- sen. Bar. Bry. Canth. Caps. Carbo an. Carbo veget. Cham. Cina. Coccul. Coff. Dros. Hep. s. Ign. Iod. Ipec. Merc. Mur. ac. N. vom. Pulsat. Sabad. Sabin. Sep. Sil. Spongia. Staph. Sulph. FROAI IRRITATION IN THE REGION OF THEJVOIDRODY: (Iodine.) Spong. FROAI IRRITATION IN THE STOMACH: Bell. Bry. Merc. BY LAUGHING: Arg. Chin. Stann. BY LOSS OF BREATH: Aur. Coccul. Dros. Euphr. Hep. sulph. Ign. Ipec. Nux vom. Spig. AFTER LYING DOAVN: N. vom. Pu's. Rhus. Ruta. Sabad. Staph. WHEN LYING DOWN : Ambr. Ars. Bellad. Cham. Coccul. Con. Dros, Ferr. Hyosc. Ignat. Ipec Merc. Phosph. Puis. Rhus. Sabad. ---in bed: Cham. Ferr. Nux vom. Puis. Rhus.] ---on the back: N. vom. ----on left side: Aeon. Bryon. Ipec. Phosph. Puis. ---on right side: Aco. Carbo an. Ipec. FROAI MENTAL LABOR: Ignat. N. vom. BY AIOTION : Arn. Ars. Bryon. Ferr. N. 'loin, BY MUCUS : Cham. Cina. Puis. BY MUCUS ON CHEST: Caustic. Stann. BY MUCUS IN TRACHEA: N. vom. FROM NAUSEA: (Bry.) N. vom. COUGH. 53 WHILE NUBSING: Chin. Ferr. DURING PREGNANCY: Ipecac. Puis. BY PRESSURE: Iod. BY READING : N. vom. BY READING ALOUD : Nitric acid. Phosph. IN REST: Caps. Dros. Euphorb. Ferr. Hyosc. N. vom. Phosph. Puis. Rhus. Samb. BEFORE RISING: N vom. IN THE ROOM: Arg. Bry. Croc. Puis. Spig. IN SCREAMING: Arn. BY SHOCKS : N. vom. WHEN SITTING: Hell. Phosph. IN SLEEP: Am. Bell. Calcarea. Cham. Lach. Nitr. ac. Sep. WHEN SMOKING: Aeon. Bryon. Coloc: Ferr. Hell. Ign. Nux vom. Petr. Spong. Staph. WHEN STEPPING INTO WA- TER: Spig. BY STITCHES: Aconit. Bryon. N. vom. WHEN STOOPING: Arg. Caust. Hep. s. Spig. BY SUFFOCATIVE FITS: Cham- om. Ipec Puis. AS FROAI A'APOR OF SULPH. Carbo veg. Chin. Ign. Lye. Puis. FROAI SAVALLOAVING: Op. FROAI TALKING: Bar. (ham. China. Hep. s. Ign. Ipec. Alere Phosphor. Stann. Rhus. WHEN TEETHING: Chamom. Cina. Hyosc. Ipec. Rhus. THROAT, as if SAvoUen : Ars. —scraping in: Ambr. Croc —roughness in: Bry. Nux vom. Plumb. Rhus. Sabad. —irritation: Coff. —scraping in: Puis. Sab. —mucus in: Caustic. Chamom. Coc- cul. Euphr. —stitches in: Cham. Stann. —dryness in: Bry. Dros. Puis. Rhus. Stann. —constriction in: Coccul. Ign. —rising in: Cham. THROAT-PIT, tickling in: Bella. Cann. Cham. Coccul. Ign. Phos. ac. Puis. —pain generally: N. vom. STOMACH, tickling in pit of: Bar. Bell. Bry. Hep. s. Natr. mur. Phosph. ac. BY TICKLING IN THROAT : Dig. N. vom. BY TITILLATION IN THROAT: Ambra. Bryon. Case. Caustic. Chin. Euphorb. Hepar sulph. Iod. Zinc. HIP, twitching in: Ars. ON WAKING: Ign. Nux voin. Puis. Rhus. WHEN WALKING: Alumina. Ars. Carbo veget. Ferr. Natrum mur. AFTER AYALKING IN THE OPEN AIR: Ferr. Ipec. WHEN GETTING WARM IN BED: Cham. N. vom. Puis. BYAVEAKNESS: Stann. WORSE BY COUGH: Ign. BY YAAVNING: Arn. N. vom. Accompanying Ailments. ABDOAIEN, pain in: Dros. Lye N. vom. Phosph. Ph. ac. Sil. ATe- ratr. —cutting in: Areratr. —stitches in: Ars. Sep. Veratr. -shocks in: Natr. mur. —bruised in: Arsen. N. vom. Puis. —contraction: Dros. —pain in muscles of: Hyosc. —stitches in sides of: Arn. ABDOA1INAL RING, stitches in: A'eratr. ANXIETY: Aeon. Cina. Coffea. Rhus. ASTHAIA: Am. Carb. v. Canst. Coccul. Dig. Euphorb. Ferr. Ipec. 54 COUGH. Natr. mur. Phosphor. Rhodod. Rhus. Sep. A'eratr. BACK, stitches in: Aco. Chin. Merc. Puis. Sep. BLADDER, pain in: Caps. BREATHING, breath, hot: Ant. cr —snorting: Chin. —fetid: Caps. —want of: Ferr. Ipec. —incarceration of: Aeon. Arn. Bar. Bryon. Calc. Cina. Cupr. Ipec. Merc. Nat. mur. Sil. Spig. CATARRH: Bell. CERVICAL GLANDS, pain in: Natr. muriat. CHOKING: Carbo veget. Droser. Hep. sulph. Ipec. N. vom. Puis, Sep. Sulph. CHEEKS, drawing in: Carb. veg. CHILLINESS : Calcar. Carbo veg. Con. Phosph. Sulph. COLIC: Ambr. Arsen. Canth. Coloc, Con. Droser. (Ferr.) Ipec Lycop. N. vom. Phosph. Sep. St ami. Ve- ratr. CONCUSSING THE BODY: Ant, cr. Ipec. Puis. Rhus. CONSCIOUSNESS, loss of: Cina CONSUMPTION: China. Ferr. A vom. Puis. CRYING : Arnie Bellad. Cini Hep. s. CHEST, oppression in: Rhus.A'eratr. —burning in: Ant. crud. Carb. ve,-; Caust. Cina. Ferr. Phos. Ph. ae Spong. —pressure in: Carb. veg. Chin. Iod. Ph. ae Sil. —as if shaken: Rhus. —ulcerative pain : Staph. —as if hollow: Sep. Zinc. —itching: Ambr. —coldness in : Zinc. —cramp in: Cina. —scraping in: Ruta. Staph. —roughness: (Arn.) Carb. veg. carl). Lye. Sep. —rattling: Bell Caust. Cham. COUGH, —pains generally: Ambr. Ars. Bel- lad. Carb. veg. Caustic Cham. Cina. Coff. Dig. Dros. Kali carb. Lye Merc. Mur. ac. N. vom. Nat. mur. Nitr. ac. Phosph. Ph. ac. Puis. Sep. Spong. Sulph. Veratr. —reheved by pressure: Phosph. —cutting: Natr. mur. Sulph. —excoriated, as if: Carbo. veg. Lye Phosph. Sep. Spong. —heaviness: Zinc. —tension in: Phosph. Rhus. —stitches in: Aco. Am. Ars. Bell. Br\. Cann. Chin. Coff. Con. Dro.s\ Merc. Nux vom. Natr. mur. Pulsat. Rhus. Sabad, Sep. Zinc —fullness: Sabin. —qualmishness: Rhus. —as if sore: Alum. (Arn.) Bar. Carb. veg. Caust. Cina. Hepar sulph. Ipec Lye Mur. ac Nux vom. Nitr. acid. Phosph. Sep. Silic Spig. Spong. Stann. Sulph. —pain as if bruised: Arn. —as if flying to pieces: Arsen. Bry. Caps. Merc. Zinc. —drawing: Caps. —contraction: Dros. EAR-ACHE: C-ps. (N. vom.) EPYGASTRIUM, pain in: Ambra. Di os. N. vom. —stitches in: Sep. ERECTIONS: Cann. Canth. ERETHISAI, vascular: Am. Chin. ERUCTATIONS : Ambr. Veratr. EYES, obscured: Coff. —sparks before: Kali. —tears in: Cina. Puis. Sabad. FACE, blue: Ipec. Op. A'eratr. — pale: Cina. —hot: BeU. Ipec. Sulph. —«weat in: Ipec. —distorted: Spong. FAUCES, burning in: Caust. Ph. acid. COUGH. 55 —sore feeling in: Caust. FALLING DOWN: Ipec. FOREHEAD, cold sweat on: Veratr. HANDS, swelling of: Aeon. —coldness of: Sulph. HEAD, pressure in: Alum. Bry. Con. Nitr. ac. Phosph. Ruta. —as if shaken: Rhus.. —haat in: Ars. Ipec. Sulph. —tearing in: Alum. Calc. Sep. —pain generally: Aco. Bell. Bry. Chin. Con. Lye Sabad. —stitches in: Alum. Arn. Bry. Calc. Carb. veg. Con. Ruta. Sabad. —shocks in: Arsen. Ipecac. Lye. Natr. mur. Rhus. —as if bruised: Sulph. —as if flying to pieces: Bryon. Caps. Merc. Nux vom. Natr. mur. Phosph Ph. acid. Sep. Sulph. —contractive pain in: Petr. HEAT : Arn. Bell. Nux vom. Sabad. HOARSENESS: Aco. Ambr. Asa feet. Chin. Cina. Droser. Samb. Spong. Stann. A7erat. ILL-HUMOR: (Bell.) (Spong.) LARYNX, ulcerative pain in: Car- bo veg. —crawling: Sabin. —irritation in: Coccul. —pain generally: Spong. —stitches: Kali c. Phosph. —as if sore: Arg. Bry. Carbo veg. Hep. sulph. Ign. Kali c. Natr. mur. Sep. LARYNX, as if torn: Staph. LLAIBS, pain in: Caps. MOUTH, dry: Coccul. NAPE OF NECK, pain in: Bell. NAUSEA: Bryo. Caps. Drosera. Ipec. Merc N. vom. Puis. Ruta. NOSEBLEED: Aco. Dros. Merc. Puis. PAIN IN ARAL Dig. Puis PALPITATION OF HEART: Ar- nic. Calc. PAIN AS FROM HERNIA: Petr. —as from fatigue: Puis. —generally: Ambra. Droser. N. \;m. —tension: Hell. —stitches: Aco. Ars. Bryon. Phosph. Sabad. Sulph. —as if bruised: Bry. —contraction in: Dros. —hip: Ars. BeUad. Caustic Rhus. PRESSURE IN HYPOCHON DRIA: Coccul. Spong. Valer. PENIS, pain in the: (Ign.) PTYALISAI: Veratr. BECTUM, stitches in: Nitric ae RESTLESSNESS: Aconit. Coff. Samb. RIBS AS IF BRUISED: Arn. SALIVA, bloody: Dros. JCREAMTNG: Op. Samb. SHORTNESS OF BREATH: Bry. SHOULDER, stitches in: Puis. blade, stitches in: Mercur. Sep. SIDE, stitches in: Aco. Bry. Puis. Zinc. SLEEPLESSNESS: Hyosc. Lycop. N. vom. Puis. Rhus. Sabad. SNEEZING: BeU. Bryo. Hepar sulph. SAIALL OF BACK, pain in: Alere —stitches in: Aco. Arn. Nitric acid. SPERMATIC CORD, stitches in: Veratr. START, tendency to: Aco. STERNUM, pain of: Bell. Chin. Sep. Sil. STOAIACH, pressure in: Lye —pain in: Bry. HeU. Ipecac. Lye Phosph. Puis. Rhus. Ruta. Sabad. Sep. —pressure in pit of: Phosph. —simplepain: Sepia'.. Stannum. Thuj. —pain generally : Ambr. Bryo. Ipec —stitches: Ars. Bry. Phosph. Sulph. -qualmishness: Ign. sore pain: Bry. —as if bruised: Stann. —contraction: Ars. 56 LARYNX AND TRACHEA. SUFFOCATIVE FITS : Aco. Bryon. Cham. Cupr. Hep. s. Ipec. Op. Spig. Spong. SWEAT : Ars. Dig. Hep. sulph. Ipec. Rhus. Sabad. Spong. TASTE IN MOUTH, as of blood: BeU. Rhus. —bad: Caps. TEETH, gritting of: Bell. TOOTH-ACHE: Lye TREA1BLING OF WHOLE BODY: Phosph. TESTICLES, pain in: Zinc. THROAT, bitter taste in: Rhus. —burning in: Mur. ac. Phosph. —pressure in: Caps. —inflammation: Aco. Cham. Ipec. Nnx A'om. Puis. —ulcerative pain: Caps. —as if swollen: Caps. Puis. — itching: Ambr. —titillation: Bry. Kali c. —scraping: Ambr. Bell. Bry. Croc. Hep. s. —roughness: Carbo an. ('aust. Hep. s. Kali c. Phosphor. Rhod. Sep. Spong. —pain generaUy: Caps. Hepar s. Natr. mur. Phosph. Sil. Sulph. —stitches in: Bryo. Nitric acid. Phosph. —dryness: Puis. Rhus. —sore pain: Ambra. Phosphor. Hip. THROAT-PIT, pain in: X. vom. THROBBING IN ARTERIES: Calc. THYROID GLAND, itching in: Ambra. —CARTILAGE, titillation in : Puis. TOSSING ABOUT: Aeon. Arn. TRACHEA, itching in: Ambr. N. vom. —tickling in: Cham. Sabin. —pain generally: Camph. Chin. Ign. N. vom. Spong. —shocks: Bry. Cina. —as if sore: Ant. crud. Bryon. Cann. Caust. Chin. Nux vom. Natr. mur. Plumb. Stann. —as if torn: Staph. ULCERS, pain in: Con. UMBILICUS, pain in: Ambr. URINATE, urging to: Ipec URINATION, involuntary: Antim. crud. Bry. Puis. Spong. Staph. Veratr. URINE, retention of: Ipec. VERTIGO: Aco. Coff. AOMITING, in general: Arnica. (Bell.) Bry. Calc. Capsic Carbo v.cy- Con. Cuprum. Dros. Hep. s. Iod. Ipec. Kali c. Nux vom. Phosph. ac. (Puis.) Sabad. Sep. —bitter: Ch tin. Sep. —of food: Bryo. (Dig.) Dros. Ferr. Natr. mur. (Rhus.) —of mucus: Dros. Hyosc. — sAveet: Calc. —of A\ater: Dros. AVATERBRASH: Amb. Ars. Bry. Spig. Staph. AVEAKNESS : Chin. Ferr. Veratr. YAWNING: Op. XX. LARYNX AND TRACHEA. Sensations. 1. Larynx. AIR, rising of: Lye APHONIA: Bell. Carb. yes. (aust. Hep. sulph. Merc. Natr. mur. Phos. Plat. BURNING: ( -nth.Chainom. Sponfi. CHOKING: Cupr. Dros. CONSTRICTION: Camphor. Cham. LARYNX AND TRACHEA. 57 Coccul. Coff. Ipec. Mosch. N. vom. Plumb. Puis. Spong. Veratr. CONTRACTION : Spong. CONTUSIA'E PAIN: Ruta. COUGH, desire to: Aeon. Arnica. Bry. Canth. Caps. Chain. Cina. Coccul. Coff. Droser. Ign. Ipec. N. vom. Puis. Sabad. Sabin. Spong. Staph. CRAAIPY FEELING: Cham. Nux vom. CRAWLING: Sabin. CROUP, gangrenous: Chin. —membranous: Aco. ('ham. Dros. Lach. Samb. Spong. DRYNESS: Alum. Carb. an. Con, Hyosc Nux vom. Natr. mur. Petr. Phosph. Spong. Sulphur. Zinc. FOOD GETS INTO THE LAR- YNX: Aco. Cann. Rhus. A'eratr. HAWKING UP AIUCUS : Alumina. Ambr. Ant. crud. Arg. Aur. Bryon. Calc. Camph. Cann. Canth. Carb. an. Caust. Cham. Chin. Cina. Coc- cul. Croc. Dig. Dulc. Hyosc. Iod. Kali c. Lach. Lye. N. vom. Natr. mur. Phosph. Plumb. Rhod. Rhus. Sabad,. Sabin. Samb. Selen. Spig. Stann. Staph. Sulph. A'aler. HEAT: Ant. crud. Canth. Iod. HOARSENESS: Aeon. Alumina. Ambr. Arn. Ars. Asa f. Bell. Bry- on. Calc. Camjih. Canth. Cups. Carb. an. Carb. veg. Caust. Cham. Chin. Cic. Coff. Con, Croc. Cupr. Dig. Dros. Ferr. (..ir^b. Hep. Ign. Iod. Kali c. L . Stannum. Staph. Veratr. Zinc. AS IF GONE TO SLEEP : Aler- cur. Phosph. RIGIDITY: Ang. Petr. SHUDDERING: Ang. Bell. Canth. Chel. Cocc. Dnult. Colchic. Graph. Lach, Led. Natr. mur. Nux vom. Puis. Rhus. Sabad. Staph. Sulph. Thuj. SPASM: Agar. Bell. Iod. Lye. SPOTS : Sep. Carbo veg. STIFFNESS : Agar. Alum. Carb veg. Canst. Kali. Led. Nux vom. Petr. Pulsatilla, Sep. Sulph. STITCHES: Aeon. Ant. crud. Ar- gent. Arn. Asa f. Bry. Calc. carb. Cann. 'Caps. Caust. Chin Colch. Con. Cycl. Dros. D::1. . Hep. Kali. Lachesis. Lycop. Aluriatic acid. Natr. Oleand. Platina. Plumb. Puis. Rhus. Rhod. Sabin. Spig. Sil Stann. Thuj. Valer. Verb. SAVEAT: Chin. Ipec. Lye Nux vom. Phosph. Pulsat. Sepia-. Stram. Sulph. SAVELLING: Baryt. Bell. Puis. Staph. TEARING AND DRAAYING : Aco- nit. Ars. Bell. Bry. Calc carb. Canth. Caps. Carbo veg. Caustic. Cina. Cham. Cocc Ferr. Hep. Kali. Lach. Led. Lyc. Mang. Ale/. Natr. Natr. mux. N. vom. Op. Phosph. Puis. Rhus. Sep. Sil. Stann. Strum. Sulph. TENSION: Amm. mur. Bell. Con. Hep. Mosch. Natr. Natrum mur. Sulph. Zinc TETANUS: Ang. Cicut. Nux vom. Op. Petr. Plumb. THROBBING: Baryt. Lye Phos. Puis. TREMBLING: Coff. Mere TUBERCLES: Ant. crud. Caust. WARMTH, feeling of: Carbo veg. Coff. Laur. AYEAKNESS : Agar. Arn. Curb. veg. Lach. Lye Nitric ac N. vom. Pe- trol. Phos. Plat. Sulph. Sec. corn. 3. Small, of the back. BORING: Aeon. BURNING: Aeon. Mur. ae Nux vom. Phosphor. Rhus. Sepia?. Thuj. CHILLINESS : Lach. Lycop. Puis. Sabin. COLDNESS: Carbo veg. Spong. —feeling of: Hell. CONTUSIA'E PAIN: Arn. Ruta. CRACKING: Sulph. Zinc CRAWLING: Alum. Menyanthes. Sassap. CRAMPY FEELING: Bryon. Caust. Chin. Nux vom. CUTTING: Aur. BeUad. Canthar. I Natr. Natr. mur. Puis. Zinc. | ERUPTION: Calc. carb. Natrum. | Sep. Thuj. GNAAVING: Amm. Canth. Phos. | Sulph. STOOL AND ANFM. 73 GRIPING: Cham. Graph. Alere ITCHING: Carbo veget. Caust. Kali. Alere Natr. mur. JERKS : Asar. Bry. Chin. Rhus. LAMENESS: Cocc Dub: Lach. Natr. mm: Nux vom. Selen. Sil. NUA1B FEELING: Carbo veg. Plat. Spong. AS IF FLASHING THROUGH : Natrum mur. PAIN, as if dislocated: Agaric Arn. Rhus. Sulph. — —sore: Caust, Natr. Sulph. ae ----bruised : Aco. Alum. Amm. mur. Arg. Am. Aur. Bryon, Caust. Cham. Cina. Graph. Ign. Lach. Alagn. mur. Nux mosch. Nux vom. Platina. Rhus. Ruta. Stront. Sulph. Tliuj. Veratr. —simple: Aconit. Agar. Amm. mur. Arn. Baryt. Bov. Bry. Cede. carb. Carbo an. China. Kali. Ign. Ipec, Led. Lycop. N. vom. Puis. Petr. Rhod. Rhus. Ruta. Sabadilla. Sepise. Stront. Sulph. Zinc. PRESSURE: Aeon. Bryon. Carbo veg. Caust. Graph. Kah. Lach. Lye Men, Mosch. Nitric acid. Puis. Rims. Sep. Spong. Staphys. Sulph. Veratr. PULSATIONS: Caust. Natr. mur. Constipation. 1. C.i .r.wt'rof Stool. ACRID: Ars. Bry. Cham. Lach. Merc Puis. Veratr. ASH-COLORED: Asar. Dig. BILIOUS: Arsen. Chamom. Chin Dulc. Ipec. Merc. Puis. Sulph. Veratr. BLACK: Ars. Calc. c. Camph. Chin. Cupr. Hep. Merc Op. Squill Stram. Veratr. SPASMODIC PAIN: Bellad. Cocc. Sil. Sulph. STIFFNESS: Aeon. Ambra.Amm. mur.Baryt.Bell.Bry. Carbo veget. Caustic. Kali. Lach. Lycop. Pulsat. Rhus. Sil. Sulph. STITCHES: Aeon. Ambra. Anac. Arg. Arn. Bell. Bry. Canthar. Carbo veg. Carbo an. Caust. Chin. Cocc. Con. Graph. Ign. Iod. Lach. Lye. Magn. carb. Alere Natr. Natr. mur. Nux vom. Phos. ae Puis. Rhus. Sab. Sep. Sil. Stront. Tart. Thuj. TEARING AND DRAAYING: Alum. Ars. Baryt. Bry. Calc. carb. Canth. Carbo veg. Caustic. Cham. Chin. Cocc Hep. Kali. Kreos. Lach. Lye Natrum mur. Nux vom. Phosph. ae Rhus. Sab. Sep. Sil. Sponga. Stann. Strain. Stront. TENSION: Aeon. Barit, Carbo veg. Caustic Nitric ae Nux vom. Sil. Thuj. THROBBING: Graphit. Ign. Nux vom. Natr. mur. Sej). TWITCHING: Calc. carb. Caustic. Chin. Con. Puis. Staph WEAKNESS : Ars. Cocc. Lach. Alere Natrum mur. Nux vom. Phosph. Sep. BLOODY: Ant. crud. Arn. Ars. Asar. Bry. Canth. Carb. veg. Chin. Cupr. Dulc Ipec. Lye Merc. Nitr. ac. N. mosch. N. vom. Phosph. Puis. Rhus. Sep. Sil. Sulph. acid. Tart. Veratr. BLOOD, lined with: Alum. Ambr. Con. Bry. Ipec. Mere Nux vom. Puis. Rhus. Thuj. BROWN: Arnic Bryon. Chin. Mer- XXIV. STOOL AND ANUS. 74 STOOL AND ANUS. cur. Rheum. Sec. Squill. Sulph. Veratr BRIGHT-COLORED: Anac. Carbo veg. Caust. BURNING: Ars. Lach. Mere. CADAVEROUS SMELL: Bism. Carb. veg. Stram. CLAYEY: Calc. Carb. CONSTIPATED: Aeon.Amm.mur. Arn. Aur. Bar. Bell. Bry. Calc. carb. Cann. Canth. Carbo veg Caustic, Cham. Chin. Cina. Coccul. Coloc. Con. Crot. Daph. Ferr. Graph. Hep. Kali bieh. Lach. Laur. Lyc. Merc. Mosch. Natr. mur. Nux vom. Op. Plat. Plum. Puis. Rhodod. Rhus. Sabad. Seneg. Sep. Sil. Spong. Stajdi. Stram. Sulph. Thuj. Veratr. Zinc. DIARRHCEIC: Aeon. Amm. mur. Ant. crud. Ant. carb. Ars. Asa feet. Aur. BeU. Bism. Bry. Calc carb. Calad. Caps. Carb. veg. Carb. an. Chamom. Chin. Coloc. Cicut. Cocc Coffea. Cupr. Dulc. Ferr. Graph. Hep. Hell. Hyosc Ign. Ipec. Lach. Lyc. Magn. carb. Merc. Natr. Natr. mur. Nitr. aeid.'N. mosch. N.vom. Op. Petr. Phosph. Phosph. ac: Puis. Ran. seel. Rheum. Rhodod, Rhus. Sabad. Sec. Sepise. Spigel. Spong. Squill. Stann. Staph. Stram. Sulph. Tartar. Valer. Veratr. Zinc. DIARRHCEA, from cold: Bell. Bry. Cham. Dulc. Merc. Nux vom. Puis. Rhus. Sulph. —after drinking beer: Ferrum. Rhus. —after eating: Arsen. China. Coloc. Lach. —after getting heated: Bryon, Coff. Nux, vom. —after a fright: Aco. Op. Verat. —after a fit of joy: Coff. Op. —with vomiting: Antim. tart. Ars. Asar. Cupr. Ipec. Nux vom. Phos. Rheum. Veratr. —after eating fruit: Ars. Chin. Puis. —after eating milk: Bry. Lyc. Sulph. —after a cold drink: Ars. Bry. Carb. veg. Puis. —after drinking: Arsen. Caps. N. vom. —of children: Cham. Ipecac. Mere Rheum. Sulph. —chronic: Arsen. Calc. Canth. Chin. Graph. Ipec. Nitr. ac. Phosph. Rhus. Sulph. —nocturnal: Ars. Bry. Cham. Chin. Dulc Kali. Merc. Phosphor. Puis. Rhus. Sulph. Veratr. —dysenteric: Ars. Caps. Carb. veg. Coloc. Chamom. Colchic. Aleve. N. vom. Op. Pulsat. Rhus. Sulph. Ve- ratr. —frothy: Calcar. carb. China. Rhus. Sulph. —painless: Arsen. Carbo veg. Cha- mom. Chin. Ferr. Hyosc. Lyc. Alere Op. Phosph. Sec. Sulph. Stram. —watery: Ant. crud. Ant. tart. Ars. Calc. Carb. Caps. Cham. China. Cupr. Ferr. Helleb. Hyosc. Ipec Natr. mur. Nux, vom. Petr. Phosph. Ph. ac. Puis. Rhus. See cor. Sulph. Tart. Veratr. —spirting: Ars. Merc. N. vom. DIFFICULT: Amm. mur. Anac. Ant. Arn. Aur. Bar. Bry. Canth. Carb. v. Chin. Cocc. Graph. Hep. Ign K.ali. Lyc. Magn. mur. Natr. mur. Nux mosch. Nux vom. Oleand. Petrol. Phosph. Plat. Pul- sat. Rhodod. Ruta. Sassap. Silic. Staxdi. Sulph. Thuj. FERMENTED: Ipec. FETID: Ars. Bry. Calc. Carbo veg. Chin. Lach. Merc Nitr. acid. Puis. Sil. Sulph. WITH FLOCKS : Ipec Veratr. HAVING A FOUL SMELL : Ars. Bry. Carb. v. Cham. Chin, Nitr. ac. N. vom. Sec. cor. Sulph. STOOL AND ANFM. 75 FREQUENT, too: Anac. Arn. Ars. Bellad. Calc. carb. Caps. Cham. Chin. Cocc. Coff. Coloc. Dulc. Ferr. Graph. Ignat. Natr. mur. Nitr. ac N. vom. Phosph. Ph. ae Petr. Puis. Ran. seel. Rhus. Silic. Thuj. Valer. GRAYISH: Asar. Digit. Mercur. Phosph. ac. Rheum. GREENISH: Arsen, Aur. Bellad. Cham. Cupr. Dulc. Ipec. Merc. Phosph. Phos. ae Puis. Stann. Sulph. Veratr. HARD: Agar. Amm. Amm. mur. Ant. crud. Asa foet. Aur. Bar. Bell. Bry. Calc. carb. Cann. Carb. veg. Caustic Cham. Cina. Coccul. Con. Daph. Graph. Hyosc. Guaj. Hep. Ign. Kali. Laur. Led. Lycop. Magn. mur. Merc. Natr. mur. N. vom. Op. Petr. Phosph. Phosph. acid. Plumb. Puis. Rheum. Rho- dod. Rhus. Ruta. Sabad. Sec. corn. Selen. Sep. Sil. Spong. Stann. Staph. Sulph. Sulph. acid. Thuj. A'eratr. Verb. HARD AND LOOSE ALTER- NATELY : Ant. cmd. Ars. Iod. N. vom. INSUFFICIENT: Anac. Alum. Arn. Ars. Calc. Chin. Daph. Hep. Kali. Lach. Lyc. Mur. magn. Natr. N. vom. Sep. Sil. Sulph. INVOLUNTARY: Aeon. Arn. Bell. Calc. Chin.Hyose.Iia.ch.. Nat. mur. N. vom. Op. Phosph. ac. Rhus. Sec. corn. Sulph. Veratr. —at urinating: Mur. ac. —during sleep: Arn.Puis. Rhus. LEAD-COLORED: Plumb. LOOSE: Ant. cmd. Canth. Chin. Ign. Merc. N. mosch. Rheum. Sep. Sulph. LUMPY: Agar. Bar. BeU. Graphit. Lach. Magn. mur. Nux vom. Op. Plumb. Sil. Sulph. Sulph. ac Thuj. PAPESCENT: Agar. Antim. crud. Am. Awi f. Bell. Chin. Daph. Dros. Euphorb. Lach. Mezer. Nitr. Phosph. ac. Puis. Rheum. Rhod. Selen. ,S'v7. Sulph. Tart. PITCH, like: Hep. Lach. Merc. Sassap. PURULENT: Arn. Canthar. Iod. Lach. Merc. Sulph. SHEEP-DUNG, like: Brom. Magn. mur. Plumb. SLIMY: Agar. Amm. m. Ant. cr. Arn. Ars. Asar. Bell. Bor. Canth. Caps. Cham. Carb. veg. Coloc. Chin. Colch. Dulc. Graph. HeU. Hyosc. Kali. Ipec. Merc. Mur. magn. Natr. mur. N. vom. Phosph* Ph. ae Puis. Rhus. Ruta. Sec. Spig. Stann. Staph. Sulph. Tart. Veratr. SMARTING: Merc. Puis. SMELLING SOUR: Calc. carb. Chamom. Dulc Hep. SOFT: Aeon. Amm. mur. Antim. crud. Bryon. Calc. Carb. an. Carb. veg. Chin. Cocc. Coff. Con. Dros. Dulc. Graph. Guaj. Kali. Alur. ac. Natr. mur. Nitr. Nitr. ac. Phosph. Ph. ac. Puis. Rhodod. Sep. Sulph. Veratr. Viol, trie Zinc. STIRRED EGGS, like: b Chamom. Chin. Merc. N. mosch. Pulsat. Rhus. Sulph. A'iol. trie TENACIOUS: Ars. Caust. Hell. Kali. Laches. Mercur. Plumb. Zinc UNDIGESTED : Antim. crud. Arn. Arsen. Bryon. Cham. Chin. Ferr. Lach. Mere Nitr. ac. Oleand. Phosph. Ph. ac. Sulph. Veratr. WITH T^NIA: Calc. Carb. veg. Filix m. Graph. Magn. mur. Merc- N. vom. Petrol. Sabad, Sab. Stann. Sulph. Valer. WITH ASCARIDES: Aconit. Asar. Calcar. Cham. Chin. Cina. Ferr. Ignat. Mere N. vom. Squill. Spong. Sulph. Teucr. 76 STOOL AND ANT'S. WITH LUMBRICI: Aconit, Anac Bell. Calc. carb. Cham. Cicut. Cilia. Graph. Lycop. Merc Natr. mur. Nux vom. Ruta. Sabad. See corn. Spigel. Sulph. A'al. WHITISH: Aeon. Ars. Caustic. Cham. Chin. Colch. Digital. Iod. Mere. Nux vom. Plumb. Phosph. Pulsat. Rhus. Sec. Spong. Sulph. Veratr. YELLOWISH: Ars. Asa foet. Calc. carb. Chamom. China. Coloc Cocc. Dulcam. Merc Petr. Phosph. Puis. Rhus. A'eratrum. 2. Accompanying Ailments. a. BEFORE STOOL. BACK-A CHE: Veratr. COLIC: Agar. Amm. mur. Ant. tart. Ars. Asar. Bry. Canth. Chin. Croc Dig. Kali. Ignat. Laur. .Merc. Nitr. Nux vom. Petr. Puis. Rheum. Rhus. Stann. Stajdi. Sulph. Verat. CHILLINESS: Mercur. Nux vom. Yeratr. DREAD OF MEN: Ambr. FLATULENCE, distress from: Agar. Amm. mur. Arn. Calc. phosjth, Dulc Ferr. Phosph. Ph. ae Puis. Spig. Stront. HEAT: Alere Phosph. NAUSEA: Aeon. Rhus. Veratr. PAIN'S IN THE ANUS: Carbo anim. Colchic. Kali. Lach. Oleand. Phosph. Plat. RECTUA1, pain in: Nux vomica. Puis. Rhus. SAIALL OF BACK, pain in: Dulc. Sulph. PROSTATIC JUICE, discharge of: Selen. Sulph. Ph. ae RUSH OF BLOOD TO THE HEAD: Opium. SCREAMING OF CHILDREN: Cham. Rheum. Rhus. SWEAT: Aeon. Bell. URGING TO STOOL: Cocc. Con. Lach. Merc. Rhus. Sil. Staphys. Thuj. A'OMITING : Ant. tart. A'eratr. b. DURING STOOL. BACK-ACHE: Puis. CHILLINESS: Veratr. COLIC: Agar. Amm, mur. Anac. Ant, crud. Arn. Ars. Asa foet. Bry. Calad. Canth. Carbo an. Cham. Cupr. Dulc Drosera. Ferr. Graph. Hep. Ignat. Ipec Kali. Merc. Natr. mur. Nitric ae Nux vom. Phosphor. Plumb. Puis. Rheum. Rhus. Sep. Spig. Sulph. Sulph. ac A'eratr. DROWSINESS: Nux mosch. FAINTING: Petr. Sassap. Spig. FLATULENCE, discharge of: Calc. carb. Calc. phosph. Cocc Sab. Staph. —distress from: Amm. muriat. Arn. Hyosc Nux vomica. Sab. Spong. HEAT: Rhus. Sulph. LABOR-LIKE PAIN: Op. NAUSEA: Ant. tart. Ars. Asar. Cupr. Hell. Merc Nitric acid. Prun. Sulph. Veratr. PALPITATION OF HEART: Ant. tart. Nitric acid. PROSTATIC JUICE, discharge of: Ign. Phosph. ae Sil. RECTUM, pain in: Asar. Culcur. Merc. Magn. mur. N. vom. Puis. Sab. Sulph. A'eratr. —falling of: Ars. Asar. Calcar. Daph. Ignatia. Alere. Nux vom. Puis. Ruta. Sepiae. Sulph, RUMBLING IN BOWELS: Ar- senic Calc carb. Lycop. Olean- der. Phosph. Phosph. acid. Sulph. acid. RUSH OF BLOOD TO THE HEAD: Rhus. SHUDDERING: Bell. Nitric acid. Rheum. Veratr. SWEAT: Bell. Mercur. Stramon. Veratr, STOOL AND ANUS. 77 TENESAIUS: Aeon. Ars. Colch. Laur. Merc. Nux vom. Op. Rhus. Selen. Sulph. A'eratr. THIRST: Ars. Cham. Chin. A'ARICES, protrusion of: August. Kali. Merc. Nux vom. VERTIGO: Cham. Veratr. VOMITING: Arg. Ant. tart. Ars. Cupr. Kah bichr. Ipec. Rheum. Sulph, Veratr. WEAKNESS, feeling of: Veratr. C AFTER STOOL. ANIXETY: Caust. AS IF BRUISED: Calc. CHILLINESS : Canth. Alezer. Puis. CHILL : Daph. Alez. Plat. COLIC: Agar. Amm. mur. Anac. Carbo veget. Con. Dros. Dulc. Iod. Kali bichr. Lyc Nux vom. Natr. mur. Op. Phos. Pulsat. Rheum. Stann. Sulph. Veratr. CONGESTION OF THE HEAD: Lach. DROWSINESS: Nux mosch. ERUCTATION'S: Baryt. Alere FLATULENCE, discharge of: Agar. Calc Carbo veget. Hep. Lyc Nux vom. Phosph. Puis. Sulphur. Thuj. HEAD-ACHE: Ambr. Sab. Sil. LANGUOR: Arn. Ars. Bry. Calc. carb. Chin. Colic Cuprum. Daph. Ferr. Hyosc. Ipec Lach. Lyc. Phosph. Puis. See. com. Veratr. AIUCUS, discharge of: Asarum. Merc Phosph. Stann. NAUSEA: Aeon. Caust. Veratr. SAIALL OF BACK, pain in: Puis. PALPITATION OF THE HEART: Caustic. Con. RECTUAI, pressure in : Hellebor. Ignat. —pain in: Cham. Nux vom. —constriction of: Nux vom. —prolapsus of: Merc SAVEAT: Aeon. Caust. TENESAIUS: Capsic. Ipec. Merc. Nitr. Phosph. Rheum. Rhus. Sulph. Staph. THIRST: Caps. VERTIGO : Carbo an. Zinc. VOAIIT1NG: A'eratr. 3. Anus, irilh rectum and perineum. a. ANUS AND RECTUM. BLEEDING BETWEEN STOOL: Alum. Ant. crud. Caps. Carbo veg. Merc Phosph. Puis. Sabin. Sep. Stram. Sulph. BOEING IN THE RECTUAI: Va- ler. BURNING IN THE ANUS: Am- nion, mur. Ant. tart. Ars. Baryt. Bov. Bry. Caps. Carbo anim. Carbo veget. China. Cocc Coloc. G-raph. Iod. Ipec Kali. Laur. Merc. Mur. ae Natr. Natr. mur. Nitric ac N. A'om. Oleand. Phosph. Puis. Sepice. Stront. Sulph. Thuj. A'erat. —in the rectum: Alumina. Aur. Ars. Calc Carbo an. China. Con. Eu- phorb. Lyc Alur. ac. Magn. mur. Nntr. mur. Nitric ac. Petr. Phosph. Puis. Sep. Stront. Sulph. Veratr. CONTRACTION: Camph. Conium. Natr. mur. Nux vom. Op. —in annus: Alum. Ang. Carbo an. Cocc. Graph. Ign. Nitric ac. Nux vom. Plumb. Sec Sep. Sulph. —in rectum: Amm. Bell. Calc. Chin, Coloc Ferr. Ign. Nu.r vom. Phosph. Sep. Thuj. CREEPING : Calc Colchic Croc. KaU. Natr. Nux vom. Plat. Rhus. Sabad. Sep. Zinc CUTTING IN ANUS : Arsen. Chin. Caust. Kali. Laur. Lyc. Natr. Nux vom. Phosph. Staphys. Sulph. —in rectum: Canth. Canst. Chin. Lyc Mang. Nux vom. Phosph, Sep' Sulph. DRAAYING IN: Ilumb. EXCORIATION: Cham. Graph, 78 STOOL AND ANNUS. —in anus : Alum. Amm. Arsen. Graph. Hep. Merc Nux vom. Phosph. Puis. Sassap. A'eratr. —in rectum : Camph. Natrum mur. Phosph. Ph. ae Puis. FIGAVARTS: Nitric acid. Sabina. Thuj. FISTULA RECTI : Calc. Caust. Petr. SU. Sulph. GNAWING: Ang. Merc. Phosph. HEAT: Canth. Con. HERPES: Natr. mur. ITCHING IN ANUS : Aeon. Alum. Ambr. Ant. crud. Baryt. Bell. Bry. • Calc. Carbo veg. Caust. Chma. Cina. Croc. Euph. Ign. Kali, Lyc. Merc. Nitric ac Nux vom. Op. Phosphor. Platin. Rhus. Sabad, Sassap. Sep. Sil. Stann. Staph. Sulph. Teuc. Thuj. Zinc —in rectum: Aco. Ambr. Asar. Bell. Cic <'in. Chin. Euphorb. Ferr. Ign. Nitric ac Nux vom. Ruta. Sabad. Sep. Sil. Spigel. Stann. Sulph. Teuc Valer. MUCUS, discharge of, betAveen stool: Antim. Caps. China. Colchic. HeU. Graph. Mere. Phosph. Puis. Rhus. Sep. Spig. Sulph. Tart. PAIN, simple: Aconit. Canthar. Car- bo an. Caust. Lye Merc. Natr. mur. Nux vom. Phosph. Seneg. —in rectum: Aeon. Ambr. Camphor. Merc. Alagn. mur. Sep. PINCHING: Alere Natrum mur. Sabad. PRESSURE IN ANUS: Aeon. Baryt. Calc. Cyclam. Laur. Nitric ae. Nux vom. Petr. Phosphor. Puis. Seneg. Staph. —in rectum: Arn. Bell. China. Kali. Lyc. Nitric ac Nux vom. Opium. Phosph. Sen. Stann. RECTUAI, prolapsus of: Antim. crud. Ars. Asar. Bry. Colch. Dulc Ign. Lach. .Merc. Natrum muriat. Nux vom. Ruta, Sep. Sulph. REAIAINING OPEN, always: Phos. SORENESS: Am. Carbo an. Cau- stic. Hep. Graph. Merc Nitric ac. Phosph. Sep. Sulph. —pain as of: Amm. Ars. Caust. Graph. Hep. Ign. Alur acid. Natr. mur. Nux vom. Phosph. Puis. Sep. Spongia. Sulphur. A'eratr. SPASAI, (in anus): Colch. Lach. Kali bichr. —in rectum: Calc. Caust. Chin. Colch. Lach. Lye SPHINCTER ANI, lameness of: Bell. Cole Hyosc. STITCHES IN ANUS: Aeon. Ars. Bry. Canth. Carbo an. Carbo veg. Chin. Con. Croc. Graph. Ign. Ipec Kali. Lye Natrum. Natr. mur. N. vom. Phos. Phosph. ac. Plat. Ran. bulb. Sab. Sep. Sil. Sulph. —in rectum: Alum. Ant. tart. BeU. Boa\ Carbo an. Caustic. Chin. Graph. Ign. Lyc. Magn. mur. Natr. mur. Nux vom. Phosph. Puis. Ru- ta, Sep. Sil. Sulph. Valer. SAVELLING: Camph. Graph. Hep. Ign. Nux vom. TEARING IN THE ANUS : Colchic. Daph. KaU. Nux vom. Phos. ac Sep. Thuj. —in rectum: Carbo veg. China. Lyc. Kali. Nux vom. Phosph. ac. Ruta. Sabad. TENESMUS: Aeon. Arn. Arsen. BeUad. Bov. Calc Canthar. Caps. Colch. Daph. Euphorbium. Hep. Ipec. Kali. Laur. Merc. Natr. Ni- tric ac. Nux vom. Phosph. Plat. Rheum. Rhus. Ruta. Sep. Staph. Sulphur. Veratr. Zinc. THROBBING: Graf, Lach. Natr. mur. TORPOR: Alum. Carb. veg. Chin, Ign. Kali. Lycop. Natr. mur. Nux vom. Op. Ruta. Sep. Staph. Thuj. Veratr. ULCERS: Caust. Sassap. URINE AND URINARY ORGANS. 79 URGING TO STOOL : Alum. Anne. Am. Ars. Asa f. Bar. BeUad. Calc Camph. Canth. Carb. v. Caustic Coccul. Colch. Coloc Con. Ferr. Graphit. Hepar. Hyosc. Ign. Kali. Lach. Lye Merc. Magn, mur. Na- trum. Natr. mur. Nitr. ac. N. mosch. N. vom. Petr. Phos. Puis. Rheum. Rhodod. Rhus. Ruta. Sabad. . an. Lach. —with falling of rectum: Ruta. AI r • —at night: Merc Puis. Sulph. — ,vith erections: Thuj. —painful: Ars. Caust. Sulph. —ineffectual: Aeon. Anac Am. Asa f. BeH. Calc. Carb. Caps. Carb. veg. Caust. Coccul. Colch, Con. Graph. Hell. Ign. Lach. Lyc. KaU bich. Merc. Magn. mur. Natr. Natr. mur. Nitr. ae Nux vom. Phosph. Plumb. Pulsat. Rheum. Rhus. Ruta. Sa- bad. Sassap. Sep. Sil. Spig. Stann. Staph. Stram, Sulph. Thuj. Veratr. A'ARICES: Ambra. Amnion, mur. Anac Antim, crud. Ant. tart. Ars. Bar. Bell. Brom. Calc Caps. Carb. an. Carl), vcir. Caust. Coloc. Ferr. Graph. HI1. Tgnat. Kali. Lach. Lyc. Alagn. Alere Mur. <7<*. Natr. mur. Nitr. ae Nux vom. Phosph. Ph. ac. Plumb. Puis. Rhus. Sabin. Sep. Sil. Stram. Sulph. Sulph. ac. Thuj. —protruding: Calc Caustic. Ferr. Graph. Merc. Puis. Sep. Sulph. Thuj. —witheohc: Curb. veg. Nux vom. Sulph. -blue: Carb. veg. Mur. ae —blind: Ars. Cham. Ign. Nux vom. Puis. Sulph. A'eratr. —bleeding: Aconit. Amm. Antim. crud. Bell. Calc. Caps. Carb. veg. Chin. Cupr. Ferr. Ipec Ign. Mere Nux vom. Phosph. Puis. Sab. Sep. Stram. Sulph. -burning: Ant. crud. Arsen. Calc carb. Caps. Carb. an. Graph. Nitr. <: com. Sep. Squil- la. Sulph. Zinc. BROAVN: A< on. Ambr. Am. Ars. Asa f. Bell. Bry. Calc. Caust. Colch. Dig. Merc. Nitr. j:c. Petr. Phosph. Rhodod. Puis. Sep. Sulph. Tart. Valer. BURNINO ; Aeon. Arsen,', Camph. Cann. Canthar. Caps. Creos. IVrit. Hep. M r<: Phosph. Staph. A'eratr. BLACKISH- Colch. CAT'S URINE, smelling like: Viol. tart. —like garlic : Phosph. —sour. Ambr. Calcar. Graph. Men: Natr. —pungent: Asa'f. Bor. Men: —like sulphur: Phosph. —foul: Carbo veg. Dulc Alere Xitr. in: Phosph. ac Puis. Rhod. Sulph. Viol. trie. —like Aioiets: N. mosch. Tereh. CLEAR: Amm. muriat. Euphr. Hy- osc Laches. Nitr. Squill. Stramm. COLD: Agar. Nitric acid. COLORLESS (see pale): Puis. COPIOUS: Aeon. Alum. Ambra. Amm. mur. Arg. Arn. Ars. Aur. Baryt. Bell. Bism. Bryo. Canth. Carbo veg. Carbo an. Chin. Cicut. Clem. Coloc. Creos. Cycl. Daph. Digital. Euph. Guaj. Hyosc. Ign. Iod. Laur. Led, Lycopod. M. arct. Merc. Mur. ac. Natrum. Nitric Oleand. Petr. Phosph. Phosph. ac Pulsat. Rhus. Sab. Sassap. Selen. Senega. Spig. SquUla. Staph. Sulph. Tar. Thuj. Valer. Verat. Verb. Vi- ola trie. Vit. LIKE CURD : Ambr. Cina. DARK: Aeo. Ant. tart. Arn. Asa f. Bell. Bry. Carbo veg. Chin. Colch. Dig. Hell. Hep. Iod. Ipec. Lach. Lycop. M. arct. Alere Nit/ic acid. Op. Phosph. Rhus. Selen. Sej>. Staph. Sulphur. Tart. Veratr. DFMINISHED: Aco. Agar. Ambr. Animon. mur. Ant. tart. Am. Ars. Aur. Bell. Bry. Calcarea carb. Cann. Canth. Carbo veg. (aust. Cham. Chin. Coccul. Coff. Colch. Con.( upr. Daph. Dig. Dulc Graph. Grat. Hell. Hep. Hyosc. Iod. Ipecac Kali. Laur. Led. Lyc Alere Mur. acid. Nitric en: Nux mosch. Nux vom ica. Op. Petr. Phosph. Phosphoric ac. Plumbum. Puis. Ruta. Sabad. Sas- saji. Sec. com, Selen. Seneg. SquU- la. Stannum. Staph. Strum. Stront. Sul[ih. Veratr. Zinc. FIBRES, full of: Cann. FIERY: Aeon. Bry. Cann. Colch, Plumb. LIKE FLOUR: Calc. Graph. Mop. Natrum mur. FROTHY: Lach. Laur. Lycopod. Seneg. GREENISH: Ars. Camph. Iodine. Kali. Rhod. Ruta. Veratr. HOT: Aeon. Am. Bry. Canthar. Cham {Colchic. Dulcam. Hep. Lach. Nitric ac. INODOROUS: Ambr. Dros. LIGHT-YELLOW: Ambra. China. See corn. LITTLE AT A TIME: Aconit. Agar. BeU. Cann. Canth. Caust. Colchic Dig. Euphorb. Hell. Hyosc. Iod. Kali. Laur. Led. Merc Nitric ac. Nux vom. Op. Petr. Phosph. Puis. Rhus. Ruta. Sil. Staph. Sulph. Tart. A'eratr. LOAAl-COLOIXD: Anac Canthar. Ign. Sabad. Sassap. Sep. Sulphur. Zinc. URINE AND URINARY ORCtANK. 81 MILKY : Aur. Carbo veg. Dulc Iod. Phosph. ac. OPALESCENT: Iodine. Phosphor. Puis. PALE : Agar. Alum. Arn. Aur. Bell. Bism. Canth. Chel. Chin. Cocc. Colchic Coloc. Con. Creos. Dig. Hep. Ignat. Iod. Lach. Laur. Mur. acid, Nitr. N. jugl. Nux vom. 01. an. Par. Phosph. Phos. ac. Pulsat. Rhod. Rhus. Sassap. Secale corn. Staph. Stram. Strontia. Sulph. Sulph. ae Zinc. PURULENT: Cann. Canth. Clem. Lyc. Nux vom. Sabin. Sep. RED: Aco. Ant. crud. Antim. tart. Arn. Bell. Bry. Calc. Camph. Cann. Canth. Carb. veg. Chin. Colch. Coloc. Con. Dig. Hep. Ipec. Kali bichr. Merc. Nux vom. Op. Phos. Plumbum. Puis. Sassap. Sep. Sil. SquiUa. Staph. Sulph. SEDIAIENTOUS: Aconit. Alum. Ambr. Ant. crud. Arn. Arsen. Aur. Baryt.Bry. Calc. carb. Camph.Cann. Canth. Carbo an. Carbo veg. Caust. Cham. Chin, Chinin. Cicut. Col- chic. Coloc. Con. Creos. Dulcam. Graph. Hep. Hyoscyam. Iod. Ipec. Kali. Lach. Laur. Lol. tern. Lyc. Mang. Mercur. Mezer. Natr. mur. Nitr. Nitric ac Nuxmosch. Oleand. 01. an. Opium. Petr. Phosph. Phosph. ac. Puis. Rhus. Ruta. Sas- sap. Selen. Seneg. Sepia). Sil. Spong. SquiUa. Sulph, Sulph. ac Tar. Thuj. Valer. Zinc. SEDIAIENT, blueish: Prun. —bloody: Aconit. Calcar. carb. Cann. Canth. Caps. Coloc. Dulc Lyc Merc. Phosphor. Phosph. ac. Puis. Sep. Sulph. Sulph. ac. Zinc. —brown: Ambr. Lach. Valer. —thick: Camph. Laur. Mercur. Se- cale corn. Spong. Sulphur. Valer. —dark: Iod. —purulent : Canthar. Clem. Con. Lyc. Puis. Sep. —fibrous: Cann. Canth. Cham. Men Mezer. Sassap. Seneg. Tart. Zinc. —flocculent: Cannab. Cham. Merc. Nitr. Nitric ac. Seneg. Tart. —gelatinous: Puis. —yelloAV: Ammon. mur. Bry. Cham. Chin. Cupr. Lyc. Phos. Sil, Spong. Sulph. Sulph. ac. Zinc —of yellow sand: Sil. —gray: Ant. tart. Con. Spong. —gravelly: Ambra. Ant. crud. Calc carb. Canth. Chin. Lach. Lyc. Natr. mur. Nitric acid. Nux mosch. Nux vom. Op. Phosph. Puis. Ruta. Sas- sap. Sep. Sil. Thuj. Valer. Zinc: —clayey—Amm. m. Anac. Kali. Sas- sap. Sep. Sulph. Sulph. ac. Zinc. —floury: Ant. tart. Calc Graph. Mere. Hyos. Natr. mur. Phosph. ac. Tart. —reddish: Aeon. Ambr. Amm. mur. Ant. crud. Arn. Ballad. Canth. Chin. Coloc. Con. Creos. Dulc. Graph. Iod. Ipec. KaU. Lach. Lyc Afang. Mez. Natr. mur. Nitr. ac Op. Petr. Phosph. Puis. Sec. corn. Selen. Sep. Sil. Squill. Thuj. Valer. - -like blood: Amm. —like red sand: Natr. mur. Nitr. ac. Sil. —slimy: Ant. crud. Ars. Aur. Bry. Calc. carb. Carb. veg. Caust. Chin. Cina. Coloc Con. Dulc. Hep. Ipec. Merc Natr. Natr. mur. Nitr. acid. N. vom. Phosph. Phosph. ac. Puis. Rheum. Sassap. Seneg. Sulphur. Valer. -turbid: Alum. Con, Rhus. Zinc. violet: Puis. —Avhitish : Amm. Baryt. Bell. Calcar. Canth. Caps. Colch, Coloc Con. Dulc. Graph. Hep. Ignat. Nitr. ac. Oleand, Petr. Phosph. Phosph. ac. Prun. Puis. Rhodod. Rhus. Sep. Spig. Spong. Sulph. Valer. Zinc. 82 URINE AND URINARY ORGANS. —whitish-turbid: Con. Rhus. —cloudy: Alum. Ambr. Bryon. Caust. KaU. Laur. Alere Nitr. Petr. Phosph. a<: Plat. Seneg. Thuj. Valer. —brick-dust: Aeon. Arn. Chin. Ipec. Puis. TENACIOUS: Canth. Cupr. Creos. Dulc. Phosph. ae THICK: Camph. Con. Dulc. Iod. Nux vom. Plumb. Sabad. Seneg. Sulph. ac. TURBID: Ambr. Anac. Ant. tart. Ars. Aur. Bell. Cann. Canth. Car bo an. China. Chlorof. Cina. Clem. Colch. Coloc. Con. Cycl. Dig. Dulc Hep. Ignat. Iod. Kali. Lach. Lyc-. Merc. Mosch. Mur. ac. Nitr. acid. Phosph. Plumb. Pulsat. Rhus. Sabad. Sassap. Sep. Sulph. Sulph. ac. Valer. Veratr. Zinc —becoming: Ambr. Ang. Arn. Aur. Bry. Caust. Chain. Cina. Con. Dig. Graph. Hep. Iod. Laur. Mercur. Mezer. Nitr. Petr. Phosph. ac. Rhus. Sassap. Seneg. Sepia*. Sulph. Thuj. Valer. WHITISH: Ang. Arn. Aur. Cann. Carb. veg. Cina. Con. Iod. Merc. Phosph. Ph. ac. Rhus. Sassap. Sulph. WHITISH-YELLOW: Amm. Phos. AVHITISH-GREEN: Camph. WHITISH-TURBID: Cann. China. Con. YELLOW: Ant. crud. Arn. Ars. Bell. Bry. Canth. Cham. Chin. Daph. Hyosc. Iodine. Ipec. Lach. Led. Magn. m. Nitr. Petr. Rheum. Samb. Sassap. Veratr. Zinc. 2. Urine After Stool. BURNING URINE: Cann. Canthar. Caps. N. mosch. Puis. Staph. Veratr. DIABETES : Aeon. Argent. Bell. Cann. Cupr. Clem. Dig. Hyosc. Led. Nitr. ac. Pulsat. Rhus. Squill, Stram. Tar. Veratr. —with emaciation: Merc. —Avith head-ache: Veratr. —Avith back-ache: Phosph. ac. —Avith sweat: Aeon. Bell. A1ICTURITION, nocturnal: Agaric. Ambr. Amm. mur. Anac. Arn. Ars. Bry. Bov. Calc. Canth. Con. Graph. Iod. Kali. Lach. Lyc. Natr. Natr. m. Nitr. ac. Puis. Rhus. Ruta. Sep. Sil. Stront. Sulph. Thuj. Zinc. —too frequent: Aeon. Anac. Ant. cruel. Arg. Arn. Ars. Aur. Bar. Bell. Bry. Calc. carb. Calc. phosph. Camph. Can. Caps. Caust. Chel. Chin. Coff. Con. Creos. Cyclam. Daph. Euphorb. Graph. Hell. Hyosc Ign. Iod. KaU. Laches. Led. Lyc. M. austr. Merc. Mur. ac: Natr. Natr. mur. Nitr. N. vom. Oleand. Petr. Phosph. Phosph. ac. Plumb. Rhus. Sassap. Selen. Sil. Spig. Spong. Squill. Staph. Sulph. Tar. Thuj. Valer. Veratr. Verb. r—difficult : Aeon. Agar. Bellad. Camph. Cann. Canth. Cic. Dig. Euphorb. Hyosc. Hep. Nux mosch. Op. Phosph. Plumb. Sec. corn. Thuj. —too seldom: Aeon. Agar. Ammon. mur. Apis. Am. Arsen. Aur. Bell. Bry. Camph. Canthar. Carb. veg. Chin. Cic. Colch. Cupr. Dig. Graph. Hep. Hyosc. Iod. Laur. Led. AI. austr. Mane Merc. Nitr. ae N. vom. Op. Phos. Plumb. Puis. Ruta, Sec. corn. Squill. Staph. Stram. Sulph. ac. Verat. —drop by drop: Agar. Am. Bell. Camph. Cann. Canth. Caps. Caust. Chin. Clem. Colchic. Con. Dig. Dros. Dulc. Euphorb. Graph. M. austr. Alere. N. mosch, Nux vom. Petr. Phosph. ac. Puis. Rhus. Ruta. Sil. Staph. Strum. Sulph. Thuj. URINE AND URINARY ORGANS. 83 —interrupted: Agar. Carb. an. Caust. Clem. Con. Dulc. Led. M. austr. Op. Phosph. acid. Puis. Sulph. Thuj. Zinc. —involuntary: Aeon. Ant. tart. Arn. Ars. BeU. Bry. Calc. Canthar. Carb. veg. Caust. Chin. Cic. Cina. Creos. Dig. Dulc. Ferr. Hep. Hyosc. Iod. Lach. Laur. Led. Lyc. M. austr. Merc. Natr. mur. Nitr. ae Nux vom. Petr. Phosph. ac. Puis. Rhus. Ruta. Sep. Sil. Spig. Squill. Stram. Sulph. Veratr. ----when coughing: Bry. Caust. Natr. mur. Veratr. —at night, in bed: Aeon. Ars. Bell. Bry. Carb. v. Caust. Cham. Cina. Con. M. austr. Natr. Op. Puis. Rhus. Ruta. Sep. Sil. Stram. Sulph. ----in the first sleep: Sep. —in the day-time: Ferr. ISCHURIA: Aconit. Agar. Arn. Aur. Bellad. Camph. Cann. Canthar. Chin. Cic. Coloc. Con. Dig. Eu- phorb. Graphit. Hep. Hyosc. Laur. Lycop. Nitric ac. Nux vom. Ojj. Plumbum. Pulsat. Ruta. Sabina. Stram. Sulph. Veratr. Zinc STREAAI, double: Canth. —thin: Camph. Canth. China, Led. Mercur. Puis. Spongia. Staph. —scattering: Cann. Canth. —slow: Camph. Alere Plat. —strong: Agn. Cic. Vit. TENESMUS OF BLADDER: Aco- nit. Arn. Camphor. Cann. Canth. Caps. Colch. Mere Nux vom. Puis. Sabin. Sassap. SquiUa. Sil. Viol. trie URGING TO URINATE: Aeon. Agar. Alum. Ambra. Ammon. mur. Ant. tart. Arg. Arn. Ars. Bar. Bell. Bor. Bovist. Bry. Calc. carb. Cann. Canth. Caspic. Carbo an. Caust. Chamom. Cicut. Cocc. Colchic. Coloc: Con. Copaiv. Creos. Dig. Dulc. Euphorbium. Graph. Guaj. Hell. Hyosc. Ignat. Iod. Ipec. Kali. bichr. Lach. Lycop. M. austr. Mur. magn. Men. Merc. Mur. ac. Natr. Nitric, ac. N. jugl. N. vom. Petr. Phosph. Phos. ac. Plumb. Puis. Rhod. Rhus. Ruta. Sabadilla. Sabina. Sambue Sassap. Selen. Sep. Sil. Spig. Squill. Stann. Staph. Sulphur. Tar. Tart. Thuj. Veratr. Zinc —Avith scanty discharge: Aeon. Anac. Ant. crud. Antim. tart. Bell. Bry. Calc. carb. Cann. Canth. Caps. Carb. veg. Caust. Cocc. Colch. Cuprum. Con. Digit. Dros. Euphorb. Hell. Hyosc. Iod. Led. M. austr. Men. Merc. Natr. Nitric ac. Nux mosch. Nux vom. Petr. Phosph. Phosph. acid. Plumb. Puis. Ruta. Sabad. Samb. Sassap. Staph. Sulph. Ve- ratr. —Avith copious discharge: Agar. Alum. Ant. tart. Arg. Ars. BeUad. Bism. Carbo an. Cin. Calc. Cycl. Creos. Lach. Mur. ae Natr. mur. Rhus. Spig. SquiUa. Stann. Sulph. Tar. Verb. Viol, trie —irresistible: Baryt. Bell. Bry. Calc. Chin. Ign. Merc. Nitr. ac. Phosph. Phosph. acid. Pulsat. Rhus. Ruta. SquiUa. —ineffectual: Aco. Arnica. Camph. Canth. Caps. Caust. Cham. Chin. Dig. Hell. Hyosc Mere Mur. acid. Nux vom. Petr. Ph. ac. Plumb. Pulsat. Sabina. Sassap. Sec. corn. Sep. SquUl. Sulph. 3. Accompanying Ail- ments. a. Before urination. BURNING IN THE URETHRA: Arn. Cann. Natr. Nux vom. Puis. Zinc. Si URINE AND URINARY ORGANS. CUTTING IN THE URETHRA: Canth. —in the abdomen ■ Puis. DRAWING IN RENAL REGION : Clem. —in penis: Cic. GENERALLY: Arn. Bor. Bryon. Bellad. Canth. Chin. Cic. Coloc. Creos. Digit. Dulc. Hep. Nux vom. Phosph. ac Plumb. Puis. Rhod. Rhus. Sulphur. Tar. PAIN IN THE BLADDER: Nux A'om. SORE PAIN IN URETHRA: Oop. Nux vom. Phosph. STINGING IN THE BLADDER: Canth. TEARING IN THE GLAN'S : Chin. b. During urination. BUBNING IN BLADDER: Aconit. Camph. Lach. Staph. — in urethra: Ambra. Ars. Bar. Calc. Cann. Cmth. Canst. Cham. Clem, Chin. Colch. Dulc Ferr. Hep. Ipec. Kali bichr. Mcj-c. Nitric ae Nux vom, Phosph. ac Puis. Sabad. Sus- sap. Sep. StajUi. Sulphur. Thuj. Areratr. GENERALLY: Aeon. Anac Apis. Ars. Bell. Bor. Bry. Calcar. Camph. Cann. Canthar. Caps. Carbo veg. Caust. Chin. Clem. Colch. Ch. Ruta. Sussnp. Sil. SUPPUBATION: Canth. Puis. SWELLING OF NECK OF BLADDER: Puis. THICKENING: Dulc 2. Urethra. BURNING: Arsen, Baryt, Bryon. Calc curb. Cann. Canth. Canst, Clem. Colch. Cupr. Ipec Kali bichr. Lye Mercur. Natr. Nitric ac. Petr. Phosph. Phosph. acid. Sassap. Sepire. Staph. Sulph. Thuj. 86 URTNE AND UK CUTTING: Ant. crud. Calc. Carb. Cann. Canth, Carbo veg. Colchic. Con. Cupr. Dig. Ignat. Lye. Alere Nux vom. Phosph, ac. Rhod. Sep. Sulph. Thuj. DISCHARGE: Agn. Calc. carbon. Cann. Canthar. Caps. Dulc. Hep. Merc. Nitr. ac. Nux vom. Petr. Puis. Sassap. Sulphur. Thuj. —bloody: Calc. carbon. Lycop. Merc Nitric ac. Zinc. —thick: Alere —purulent: Cann. Canthar. Clem. Mercur. Nitric acid. Sassap. Sulph. Thuj. —yelloAvish: Cann, Mercur. Natr. mur. Nitric ae Thuj. —greenish: Merc. Nitric ae —sUmy: Ant. Cann. Caps. Dulc. Merc. Mezer. Nitric ac. Phos. ac Puis. Sulph. —watery: Cann. Mere Sulph. DRAWING: Cole Kali. Lyc. Puis. Sabad. Sulph. Zinc. GENERALLY: Aeon. Alum. Ant. crud. Antim. tart. Am. Arg. nitr. Aur. Bov. Bryon. Calc curb. Cann. Canth. Capsicum. Caust. Chel. China. Clem. Coff. Colch. Con. Cop. Cupr. Dulc. Ferr. Graph. Hep. Ign. Kali. Lach. Lycop. M. austr. Merc. Mezer. Natrum mur. Nitric ac. Nux vomica. Phosph. Phosph. ae. Puis. Rhus. Sabin. Sep. Staph. Sulphur. Thuj. Ye- ratr. Zinc INFLAMMATION: Aeon. Bovista. Cann. Canth, Clem. Digital. Hyosc. Merc. Nux vom. Puis. SquiUa. Sulph. ITCHING: Agar. Arn. Bov. Bry. Canth. Chin. Lyc. Alere Natrum mur. Nux vom. Sulph, Thuj. PRESSURE: Canth. Colch. Nux vom. Puis. TNARY ORGANS. PULSATING: Canth. Merc. SORENESS, as from: Bar. Daph, Natr. mur. Phosphor. Teucr. Zinc. SPASAI: Chin. Carbo an. STITCHING: Arn. Bryon. Cann. Canth. Capsic. Con. Cuprum. Daph. Graph. Ign. Iod. Lach. Lye Merc. Mur. ae Natrum mur. Nux vom. Phosphor, ac. SquiUa. Sulph. Thuj. STRICTURE: Camph. Canth. Carbo veg. Clem. Dulc. Lyc. N. vom. Petr. Puis. Rhus. Sulph. SWELLING: Canthar. Merc. Nitr. Rhus. TEARING: Cann. Carbo vegetab. Clem. Colch. Lycop. Natrum. Sas- sap. Sulph. TICKLING: Canth. TWITCHING: Con. Natr. Phosph. ULCER: Merc. Nitric ac. 3. Kidneys. BURNING: Bell. DRAWING: Clem. GENERALLY: Aeon. Alum. Bell Cann. Canth. Carbo veget. Clem. Colchic. Hep. Kali. Lyc. Nitric ac. Nux vomica. Phosph. Phosph. ac. Pulsat. Rheum. Ran. seel. Sassap. Sep. Sulph. Thuj. Zinc. GRAVEL: Alum. Calcar. carbon. Cann. Canth. Lyc. Nitric ae Nux vom. Petr. Phosph. Ruta. Sil. Sas- sap. Sulph. INFLAAIA1ATION: Bell. Cann. Canthar. Hep. Lyc. N. vom. Puis. JERKING: Canth. PULSATIONS: Canth. PRESSURE: Thuj. Zinc. AS IF SORE: Zinc. SPASAIODIC PAINS: Sulph. STITCHES: Aeon. Bell. Canthar. Hep. Kali. Phosph. ac. Zinc. 87 XXVI. SEXUAL ORGANS AND FUNCTIONS. MA.LE OJiaAJSTScltlcL THEIR FUNCTION'S. 1. Penis. BLUENESS: Arn. BURNING: Canth. Euphorbium. Merc. Alur. ac. Plumb. COLDNESS: Lyc. Merc. Sulph. DEADNESS: Lyc. Alere DRAWING: Canth. Cic. Iod. Kali. Al. austr. Alere Ran. sc. Zinc. ERUPTION: Graph. Phosph. acid. GANGRENE: Ars. Canth. GENERALLY: Alum. Ambr. Anac. Ant. crud. Arn. Ars. Bovista. Bry. Calc. carb. Camphor. Cann. Canth. Caps. Carbo veg. Caust. Chin. Clem. Colch. Con. Cupr. Dig. Ferr. Graph. Hep. Ign. Iodine. Ipec. Kali. Lach. Lyc M. austr. Merc. Mezer. Mur. ac. Natr. Natrum mur. Nux vom. Op. Phosphor. Phosph. ac. Plat. Plumbum. Puis. Ran. Rhus. Sabin. Selen. Sep. Sil. Spigel. Staph. Sulph. Thuj. Viol. trie Zinc. GONORRHOEA: Cann. Cantharis. Caps. Clem. Dulc. Ferr. Lyc. Merc. Natr. mur. Nitric ac. Nux vom. Puis. Sabina. Sec. corn. (?) Selen. Sulph. Thuj. —acute: Cann. Canth. Merc. Nitr. ac. —chronic: Cann. Capsic. Dulc. Ferr. Merc. Nitr. ac. N. vom. Sep. Sulph. —green: Cann. Merc. —white: Cann. Caps. Ferr. —clear: Mere Sulph. —yellow: Cann. Merc. Nitric ac. Sulph. INFLAMMATION: Canthar. Merc, Plumb. Sulph. ITCHING: Ars. Con. Spig. Sulph. PAIN AS IF BRUISED: Arn. PRESSURE: Viol, trie PUSTULES: Bovist. REDNESS: Arn. Cann. RELAXED: Calc. Lyc. Merc. Prun. SORE, painful as if: Arn. Cann. Cicut. SPASAI: N. mosch. STITCHES: Asa feet. Lyc. Merc. Puis. Spig. Sulph. Thuj. SAVELLING: Am. Cann. Canthar. Merc. Plumb. TEARING: Con. Kali. M. austr. Alere Thuj. TAVITCHING: Lye TENSION: Am. Graph. ULCER: Mere. 2. G-lans. BURNING: Ars. Cann. Chin. Lyc. Merc. Stann. Tart. COLDNESS: Lyc. Merc. CREEPING: Alum. Mere Natr. mur. Tart. CUTTING: Lye Thuj. DAAIPNESS: Alum. Lyc. Merc. Natr. mur. Nitr. ac. N. vom. Sulph. Thuj. DRAWING: Alum. Asa feet. Iod. Lyc. ERUPTION: Calad. Lycop. Nitr. Petr. Sep. FORMICATION: Alum. GENERALLY': Alum. Antim. crud. Ars. Calc. carb. Cann. Canth. Carb. veg. Caust. Chin. Colch. Dig. Graph. Ign. Iod. Lach. Kali. Lyc. M. austr. Merc. Mez. Natr. Natr. mur. Nitr. ac. N vom. Petr. Phosph. Puis. Rhus. Sabin. Sep. Sil. Stann. Staph. Sulph. Thuj. HARDNESS: Cann. INFLAMMATION: Arnie Cannab. Cupr. Merc. Rhus. ITCHING: Ambr. Angust. Ars. Cann. Euphr. Hell. Iod. Mang. 8fe SEXUAL ORUAN^ Alere Natr. A^ifr. ac. N. vom. Phosph. ac. Sep. Sil. Thuj. PRESSURE: Lyc. VioL trie REDNESS: Arsen. Cann. Alere Sabin. SMEGMA : Alere Nitr. ac. SORENESS, as from: Nux vom. Sabin. SPOTS, red: Cann. Carbo veg. Lach. Nitr. ac. SWELLING: Ars. Cann. Canth. Merc. Rhus. —on one side: Spig. STITCHES: Aeon. Arn. Ars. Eu- phorb. Euphr. Lycop. Men: Phosph. Rhod. Sabin. Sulph. Thuj. TEARING: Daph, Euphorb. Kali. Lyc Merc. TUBERCLES: Hell. ULCERS: Merc. Nitr. ac Sep. Sulph. Thuj. —chancrous: Merc. Nitr. ac. Rhus. Sulph. Thuj. ULCERATIVE PAIN: Ambr. Ign. SSICLES: Alere Phosph. acid. Rhus. 3. Prepuce. BURNING: Arsen. Cann. Alere N. vom. CREEPING : Croc. Alere Ph. ae DRYNESS : Calad. Ign. Sil ERUPTION: Aur. Graph. Men: Nitr. ac. Rhus. Sulph. GENERALLY: Aeon. Arn. Arsen. Calad. Calc. carb. Cannab. Canth. Caust. Chin. Euphorb. Graph. Hep. Ign. Lach. Lyc. M. arct. Merc. Mezer. Natr. mur. Nitr. ac. Nux vom. Phosph. ac. Plumb. Puis. Rhod. Rhus. Selen. Sep. Sil. Staph. Sulph. Thuj. Viol. trie. Zinc. HARDNESS: Lach. Merc. Sulph. HERPES: Caust. Dulc. Hep. Merc. Nitr. ac Phosph. ae Sep. INFLAMMATION: Calc. carb. AND FUNCTIONS. Cann. Merc Nitr. ac. Sulph. ITCHING: Aco. Agar. Bry. Calad. Carb. veg. Cann. Caust. Euphras. Mere Nitr. ac N. vom. Puis. Sep. Sil. Sulph. Thuj. PAIN AS IF SORE : Calad. Cham. Ign. N. vom. PARAPHIMOSIS : Bell. Coloc Ign. M. arct. Merc N. vom. PHIMOSIS: Cannab. Canthar. Merc. Nitr. ae Rhus. Sulph. Thuj. REDNESS: Calc Cann. Merc. SCURFS: Caust. Nitr. ae (Coinp. Herpes.) STITCHES: Ars. Bry. Cann. Eu- phras. Hep. Merc. Puis. SMARTING: Calad. Merc Nux vom. Puis. SPOTS, red: Nitr. ac. Rhus. SORENESS: Calad. Cann. Carbo veg. Ign. Nitr. ac. N. vom. STRICTURE: Cann. Merc. Sep. Sulph. SUPPURATION: Alere SWELLING : Calad. Cann. Graph. Mercur. Nitric ae Rhus. Sulph. Thuj. ULCERS: Aurum. Caustic. Hep. Merc. Nitric a<: Rhus. Sep. Sulph. Thuj. —chancrous: Kali bichr. Mercur. Nitric ac Rhus. Thuj. VESICLES: Alere Rhus. 4. Testicles. BURNING: Iod. Plat. Staph. COLD FEELING: Alere CONSTRICTION : N. vom. Plumb. DRAWING: Amm. Clem. Ipecac, AI. arct. Merc Phos. Puis. Rhod. Staph. Zinc DWINDLING: Aur. Lyc. GENERALLY: Agn. Amm. Antim. crud. Arn. Aur. Bell. Calc. carb. Canth. Carbo veg. Caustic. Chin. Clem. Cocc. Con. Dig. Graph. Ignat. Iod. Kali. Lyc. AI. austr. SEXUAL ORGANS AND FUNCTIONS. 89 Merc Natrum. Nitric ac. Nux vom. Phos. Phosph. ac. Plat, Plumbum. Puis. Rhod. Rhus. Selen. Sep. Sil. Spong. Staph. Sulph. Tar. Thuj. Zinc GNAWING: Plat. HANGING DOWN: Nitr. ac. Puis. HARDNESS : Agn. Arg. Arnica. Aur. Clem. Iod. Alere A. vom. Rhod. Spong. HEAT: Arn. —feeling of: Sulph. ac. HERNIA : Lach. N vom, Rhus. INDURATION: Amm. Ignatia. AI. austr. Plumb. INFLAAIAIATION : Aeo. Aur. Clem. Lye Alercur. Nux vom. Puts. Staph. Zinc. ITCHING : Iod. Ign. Alere Nux vom. Spig. JERKS: M. austr. PAIN AS IF BRUISED : Arn. Clem. Con. Dig. PRESSING TOWARD THE TESTICLES: Iod. PRESSURE: Aur. Bism. Cannab. Caust. Ign. Lach. Phos. ae Puis. SquiUa. Staph. Zinc SENSITIVENESS: Am. Asa feel. Cann. Phosph. ac. Zinc. SPASAI: Phosph. STITCHES: Arn. Bell. Men: Nux vom. Rhod. Spig. Thuj. SWELLING-: Arn. Arsen. Aur. Can- thar. China. Clem. (Jon. Iod. Lyc Merc. Nitric acid. Nux vom. Puis. Rhod. Ruta. Spong. Staph. Zinc. —of epidydimis: Sulph. TEARING: Chin. M. uuslr. Phos. ac. Puts. Staph. TENSION: Arn. Sulph. TURNING: Sabad. 5. Scrotum. BLUENESS: Arn. BURNING: Euphorb. Rhod. CONTRACTION: Petr. Puis. COLDNESS: Caps. CREEPING: Arn. Carbo veg. Selen. Thuj. DAAIPNESS: Petr. Rhus. Sulph. ERUPTION: Petr. Phosphor, ae Rhus. ERYSIPELAS: ^n. GENERALLY: Aeon. Ambr. Ant. crud. Arn. Ars. Baryt. Bell. Calc. carb. Camphor. Cannab. Carbo veg. Caust. Chin, Clem. Con. Eu- phorb. Graph. Hep. Ign. Iod. Kali. Lyc M. austr. Mezer. Natr. Nitric ac. Nux vom. Petr. Phosph. Phos. ac Plumbum. Puis. Rhodod. Rhus. Selen. Sep. Sil. Staphys. Sulph. Thuj. Viol, trie Zinc. HERPES : Calc. carb. Dulc. Petr. HYDROCELE: Am. Graph. Nux vom. Puis. Rhodod. Rhus. Sil. INFLAMMATION: Ars. Phosph. ae Plumb. ITCHING : Ambr. Amm. Aurum. Baryt. China. Cocc. Graphit. Lyc. Meph. Nux vom. Petr. Pulsat. Rhodod. Rhus. Selen. Staph. PAIN AS IF BRUISED : Aeon. Arn. Kali. PULLING: Petr. RASH: Rhus. REDNESS: Puis. RELAXED: Chin. Lyc. SHRIVELING: Rhod. SORENESS : Arn. Petr. Plumb. Sulph. STITCHES: Arn. Mere Sulphur. Thuj. SWELLING: Am. Canth. Carbo veg. Graph. Plumbum. Puis. Rhus. Sep. SWEAT : Baryt. Ignat. Rhodod. Thuj. TENSION: Arn. 6. Spermatic Chord. BURNING: Staph. DRAWING: Agn. Canthar. Clem. 90 SEXUAL ORGANS AND FUNCTIONS, AI. austr. Alere N. vom. Puis. Bhod. GENERALLY: Alum. Amm. mur. Ant. crudum. Arn. Canthar. Clem. Iod. Kali. M. austr. Mercur. Nitric ac. Nux vom. Phosph. acid. Plumb. Puis. Sabin. Spong. Staphys. Thuj. Veratr. HARDNESS: Phosph. ae PRESSURE: Nux mosch. Spong. Sulph. Thuj. STITCHES: Amm. mur. Arn. Grat. Staph. Thuj. SAYELLING : Cann. Phos. Puis. Spong. TEARING: Colch. Puis. TENSION: Cann. AI. austr. THROBBING: Amm. mur. TWITCHING: Plumb. 7. Prostate Gland. HARDNESS: Iod. INFLAMA1ATION: Agn. Iod. Alere. Puis. PROSTATIC JUICE, discharge of: Alum. Anac. Calcar. Con. Hep. Lycop. Nitric acid. Petr. Phosph. ac. Plat. Selen. Sep. Sil. Staph. Sulph. Zinc. —when urinating: Anac. Calc. Sep. Sulph. —at stool: Alum. Calcar. Hep. Ign. Selen. SU. Sulph. —after stool: Selen. —before stool: Selen. —with relaxed parts: Calcarea. Phosph. ac. SAVELLING: Puis. 8. General Symptoms. COLDNESS: Agn. Capsic. Lycop. Ale re ERUPTION: Aur. Calad. Caustic. Dulc Graph. Merc. Nitric ac Petr. Phosph. ae Rhus. Sep. Sil. Sulph. Thuj. —on the hairy part of [the parts: Ka- li, bichr. Lach. FETID SAIELL : Natr. mur. Sassap. FIGWARTS: Euphr. Lyc. Nitric ae. Phosph. ac. Sabin. Sassap. Thuj. —bleeding: Thuj. —flat: Nitric ac. Thuj. —like cock's-crest: Nitric acid. Thuj. —humid: Nitric acid. Sulph. Thuj. —dry: N. vom. Sulph. Thuj. GANGRENE: Ars. Canth. HAIR, falling off: Natrum mur. Nitric ac. Rhus. Selen. HERPES: Aur. Dulc. Nitric acid. Petr. Phosph. ac Sulph. RELAXED: Calc Lyc. Phos. ac. Selen. SWEAT : Calad. Merc. Phos. ac. Sep. Suljjh. Thuj. WEAKNESS : Agn. Calc. Lycop. Alang. Sep. Sulph. 9. Sexual Instinct, Functions. ERECTIONS: Agar. Alum. Ambr. Anac Arn. Ars. Aur. Baryt. Bell. Bov. Calc. carb. Cann. Canth. Caps. Carbo animal. Carbo veg. Chin. Clem. Colch. Con. Dig. Graph. Ig- natia. Kali, Lach. Lycop. M. arct. Mur. magn. Merc. Mosch. Natr. Natr. mur. Nitric ac. Nux vom. Op. Phos. Phosj'h. ac. Plat. Plumbum. Puis. Rhus. Sabin. Sep. Sil. Spig. Staph. Sulph. acid.Tar. Thuj. Viol. trie Zinc. —in the evening : N. vom. Phos. Staph. —in the morning: Ambr. Anac. Arn. Brom. Caps. Lach. Natrum. N. vom. Phos. Plumb. Puis. Rhus. Thuj. Vit. —at night: Canth. Merc. Natr. mur. Nitric ae Plumb. Puis. Staph. Sulph. ac. Zinc. —in the day-time: Cann. Hyosc. Lach. Puis. SEXUAL ORGANS AND FUNCTIONS. 91 —day and night: Canth. —too short: Calad. Calc. Con. Selen. —deficient: Agn. Calad. Camphor. Con. Graph. Hell. Lach. Lyc. Magn. carb. Nux mosch. Puis. Teucr. Vit. —too feeble: Baryt. Caladium. Lach- esis. Lyc. Mercur. Selen. Sulph. —too strong: Canthar. Creos. Lach. Natr. mur. Nux vom. Op. Phos. Puis. Sabin. Zinc. —too painful: Cann. Canth. Graph. Ign. Kali. Merc. Nitric ac. Nux vom. Plumb. Sabad. Sulph. Thuj. —without sexual lust: Ambra. Calad. Cann. Caps. Graphit. Lach. Magn. Natrum muriat. Phosph. ac. Sabad. Sabin. Sil. Spig. SEAIEN BLOODY: Caust. Canth. Led. Alere —thin: Selen. —inodorous: Selen. —watery: Led. Sulph. —flow of: Agar. Alum. Anac. Arg. Arn. Ars. Aur. Baryt. Bell. Bism. Bov. Brom. Calad. Calc. Canth. Carbo an. Carbo veg. Caustic. China. Cicut. Con. Ferr. Graphites. Guaj. Kali. Lach. Led. Lyc. Magn. Merc. Natr. Natr. mur. Nitric ac. Nux mosch. Nux vom. Op. Petr. Phosph. Phosph. ac. Puis. Ran. bulb. Rhus. Ruta. Sangv. Selen. Sep. Silicea. Stann. Staph. Sulphur. Thuj. Verb. Vit. Zinc. ----in the day-time: Canthar. Car- bo an. Caust. Graph. Lach. ----not taking place during inter- course: Calad. Graph. Kali. Lach. Lyc. ----with relaxed penis: Bellad. Con. Graph. Mosch. N. vom. M. arct. Plumb. Selen. ----at stool: Phosph. ac. —weakening: Baryt. Carbo an. Chin. Kali. Lach. Lyc. Nux vom. Phosph. Phosph. ac. too soon: Bor. Calad. Calcar. Lyc. Phosph. Set. Zinc. —too often: Bar. Calc. carbon. Canth. Carbo veg. Chin. CI Con. Kali. Lyc Nitric ac. Petr. Phosph. Phosph. ac. Sep. Sil. Sulph. —during the siesta: Alumina. Caust. Clem. Mercur. Staph. Sulph. —without force: Canthar. Con. Phosph. Selen. —deficient: Calad. Calc. Camphor. Kali. Lach, Lyc. Natr. mur. —followed by languor: Baryt. Calc. carb. ----by anxiety: Carbo an. ----by head-ache: Calcar. Lach. Sil. ----irresistible desire: Rhus. ----heaviness in the limbs next day: Puis. ----amorous fancies: Alumina. Ars. Aur. Baryt. Bism. Calc. Chin. Grat. Led. Natr. Nux vom. Ole- and. Op. Phosphor. Plumb. Sa- bad. Samb. Sassap. Sil. Staph. Viol, trie SEMEN, followed by dryness of the skin: Baryt. ----contractive feeling in urethra: Thuj. ----voluptuous dreams: Calcar. ph. Kali carb. —early in the morning: Lach. N. vom. Plumb. Puis. —after midnight: Samb. —several nights in succession: Aur. Caust. Carb. an. Con. —after onanism: Calc. Carbo veg. Chin. Natr. mur. Ph. ac. Sep. Staph. —without dreams: Anac. Ant. crud. Bism. Calc. Cic. Guaj. Phosph. Puis. Ran. se Ruta. Stann. Verb. Zinc. ----fancies: Phosph. ----thrill: Anac. Natr. Carb. Sulph. ae Plat. —painful: Calc. Cann. Canth. Clem. Mosch. Natr. carb. Sassap. Thuj. 92 SEXUAL ORGANS AND FCNCTIONS. —with cutting in urethra: Bor. —with cutting in urethra afterwards: Natr. mur. —too late: Agar. Calc. Lach. Lye. Petr. SEXUAL INTERCOURSE, aver- sion to: Agar. Cann. Caust. Clemat. Kali. Lv«. Phosph. Rhod. —desire for: Calcar. Canth. Chin, Lach. Mosch. Phos. Puis. Stann. Veratr. —falls asleep during: Bar. Lyc. —followed by mental languor: Calc. Sep. ----by pain in urethra: Canth. ----by dullness of head: Bov. Chin. Lye ----by ill-humor: Petr. ----by back-ache: N. vom. —with relaxed penis: Con. Lye N. vom. —followed by weakness: Agar. Calc Knli. Lycop. Nitr. ac. Selen. ----by sweat: Agar. ----by bruised feeling: Sil. ----by tremor of the legs: Calc. carb. SEXUAL LUST: Calc. carb. Canth. Carb. veg. Chin. Graph. Hyosc. Lach. Mosch. Natr. mur. N. vom. Phosph. Plat. Puis. Sep. Stann. Stram. Veratr. Zinc. SEXUAL DESIRE TOO STRONG: Agar. Alum. Ant. crud. Aur. Baryt. Bov. Calc. Cann. Canth. Curb. veg. Ch ina, Coff. Con. Dig. Dulc. Ferr. Graph. Hyosc. Ign. Iod. Kali. Lach, Lycop. Mem: M. arct. M. aust, Alen. Merc. Mos. Sulph. WEIGHT, feeling of: Nux vom. SEXUAL ORGANS AND FUNCTIONS. 95 SEXUAL FUNCTIONS ANI) INSTINCT. BLOOD, loss of, between the pe- riods: Ambr. Arn. Bell. Bov. Calc. Cham. Chin. Coe Coff. Croc. Hyosc. Kali. Ipecac. Alere Alagn. mur. Nux vom. Petr. Phosphor. Prun. Rhus. Sabin. Sec. corn. Sep. Sil. Sulph. Stram. —of pregnant females: Cham. Cocc. KaU. Phosph. Sabina. Sec com. —of nursing females: Sil. INTERCOURSE, aversion to: Cann. Caust. Chlor. Cub. Kali. Lyc. Natr. mur. Petr. Phosph. —desire for: Calc Creos. Kali. Sa- bin. Sulph. ac. —with pains: Creos. Ferr. mur. Kali. —with too ready conception: Bor. Canth. Merc. Natr. —with nausea: Sil. —without thriU: Ferr. m. MISCARRIAGE: Aco. Apis. Arn. Asar. Bell. Bry. Calc. Calend. Canth. Caps. Carbo an. Carbo veg. Cham. China. Cocc. Croc. Cycl. Ferrum. Hyosc. Ipec. Iod. Kali. Lach. Lycop. Alere Nitric ac Nux mosch. Nux vom. Op. Phosph. Plat. Plumbum. Puis. Rhus. Ruta. Sabin. Sec. corn. Sep. Sil. Sulph. Zinc. —disposed to: Asar. Calcarea. Carb. veg. Cocc. Creos. Ferr. Kali carb. Lyc. Nux mosch. Plumb. Puis. Ru- ta. Sabin. Sabad. Sep. Sil. Sulph. —of chlorotic females : Carbo veg. Chin. Ferr. Sep. Sulph. —with congestion of blood to the womb: Bell, N. vom. Plat, Sep. —with|spasms: Cham. Hyosc. Ipec. Nux vom. —with leucorrhcea: Calc. Ferr. Sep. Sulph. —at the outset of pregnancy: Sabin. Confinement, Ailments Incident to. AFTER-PAINS TOO VIOLENT, LONG: Am. Bryon. Bell. Calc. carb. Chain. Coff. Cupr. Ferr. Ign. Kali. Nux vom. Puis. Rhus. Ruta. Sabina. Sep. Sulph. INJURY OF PARTS DURING DELIVERY: Am. PAINS SPURIOUS: Bell. Cham. Cocc. Coff. Cupr. Hyosc. Ign. Ipec. Kali. Nux mosch. Nux vom. Op. Puis. See corn. Sep. Stann. ----with urging on the rectum: Nux vom. ----violent: Aeon. Coff. ----with contraction of the womb: Bell. —too feeble: Arn. Bell. Camphor. Carb. veg. Cham. Chin. Cocc. Coff. Graph. Ign. Kali. Lyc. Alagn. mur. Alosch. Natr. Natr. mur. N. mosch. Nux vom. Op. Puis. Rhus. Ruta. Sec. corn. Sep. Sulph. Sulph. ac. ----after a fright: Op. ----of feeble persons: See corn. ----with spasmodic pains: Puis. —too strong: Aeon. Arn. Aur. Bell. Cham. Cocc. Coff. Con. Hyosc. N. vom. See corn. Sep. PLACENTA ADHERING : Bell. Puis. Sec corn. SEXUAL INSTINCT EXCITED : Bell. Calc. Canth. Chin. Coff. Con. Creos. Ferr. Graph. Hyosc. Kali. Mane Mosch. Nux vom. Plat. Phosph. Puis. Stram. Sulph. Sulph. ac. Thuj. Veratr. Zinc. —unto nymphomania: Bell. Canthar. Hyosc. Alere Natr. mur. Phosph. Plat. Puis. Raph. sat. Stram. Veratr. SPASMS : Bell. Chain. Cic Cocc. Hyosc. Ignat. Ipecac. Mosch. Plat. Stram. Veratr. 96 SEXUAL ORCtANS AND FUNCTIONS. UTERINE HEMORRHAGE: Bell. Chamom. Chin. Croc. Ferr. Ipec. Plat. Sabin. Sec com. Menses. AIENSES, pale, watery: Alum. Arn. BeU. Berb. Bov! Calc Carb. an. Carbo veg. Cocc. Con. Creos. Dig. Ferr. Graph. Hell. Hyosc. Ipec. KaU. Led. Lyc Alagn. Mane M. austr. Alere Natr. m. Nitr. ac N. mosch. Phosph. Plat. Puis. Rhus. Sabin. See corn. Sep. Sulph. Tart. —brown: Bry. Calc. Carb. veg. Con. Rhus. —thick: Arn. Croc. Cupr. Alagn. e N. mosch. N. vom. Plat. Puis. Sulph. —dark,biack: Amm. Ant. crud. Arn. Asar. Bell. Bism. Bry. Canth. Carb. an. Carb. veg. Cham. Chin. Creos. Croc. Ferr. Ign. Lach. Alagn. Nitr. Nitr. ac Nux vom. Ol. an. Plat. Puis. Sec corn, Selen. Sep. Sulph. —thin: Ferr. Graph. Sabin. Sec. coin. —flesh colored: Sabin. Stront. —too soon: Alum. Ambr. Amm. Arn. Asa f. Asar. Bell. Bor. Bov. Bry. Calc. Canth. Carb. an, Carb. veg. Cham. Clin. Cin. Cocc Colch. Coloc. Con. Creos. Croc. Dulcam. Ferr. Flu or. ac Gent. Graph. Grat. Hell. Hep. Ign. Iod. Ipec. Kali. Laur. Led. Lyc. Alagn. M. austr. Alang. Alosch. Alur. ac. Natr. mur. Nitr. ae Nux mosch. Nux vom. Petr. Phosph. Phosph. ac. Plati Puis. Rhod. Rhus. Sabin. Sec com. Sep. Silic Spong. Stann. Staph. Sulph. Sulph. ac. Veratr. Zinc. —light-colored: Am. Bell.Bry. Calc. Canth. Carb. veg. Dros. Dulc. Hyosc Led. M. austr. Phosph. Rhus. Sabin. Sec. corn. Stront. -too short: Amm. Bar. Con. Pule. Graph. Lach. Magn. mur. AI. arct. Mang. Mercur. Phosph. Plat, Puis. Ruta. Sulph. -too long: Aeon. Ars. Asar. Bar. Bryon. Canth. Carb. an. Canst. Chin. Coff. Croc. Cupr. Dulc. Ferr. Ign. Lyc. AI. austr. Natr. mur. Nux vom. Phosph. Plat. Puis. Sabin. Sec. corn. Sil. Sulph. Sntjdi acid. -at night: Bov. Alagn. carb. Sabin. -by fits and starts: Cham. Puis. Sabin. -acrid: Amm. curb. Ars. Canth. Carb. v. Graph. Kali. Nitr. Phosph. Puis. Sassap. Silic. Sulph. Sulph. ae -frothy: Am. Ferr. Ipec. -slimy: Cocc Puis. -too scanty: Aco. Alum. Amm. Arn. Asa. Baryt. Bor. Bry. Calc. Carb. veg. Caust. Cicut. Coccul. Con. Creos. Crot. Cupr. Dig. Dulc. Ferr. Graphit. Ign. Iod. Kali. Kali hydr. Lach. Lye AI. arct. Magn. Alere Natr. mur. 01. an. Phosph. Puis. Ruta. Sabad. Sassap. Sep. Sil. Staph. Sulph. Veratr. Vit. Zinc. -too late: Aeon. Amm. Ast. Aur. BeU. Bry. Caust. Chamom. Chel. Cic. Cocc Con. Croc. Cupr. Dulc. Ferr. Graph. Hyosc. Hyp. Iod. Kali. Lach. Lyc. Alagn. Alere Natr. carb. Natr. mur. Nie Nitr. ac. Nux mosch. Petr. Phosph. Puis. Rhus. Sabad. Sabin. Sassap. Sep. Silic Stront. Sulph. Vifr. Zinc. -too copious: Aco. Agar. Ambr. Amm. mur. Ant. cr. Arg. nitr. Ars. Bar. carb. Bell. Bor. Bry. Calc. Canth. Curb. v. Cham. Chel. Chin. Cina. Coff. Creos. Croc. Cycl. Dulc. Ferr. Hyosc Ign. Iod. Ipec. Laur. Led. Lyc. M. austr. Mere. Alosch. Alur. ae Natr. mur. Nitr. ac. N. mosch. Nux vom. Phell. SEXUAL ORGANS AND FUNCTIONS. 97 Phosph. Platin. Plumb. Rhus. Ruta. Sabin. Samb. Sec. corn. Sep. Sil. Spong. Stram. Sulph. Sulph. ac. Verat. Vine Zinc. —too copious at nignt: Amm. carb. —lumpy: Amm. carb. Arn. Bell. Canth. Cham. Chin. Croc. Ferr. Fluor, ac. Hyosc. Ipec N. vom. Plat. Puis. Rhus. Sabina. Stram. Stront. —irregular: Cocc. Iod. N.vom. Puis. Ruta. —suppressed: Aeon. Agn. Alum. Amm. Ars. Baryt. Bell. Bry. Calc. Caust. Cham. Chin. Cocc. Coloc. Con. Croc. Cupr. Dulc. Ferr. Graph. Hyosc. Ign. Iod. Kali carb. Lyc. AI. arct. Alagn. mur. Mercur. Natr. mur. N. mosch. Paeon. Petr. Phosph. Puis. Rhod. Rhus. Ruta. Sabad. Sang. Sassap. Sep. Silic. Staphys. Stram. Sulph. Valer. Verat. Vit. Zinc. —of young girls, delaying: Bry. Calc. Caust. Cocc. Con. Dulc. Graph. Kali. Lach. Lyc. Alagn. Natr. mur. Petr. Puis. Sabin. Sep. Stramon. Sulph. —fetid: Bell. Bry. Carb. an. Cham. Chin. ('roc. Ign. Kali. Mere Phos. Rheum. Sabin. Sil. Sec. corn. —repeating: Alum. Bry. Ferr. M arct. Natr. mur. N. vom. Phosph. Ph. ac. Puis. Rhus. Sep. Veratr. Zinc. Menses and the Accompa- nying Ailments. 1. Previous to the menses. ABDOMEN, distended: Ammon. mur. Creos. Lyc. —distention: Creos. Lyc. ANXIETY: Ammon. Cocc. Con. Merc. Natr. mur. Stann. BACK-ACHE: Ann. Bar. Brom. Calc. Caust. Hyosc. Magnes. carb. Mosch. Nitr. N. mosch. Nux vom. Spong. BREAST, spasm of: Cocc Cupr. BREASTS SWOLLEN: Bry. Calc. —painful: Calc. Con. BURNING IN PUDENDUM: Calc. CANINE HUNGER: Alagn. carb. CARDIALGIA: Lach. Nux mosch. Puis. Sep. CATARRH: Graph. Puis. CHILL: Lyc. Puis. Veratr. COLDNESS OF THE TRUNKS: Alang. COLIC: Amm. Bell. Calc. Cham. Puis. Sep. —labor-like: Hyosc. —with fainting: Sep. —with vomiting: Puis. —with pressing: Magn. carb. COLIC: Alum. Amm. mur. Cham. Croc. Ferr. Hyosc. Nux vom. 01. an. Plat. Puis. COUGH: Graph. Sulph. Puis. DELIRIUAI: Lye. Hyosc. DIARRH(EA: Bov. SU. Veratr. DREAA1S: Calc. Caust. Con. DROWSINESS: Puis. EXCITED NERVES: Creos. Lyc. ERUPTION IN NAPE OF NECK: Carbo veg. EXPECTORATION, bloody: Phos. FACE HOT: Alum. Lyc. —pale: Puis. —blue: Veratr. —bloated: Chin. IN GENERAL: Alum. Amm. Asar. Bar. Bry. Calc. Carbo veg. Caustic. Cham. Chin. Coccul. Coff. Con. Creos. Cuprum. Ferr. Glon. Graph. Iod. KaU. Lach. Lyc. Alane Alang. Merc Alur. ac. Natr. mur. N. mosch. Nux vom. 01. an. Phosphor. Phos. ac. Plat. Puis. Rhus. Sep. Sulph. Sulph. ac. Veratr. GUMS SWOLLEN: Baryt.Mercur. Phosph. HARD HEARING: Creos. 98 SEXUAL ORG AND FUNCTIONS. HEAD-ACHE: Carbo veg. Cupr. Ferr. Iod. Lach. Natr. mur. Sulph. Veratr. HEARTBURN: Sulph. HEAT: Calc INCLINATION TO VOA1IT: Ve- ratr. ITCHING HERPES : Carbo veg. —of the parts: Graph. Sulph. LABOR-LIKE PAIN: Rhus. Plat. LANGUOR: Alum. Nux mosch. LAUGHTER: Hyosc. LEGS WEARY AND HEAA7Y: Bar. Lyc LEUCORRHCEA: Alum. Calcar. Ferr. Sulph. LIA1BS AS IF BRUISED: Nitric acid. LIVER, stitches in: Con. —pains in the: Nux mosch. LOSS OF APPETITE : Bell. LOSS OF CONSCIOUSNESS: China. Sep. MELANCHOLY: Caust. Lyc. Natr. mur. NAUSEA: Veratr. NOSEBLEED: Sulph. Veratr. PAINS IN THE BREASTS : Con. PALPITATION OF HEART: Al- umina. Cupr. Iod. Sep. Spong. PEEVISH: Cham. Natr. mur. PRESSING TOWARD THE PARTS : Magn. carb. Plat. PUPILS DILATED: Lyc. RUSH: Dulc. RESTLESSNESS : Creos. Kali carb. RUSH OF BLOOD: Alum. Cupr. Alane Merc. —to the head: Merc. SENSITIVENESS: Sep. SHUDDERING: Sep. SLEEP, RESTLESS: Alum. SORENESS OF PARTS:' Kali carbon. Sil. SPASMS, abdominal: Cham. Cupr. SPASAIS: Cham, Cocc. Coff. Cupr. Hyosc. Alere —hysteric: Hyosc —in abdomen: Carbo veget. Cham 2. At the appearance of the menses. COLIC: Graph. Staph. DIARRHOEA: Veratr. FLATULENCE: Staph. IN GENERAL: Aco. Bryon. Ciiusl. Cham. Graph. Hyosc Ign. Iodine. Alere Natr. mur. Plat. Puis. Sep. Sil. HEAD-ACHE: Hyosc. NAUSEA: Hyosc. PAINS IN LIAIBS: Sep. SPASMS: Aeon. Cham. Coff. Plat. SWEAT: Hyosc. %URGING TO URINATE: Sassap. * VOAIITING: Carbo veget. Phosph. Puis. 3. During the menses. ABDOMEN DISTENDED: Alum- ina. Natr. Zinc. —co'dness in: Kali carb. pinching in: Alum. —pressure in: Cocc. Con. Nux vom. Sec corn. —cutting in: Sulph. ANXIETY: Bell. Natr. mur. Zinc. BACK-ACHE: Amm. carb. Caust. Lyc. BLOODY EXPECTORATION : Phos. BURNING IN ANUS: Amm. mur. BURNING IN THE HANDS AND FEET: Carbo veg. Calc. COLIC: Alum. Amm. Bar. Bell Calc. Carbo an. Carbo veg. Chum. Cocc. Con. Graph. Kali. Ign. Lach. Lyc. Magn. carb. Natr. Nitr. Nux vom. Phos. Plat. Sec. corn. Sil. Stront. Sulph. Zinc. CONSTIPATION : Natr. mur. Sil. CONVULSIONS: Chin. Cham. DELIRIUM: Hyosc, ! DISCHARGE OF BLOOD AT j STOOL: Amm. mur. j EARS, humming in: Petr. ATerat. SEXUAL ORGAifS AND Fl'NCTIONS. 99 ERUCTATION: Bry. Graph. Kali carb. EYES, agglutinated: Calc carb. —black before the: Puis. ERUPTION: Kali. Sil. FACE, pale: Amm. Graph. Lye Puis. —blue: Veratr. —color of, changing: Zinc. —jaundiced: Caust. FAINTING: Ign. Lyc. Natr. mur. Nux vom. FEVER (chill and heat): Natr. mur. Phosph. CHILL : Graph. Nux vom. Puis. —and shaking: Natr. carb. FLATULENCE : Cocc. KaU carb. IN GENERAL: Aeon.Alum.Amm. carb. Amm. mur. Bell. Bov. Calc. Canth. Carbo an. Caust. Chain. Chin. Cocc Coffea. Con. Creos. Cupr. Graph. Hyosc. Ign. Kali. Laches. Lye Alagn. in. Alur. ac. Natr. Natr. mur. Nux vom. Phosph. Plat. Pulsat. Sabin. Sep. Sil. Stan- num. Sulph. Veratr. Zinc. GUAIS SWOLLEN: Alere Nitr. ac. HEAD: congestion of: Calcarea. Caust. Chin. Con. Glon. Iod. Mere Phosph. —ache: Alum. Bry. Calcar. Carbo veg. Graph. Hyoscyam. KaU carb. Laur. Lyc Magn. carb. Natr. mur. Nux vom. Phosph. Puis. Plat. Sepise. Sulph. Veratr. —heat in : Calc. Cham. HEAT: Magn. mur. N. vom. Sep. LANGUOR: Alum. Bov. Carbo an. Graph. Ign. Iod. Kali. Magn. carb. Alagn. mur. Nux vom. Petr. Puis. Phosphor. See corn. Zinc. LEGS, languor in the: Sulph. —drawing in the: Spong. LEUCORRHCEA: Coccul. LIMBS AS IF BRUISED: Phosph. BODY AS IF BRUISED: Ambr. Conium. Petr. SAIALL OF BACK AS IF BRUISED: Caust. LIAIBS, cold: Cham. —pain in: Bry. Con. Graph. Alagn. mur. Nux vom. Sep. A'eratr. LOINS, pain in: Berb. Sec corn. LOSS OF CONSCIOUSNESS: Cham. LOSS OF APPETITE: CuprMagn. carb. LOWER LIAIBS GO TO SLEEP: Puis. LOWER LIMBS, pain in the: Cha- mom. Nitr. Veratr. —blueness of the: Ambr. AIELANCHOLY: Mane Natr. mur. Sep. AIENTAL DERANGEMENT: Hy- osc. Veratr. NAUSEA. Amm. Calc Graph. Lye Alagn. carb. N. vom. Phosph. Puis. Veratr. —with water-brash: Puis. NIGHT-SWEAT: BeU. Graph. NOSE-BLEED: Sep. OPPRESSION: BeU. Ign. Nitr. ac. PAIN, labor-like: Cham. Graph. Hy- osc. Lach. Sabin. PALPITATION OF HEART: Crot. Ign. Iod. Phosph. Sep. PARTS, burning in the: Rhus. Sil. —itching in the: Hep. Lycop. Stdph. Zinc. —pains in the : Canth. Sep. PRESSING DOWNWARD: Amm. carb. PRESSURE IN PIT OF STOM- ACH : Caps. Sulph. —in small of back: Puis. —in vertex: Cede, caust. DIARRHCEA : Amm. mur. Bov. RESTLESSNESS: Plat. Sep. RUSH OF BLOOD TO THE HEAD: Calc. Chin. SLEEP,restless: Alum. Calcar. Kali curb. SLEEPLESSNESS: Amm. Sep. 100 SEXUAL ORGANS AND FUNCTIONS. SAIALL OF BACK, pains in: Amm. Amm. mur. Bell. Berb. Calc. Carbo vegetabil. ('ham. Cocc. Creos. Croc Graph. Ign. Iod. Kali. Lach. Lyc Natr. Nux vom. Phosph. Puis. Se- cale corn. Sulph. SNEEZING: Magn. carb. SORENESS BETWEEN THE THIGHS : Graph. Kali curb. Sas- sap. —of the parts: Graph. Kali carbon. Sil. SPASAIS: Aeon. Chain. Cocc Coff. Cupr. Hyosc Ign. Lach. Nitric ac. Puis. —in abdomen: Cltam. i\m: Graph. Mane. Nux vom. Puis. Sulph. —with pressure down: Sep. —in the chest: Phosph. Puis. STITCHES IN THE PARTS : Sul- phur, acid. STOMACH, pressure in: Amm. Bry. Puis. Sassap. SAVEAT: Graph, Hyosc. Alagn. mur. SWOLLEN CHEEKS: Graph. SWOLLEN FEET: Calcar. Graph. Lycop. THIGHS, pain in the: Con. Magn. mur. Sassap. THIRST : Nitr. Veratr. ' TOOTH-ACHE : Amm. Calc. Cham. Carbo veget. Kali. Laur. Phosph. Sep. TREA1BLING: Hyosc. Sil. TRISMUS: Hyosc. URGING TO STOOL, ineffectual: Calc. Puis. URINATION, involuntary: Calcar. carb. URINATE, urging to: Puis. Sabin. VERTIGO: Calc. Caustic. Iodine. Phosph. Puis. Veratr. VOAIITING: Ammon. mur. Carbo veg. Lyc Phosph. WHINING AIOOD: Plat. Zinc. YAWNING: BeU. Carbo animal. Phosph. I After the menses. ANXIETY: Phosph. BACK, coldness in: Kali. CARDIALGIA: Kali carb. CHILL: Graph. Pulis. COLIC : Graph. Lyc Nux vom. DIARRHCEA: Graph. ERYSIPELAS: Stram. EXHAUSTION: Alum. FALNTNESS: Alum. Phos. Plat. IN GENERAL: Alum. Berb. Bor. Bryon. Calc. Carbo an. Con. Creos. Cupr. Graph. Kali. Lye Alere Natr. mur. Nux vom. Phosph. Phosph. acid. Plat. Puis. Sep. Sil. Stramon. A'eratr. Zinc. HEAD, heavy: Natr. mur. LEUCORRHCEA: Alum. Bov. Canth. Creos. Merc Phosph. acid. —bloody: Sil. —yellowish: Phosph. acid. PALPITATION: Iod. PARTS, pain in the: Creos. Natr. mur. PRESSING TO THE PARTS: Creos. RELAXED: Alum. SAIALL OF BACK, pain in: Alagn. carb. Puis. SPASAIS, abdominal: Creos. STERILITY: Amm. Calc. Cann. Caust. Cic. Con. Croc. Ferr. Graph. Merc. Natr. mur. Phosph. Plat. Plumb. Puis. Ruta. Sabin. Sepioe. Sulph. Sulph. ac. STOOL, bloody: Graph. TOOTH-ACHE: Calc. Magn. VOAIITING: Puis. Whites. LEUCORRHCEA: Alum. Ambra. Amm. Amm. mur. Anac Ant. crudum. Ars. BeU. Bor. llor. Bry. Calc. Carbo an. Carbo veg. ('aust, Cham. Chin. Coccul. Con. Creos. Drosera. Ferr. Graph. Guaj. Hep. Iod. Kali. Lyc. Alagn. Alagn. mur. SEXUAL ORGANS Merc. Mezer. Natr. Natrum mur. Nitric ac. Nux vom. Petr. Phosph. Pulsat. Ran. bulb. Ruta. Sabina. Sassap. Sep. Sil. Squill. Stannum. Sulph. Sulph. ac. Thuj. Vit. Zinc. 1. According to its Quality. LEUCORRHCEA, old: Iod. —smarting: Cham. Ferr. Lach. Phosph. Merc. —blistering: Phosph. —pale-yellow: Merc. corr. —bloody: Canth. Carbo veget. Chin. Cocc Creos. Nitric ae Sep. Sulph. ac. —blood-red: Chin. Lye —brown: Amm. mur. Carb. an. Nitric ac —burning: Calc: Carbo an. Con. Creos. Puis. Sulph. ac. —thick: Ars. Bov. Caust. Kali bichr. Natr. mur. Puis. Sabina. Zinc. —thick-sUmy: Bov. Con. —thin: Carbo veg. 01. an. Puis. Sulph. —transparent: Sep. Stann. Sulph. ae —purulent: Calc. Chin. Coccul. Creos. Ign. Merc. Nitric ac. Sabin. Sep. —albuminous: Ammon. muriat. Bor. Bov. Mez. Petr. Plat. —staining the linen: Creos. —flesh-colored: Cocc. Nitr. ac. —yellow: Aeon. Alum. Arsen. Bov. Carbo an. Cham. Creos. Kali carb. Kali bichr. Lycop. Natr. Nux vom. Sabin. Sep. Stann. Sulph. —staining yeUow: Carb. an. —yellow-green: Bov. —greenish: Bov. Carbo veget. Lach. Merc. Sep. —green-reddish: Sep. —ichorous: Sabin. —itching: Alum. Ars. Calc. Creos. Kali. Merc. Natr. m. Sabin. Sep. —milky. Amm. Calc. Carbo veg. Creos. Ferr. Lye Phos. Puis. Sil. Sabin. AND FUNCTIONS. 101 —milk-colored: Carbo veg. —reddish: Calcar. China. Cocc. Nitric ac. Phosph. —in fits and starts: Calc. Cham. Lye —acrid: Alum. Amm. Arsen. Bov. Calc. Carb. veg. Cham. Con. Creos. Ferr. Ign. Iod. Kali. Kali. hydr. Lyc. Merc. Mezer. Natr. mur. Phosph. Puis. Ran. bulb. Ruta. Sep. Sil. Sulph. —sUmy: Alum. Amm. m. Bor. Bov. Calcar. Coccul. Creos. Daph. Ferr. Graph. Guaj. Lach. Magn. Mere Mezer. Natr. Natr. mur. Nitr. acid. N. vom. 01. an. Plumb. Puis. Sabin. Sassap. Stann. Sulph. Thuj. Zinc. —painless: Creos. N. vom. Puis. —excoriating: Alum. Natr. mur. — starch like: Sabin. —fetid: Chin. Creos. Natr. Nitr. ac. N. vom. Sabin. Sep. —watery: Amm. Ant. tart. Carb. veg. Cham. Creos. Graph. Mere Mezer. Alur. ac. Puis. Sep. Sil. —white, slimy: Graph. —tenacious: Aeon. Bar. Bov. Mezer. Phosph. Sabin. Stann. 2. Accompanying Ailments. ABDOMEN, distended: Amm. m. Sep. —pains in: Bell. Caustic. Con. Creos. Ign. Lyc. Magn. mur. Puis. Sil. Sulph. ----labor-like: Dros. AT URINATING: Sil. AFTER URINATING: Carb. veg. DISCHARGED IN THE MORN- ING : Natr. mur. FACE, pale: Ars. Puis. Sep. IN GENERAL : Alum. Ambr. Amm. mur. Ars. Bell. Bov. Calc. Carb. an. Caust. Cham. Cocc. Con. Cop. Creos. Ferr. Graph. Ign. Kali Lyc. Magn. Magn. mur. Merc Natr. mur. Phosph. ac. Prun. Puis. Sabin. Sec. corn. Sep. Sil. Sulph. Sulph. ae Zinc, 102 UPPER EXTREMITIES. PRESSING DOWN: Natr. mur. SMALL OF BACK, pains in: Bar. Caust. Graphit. Kali. Magn. mur. SPASAIS, abdominal: Magn. mur. STITCHES IN UTERUS: Sep. WEAKNESS: Alum. Creos. Sep. XXVII. EXTREMITIES. TJFJPFR. Arm-Pit. BORING: Arg. Phosph. BURNING : Carbo veg. Cocc. Men. Phosph. Plumb. Puis. Rhus. Sep. CREAKING: Croc. Daph. Merc. CRAWLING: Cocc. DISLOCATION-PAIN : AI a g n. Phos. ERUPTION: Alum. Ant. crudum. KaU. Sulph. IN GENERAL: Aeon. Alum. Ambr. Amm. mur. Asa feet. Bell. Bry. Carbo veg. Caust. Chin. Colch. Creos. Digit. Euphorb. Ferr. Kali. Lach. Laur. Led, Lycop. Alagn. Alagn. mur. Merc Alczer. Natr. Nux vom. Phosph. Puis. Rhod. Rhus. Sep. Sil. Squill. Stann. Stront. Sulph. Thuj. Viola, tricol. Zinc HEAATINESS: Aeon. Arn. Phosph. Puis. ITCHING: Caustic Alagn. Ignat. Natr. Op. LAMENESS : Lach. Puis. Sil. MUSCLES, twitching of: Croc. Spig. Spong. PAIN AS IF BRUISED: Aco. Alum. Coccul. Ferr. Ign. Lyc. Magn. Plumb. Spig. Sulph. Zinc. PAIN, simple: Bry. Daph. Graphit. Kali. Magn. —laming: An\br. Chin. Euphor- bium. Alur. ac. Nux vom. PRESSURE: Arn. Bob. Bryon, Caust. Colch. Creos. Dn/itul. Laur. Lycop. Natr. Oleand. Phosph. ac. Ran. bulb. Rhus. Sep. Staph. Sulph. Zinc. RAISED: Merc. GONE TO SLEEP: Ferr. SPOTS, brown : Ant. crud. STITCHES: Aeon. Alum. Asa f. Bell. Bry. Calc. Caust. Cice Cocc. Ferr. Graph. Guaj. Ign. Kali. Lach. Laur. Lyc. Nitric acid. Phos. Plumb. Pulsat. Rhus. Sil. Staph. Stann. Sulph. Thuj. Zinc Veratr. SWELLING: Aeon. —feeling of: Jlell. TEARING: Aeon. Ambr. Argent. Bell. Bov. Bry. Caust. Canth. Carb. veg. Chin. Graph. Iod. Kali. Laur. Led. Lye. Natrum mur. Nux vom. Phos. Rhus. Stront. Zinc. TENSION: Dig. Euphorb. Hyosc. Kali. Petr. Teucr. Zinc. THROBBING: Daph. Magn. mur. Rhod. Sulph. Tar. Arms. Upper arms.*) BLUE SKIN: Cupr. Lach. Secale corn. Veratr. BORING: Canth, Plumb. Rhus. BURNING: Agaric. Am: Borax. Carbo veg. Dulc. Kali. Lach. Nux vom. Phosph. Rhus. Sep. Zinc. BONE-PAINS: Bar. BeU. Lycop. Merc. Nitric ac. Thuj. COLDNESS: Bell.. Camph. Cham. Hyosc. Kali bichr. Rhus. Veratr. *) U. means Upper, L. Lower arms. UPPER EXTREMITIES. 103 —feeUng of: Graph. Rhus. Sec. com. I CONTRACTION: Bism. Calc. CONTUSIVE PAIN: Cycl. Hell. CONVULSIONS: BeU. Chamom. Cocc Cupr. Hyosc Ipecac. Op. Rhus. Squill. Secale corn. Stram. Veratr. CRAMPY : Calc. Cin. Dulc. Men. Oleand. Phosph. Valer. CREEPING: Bell. Cocc. Sec. corn. Sep. ERUPTION : Ant. crudum. Cam: Carbo veg. Dulc Kali. Phos. nc Sep. ERYSIPELAS: Bell. Rhus. FAINTNESS : Alumin. Anac. Arn. Asar. Calcar. Cupr. Cycl. Guaj. Ign. Kali. Led. Natr. mur. N. vom. Plat. Plumb. Rhod. Sep. Stann. Araler. IN GENERAL: Amm. mur. Antim. crud. Asa foet. Aur. Bell. Bryon. Canth. Carbo an. Carbo veg. Chel. Clem. Coccul. Con. Cupr. Dig. Ferr. Hep. Ign. Iod. Kali. Lach. Lycop. M. arct. Mang. Mezer. Mur. acid. Natr. mur. Nitr. Oleand. Petr. Plumb. Phos. Puis. Rhodod. Rhus. Selen. Sep. Sil. Stann. Staphys. Sulph. Sulphur, ae Valer. HEAT: Bryon. Natr. mur. Nitr. acid. FEELING OF HEAT : Bry. Graph. Nitric ae Staph. HERPES : Kali carb. Natr. mur. Sulph. —U. and L.: Bov. Con. Dulc. Graph, Natr. muriat. Phosph. Sil. ITCHING: Daph. Dulc Euphorb. Lach. Laur. M. austr. Nux vom. Oleand. Ran. se Ruta. Stront. Thuj. JERKS : Anacard. Oleand. Ruta. Stann. LAMENESS: Agar. Bism. Cnust. Chel. Cocc. Kali. Lach. Nux vom. Phos. ac. Staph. [ AIUSCLES, twitching of : Coccul. Men. Valer. NUMBNESS : Ambr. Aur. Bell. Cham. Coccul. Iod. Plat. Puis. Veratr. PAIN, simple : Agar. Baryt. Bell. Bry. Calc. Cupr. Graph. Puis. Zinc. —laming: Bell. Chamom. Dig. Natr. mur. Rhod. Sil. Zinc. —as if dislocated: Alum. Bry. Eu- phorb. Rhod, —as if bruised: Bellad. Coccul. Cycl. Daph. Ferr. Hep. M. austr. Magn. mur. Natrum mur. Nitric ac. Plat. Plumbum. Puis. Sep. Sulph. Thuj. Veratr. PARALYSIS: Agar. Bell. Caustic. Chel. Lach. Oleand. Rhus. PRESSURE : Ammon. mur. Anac. Arg. Asa foet. Aur. Bell. Calcar. Camph. Cycl. Daph. Euphorb. Led. Nux vom. Petr. Puis. Rhod. Sabin. Stann. Staphys. Sulph. Vit. GONE TO SLEEP: Ambr. Baryt. Cham. Coccul. Croc. Graph. Ignat. Kali. Lach. Lycop. Magn. mur. Nux vom. Petr. Rhus. See corn. Sep. Sil. SPASMS: Bell. Cuprum. Ipec. Sec. corn. SPOTS, red: Plat. Rhus. Sulph. STIFFNESS : Amm. mur. Caust. Nux vom. Oleand, Sassap. Rhus. STITCHES : Aeon. Alum. Antim. crud. Arn. Asa f. Bell. Bry. Canth. Cocc. Con. Dulc. Ferr. Guaj. Kali. Laur. Mang. N. mosch. Phosph. Phosph. acid. Puis. Rhod. Rhus. Sabina. Squill. Stann. Staph. Sulph. Tar. Thuj. SWEAT: Asar. Ipec. SWELLING : Antim. crud. BeU. Bry. Hell. Rhus. SAVELLING OF BONES : Rhus, Sil. Sulph. 104 UPPER EXTREMITIE8. TEARING : Agar. Amm. mur. Anac Arn. Aur. Bell. Bryon. Canth. Carbo an. Caustic. Chel. China. Cin. Con. Digit. Dros. Ferr. Guaj. Kali. Led. Lyc. Alur. ac Alagnes. mur. Nitr. Nux vom. Phosph. Plumb. Puis. Rhus. Sabina. Sassap. Sil. Stann. Staphys. Sulph. Zinc. TENSION: Ant. cmd. Asa feet. Bry. Dig. Laur. Rhus. TREAIBLING: Ars. Bry. Capsic. Caust. Cicut. Hyosc. AI. arct. Op. Petr. Phosph. Puis. Rhus. Sabad. Sil. Spig. Sulph. Veratrum. TUBERCLES: Ant. crud. Arsenic Cah . Cocc, Nitric ac. Staph. TUAIORS: Ant. crud. Ars. Caust. Natr. mur. Nitric ac. ULCERS: Lach. Rhus. Shoulder-Joint. BEATING: Magn. Merc. Thuj. BURNING: Brom. Graph. CONTUSIVE PAIN: Dros. CREAKING: Ant. tart. Bar. Cic, Croc. Ferr. Alere Thuj. DISLOCATED, as if: Alagn. DRAWING: Asa f. Carbo veget. Cham. Magn. mur. Staph. FEELING OF AVEAKNESS: Dros. —of heaviness: Puis. IN GENERAL: Arn. Asa f. Bry. Calc. Carbo veg. Caust. Croc. Bros. Ferr. Ign. Kali. Lach. Lyc. Led,. Merc. Natrum mur. Nux vom. Pulsat. Rhus. Staph. Sulph. ATe- ratrum. Vit. Zinc. HEAT, feeling of: Brom. INFLAAIAIATION: Aeon. Bry. Led. Puis. Rhus. JERKING: Puis. JERKS: Colch. Sil. LAAIENESS : Lyc. Puis. Stann PAIN AS IF DISLOCATED : Alu- min. Ambr. Arn. Caps. Croc. Ign. Natr. mur. Petr. Puis. Rhod. Rhus. Sabina. Sejj. Spigel. Thuj. —as if bruised: Ferr. Ign. Kali. Nux vom. —simple: Aco. Calc. Croc. Ign. Natr. mur. Phosph. —laming: Euphorb. Nux vom, Puis. Staph. PRESSURE: Bism. Bryon. Calcar. Dros. Kali. Laur. Led. Staph. A'it. STIFFNESS: Caust. Euphorbium. Staph. STITCHES : Asa feet. Bry. Calcar. Coccul. Crot. Ferr. Graphit. Hell. Ignat. Iod. Laur. Led. Merciu. Puis. Staph. Stront. Sulph. ac. Thuj. SWELLING: Aeon. Bry. Hep. TEARING : Ambr. Argent. Bism. Bry. Carbo veg. Cnust. Ferr. Graph. Ign. Led. Alere Phos. Puis. Rhus. Sabin. Sulph. Vit. TENSION: Asa f. Bov. Bry. Eu- phorb. Laur. Lyc. Zinc. Arm-Pit. BURNING: Carbo veg. Caust. CUTTING: Kali. ERUPTION : Lyc. Merc. Natrum mur. Nitric ae Petr. Sep. GLANDULAR SWELLINGS bel- lad. Calc. Hep. Iod. Mercur. Natr. mur. Nitric ac Sulph. Rhus. Staph. SORENESS: Carbo veg. SORE, as if: Teucr. STITCHES : Arn. Canth. Graph. Men. Staph. Zinc. SWEAT: Hep. Kali. Lach. Alere Nitric ae Phosph. Rhus. Sep. TEARING: Colch. Kali. Natr. mur. Lower Arm. BLUE SKIN: Samb. BORING: Asa f. Natr. Phosph. ac. Ran. se BURNING: Agar. Amm. mur. Asa feet. Carb. veget. Euphorb. Graph. Alcrc. Alur. ae Oleander. RIiuh. Sulph. Zinc. UPPER EXT1 BONE-PAIN: Kali bichr. Natr. mur. Spong. CHILL: Ign. Puis. Rhus. COLDNESS: Bry. Nux vom. Rhus. CONTUSTYE PAIN: Dros. CRAMPY: Anac. Cin. Conium. Ole- and. Plat. Rhodod. Ruta. A7aler. CREEPING: Arn. Bell. Cocc Con. Alere Op. Sec. corn.. DEADNESS: Nux vom. ERUPTION: Amnion, mur. Calad. Caust. Lach. Lyc. Alere Nitr. ac. Phosph. ac Sil. Staphys. Sulph. Thuj. Zinc. FAINTNESS : Nux vom. Rhus. IN GENERAL: Aeon. Agar. Alum. Amm. mur. Anac. Arg. Arn. Asa f. Bell. Baryt. Bism. Bryon. Calad. Calc. Camph. Canth. Carbo an. Caust. Chamom. China. Cic. Cin. Colchic Con. Creos. Croc. Cupr. Dulc. Ferr. Grujih. Guaj. Hep. Hy- osc. Ign. Kali carb. Laur. Lyc. M. arct. Alang. Merc. Mezer. Mosch. Alur. ac. Natr. Nitr. Nitric ac Nux vom. Oleand. Phosph. Phosph. ac. Plumb. Puis. Ran. sc Rhod. Rhus. Ruta. Sabin. Sassap. Selen. Sep. Sil. Spig. Squill. Stann. Staph. Sulph. Tar. Teucr. Thuj. Valer. Vit. Zinc HEAT: Bry. HEAVINESS : Anne Aur. Croc. M. austr. Phos. ae Sulph. HERPES: Con. Alagn. ATerc. Nux vom. INSENSIBILITY: Stront. ITCHING • Agar. Amm. mur. Carb. an. Caust. Dulc Hyosc. Laur. Alere Puis. Ran. Rhus. Spig. Sulph. JERKS: Dulc. LAA1ENESS: Bellad. Calc. Caust. Dulcam. Lach. Lycop. Sil. Sulph. PAIN AS IF BRUISED : Con. Croc, Alur. ae Rhus. Ruta. Zinc —as if dislocated: Coccul. Led. —as if sore : Arn. Cic Rhus. RKMITIES. 105 —simple: Croc. Baryt. Bellad. Calc Graph. Phosph. —laming: Baryt. Bism. Cycl. Dulc. Alosch. Natr. mur. Nux vom. Ruta. S^. Staph. Stront. Zinc. PBESSURE: Anac Asa f. Baryt. Bismuth. Camph. Cocc. AI. arct. Alang. Oleander. Plat. Prun. Ruta. Sabin, Spigel. Staphys. Verb. BASH: Alere Selen. SHOCKS: Oleand. SPOTS, blueish: Sulph. ae Thuj. —red: Vit. STITCHES: Aconit. Anac Ant. crud. Am. Asa f. Bell. Bov. Bryon. Calc. Carbo an, Caustic. Cicut. Cycl. Dig. Hyosc Lycop. Alagn. AI vc Alosch. Oleand. Phosjihor. Phosph. ac. Ran. bulb. Sabin. Sas- sap. Spig. Staph. Stram. Tar. Thuj. SWELLING: Bry. Calc Caust. Lyc. Nux vom. Rhus. TEARING: Aeon. Alum. Ammon. mur. Anac. Arg. Asa f. Aur. Baryt. Bell, Bism. Bry. Canth. Carbo veg. Caust. Cina. Colch. Cupr. Cycl. Daph. Dig. Graph. Grat. Guaj. Kali. Lach. Lycop. Alur. ae Magn. mur. Natr. mur. Nitric ac. Phosph, Puis. Ran. bulb. Rhod. Rhus. Sns- sap. Sil. Stannum. Staph. Stront. Sulph. Teucr. Thuj. Valer. Zinc. TENSION: Anac. Arn. Caustic. Co- loc. Dig. Kali. Led. Puis. Stront. Sulph. Zinc. THROBBING: Sabad. TREAIBLING : Caustic. Nitric ac. Rhus. TUBERCLES: Coccul. —miliary: Agar. WARTS: Cede Sil. WEAKNESS : Dulcam. Nux vom. Rhus. Elbow and Joint. BONE-PAIN, nocturnal: Lyc. BORING: Caust. Thuj. 106 I'PPER EXTREMITIES. BUBNING: Asa, fod. Carbo animal. Carbo veg. Cub: phosph. Alereur. Mill. Nitr. Phosph. Plat, Rhus. Sulph. BRUISING PAIN : Canst. Dulcam. Puis. Ruta. Sulph. Veratr. CONTRACTION : Caust. Laur. Sec. corn. CONTUSIVE PAIN: Caustic.Dros. Ruta, TEARING: Alum. Ambr. Aur. Bov. Canth. China, Colchic Daph. Iod. Kali carb. Kali bichr. Laur. Lyc. Alere Alur. ac. Nitr. Nux mosch. Pulsat. Rhus. Ruta. Sassap. Sil. Stront. Sulph. Zinc. CREAKING: Ant. crud. Conium. Merc At. arct. Sulph. DISLOCATION PAIN: Am. Alang. Rhus. ERUPTION: Dulc Hyosc. Merc Sabin. Staph. Sulph. FAINT FEELING: Led GNAWING: Dulc ITCHING: Agar. Alum. Caustic. Laur. Merc. Natr. Phosphor. Rhus. SuljAi. —in the bend of the elbow: Canth. Laur. Spig. JERKING: Bellad. Caustic. Croc Natr. mur. Nitric ae Rhus. Veratr. LAA1ENESS: Bell. Graph. PAIN, simple: Cupr. Dig. Laur. Phosph. Puis. Sulph. ac. —laming: Bell, Cham. Coccul.Daph.- Sabin. Staph. Stront. PARALYSIS: Dulc Petr. PRESSURE: Alum. Argent. Hep. Led. Zinc. STEATOMA: Hep. STIFFNESS: Kali carb. M. arct, AI. austr. Stann. Thuj. STITCHES : Asa f. Bellad. Bryon, Coccul. Coloc HeU. Kali. Laur. Alere Mur. ac Nu:■; mosch. Phosph. Rhod. Sabin. Spig. Spong. Thuj. SWELLING: Bryon. Hep. Lach. Areratr. Vit. TENSION: Daph. Dros. Mur. ae. Puis. Rhus. Stann. Sulph. THROBBING: Rhus. Thuj. TUBERCLES : Caust. Mur. ac. WEAKNESS: Staph. Sulph. Bend of the Elbow. IN GENERAL: Amm. mur. Anac. Am. Bell. Canth. Caust. Clem. Con. Cupr. Dros. (Iraph. Iod. Kali. Laur. Lyc Alen. Petr. Phosph. Puis. Sep. Spig. Sulphur. Thuj. Valer. Zinc. Tip of Lhe Elbow. IN GENERAL: Agar. Alum. Bry. Carbo an. Causticum. Graph. Hep. Merc. Mur. ac Oleand. Phosphor. ac Rhus. Sabina. Spong. Stann. Wrist-Joints. BORING: Hell. Rhod. COLD FEELING: Rhus. CREAKING: Con.Mere Selen. DISLOCATION-PAIN: Arn. Bov. Bry. Calc. c. Canst. Graph. Ign. Lyc. Nux vom. Rhodod. Rhus. Ruta. Sabin. Stannum. Staph. Sulph. ERUPTION: Merc. Calc. phosph. Rhus. Sulph. EXCORIATION: Sulph. GANGLIA: Magn. m. Sil. IN GENERAL: Aeon. Amm. Anac. Arn. Ars. Asa f. Bism. Bov. Bry. Calc. c. Cede: jihosph. Carbo veg. Caustic. Chel. Colch. Creos. Cycl. Dig. Euphrasia. Graph. Hep. Hyosc Iod. Ka'i. Led. Lye Mang. Merc Mezer. Nitr. Phosphor. Puis. Rhod. Rims. Biita. Sabin. Sassap. Selen. Sep. Sil. Staphys. Stront. Sulphur. Teucr. Thuj. Arerb. Zinc. rCIIING: Amm. mur. cANTOF AIOBILITY: Sep. UPPER EXTREMITIES. 107 NODES, gouty: Calc. c. Lyc. NUMBNESS: Bov. Croc. SPOTS: Kali. Petr. STIFFNESS: Bellad. Caust. Chel. Lach. Led. Lye Pals. Rhod. Ruta, Sabina. Sep. Sulphur. Thuj. STITCHES: Alum. Arn. Bryon. Calc c Caust. Con. Graphit. Hell. Kali. Laur. Alere Natr. mur. Nux vom. Rat. Sep. Sil. Squill. Sulph. SWELLING: Bry. Calc. TEARING: Baryt. Bov. Calc. c Carbo reg. Chel. Grat. Kali. Lach. Mezer. 01. an. Phosph. Plumb. Puis. Rhod. Sabina. Sulph. Teucr. TENSION: Amm. carb. Spongia. Zinc. TREAIBLING: Aeon. TWITCHING: Bar. Rhus. Sulph. Valer. PAIN: Aeon. Ammon. Asa foet. Hyosc. Alere Nitr. Sulph. —laming: Aconit. Asar. Bism. Eu- phorb. Kali. Led. Nux vom. —as if sprained: Arn. Calc c. Puis. Rhod. —as if bruised: Calc phosphor. Caust. Nitric ac. Puis. Ruta. PRESSURE: Led. Nitr. ac. Stann. Zinc. WEAKNESS: Merc. Phosph. Hands. BEATING: Sabad. BLISTERS: Amm. mur. Arg. nitr. Bell. Canth. Clem. Hep. Kali. Lach. Natr. mur. Rims. Sep. Squill. Sulph. BLUENESS: Aco. Camph. Cupr. Lad. Nux vom. Rhus. Samb. Ye- ratrum. BOILS: Calc. carb. Hep. Lycop. Alere BURNING: Aeon. Anac. Aurum. Bryon. Calc Chin. Hell. Kali. Lach. Laur. Nux mosch. Nux vom. Op. Phosph. Sec. com. Sep. Squill. Stann. Staphys. Sulph. Zinc. BRITTLE, skin: Graph. Natr. mur. CHILBLAINS : Agar. Nitr. ac Petr. Phosph. Puis. Stann. Sulph. CHILLINESS: Ambr. Anac Merc. Nux vom. Petr. COLDNESS: Aeon. Agar. Ambr. Am. Aur. Bar. Bell. Calcc. Camph. Cann. Caustic. Cham. Chin. Crot. Cuprum. Cycl. Daph. Dig. Dros. Ferr. HeU. Iod. Ipecac. Kali. M. arct. Mang. Nitric ac. Nux vom. Phosph. Puis. Ranunc bulb. Rhus. Samb. Sep. Spigelia. Sulph. Thuj. Yeratr. Vit. —feeling of: Rhus. Sec. corn. CONTRACTION: Cann. Cin. Merc Nux vom. Prun. See corn. CRAAIPY FEELING: Aeon. Ambr. Anac. Asa f. Aur. Calc. carb. Cann. Euphr. Graph. Lycop. Mang.Men. Mercur. AIoscli. Nitr. Nux vom. Pled. Sil. Spig. Spong. Stram. CREEPING: Arn. Ars. Bar. Bell. Caust. Croc. Lach. Laur. Nux vom. Phosph. Plat. Rhodod. Ruta. Sec. corn. Spig. Sulphur. Veratr. —as if gone to sleep: Bry. DEADNESS: Calc Con. Laches. Nux vom. Phosph. Rhus. Sec. corn. Sil. Zinc. DESQUAMATION OF HANDS: Amm. Barr. Ferr. Merc. Phosph. ac. Sep. Sulph. DISLOCATION-PAIN: Bar. Rhus. DRY PALMS OF HANDS: Bism. DRYNESS: Lyc Natrum. Sabad Sulph. EAIACIATION: Graph. Gratiola. Selen. ERUPTION: Alum. Antim. cmd. Ars. Canth. Carbo veget. Cic. Hep. Lyc Merc. Mur. ac. Nitric ac Rhus. Secale corn. Selen. Spig. Staph. Sulphur. Sulph. ae Zinc. ERYSIPELAS : Ran. bulb. Rhus. 10S UPP..R EXTREMITIES. IN GENERAL: Aeon. Agar. Ambr. Amm. Anac: Arg. Arn. Ars. Asa f. Aur. Bar. Bell. Bism. Bry. Calc. Carbo veg. Caustic. Chamom. Chin. Coccul. Creos. Cupr. Dig. Dulc. Ferr. Graph. Hep. Ipec. Kali. Lach. Laur. Led. Lyc M. arct. Alang. Alen. Merc Mur. ae Natrum. Natr. mur. Nux vom. Op. Petr. Phosph. Phosph. ae Plumb. Puis. Ran. bulb. Rhod. Rhus. Ruta. Samb. Sec com. Selen. Sep. Sil. Spig. Stann. Staph. Sulph. A'eratr. ATerb. Zinc HEAVINESS: Bov. Caust. Nitric. Phosph. HEAT: Aeon. Bry. Carb. veg. Coc- cul. Graph. Hell. Hepar. Led. Lyc. Nitric ac. N. vom. Phosph. Sep. Stann. Staph. Zinc. HERPES: Ambr. Bov. Calcarea. Clem. Dulc Alere Natr. mur. Sas- sap. Sep. Sulph. Zinc INSENSIBILITY: Bell. Lyc. Natr. mur. Rhus. Sec. cornut. Stann. Stront. Zinc. ITCH: Mere Sep. Selen. Sulph. ITCHING: Aur. Bov. Cann. Caustic. Cina. Coccul. Hep. Kali. Nitric ac Phosph. ac. Plat. Plumb. Rhus. Sulph. Veratr. JERKS: Valer. NODES, arthritic: Calc carbon. Calc. phosph. Led. Lyc. Rhod. Rhus. Sep. Sulph. NUMBNESS : Asa feet. Coccul. Car- bo veg. Lach, Lyc. Puis. Rhus. Ruta. PAIN : Agar. Daph. Nux vom. Plumb. —laming: Bell. Bism. Caustic. Cycl. Dig. Nux vom. Sil. Vit. PARALYSIS: Ambr. Crot. Cupr. Lach. Natr. mur. Nux vom. Phos- phor. Plumb. Rh.s. Sil. Zinc. PARCHED SKIN: Lycop. Phosph. acid. PRESSURE: Ana f. Calc. phosph. Carbo veg. Cycl. Hep. KaU. Men. Nitric ac. Staph. Zinc. REDNESS: Dulc. Fluor, ac. Nux vom. Sabad. Sangn. Staph. RHAGADES: Cycl. Graphit. Petr. Sulph. ROUGH: Alum. Kali. Nitric ac. Phosph. ae GONE TO SLEEP: Ambra. Baryt. Carbo an. ('roc. Fluor, acid. Graph. Kali. Lach. Lycop. AI. austr. Natr. mur. N. vom. Phosph. Puis. Sec. corn. Sil. Veratr. SORE, pain as if: Calc. c. Nitric ac. Rhus. BRUISED, pain as if: Carbo veg. Dros. Ruta. SPASM: Bell. Caust. Sec. corn. SPASMODIC FEELING: Anac. Bell. Caust. Plat, —pain: Anac. Caustic Lycop. Spig. SPOTS : Ant. tart. Nitr. ac. Sep. —red: Merc. Sep. STIFFNESS: Ars. Bellad. Caust. Cham. Coloc. Croc. Mercur. Rhus. Zinc STITCHES : Aconit. Ang. Arn. Asa f. Bellad. Calc phosphor. Carbo an. Caust. Caps. Chel. Cina. Hell. Graph. Lach. Led. Lyc. Mosch. Magn. mur. Par. Plumb. Squill. Stann. SWEAT: Ant. tart. Calcar. c Cann. Chamom. Coccul. Con. Laur. Natr. mur. Nitric acid. Nux vom. Phosph. Sulph. Veratr. —cold: Caps. -Sep. —in palm of hands: Aeon. Bar. Cede c Con. Dulc. Fluor, ac Ignat. Laur. Merc. Nux vom. Rheum. SWELLING: Aconit. Ars. Bell. Bry. Calcar. Caust. China. Coccul. Dig. Ferr. Hep. Lach. Lyc. Merc Nux vom. Phosph. Rhus. Ruta. Sec. corn. Stann. Sulph. —nocturnal: Dros. UPPER EXTREMITIES. 109 TEARING AND DRAWING: Agaric. Amm. Arn. Ars. Aur. Bel- lad. Calc. Canth. Carbo veget. Caust. Chamom. Chel. China. Colch. Cuprum. Digit. Graph. Grat. Iod. Kali. Lach. Laur. Led. Lyc. Alang. Mur. acid. Natr. mur. Nitr. Petr. Phell. Phos. Plumb. Rheum. Rhod. Rhus. Sabin. Selen. Sep. Spig. Stann. Sulph. Teucr. Verb. Zinc. TENSION: Bell. Canth. Caustic. Chin. Hyp. Zinc. TREMBLING: Agar. Anac. Ant. tart. Ars. Bell. Bism. Bryon. Calc. c Caustic Chin. Cic. Coccul, Coffea. Crotal. Ferr. magn. Hyos- cyam. Iod. Kali. Lach. Led. Nitr. ac. Oleand. Op. Phosph. Plat. Plumb. Rhus. Sil. Spong. Stan- num. Stram. Sulph. Zinc. TUBERCLES: Ars. Calc. Coccul. Lyc. Natrum mur. Nitric ac. Rhus. TWITCHING: Anac. Bar. m. Asa f. Bell. Cina. Cupr. Graph. Ignat. Lach. Laur. Meph. Natr. Op. Plat. Ran. bulb. Sep. Stann. Sulph. ae Vit. ULCERS: Ars.Lyc. Sil. Sulph. URTICARIA: Hep. VARICOSE VEINS : Alumin. Arn. Calc. CheLChin. Laur. Men. Nux vom. Op. Phosph. Puis. Rheum. Rhod. Stront. Sulphur. Thuj. CRACKED VEINS: Alum. Calc. Creos. Graph. Lach. Magn. c Alere Natrum mur. Nitric ac. Petr. Sil. Sulph. Zinc. VESICLES: Daph. WARTS: Calc. c Caust. Dulcam. Rhus. Sep. Thuj. WEAKNESS: Calc. Carb. veg. Caust. Chin. Cupr. Hell. Nitr. Nux vom. Phosphor. Sil. Tab. Zinc YELLOWNESS • Canth. Ign. Merc. Spig. Fingers. BLOTCHES : Lach. Lyc. Staph. BURNING: Asa f. Asar. Calcar. Caust. Con. Dig. Kali. Lach. Natr. Nitric ac. Nux vomica. Oleand. Plat. Sil. Sulph. Sulphur, ac. Ve- ratr. BONE-PAIN: Fluor, ae CHAPPING: Fluor, ac. Natrum mur. Petr. Sil. CHAPPING OF SKIN: Petr. CHILBLAINS : Agar. Croc. Nitr. ac. Nux vom. Petr. Puis. Rhus. Sulph. COLDNESS : Antim. tart. Calad. Cham. Chel. Digit. Hell. Lyc. Mur. ac. Merc. Rhod. Sulph. Tar. Thuj. CONTRACTION: Ambra. Anacard. Antim. tart. Arg. Bism. Calc Caus- tic. Cina. Colchic. Coloc Graph. Lyc Merc. Nux vom. Plat. Rhus. Ruta. See corn. Sep. Sil. CONTRACTION OF TENDONS : Caust. CRAAIPY FEELING : Anacard, Am. Ars. Asa f. Calc Cin. Coccul. Cycl. Euphr. Graphit. Ignat. Lyc. Mur. ac. Alosch. Nux vom. Oleand. Phosph. Plat. Rhus. Stann. Staph. Sulphur. Veratr. CREAKING: Bar. Caps. Nitr. CREEPING : Aeon. Ambr. Amm. mur. Ars. Calc Caust. Cina. Croc. Graphit. Kali. AI. arct. Alagn. Natr. mur. Opium. Plat. Ran. bulb. Rhod. Rhus. Sec. corn. Sep. Sil. Sulph. Thuj. Veratr. Verb. —in the tips of the fingers : Aco. Ammon. mur. Croc. M. austr. Sec. com. Sep. Thuj. —as of ants: Sec. corn. —as if gone to sleep: Mur. ac. DEADNESS: Agar. Calc. Caust. Cic. Con. Hep. Lycop. Merc Nitric ac. Phosph. ac. Puis. Rhus. Sec. corn. Sulphur. Thuj. Veratr. 110 UPPER EXTREMITIES. —gangrenous: Sec. corn. —of tips of fingers: Ant. tart. Chel. DESQUAAIATION OF THE SKIN: Amm. mur. —on the tips of the fingers: SabadiUa. DISLOCATION-PAIN: Bell. Cham. Ign. Natr. mur. riiosphor. Spig. Sulph. DRYNESS OF TIPS OF FIN- GERS : Ant. tart. ERUPTION: Antim. crud. Baryt. Canthar. Caust. Clem. Cycl. Daph. Graph.Lach. Lyc.Alur. ae Phos.ac Plumb. Puis. Rhus. Spigel. Squill. A'eratr. Zinc. —between the fingers: Graph. Sulph. acid. ERYSIPELAS: Lye. Rhod. -of the tips of fingers: Thuj. ENHAUSTIGX: Sil. Rhus. HEAT: Sabad. Thuj. IN GENERAL: Aeon. Alum. Ambr. Amm. nun*. Anac. Antim. tart. Am. Ars. Asa f. Baryt. Bell. Bism. Bor. Bi-y. Calcar. Canth. Carbo vegetab. Caust. Cham. Chel. Cic Cina. Coc- cul. Colch. Creos. Croc Cyclam. Dros. Ferr. G'r«p7».Hell. Hep. Ign. Kali. Lach. Lyc. M. arct. AI. austr. Alagn. Mercur. Alosch. Natr. Natr. mur. Nux vom. Oleand. Phosph. Puis. Ran. Rhodod. Rhus. Ruta. Sabad. Sec corn. Sep. Sil. Spigel. Stann, Staphys. Stront. Sulphur. Teucr. Thuj. ATaler. Veratr. A7erb. Vit. Zinc. HERPES : Ambr. Merc. Nitric ac. Ran. bidb. INFLAA1MATION : Aco. Con. Hep. Kali. Lyc. Alere Puis. Ran. Sil. INSENSIBILITY: Digit. Ferr. N. vom. Phosph. Rhus. Sec corn. —of tips of fingers: Ant. tart. Cham. Ferr. AI. austr. Staph. ITCHING: Agar. Alum. Aur. Calc. Camph. Caust. Chel. Con. Cycl. Lach. Lyc. Nux vomica. Oleander. Phosph. Plumb.;Puls.i»/iof/. Sulph. ae Zinc A eratr. ITCHING, between the fingers: Aur. Lach. Plumb. Rnod. —at the tips of fingers: Ambra. Ant. crud. Sulph. ac Spig. LAAIENESS: Carbo veg. —of the thumb: Kali. NODES, arthritic: Graph. Lyc. NUA1BNESS: Ang. Calc. Canst. Con. Cina. Euphr. Ferr. Graph. Kali. Lach. Lycopod. Phosph. Plat. Rhus. Sec. corn. Sil. Staph. Sulph. PAIN: Caust. Led. Sassap. Veratr. —as if bruised: Amm. carbon. Cina. Natr. mur. Nitric ae —laming: Bellad. Cycl. Digit. Kali. Alosch. Sabin. Sil. PARALYSIS: Calc. Bryon. Kali. Lach. Phosph. PRESSURE: Asaf. Bell. Con.Cycl. Dig. Hell. Hyosc. Ran. Rhod. Ruta. Sassap. Staphys. Tar. Teucr. Vit. Zinc REDNESS : Agar. Nux vomica. RIGIDITY: Ars. Alere. GOING TO SLEEP : Aeon. Ambra. Amm. mur. Aur. Bar. Calc Carbo an. Cham. Cina. Croc Dig. Graph. Iod, Kali. Lach. Lyc Alere Alagn. mur. Natr. mur. Nux vom. Par. Petr. Phosph. Plumb. Puis. Rhus. Sassap. See. com. Sep. Sil. Staph. Sulphur. Thuj. A'eratr. SORE BETWEEN THE FIN- GERS: Graphites. SPASM: Bellad. Chamom. Hyper. Ign. Nux vom. Rhus. Veratr. SPASMODIC FEELING: Anac. Bell. Caust. Digit. Nux vom. Plat. Rhod. SPOTS, yellow: Con. Petr. Sabadilla. —dark: Ant. tart. —red: Plumb. Zinc. STITCHES: Ambr. Ammon. mur. Anac. Arn. Bryon. Carbo an. Car- bo veg. Caust. Colch. Croc. Daph. upper ext: Dig. Graph. Kali. Lach. Lye. Alere Alur. ae Nut rum mur. Nux vom. Oleand. Petr. Phosph. Ran. so. Rhod. Rhus. Sabad. Sassap. Stann. Staph. Sulph. ac Teucr. Thuj. Arerb. Zinc. SWELLING: Amm. carb. Arsenic Bry. Calc Hep. Iod. Lach. Lye. Alagn. Merc. (Nitr. Nux vom. Phosph. Ran. seel. Rhus. Sil. Sulph. Thuj. —feeling as of a: Bell. TEARING: Agar. Ambr. Amnion. mur. Arsen. Aur. Bell. Bism. Canth. Carbo veg. Caust Chel. Colch. Daph. Hell. Ign. Iod. Kali. Lach. Laur. Lyc. Alagn. Merc Alur. ac. Natrum mur. Nitr. 01. an. Tar. Phos. ac. Plumb. Ran. bulb. Rhod. Sabin. Sil. Spig. Stann. Staph. Sulph. Teucr. Zinc. TENSION : Canth. Iod. Phosph. Plumb. Puis. Veratr. THROBBING: Carbo reget Crot. Sil. Sabad. Teucr. THUAIB GOES TO SLEEP: Kali. Plumb. —clenched: Bell. Cham. Hyosc. Ign. Rhus. TREMBLING: Ambr. Bry. Rhus. Stront. TWITCHING : Alum. Amm. mur. Anac. Bry. Caust. Cham. Cic. Cin. Crotal. Cupr. Dig. Ign. Lycop. AI. austr. Men: 01. an. Phosph. Plumb. Rheum. Rhod. Rhus. Sabad. Stann. Sulph. Sulph, ac. ULCERS: Alum. Ars. Caust. Lyc. Natrum mur. Ran. bulb. Sil. Sulph. URTICARIA: Hep. WARTS: Caust. Lach. Lycopod. Petr. Sep. Sulph. WEAKNESS: Carbo veget. Hell. Nitr. Rhus. Sil YELLOW^turning: Chel. REMITEES. ill Finger-Joints. BORING: Hell. CRAMP-PAIN: Euphr. Alagan. Plat. Sulph. CREAKING: Baryt. Caps. Aleph. Nitr. DISLOCATION-PAIN: Na t r u m mur. Phosph. Sulph. DRY, as if: Puis. IN GENERAL: Ambr. Amm. Aur. Bell. Calc. Caps. Carbo veg. Caust. Cham. Chin. Colch. Con. Creos. Drosera. Graph. Hell. Hep. Ignat. Kali. Led. Lyc. Alang. Alere Natr. mur. Nitr. Nitric ac Nux vomica. Oleand. Phosph. Plat. Puis. Rhod. Rhus. Ruta. Sep. Sil. Spig. Spong- Staph. Sulph. Sulph. ae NODES, gouty: Calcar. Clem. Hep. Lyc Rhod, Staph. PAIN: Kali. Sil. Sulph —laming: Bell. Calc. PRESSURE: Led. Alere Zinc. REDNESS: Lyc Spong. STIFFNESS: Aur. Ars. Carbo an. Caust. Graph. Hep. Lycopod. Rhus. Sep. Sulph. STITCHES: Arn. Bar. Bry. Carbo veg. Con. Hell. Ign. Alen. Nitric ac. Rhus. Sabin. Sepiaj. Sulph. ac. SWELLING: Euphr. Hep. Lycop. Nitric ae TEARING: Agar. Ammon. Anac. Aur. Bell. Bryon. Carbo veg. Caust. Chel. Colch. Hell. Kali. Led. Lyc. Phosph. acid. Plat. Puis. Rheum. Rhodod. Rhus. Ruta. Sabin. Samb. Spig. Staph. Sulph. Teucr. Zinc. TENSION: Iod. Nitric ac. Puis. Sep. ULCERS: Sep. Tips of Fingers. IN GENERAL : Ambr. Ammon. mur. Ant. tart. Asa f. Bor. Calc. Chel. Croc. Hep. Lach. M. austr. Phos. Pulsat. Rhus. Sec. corn. Sep. Sil. Spig. Staph. Sulphur. Teucr. Thuj. Veratr. 112 LOWER EXTREMITIES. Finger-Nails. ALTERED COLOR : Ars. Alur. ac. BLUE: Chel. Chin. Chlor. Crotal. Dig. Nux vom. Petr. DISTORTION: Graph. Sep. Sulph. EXFOLIATION: Graphit. Alercur. Sulph. IN GENERAL: Alum. Ant. crud. Arsen. Bar. Bism. Bor. Bov. Calc. Caust. Chel. Colch. Con. Crotal. Digit. Graph. Hep. Kali. IocUne. Lach. AI. austr. Alere. Natr. mur. Nitr. Nitric ac. Nux vom. Phosph. Pulsat. Ran. bulb. Sabad. Sep. Sil. Sulph. Sulph. ae Thuj. GNAAVING: Alum. GROAVTH, slow: Ant. crud. HANG-NAILS: Natr. mur. Rhus. Stann. Sulph. NAILS, brittle: Graphit. Alercur. Thuj. —growing in: Sil. Sulph. PRESSURE: Calc. Caust. TEARING UNDER THE NAILS: SU. —all round: Ambr. Lyc. THICKENING: Graph. Sabad. ULCERATED: Alum. Arsen. Bar. Calcar. Conium. Hep. Kali. Laches. Lycopod. Mere-ur. AI. austr. Natr. mur. Petr. Phosph. Sepia3. Silic. Sulph. Thuj. ULCERATIVE PAIN: BeUad. Con. Graph. Hep. Kali. Merc Plat. Puis. .S'v7. Sulph. Sulph. acid. Thuj. YELLOAVNESS: Ambr. Con. Merc. Nux vom. IOWUR U^TTRUJiHTIUS. Extremities. (t. signifies thigh, 1. leg.) IN GENERAL : Anac Arn. Bellad, Bry. Calc. c. Cede, phosph. Carbo vey. Caustic. China. Colchic. Crot. Dig. Graphit. Guaj. Ignat. Iod. Kali bichr. Kali carb. Lach. Led. Lycop. Merc. Mezer. Alosch. Alur. ac. Natr. Natr. mur. N. voin. Oleand, 01. an. Phosph. acid. Plat. Plumb. Puis. Rhodod. Rhus. Ruta. Sabin. Sep. Sil. Spigel. Spong. Staph. Sulph. Thuj. Valer. Viol. tr. Thighs. BLOTCHES: Calc. c. Lach. Alere Staph. BOILS: Hep. Sep. Sil. BORING: Arn. Rhus. Staph. BURNING: Asa f. Carbo animal. Carbo veget. Daph. Euphorb. Kali. Nux vom, Phos. Plumb. Rhus. Sil. Sulph. Zinc. CARIES: Asa f. Aur. Cab: c. Hep. Alere Nitric ac Phos. Sep. Sil. Sulph. COLDNESS (t. and 1.): Ars. Bell. Calad. Calc c. Camph. Carbo veg. Daph. Led. Lyc. Nitric acid. Nux vom. Op. Puis. Sec. corn. Sep. Sulph. Veratr. —feeling of: Helleb. AI. austr. Oleand. —feeling of (t. and I): Camph. Carb. veg. Chin. Merc Natr. Sec corn. CONTUSIVE PAIN (t. and I): Arn. Euphorb. Led. Nux mosch. Rhod. Ruta. CONVULSIONS (t. and 1.): Cham. Caustic. Cuprum. Hyosc Ign. Ipec. Men. Op. Plumbum. Rhus, Sec. corn. Strain. CRAAIPS : Asar. Chin. Colch. —(t. and 1.): Bell. Bism. Cina. Cupr. Lach. Nux vom. Rhus. Sec. corn. Stram. LOWER TXT] CRAAIPY FEELING : August. Arn. Calc. c. Cycl. Digit. Graphit. Hyosc Lycopod. Alen. Petr. Phos- phor. Rhus. Sep. A'aler. A'eratr. CREEPING: Arsenic. Bell. Guaj. Alane Rhus. See corn. CUTTING (t. and I): Alum. Bell. Bry. Graph. Lycop. Natr. Sil. Sulph. ac. DISLOCATION-PAIN (t. and 1.): Carbo veg. Caust. Led. Natr. mur. Rhus. EAIACIATION: Arg. nitr. Arsen. Calc. c. China. Iod. Lach. Merc Nux vom. Selen. ERUPTION: Clem. Euphorb. Gra- phit. KaU. Lye Alere Natr. mur. Rhus. Sil. Sulph. EXTERNAL SIDE: Anac Asaf. BeUad. Caustic. Coccul. Euphorb. Alere Alezer. N. vom. Phosph. ac. Rhus. Stann. Sulph. Zinc. POSTERIOR SIDE: Alum. Antim. crud. Calc. c. Canth. Carbo veget. Caust. Con. Euphob. Graph. Ign. Kali. Led. Lyc. Alen. Merc. Alezer. Phosph. Phosph. ac. hus. Selen. Sep. Stann. Staph. Sulph. Veratr. Zinc. INTERNAL SIDE : Ant. crud. Asa f. ('ale. c. Carbo veg. Caust. Grayh. Hep. lod.Keili. AI. austr. Merc. Alur. acid. Nitric ae Oleand. Petroleum. Rhod. Sabin. Selen. Stann. Staph. Sulph. Tar. Thuj. ANTERIOR SIDE : Anac. Ang. Ar- gent. Asa feet. Bar. Cann. Chin. Digit, Euphorb. KaU. Lyc. Alen. Mur. ac. Natrum mur. Nux vom. Olean. Phos. ac. Sabin. Sil. Spong. Stann. Thuj. ATaler. FAINT FEELING : Arn. Ars. Bry. Chin. Crot. Dig. Guaj. HeU. Kali. Laur. Oleand. Phosph. ac Plat. Rhodod. Ruta. Spig. A'eratr. —(t. and 1.): Agar. Alum. Ambra. Amm . Amm. mur. Arsen. Asar. remities. 113 Bell. Bryon. Calc. c. Cann. Caust China. Con. Croc. Graph. Hell. Ign. Ipec. Lach. Laur. Led. Lyc. Nitr. ac Nux mosch. Nux vom. Pliosph. Ph. ac, Plat. Plumb. Puis. Rhodod. Rhus. Ruta. Sec. corn. Sep. Stront. Sulpli. Zinc. FORAIICATION: Ast. Bellad, Nux vom. Sec. corn. IN GENERAL: Agar. Ambr. Anac Ant. tart. Arn. Asa f. Asar. Bell. Bry. Calc. c Caps. Carbo an. Car- bo veg. Caust. Chel. Chin. Cocc Colchic. Creos. Crotal. Cycl. Eu- phorb. Graph. Guaj. HeU. Hep. Ign. Kali. Lach. Led. AI. austr. Merc. Alezer. Mosch. Mur. ac. Natr. mur. Nitric ae Nux voin. Oleand. Phos. ac. Plat. Puis. Ran. bulb. Rhodod. Rhus. Sabin. Selen. Sep. Sil. Spigel. Spong. Stann. Staph. Sulpli. Thuj. Zinc HEAT : Aconit. Bryon. Caustic. Sulph. HEAVINESS : Alum. Ambr. Bry. Calc. c. Cann. Carbo veget. Graph. HeU. Ign. Iod. Kali. Lach. Lact. AI. arct. Natrum mur. Nux vom. Puis. Rhus. Ruta. Sep. Spig. Stann. Sulphur. Sulpli. ac. HERPES : Graph. Lyc Mere Staph. Sulph. Zinc INSENSIBILITY (t. and 1.): Ambr. Ars. Asar. Carbo veg. Lach. Lye Oleand. Op. Rhus. Sec. corn. ITCHING: Agar. Ant. crud. Ars. Calc. c. Carbo veg. Cic. Dig. Eu- phorb. Graph. Lach. Led. AI. arct. Merc. Natrum mur. Nitric ae N. jugl. Nux vom. Oleand. Rhod. See corn. Sil. Spig. Staphys. Sulphur. Thuj. A'eratr. Zinc. JERKS (t. and I.): Antim. tart. Cal- car. e Cic. Creos. Euphr. Alere Phosph. Stram. Sulph. Sulph. ac. LAMENESS : Causticum. Coccul. Oleand. in LOWER EXTREMITIES. —(t. and 1.): Bell. Bry. Canst. Coc- cul. Dig. Iod. Lach. Alane Natr. mur. N. vom. Rhus. Ruta, Sec. corn. Sep. Sil. Sulph. Zinc AIUSCLES RELAXED (t. andl): Ambr. Calc. c. Carbo veg. Ferr. Iod. Merc. Nux vom. Phosph. ac. NODES, gouty: Ant, crud. Calc c. Calc. ph. Lycop. Rhus. Staph. Sulph. NUAIBNESS : Carbo veget. Fen-. Graph. Spong. —(t. and I): Ang. Asa f. (.'ah: c Carbo veg. Coccul. Iod. Kali. Lach. Merc N. vom. Plat. Rhus. Sulph. Veratr. PAIN (t. and 1.): Arn. Anacard. Aur. Calcar. c. Carbo veg. Cupr. Daph. Graph. Lycop. Alur. ac Nitric ae. Phosphor. Rhus. Sil. Stann. Sulph. —laming : Carbo veg. Caust, Cina. Coccul. Ign. Natr. mur. Nux vom. Rhus. Sep. —as if sore (t. and 1.): Anac. Arn. Calcar. c. China. Graph. Kali, Tied. Lycop. Nux vom. Rhod. Staph. Sulph. —as if bruised: Bry. Bell. Calc c. Caust. Coccul. Cuprum. Graph. Guaj. Hep. Led. Alen. Natr. N. vom. Phosph. ac Plat. Puis. Ruta. Sepias. Spig. Sulph. Tar. A'aler. Veratrum. ----(t. and 1.): Bry. BeU. Canthar. Carbo veg. Croc. Graph. Laur. Natr. NAix mosch. Sep. Sil. Stann. PRESSURE: Agar. Caps. Digital. Guaj. Led. Alen. Mosch. Mur. ae Nitric, ae Oleand. Ph. ae Sabin. Sassap. SU. Stann. A^erb. PFLSATIONS : Asa feet. Coccul. Plat. SHUDDERING: Cann. Chin. Ign. Phosph. Puis. GONE TO SLEEP: Ambra. Canth. Cham. Coccul. Croc M. arct. Alosch. Nux vom. Oleander. Puis. Rhus. Sec. com. Veratr. SORENESS BETAVEEN THE THIGHS: Graph. Kali. Mercur. Rhod. Selen. Sulph. SPOTS, red: Graph. Alere STAGGERING: Asar. Coccul. HeU. Ign. Iod. Nux vom. Oleander. Op. Rhus. Sec corn. Stram. Veratr. STIFFNESS: Ars. Graphit. Ignat. Natr. mur. Oleand. Rhod. —(t. and I): Alum. Ang.Bell. Calc.c. Caust, Cic. Ferr. Ign. Kali. Led. Merc Natr. mur. Phosph. Rhus. Sep. Sulph. STITCHING: Aco. Am. Asa feet. Bell. Bry. Calc. c. Caustic. Coccul. ("on. Euphr. Graph. Guaj. Hyosc. Laur. Alangan. Alen. Nux vomica. oleand, Phos. Rhus. Sabad. Sas- sap. Sep. Spig. Spons;-. Stann. Staph. Sulph. Tar. Thuj. Viol. tr. Zinc. STRETCHY FEELING: Bellad. Daph. Phosph. ac. SWEAT: Carbo an. Alere N. vom. Rhus. Thuj. —(t. and I): Asa f. Hep. Phos. Sep. Veratr. SAVELLING (t and 1.): Arsen. Bry. Calc. e Carb. veg. Chin. Colch. Dulcam. Hell. Lm-. Merc Phosph. Sec. corn. Sep. Sil. Sulph. SWELLING OF BONES (t and 1.): Asa f. Aur. Calc c. Ca!c ph. Dulc. Iod. Lyc. Alere Phosph. Phosph. ac. Rhus. Sil. Staph. Sulph. TEARING AND DRAWING : Aga- ric. Alum. Amm. mur. Anac. Asa f. Aur. Bellad. Bry. Calc. c. Cnnlh. Carbo an. Caust. Chamom. China. Coccul. Colchic. Daph. Pub: Eu- phorb. Graph. Guaj. Kali. Lycop. Alere Alezer. Natr. -near. Nitr. ac Nux vom. Phos. ac Plat. Plumb. Puis. Rhii>. Sepia;. Sil. Staun. Sulph. A'alev. Zinc. LOWER EXTREMITIES. 115 TEN SION: Arn. Calc. c. Carbo vcjj. Creos. Guaj. Lye Alere Men. Ni- tric ae Petr. Rhod. Rhus. Sabin. —t. and 1.: Alum. Carbo anim, Caust. Cham. Dulcam. Iod. Kali. Lyc. Natr. mur. Pulsat. Sep. Sulph. Zinc. THROBBING (t. and 1.): Antim. tart. Asa f. BeU. Brom. Bry. Dig. Kali. M. austr. Natrum mur. Phos- phor. Rhus. Ruta. Sulph. TREMBLING (t. and 1.): Ammon. mur. Arn. Calc. c. Carbo veg. Caust. Cic Con. Digit. Graph. Lach. Mercur. Natr. Nux mosch. Nux vom. Plat. Plumb. Puis. Rhus. Sil. TWITCHING: Agn. Arn. Asaf. Caust. China. Graph. Laches. Lyc Alang. Nux vom. Phos. Puis. Rheum. Rhus. Sep. Sil. Staph. Sulph. Valer. Veratr. ULCERS : Calc. Sil. Thuj. —t. and 1.: Calc. Carbo veget. Graph. Lyc. Merc. Natrum. Nitric ac. Petr. Rhus. Siic. Sulph. UNEASINESS (t. and I): Ars. Cann. Carbo veg. Caustic. Chin. Con. Graph. Kali. Lach. Merc. Nux vom. Phosphor. Plat. Ruta. Sep. Sulph. VARICOSE VEINS (t. and I): Ambra. Arn. Ars. Calc. c Carho veg. Ferr. Graph. Lyc. AI, austr. Puis. Sulph. Zinc Legs. BOILS: Hep. Merc. Magn. curb. Nux vom. Sil. Sulph. BORING: Anacard. Aur. Mercur. Staph. BURNING: Agar. Arsen. Asa f. Carbo veg. Caust. Crot. Kali. Lyc. Nux vom. Phosph. ac. Rhus. Sep. Tar. Teucr. Zinc. COLD FEELING: Ambra. Mosch. Puis. Valer. CONTRACTION : Ars. Canth. Cocc. Lyc Nux vom. CRAAIP (in calves): Alum. Ambra. Ang. Ars. Calc. carb. Camph. Carb. veg. Chamom. Cin. Coloc. Cupr. Dulc. Ferr. Graph. Hep. Hyosc Ign. Laches. Led. Lyc. AI. austr, Alen. Natr. Natr. mur. Nitric ac. N. jug I. N. vom. Petr. Rhodod. Rhus. Samb. Sec. corn. Sep. Sil. Stram. Sulphur. Veratr. Zinc. CREEPING: Bell. Cic. Ipec. Nux vom. Rhus. See corn. CUTTING: Calc. c. Phos. ac. Thuj. (compt. t.) DIGGING: Spig. EMACIATION: Phos. ac. Samb. ERYSIPELAS : Arn. Rhus. Sulph. FAINTNESS: Natr. mur. Oleand. Plat. Stann. FLESH LOOSE, as if: Nux vom. Rhus. IN GENERAL: Aco. Ambr. Amm. mur. Anac. Ant, crud. Antim. tart. Ars. Asa f. Bell. Bryon. Calc. c. Carbo veg. Canth. Caust. Cham. Chel. Conium. Creos. Cupr. Cycl. Dig. Euphorb. Ferr. Graph. Hyosc. Ign. Ipec. Kali. Lach. Led. Lyc. M. austr. Alen. Mercur. Alezer. Natr. N vom. Oleand. Phosph. Phosph. ac. Plumb. Puis. Rhod. Rhus. Sabin. Sec. corn. Sep. SU. Spigel. Spongia. Staph. Sulph. Tar. Valer. Veratr. Vit. HEAT: Aeon. BeU. Bry. Guaj. Hyosc. HEAVINESS: Ars. Bell. Camph. Ferr. Ign. Ipec. Laur. Lyc. Rhus. Veratr. (comp. t.) HERPES : Lyc. Plumb. Staph. Sulph. Zinc. ITCHING: Agar. Asa f. Aurum. Cede. c. Chel. Dulcam. Daph. Kali. Lach. Laur. Lyc Natr. Op. Sabin. Sil. Staph. Sulph. LAMENESS : Agar. Ars. Carb. veg. NODES, gouty: Antim. crud. Rhus. Sulph. Staph. 116 LOWER EXTREAUTIKS. NUAIBNESS: Alum. Graph. Kali. Sil. (comp. t.) PAIN AS IF SORE: See t. —as if bruised: Alumina. Asar. Calc. c. Caust. Croc. Digital. Ferr. Phosph. Plumb. Sep'uc. (comp. t.j PRESSURE: Agar. Arn. Ars. Asaf. Bell. Camph. Cupr. Oylc. Ign. Led. Alang. Nux mosch. Nux vom. Phos. ac Rhus. Ruta. Sep. Stann. Tar. Valer. Zinc. PULSATIONS: Asa fcetida. Plat. Stann. RIGIDITY, feeling of (t. and 1.): Cham. Coccul. SHUDDERING: Kali. GONE TO SLEEP: Asa f. Cicuta, Ign. Laur. Nux vom, Plumb. Samb. SPOTS, blue: Arn. Lach. —yeUow: Stann. —red: Aeon. Calc. c. Conium. Merc. Sulph. ac. STIFFNESS: Ferr. Ipec. Petr. (comp. t.) STITCHING: Amm. mur. Anac, Ant. crud. Arn. Asa f. Bell. Bry. Calc. c. Carbo an. Caustic. Chin- Graph. HeU. Ign. KaU. AI. arct. Alen. Mur. ac. Natr. mur. Nux vom. Plumb. Phosphor. Plat. Rhus. Ruta. Spig. Staph. Sulph. Valer. SWEAT: Euphorb. Hyosc. Alercur. (comp. t.) SWELLING: Aconit. Asa f. Ferr. Led. Puis. TEARING AND DRAWING: Agar. Alum. Ambr. Ant. tart. Arn. Ars. BeU. Bryon. Cede c. Carbo an. Carbo veg. Caust. Cham. Colch. Croc. Dulcam. Euphorb. Ferr. Graph. Ignat. Kali. Lach. Lyc. M. austr. Alezer. Alagn. mur. Natrum. Niix vom. Phosph. Puis. Rhod. Rhus. Sassap. Sep. Silicea. Spong. Staph. Sulph. Valer. Zinc. TENSION: Asa f. Bry. Calc. c. Chamom. Cocc. Graph. Ign. KaU. N. vom. Puis. Rhus. Spig. Valer. (comp. t.) TICKLING: Laur. TREAIBLING: See t. TWITCHING: Anac Arsen. Asm-. Bellad. Cina. Cupr. Graph. Hyosc;. Lycop. M. austr. Alen. Op. Petr. Pbimb. ULCERS: Ars. Calc. c. Graphit, Lach. Lyc. Ruta. Staph. ULCERATIVE PAIN: Puis. UNEASINESS: See t. Heels. IN GENERAL: Amnion, mur. Ant. crud. Arg. Arn. Calc. c Caust. Coloc. Cycl. Graphit. Ign. Kali. Led, Lycop. AI. arct. Merc Natr. Nitric ae Petr. Pulsat. Rhodod. Rhus. Sabin. See corn. Selen. Sep. Sil. Spongia. Stann. Stront. Sulph. Valer. Viola, trie Feet. BENT INWARDS : Sol. n. BOILS : Calc. e Alere BURNING: Am. Ars. Calc. c. Coc- cul. Crotal. Graph. Hep. Lyc. Alere Natr. Natrum mur. Phos. ac. Puis. Rhus. Sec. coin. Sep. Sil. Stann. Tar. CHILBLAINS: Ant. crud, Cham. Nitr. ac. Nux vom. Petr. Phosph. Puis. Rhus. Sulph. COLD, Uable to take: Con, SU. COLDNESS: Ambra. Amm. mur. Ant. crud. Ant. tart. Arn. Bell. Calad. Calc c Caustic Chel. Chin. Coff. Con. Daph. Digit. Graph. Ign. Ipec Kali. Lach. Lyc. Alen. Mur. ac Natr. Nux vom. Oleand. Petr. Phosph. Puis. Rhodod. Rhus. Sabin. Samb. Sepi*. Sil. SquiUa. Stann. Sulph. Yeratr. COBNS: Ant. crud. Arn. Calc. c. Caust. Ign. Lyc. Nux vom. Puis. Ran. se Rhus. Sep. Sil. Sulph. LOWER EXTREMITIES. 117 CRAMPY FEELING: Calc. e Cal- ad. Caust. Graph. Hep. Laches. Lyc. Natr. mur. Petr. Sil. Sulph. —in the soles: Calc. c Chelid. Ferr. Euphorb. Natr. c. Selen. Sil. Sulph. CREEPING: Arn. Bell. Caustic. Dulc. Graph. Ign. Natr. Nux vom. Phosph. Rhodod. Rhus. See corn. Sep. Stann. DEADNESS: Ant. crud. Arsenic Calc. c. N. vom. Rhus. Sec. corn. Sil. DESQUAAIATION: Dulc DRY SOLES OF FEET: Bism. EXHAUSTION, feeling of: Bellad. Bov. Cham. Croc. Ferr. Lyc Phos. Plat. Rhus. Zinc ERUPTION: Graph. Petr. Sulph. ERYSIPELAS : Nux vom. Dulc. FETOS: Plumb. Sil. IN GENERAL: Aeon. Anac. Arn. Ars. Asa f. Aur. Baryt. BeU. Bry. Calc. c. Camph. Carlo vej. Caust. Cham. Conium. Creos. Cuprum. Ferr. Graph. Hep. Ign. Kali.Led. Lyc. Mere Natr. Natr. mur. Nux vom. Petr. Phosph. Plumb. Puis. Rhod. Rhus. Ruta. Samb. Secale corn. Sep. Sil. Stann.. Sil. Squill. Staph. Sulphur. Sulph. ae Veratr. ANEURYSAIS: Curbo veg. Ferr. Graph. Kali. Lach. Lyc. Puis. Sulph. APPARENT DEATH: Arn. Bellad. Carbo veg. Cham. Chin. Lach. Nux vom. Op. Tart. emet. APOPLENY: Aeon. Arn. Baryt. Bell. Calc. Camph. Caust. Chin. Coccul. Coff. Dig. Ferr. Hyosc. Ipec. Lach. Lycop. Merc. N. vom. Puis. Rhus. Sil. Stram. Tart. emet. Areratr. ATROPHY: Ars. Baryt. BeUad. Calc c China. Cina. Iod. Ipec. Lach. Merc. Nux vom. Rhus. Sil. Sulph. BONES, affections of, in general: Am. Ars. Asa tot. Aur. BeU. Calc. carb. Calc. phosph. Carbo veget. China. Con. Dulc. Graphit. Hep. Iod. KaU bichr. Lach. Lycop. Merc. Mezer. Nitric ac. Phosph. Pulsat. Rhus. Ruta. Sabin. Sec. corn. Sil. Spong. Staphysag. Sulph. Sulph. ac. Thuj. —sweUing: Asa f. Aur. Calc. Dulc. Guaj. Hep. Lyc. Merc. Nitric acid. Phosphor. Puis. Rhus. Ruta. Sil. Staph. Sulphur. . —fractures: Arn. Asa f. Calc Lycop. i Rhus. Ruta. Sil. Symphyt. Sulph. ! —inflammation: Asa tot. Aur. Bell. Calc. Chin. Hep. Lycop. Merc Ni- tric ac. Phosph. SU. Sulph. —pains: Ars.Asaf. Aur. Bar. Calcar. China. Cic. Daph. Fluor, ac. Lach. Lyc. Merc. Nitric ac. Phos. Phos- phor, ac. Plumb. Ruta. Sil. Staph. Sulph. —curvature: Asa tot. Bellad. Calc Calc. phosph. Hep. Iod. Lyc. Merc. Phosph. Plumb. Rhus. SU. Sulph. —caries: Arsen. Asa tot. Aur. Calc Fluor, ac. Hep. Lyc. Merc. Nitric ac. Phosph. Phosph. ac. Ruta. Sep. I Sil. Spong. Sulph. BLUE DISEASE : Aco. Arn. Ars. i Aur. BeUad. Camph. Carbo veget. Chin. Con. Cuprum. Digit. Ferr. Ipecac Lach. Merc. Nux vom. Op. Phosph. Pulsat. Rhus. See corn. Veratr. BOUNDING, as of something: Croc BURNS: Ant. crud. Arn. Ars.Carb. veg. Caust. Creos. Laches. Secale corn. Stram. CHAGRIN, consequences of: Aco. Ars. Bry. Cham. Chin. Coff. Coloc. N. vom. Phosph. Ph. ac. Plat. Staph. —suppressed: Ign. Phosph. ac. —with wrath: Coloc. Stax>h. N. vom. CHAA10MILE, excessive use of: Aeon. Coff. Ign. Puis. Nux vom. CHILDREN,diseases of: Aeon. Bar. Bell. Bryon. Calcar. Chain. Cin. Coff. Drosera. Hep. Hell. Ign. Iod. Ipec. Merc Nux mosch. Nux vom. Puis. Rheum. SiUe Spongia. Sulph. CHINA, aliments from abuse of: Arn. Ars. Bell. Calc. c. Canthar. Carbo veg. Ferr. Ipec. Lach. Lye Alere Natr. mur. N. vom. Sep. Puis. Sulphur. A'eratr. GENERAL SYMPTOMS. ill CHOLERA: Ant. tart. Ars. Asar. Camph. Carbo veget. Cupr. Dulc. Hydr. ac. Jatr. Ipecac. Lach. Nux vom. Phosph. Ph. ac. Sec. corn. Veratr. CHOLERINE: Bry. Puis. Rhus. CHOLERIC TEAIPERAAIENT: Aeon. Anac. Bry. Caust. Cham. Cin. Cupr. Hyosc. KaU. Lach. Natrum. Nitric ac. Nux vom. Op. Phosphor. CHLOROSIS: Bell. Calc carb. Camph. Chin. Coccul. Conium. Crot. Ferr. Graphit. Hell. Ign. Kali. Lach. Lyc. Natr. mur. Nitric ac. Nux vom. Plat. Plumb. Puis. Sep. Staph. Sulph. Valer. COLD, taking: Aeon. Ant. crud. Ars. Bell. Bry. Calc Caust. Cham. Coff. Dulcam. Hep. Ipec, Merc. N. vom. Phosph. Puis. Rhus. Sil. Sulph. —liable to take: Aconit. Bell. Bry. Calc Carbo veg. Caust. Chain. China. Dros. Dulc Hep. Lyc. Alere Natrum. Nitric ac. Nux vom. Puis. Rhus. Sep. Sil. Sulph. COAIPLAINTS, periodical: Arnic. Ars. Bell. Bry. Carbo veget. Chin. Ign. Ipec. Natrum mur. N. vOm. Puis. Rhus. Spig. Sulph. CONCUSSION: Arn. Bell. Bry. Cic. Con. Nux vomica. Rhus. Veratr. AILAIENTS INCIDENT TO CON- FINEAIENT: Aconit. Agn. Ar- nica. Bell. Bry. Calc. Chain. China. Coff. Hep. Hyosc. Ignat. Lyc. Alere. N. vom. Op. Phosph. ac. Plat. Puis. Rhus. Sec. corn. Sil. Sulph. Veratr. CONGESTIONS OF BLOOD: Aeon. Amm. Am. Asa f. Aur. BeU. Bry. Calc. c. Carbo vegetab. Chin. Croc. Cupr. Dig. Ferr. Graph. Hyosc. Kali. Lycop. Merc. Natr. mur. Nitric ac. N. vom. Op. Phosph. Puis. Rhus. Seneg. Sep. Sil. Stram. Sulph. Sulph. ac. Veratrum. Viola tr. CONTUSIONS: Aeon. Arg. Arn. Cic. Con. Led. Oleand. Petr. Puis. Rhodod. Rhus. Ruta. Sulpli. Sulph. ac. CRAWLING: Bell. Calcar. Sep. Sulph. DEBILITY, nervous: Am. Baryt. Bell. Calc. Carbo veget. Cham. Chin. Coff. Cuprum. Graph. Hyosc Ign. Iod. Ipec. Lach. Lyc. AI. arct. Mercur. Natr. Natr. mur. Nitric ac. Nux mosch. N. vom. Phos. Phosph. ac. Plat. Pulsat. Rhus. Sec. corn. Selen. Sil Stann. Stram. A7aler. Veratr. DRUNKARDS, ailments of: Aeon. Ars. Bell. Calc. Carbo veget. Hy- osc. Ign. Lach. Natrum. Natr. mur. Nux vom. Op. Puis. Rhus. Sil. Stram. S-ulph. DRYNESS OF INNER PARTS: Aeon, Ambr. Ars. .Asa f. Bellad. Bry. Calad, Calc. Carbo veg. Cham. Cie Con. Croc. Dulc. Graph. Hy- osc. Ign. Lye: Magn. mur. Alang. Merc Natrum. Natr. mur. Nitr'ic acid. Nux mosch. Nux vom. Par. Phosph. Puis. Rhus. Samb. See. corn. Seneg. Sepia?. Sil. Spong. Stram. Sulph. Veratr. Zinc. EMACIATION: Ambra. Anacard. Ars. Bar. Bry. Calc carb. Canthar. Carbo veg. Chamom. Chin. Chlor. Cina. Coccul. Cupr. Dulc. Ferr. Graphit. Hep. Ign. Iod. Ipec. Laches. Lyc. Merc. Natr. Natr. mur. Nitric ac. N. vom. Phosph. Phos. ac Plumb. Puis. Sec. corn. Selen. Sil. Stann. Staphys. Sulph. Veratr. EXCESSES, consequences of: Ana- card. Ars. Bar. Calc carb. Carbo veg. Chin. Conium. Kali. Lach. Mercur. Natr. Natr. mur. N. vom. 142 GENERAL SYMPTOMS. Phosph. Phosph. ae. Puis. Rhus. Sec. corn. Sep. Sil. Staph. Sulph. Thuj. Veratr. FAINTING: Aeon. Arn. Arsenic. BeU. Bryon. Calc. Camphor. Cann. Carbo veget. Chamom. China. Coc- cul. Coff. Creos. Dig. Ferr. Hep. Hyosc. Ign. Ipec. Lach. Laur. Mosch. N. mosch. N. vom. Op. Petr. Phosph. Phosph. ac Pulsat. Ran. sc. Rhus. Sangn. Secale corn. Sep. Sil. Spig. Stramon. Tart. emet. Veratr. Viola od. FAT, tendency to get: Antim. crud. Ars. Calcar. Caps. Croc Cupr. Ferr.|Graphit.Lach.Lyc.TVIere'Op. Pulsed. Spong. Sul'ph. Veratr. FEAR, consequences of: Aeon. Bell. Hyosc. Ign. Lach. Op. Puis. Verat. • FEAIALES, diseases of: Aeon. Agar, j Alum. Ambra. Arnica. BeU. Bor. I Calcar.Caps. Caustic. Cham. Chin, I Cic Coccul. Con, Croc. Ferrum. Graph. Hyoscyam. Ign. Ipec. Kali. Lach. Magn. mur. Alere Mosch. Nux mosch. Nux vom. Plat. Puis. Rhus. Sabin. Sec. corn. Selen. Sep. Spongia. Stann. Sulph. Valer. Veratr. Fever, General Charac- ter of. FEVER, bilious: Aeon. Ant. crud. Ant. tart. Ars. Bry. Bellad. Cham. Coccul. Coloc. Creos. Ign. Ipec Merc Natrum mur. N. vom. Puis. Sulph. A'erat. —catarrhal: Aeon. Ars. Bry. Bellad. Canst, Chamom. Con. Dulc Ipec Lach. Alagn. mur. Merc. N. vom. Puis. Rhus. Sulph. —gastric: Ant, crud. Antim. tart. Ars. Aur. Bell. Bry. Cham. Coccul. Coloc Hepar. Ignat. Ipec. Alercur. Alagn. c. N. vom. Phosph. ac. Puis. Rhus. Sulph. Veratr. —yellow: Aeon. Ars. Bell Bry. Crot Ipec. Alercur. Nux vom. Puis. Rhus. Sulph. —puerperal: Aeon. BeU. Bry. Chain. Nux vom. Puis. Rhus. —milk: Aeon. Bell. Calc. Coff. Puis. —nervous: Aeon. Arn. Arson. BeU. Bry. Camph. Chamom. Hyosc. Ign. Lyc. Mercur. Mur. acid. N. vom. Op. Phosphor, ac. Rhus. Stram. Veratr. —rheumatic: Aeon. Am. Ars. Bell, Bry. Caustic. Cham. Colch. Dul- cam. Ipecac. Mercur. N. vom. Puis. Rhus. SU. Sulph. —wound: Aeon. Arn. Bry. —dentition: Aeon. BeU. Calc. Cha- mom. Alere. Nux vom. Sulph. —hectic: Arsen. Calc. China. Coc" cuh- Cupr. Dig. Ign. Iod. Ipec Kali. Laches. Lyc Nux vom. Phosph. Phosph. ae Puis. Sil. Staph. Sulph. —typhus, abdominal: Aconit. Ars. BeU. Bry. Merc Nux vom. Phosph. ac. Rhus. —typhus, cerebral: Aeon. Arn. Ars. Bell. Bry. Carbo veget. Chin. Crot. Hyosc. Lach. Mercur. Alur. ac N. vom. Op. Phosph. Phosph. ac Pulsat, Rhus. Sulph. Veratr. —typhus, putrid: Ars. Asa f. Bry. Carbo veget. Chin, Ferr. Graph. Hep. Ipec. Lach. Merc Mur. ac. Nux vom. Op. Phos. ac Rhus. FLUIDS, ill effects of loss of: Calc. Carbo veg. Chin. Cin. Con. Lach, Lyc. Natr. Natr. mur. Nitric ac. Nux vom. Phosph. ac Sulph. Sulph. ae Thuj. Veratr. FREEZING, consequences of: Aco. Ars. Bry. Carbo veg. Laches. Ni- tric ae Sulph. ac. Fever, According to Par- ticular Symptoms. BURNTNC : Arsen. Bry. Rhus. A'e- ratr. GENERAL SYMPTOMS. 143 CHILLINESS IN GENERAL: Ambra. Ant. tart. Arn. Ars. Bryon. Calc. Canth. Cham. China. Cin. Colch. Cupr. Ferr. Graph. Hep. Ign. Ipec. Lach. Lyc. Merc Alezer. Natr. mur. Nux vom. Phosph. Phosph. ac. Puis. Rhus. Sabad. Sassap. Sep. Sil. Spig. Sulph. Thuj. Veratr. —external: Arn. Chin. Lycop. Merc. Nux vom. Phos. Rhus. Veratr. —semi-lateral: Ant. tart. Bry. Caust. Ignat. Lyc. Nux vom. Puis. Rhus. Spig. —internal: Anac. Ars. BeUad. Bry. Calc Chamom. China. Hell. Ignat. Ipec. Lach. Laur. Lycop. N. vom. Phosph. Pulsat. SquiU. Sep. Thuj. Veratr. —with shaking: Aeon. Bryon. Caps. Cham. Chin. Ign. Ipec. Nux vom. Rhus. Veratr. HEAT IN GENERAL: Aco. Amm. mur. Anac. Antim tart. Arn. Ars. BeU. Bry. Calc. Canth. Carb. veg. Caust. Cham. Chin. Cin. Coffea. Con. Cycl. Ferr. Graph. Hell. Hep. Ign. Ipec. Kali. Lach. Alagn. mur. Merc. Mosch. Mur. ac. Nitr. ac. Nux vom. Op. Phosph. Phosph. ac. Puis. Rhus. Sabad. Sil. Squill. Stannum. Staph. Stram. Sulphur. Sulph. ac. Veratr. —external: Aeon. Ars. Bell. Bry. Calc. Camphor. Carbo veg. Cham. Cie Coccul. Coff. Coloc. Digit. Dulc. Euphorb. Hell. Hyosc. Ign. Kali. Lach. Lyc. Mang. Merc Mur. ac Nux vom. Op. Phosph. Puis. Rhus. Sep. Sil. Squill. Stram. Sulph, Zinc. —flashes of: Am. Calc caro. Chin. Graph. Iod. Kali. Lycop. Natrum. Nux vom. Phosph. Plat. Puis. Rhus. Ruta. Sep. Stann. Sulph, Thuj. —semi-lateral: Am. Bell. Bry. Croc. Ignatia Lyc. Nux vom. Phosph. Puis. Rhus. Sulph. —internal : Aeon. Am. Ars. Bell. Bry. Calc. Canth. Carbo veg. Caust. Cham. Cic. China. Coloc. Con. Graphit. Hel'. Ipec. Lyc. Magn. mur. Nitric ac Nux vom. Phosph. Phosphor, ac. Puis. Rhus. Sabad. Samb. Sec. corn. Spig. Spong. Stann. Veratr. Zinc. LOSS OF CONSCIOUSNESS: Bell. Bry. Carbo veg. Hell. Hyosc Lach. Op. Phos. ac. Rhus. Stram. LOSS OF THIRST: Ant. tart. Ars. Canth. Carbo veg. Caust. Chin. HeU. Ipec. Alere Puis. PULSE, intermittent: Aeon. Ars. Bry. Dig. Kali. Lach. Natr. mur. Op. Phosph. ac. Sec. corn. Stram. Sulph. —filiform: Colch. Lach. Veratr. —large: Aeon. Bell. Bry. Cupr. Dig. Ferr. Hyosc. Ign. Merc. Nitr. Nux vom. Phosph. Spig. Stram. Veratr. —hard: Aeon, Arn. Bar. Bell. Bry. Canth. Chin. Digit. Ferr. Hyosc Ign. Merc. Nux vom. Phosph. ac Sabin. Samb. SU. Stram. Veratr. —small: Aeon. Ant. tart. Ars. Bar. Bell. Calc. curb. Camph. Carbo veg. China. Cina. Cocc Cupr. Iod. Ipec. Kali. Lach. Laur. Alere Natr. mur. Op Phosph. acid. Plat. Puis. Sec. com. Sil. Stram. Sulphur. Sulph. ac Veratr. —slow: Ambr. Ant. crud. Ant, tart. Ars. BeU. Camph. Canthar. Cie Con. Dig. Hell. Ign. Kali. Laur. Mosch. Op. Puis. Rhodod. Sec. com. Sep. Stram. Veratr. —slower than the beats of the heart: Cann. Dig. Hell. See corn. Veratr. —quick: Aeo. Ant. tart. Am. Ars. Asa f. Bell. Bism. Bry. Carbo veg. Coloc Croc. Dig. Hyosc Ignat. 144 Iod. Lach. M. austr. Merc Nitric acid. Nux vom. Phosph. Phosph. ac. Pulsat. Rhus. Samb. Sil. Spong. Stann. Stram. Sulphur. Veratr. Zinc. —imperceptible: Aconit. Ars. Car- bo veg. Coccul. Cupr. Ferr. Ipec. Lach. Merc. Op. Sec corn. Sil. Stann. Veratr. —irregular: Agar. Antim. crud. Ars. Caps. Chin. Digital. Hyosc. Kali. Lach. Natr. mur. Op. Phosph. ac. Plumb. Sec. corn. Stram. Sulphur. Veratr. —soft: Ant. tart. Ars. Baryt. Bel- lad. Carbo veg. China, Coccul. Cuprum. Iodine. Kali. Laur. Mere Op. Phosphor. Plat. Sec. corn. Veratr. —tremulous: Arsen. Calc. Cic. Kah. Phosph. Rhus. Sangn. Sjtig. SHIVERING: Aeon. Ars. Asa feet. Aurum. Bell. Calad. Canth. Caps. Cham. China. Coccul. Croc. Cycl. Ferr. Graph. Hep. Ign. KaU. Mercur. Mezer. Natr. Nitr. Nux vom. Puis. Rheum. Rhus. Sabad. Sec. corn. Sep. Staph. Araler. Ve- ratr. STRETCHING: Ars. Ipec. N. vom. Rhus. SWEAT, in general: Aco. Ambr. Amm. mur. Ant. tart. Ars. Bar. Bell. Bry. Calc. Canth. Caps. Carbo an. Carbo veget Caust. Chain. Chlor. Chin. Coff. Con. Dig. Dros. Ferr. Graph. Guaj. Hep. Hyosc. Ignat. Kali. Lyc M. austr. Alagn. mur. Merc. Natrum. Natr. mur. Nitric ac. Nux vom. Phosph. Phosphor, ac. Puis. Rheum. Rhod. Rhus. Sabad. Samb. Selen. Sepise. Sil. Staph. Stram. Sulph. Tar. Thui. Veratr. IRRITABILITY, bodily; Aeon. Arn. Asar. Ann Bell. Bry. Canthar. Cham. Chin. Coffea. Cupr. Ferr. Hyosc. Ign. Lach. M. arct. Merc. Natr. Nux vom. Phosph. Pulsat. Rhus. Selen. SU. Spong. Staphys. Veratr. —want of: Anac. Ars. Bism. Calc Camph. Carb. veget. Cic. Con. Croc Dulc. Ferr. Graph. Hyosc. Ign. Iod. Ipec. Kali. Lach. Laur. Lycop. Magn. Merc. Nitric ac. Nux mosch. Oleand. Op. Phos. ac Rhod. Sec. corn. Sep. Staph. Stram. Sulph. JAUNDICE: Aeon. Ambr. Ant. crud. Ars. Aur. Aurum mur. BeUad. Bry. Canth. Carbo veget. Cham, Chin. Con. Croc. Dig. Ferr. Hep. Ignat. Lach. Lycop. Merc Nitric ac. Nux vom. Op. Pidsat. Rhus. Sulph. Sep. Veratr. JEALOUSY, ailments from: Hyos- cyam. Ignat. Lach. N. vom. Phos. ac. Puis. Staph. JOY, consequences of excessive Aeon. Coffea. Op. LANGUOR: Antim. crud. Calc. c. Carbo veget. Coccul. Ignat. Iodine. Kali. Lach. Lyc Mercur. Alosch. Natr Natr. mur. Op. Phosphor. Phosph. ac. Plat. Pulsat. Selen. Seneg. Sulph. Teucr. Thuj. A'aler. LAZINESS: Alum. Arsen. Baryt. BeU. Bryon. China. Coccul. Guaj. Iod. Kali. Lach. Merc. Mur. ae Natr. Natrum mur. N. vom. Ole- ander. Phos. ae Puis. Sec. corn. Se- len. Sep. Zinc, LUMPING: Bell. Calc. Caust. Coloc. Alen: Pulsat. Rhodod. Rhus. Sep. Sulphur. LOCHIA, morbidly altered: Bellad. Calcar. Con. Nux vom. Plat. Puis, Sec. corn. AIARASMUS OF OLD PEOPLE: Ant. tart. Bar. Calc. e Con, Olean. Op. Phosph. Phosph. ac. Rhus. Se- eale com. IAIELANCHOLY TEMPERA- I AIENTS: Ars. A ur. Bellad. Calc. GENERAL GENERAL SYMPTOMS. 145 China. Graph. Ignat. Lach. Lycop. Alere Natr. Nux vom. Phosph. ac. Puis. Sep. Sil. Veratr. MOTION, dread of: Ant. tart. Ars. Bar. Bell. Calad. Caps. Chin. Dulc. HeU. Ign. Lach. Lyc. Merc. Natr. Natr. mur. Nux vom. Sulph. Thuj. MUCOUS AIEMBRANES, diseases of the: Alum. Apis. Arsenic. BeU. Bry. Calc. Caps. Caustic. Cham. China. Chlor. Dulc. Euphr. Fluor. ac. Hep. Ign. Lyc. Merc. Mur. ac. Natr. mur. Nitric acid. Nux vom. Phosph. Pulsat. Rhus. Sangn. Sep. Sil. Stann. Sulph. Sulph. ac. AIUSCULAR TAVITCHLNGS: Am- bra. Asa f. BeU. Clem. Coloc. Croc. Cuprum. Graph. Iod. Kali. Lach. Mezer. Natr. Natr. mur. Plat. Rhus. Secale corn. Sil. Spong. Sulphur. Sulph. ac. Viola tr. Zinc. GLANDULAR AFFECTIONS: Ammon. mur. Apis. Arsenic. Aur. Baryt. BeU. Calc carb. Carbo an. Carbo veget. Cham. Coccul. Con. Dulc. Graph. Hep. Iod. Kali. Lyc Merc. Natr. Natr. mur. Nitric ac. Nux vom. Phosph. Phos. ac. Plumb. Ran. bulb. Rhus. Sep. SU. Spong. Staph. Sulph. Sulph. ac. Thuj. GOUT: Aeon. Ant. crud. Arg. Am. Ars. Asa f. Aur. Baryt. BeU. Bry. Calc carb. Calc. phosphor. Caps. Carbo an. Carbo veg. Caust. Cham. Chin. Colch. Dig. Dulcam. Ferr. Graph. Hep. Ignat. Iod. Kali, car- bon. Kali bichr. Led. Lyc. AI. austr. Merc. Mezer. Nettr. Natrum mur. Nux vom. Phosphor. Puis. Rhodod. Rhus. Sabina. Sassap. Sep. Sil. Spong. Staphys. Sulph. Thuj. ATe- ratr. Vit. Zinc GRASPING AT FLOCKS: Arsen. Bell Hell. Hyosc Iod. Muriat. ae Op. Phosph. ae. Rhus. Stram. HEATED, consequences of getting: Aeon. Bell. Bry. Calc. Carbo. veg. KaU. Lyc. Nux vom. Puis. Sil. HEAVINESS OF THE BODY: Chin. Lach. Kali. Natr. Natr. mur. Phosph. Sep. Stann. HUNGER. Ul effects of: Ant. crud. Ars. Bry. Calc carb. Chin. Ipec. Puis. Sulph. HYDROPHOBIA: Lobelia. Arsen. Bell. Canthar. Hyosc. Lach. Phos. Stram. HYPOCHONDRIA: Asa tot. Aur. BeUad. Calc. Canth. Caust. Cham. Cina. Coccul. Con. Ferr. Graphit. Ignatia. Iodine. Lach. Lyc. Magn. mur. Merc. Mill. Mosch. Natrum. Natrum mur. Nux mosch. N. vom. Phosph. ac. Plat. Puis. Sabin. Sep. Staph. Sulph. Valer. Veratr. HYSTERIA: Agn. Asa f. Aurum. BeU. Calcar. Caustic. Coccul. Con. Ignatia. Lach. Nux mosch. Phosph. Plat. Puis. Sep. Sil. Sulph. Valer. Viola od. INDURATIONS: Am. Ars. Aur. Bell. Calc. Camphor. Carbo an. Cham. Chin. Clem. Con. Dulc. Ferr. Graphit, Hep. Iodine. Lach. Lyc Magn. mur. Phosph. Plumb. Puis. Sep. Sil Sulph. Thuj. INFLAMMATIONS: Aeon. Antim. crud. Ant. tart. Arn. Arsenic. BeU. Bry. Calc. Cannab. Canth. Carbo veget. Cham. Con. Creos. Cupr. Dig. Dros. Dulc. Euphorb. Euphr. Hepar. Hyosc. Iod. Ipecac. KaU. Lach. Lyc. Alagn. carb. Alere Alur. ac. Nitr. Nitr. ac. Nux vom. Phos. Plumb. Puis. Rhus.Ruta. Sec. corn. Sep. Spong. Squill. Sulph. Sulph. ae Veratr. NERVOUS EXCITEMENT: Ambr. Bell. Calc. c. Cham. Chin. Coffea. Ferr. Iod. Laur. Mere Nux vom. Phosph. Phosph. ac. Puis. Rhus. Sep. Sulph. Valer. Veratr. 146 GENERAL SYMPTOMS. NEURALGIA : Aeon. Arnic Arsen. BeUad. Bry. Calc Capsic Cham, j Coccul Coff. Colchic Hep. Ignat. Kali. Alere Alezer. Natr. Nux vom. Puis. Rhus. Spig. Staph. Sulph. Thuj. A'aler. A'eratr. NODES, gouty: Antiin crud. Arnica. Bryon. Calc. carbon. Calc. Phosph. Caust. Graph. Hepar. Led. Lycop. Mereu r. Nux vom. Pulsat. Rhodod. Rhus. Staph. Sulph. ONANISAI, consequences of: Calc Carbo veg. Carbo animal. China. Coccul. Con. Kali. Lach. Lycop. Merc Natr. Natr. mur. Nux vom. Oleand. Phos. Phosph. ac. Pulsat. Rhus. Sil. Staph. Sulph. Thuj. PAINS, wandering: Arn. Bell. Chin. Alang. N. mosch. Puis. Rhod. Rhus. Sabin. Sep. Sulphur. PARALYSIS : Anac. Am. Asar. Bar. Bell. Bry. Calc Caps. Carbo veg. Caust. China. Cic. Cocc Con. Croc Crot. Dig. Dulc Ferr. Fluor. acid. Hyosc. Ign. Kali. Lach. Lain: Lyc. Alagn. mur. Alere Natr. Natr. mur. Nitric ac. Nux vom. Oleand. Op. Phosph. Plumb. Puis. Rhus. Sec. corn. Sil Stann. Stram. Sulph. Veratr. Zinc. PHLEGMATIC TEA1PERA- MENTS : Bell. Caps. Chin. Iod. Lach. Men: Natr. Natr. mur. Nitric ae Puis. Sulph. PLETHORA: Aeon. Arn. Aur. BeU. Bry. Calc. Chin. Dig. Ferr. Graph. Hyosc Kali. Lycop. Natr. mur. Nitric ac. Nux vom. Phosph. Puis. Rhus. Stram. Sulph. POISONING WTITH ALUM : Puis. ATeratr. —with arsenic: Carbo veget, China, Ferr. Hep. Ipec. Lach. Lye Nux vom. Sulph. Veratr. —with lead: Alum. Bell. Nux vom. Op. Plat, —with colchicum: Coccul. Nux vom. ruis. —with iron: Ars. Hej>. Ipecac Fu's. —with adipic poison: Arsenic. Plios. acid. —with" fish-poison : Bell. Camphor. —with honey: Camph. —with iodine: Arsen. BeUad. China. Phosph. Sulph. — with toad-poison: Ars. (?) —with copper: Bell. Hepar. Ipec N. vom. —with opium: Bell. Coff. Nux vom. —with phosphorus: Coff. Nu\ voin. Sulph. —with mushroom: Carbo veget. Coff. Puis. —with mercury: Arn. Aur. BeU. Carbo veg. Cham. (Kin. Dulc. Hep. Iodine. Kali bichr. Lach. Lyc. Nitr. ac Alezer. Phos. ae Sil. Staph. Sulph. Thuj. —with sal. ammoniac: Coff. N. vom. —Avith sarsaparilla: Bell. Merc Sulph. —with acids: Acou. Bry. Op. Fids. —with sulphur: Arsen. Alercur. Puis. Sil. —with stramonium: Coff. Hyoscyani. Nux vom. —with poison-vine: Bell. Bry. Merc Sulph. —with alcohol: Coff. Nux vom. —with sausage-poison: Arsen. BeU. Bry. —with tin: Carbo veget. Hep. Puis. PREGNANCY, ailments incident to: Aco. Bell. Bry. Calc Chaniom. Con. Hyosc Lach. Lyc N. vom. Phos. Plat. Puis. Sep. Sulph. A'e- ratr. RAPHANIA: Arsen. Bell China. Hyosc Iod. Op. Rhus. Secale corn. Sol. nigr. Strum. RHEUMATISM: Aco. Arn. Ars. Bell Bry. Carb. veg. Caustic Cham. China. Colch. Hep. Ignat. Kali GENERAL SYMPTOMS. 147 bichr. Lach. Lyc. Merc. Nit no ac. Nux vom. Pulsat. Rhodod. Rhus. Sassap. Sep. Spigel. Sulpli. Thuj. Veratr. RIDING IN A CARRIAGE, ail- ments from: Ars. Carbo veg. Coc- cul. Colch. Ferr. Ign. Natr. Petr. Psor. Sil. Sulph. RICKETS: Asa f. Bell. Calc. c. Calc. phosph. Lye Alere. Phosph. Pulsat. Rhus. Silic Sulph. SALT, ill effects of eating too much: Carbo veg. Alere Nux vom. S A N G U I N TEMPERAMENT : A on. Arn. Bry. Bell Cham. Hyoscyam. Ign. Nux vom. Rhus. Sulph. Sulph. ac. Veratrum. Zinc. SCURVY: Amm. mur. Ars. Aur. Bor. Calc Carbo an. Carbo veg. Creos. Hep. Iod. Alercur. Alur. ac Natrum mur. Nitric ac. Nux, vom. Silic Staph. Sulph. Sulph, ac SEA-SICKNESS: Ars. Coccul. Creos. Ipecac Petr. Rhus. Sulph. Veratr. SEDENTARY HABITS, ill effects of: Aco. Carbo veg. Calc. Ignat. Natr. Natrum mur. N. vom. Puis. Sulph. SEAIILATERAL AILAIENTS, left side: Ae:on. Alum. Amm. mur. Apis. Am. Asa f. Asar. Bry. Calc Cann. Chin. Cic. Colch. Coloc. Croc. Cupr. Daph. Dulc. Ign. Iod. Lach. Lyc Mercur. Natr. Nitric ac. Nux mosch. Nux vom. Petr. Phos. Rhod. Selen. Sep. Spig. Sulphur. Sulphur, ac Tar. Tart. emet. Thuj. A'eratr. Viola od. —right side: Agar. Alum. Bar. Bell. Bism. Brom. Bry. Canth. Carbo an. Caust. Cina. Con. Crot. Dig. Dros. Hepar. Ignat. Kali. Led, M. arct. Mosch. Oleand. Phosph. ae Plumb. Rhus. Ruta. Sabad. Sabina. Sangn. Sil. Spongia. Staph. Stront. Sulph. ac. Tart. emet. Thuj. Vit. — cross-wise: Agar. Alangan. Sil. SENSATION AS IF BLOWN UP- ON BY AVIND : Nux vom. Ole- ander. Rhus. Stram. —as if congealing: Bellad. Cie Cin. Di-os. Hyosc. Led. Puis. .Sec com. Stram, —as if growing larger: Asa feet. Bell. Ignat. Laur. Phosph. Puis. Rhus. —as of a hair: Lycop. Natr. mur. Sulph. —as of growing smaller: Calc Croc. —as of something alive: Croc. Ig n. Lach. Alercur. See corn. Sulph, Thuj. SPANISH FLIES, iU effects of : Camph. SPASAIS, generally : Aeon. Ang. Arn. Ars. Asa f. BeU. Bry. Calc. carb. Camph. Caust. Cham. Cic. Cina. Coccul. Coff. Con. Croc. Cupr. HeU. Hyosc. Ign. Ipec Lach. Laur. Lycop. Alere Mosch. Nux mosch. Nux vom. Op. Plat. Plumb. Puis. Rhus. Ruta. Sec com. Stann. Stram. Sulph. Tart. emet. Veratr. Zinc. —in the evening: Caust. Cina. Laur. Nux vom. Puis. Stann. Strum, —with anxiety: Ars. Bell. Calc. Cham. Cin. Cupr. Hyosc. Ign. Lach. Puis. Veratr. —with dyspnoea: Aug. Bell. Camph. Cupr. Ign. Ipec. Nux vom. Op. Puis. —with staring eyes: Bell Hyoscyam. Nux vom. Op. See corn. Stram. —with contortion of the eyes: Aeon. Bell Coccul. Cuprum. Hyosc. Ign. Lach. —with upwards: BeU. Ignat. Lach. —with downwards: Cic. Lach. —with sidewise: Bell. Caust. Hyosc Lach. —glazed eyes: Coccul. —half open eyes: Caust. Cina. Ipec —with eyes protruded: Hyosc. 148 GENERAL SYMPTOMS. —with eyes closed: Bell. Cham. Coc- cul. Croc. Hyosc. Alere Natr. mur. Op. —at tor repelled eruptions : Calc. Caust. Lach. Nux vom. Sulph. —with bloated bowels: Calc Cham. Cin. Alere. —with violent movements: Calc. Cin. Cupr. Hell. Hyosc Op. Stram. —from contact: Bell. Coccul. Stram. —with loss of sense : Bell. Camph. Cic. Cina. Cupr. Hyosc. Ign. Ipec. Lach. Nux vom. Op. Sil. Stann. Stram. —with nausea: Ipec. Nux vom. Puis. Tart. emet. Areratr. —with clenched thumb: Bell. Hyosc. Ign. Lach. Merc. —with delirium: Bell. Crot. Hyosc. Op. —with diarrhoea: Chin. Hyosc. —with thirst: Cham. Nux vom. —with eclampsia: Bell. Caust. Cham. Cic. Cin. Ignat. Hyosc. Laur. Nux mosch. Nux vom. Op. Phosph. Sec. corn. —epileptic: Agar. Ars. Bell. Calc. c. Camph. Caustic. Cham. Cic. Cina. Coccul. Cupr. Glon. Hepar. Hyosc. Ign. Lach. Merc. Nitr. ac. N. vom. Op. Plumb. Puis. Rhus. Sec. corn. Sil. Stann. Stram. Sulph. Verat. —with vomiting: Cupr. Ipecac. Nux vom. Puis. Sec. corn. —with danger, of suffocation: Cupr. Ign. Nux vom. Op. —with yawning: Ign. Veratr. —after emotions: Ballad. Coff. Hyos- cyam. Ign. Nux vom. — with pale face: Ipec. Natrum. Sil. Stann. —with blue face: Camphor. Cupr. Cin. Op. Veratr. —yellow face: Cic. Nux vom. —red face: Bell. Ign. Stram. —▼ith cold sweat in the face: Cocc. —with distorted features: Belladona. Cham. Coccul. Ipecac. Stram. Are- ratr. —with involuntary emission of urine: Caust. Coccul. Hyosc —with palpitation of the heart: Lach. See com. Spig. —with heat: BeU. Cham. Nux vom. —with seansation of hunger: Hyosc. —hysteric: Aur. Belladona. Caustic. Cham. Coccul. Coff. Cupr. Ignatia. Ipec Mosch. Nux vom. Plat. Puis. Stram. Veratr. —internal: Calc. carb. Caust. Cocc. Coloc. Graph. Ipecac. Magn mur. Stann. —with delirium: Bell. Cin. —with coldness of the body: Cin. Hyosc. Puis. Veratr. —with coldness of the Umbs: Caust. Hyosc. Op. Veratr. —cataleptic: Agar. BeU. Cham. Cic. Hyosc. Ipec. Strain. Veratr. —with locked jaw: Bell. Hyoscyam. Lach. Nux vom. Opium. Plat. Ve- ratr. —of chUdren: Bellad. Calcar. Cham. Cina. Coffea. Ipec Nux vom. Op. Sulph. —clonic: Agr. Ambr. Arnica. Arsen. Bar. Bellad. Calc. Camph. Canthar. Caust. Cham. Cic. Cina. Coccul. Con. Cupr. HeU. Hyosc. Ign. Ipec. Laches. KaU. Magn. Merc. N. vom. Op. Phosph.E/itt.s-. Sec. corn. Sepiee. Stann.] Stram. Sulph. Veratr. —with movements of the head: Bell. Cham. Cie HeU. Lach. Op. Stram. —opisthotonic: Ign. —preceded by head-ache: Bell. Hy- oscyam. Lach. Nux vom. —succeeded by head-ache: Bellad. Cina. —with contraction of the limbs: Hy- oscyam. —with laughter: Bellad. Calc Caust. Ign. Lach, GENERAL SYMPTOMS. 149 —with creeping as of a mouse: Bell. Sulph. —with colic: Caustic. Cham, Cin, Cupr. Merc Sulpli. SWEAT, anxious: Arn. Ars. Calc Cham. Ferr. Ign. Alere Natr. Nux vom. Phos. Puis. Rhus. Sep. Spong. Stramon. Sulph. Veratr. —bloody: Lach. Lyc. Nux vom. —musty smell: N. vom. Puis. Rhus. —exhausting: Ambra. Arsen. Bryon. Calc. Carbo an. Chin. Digit. Ferr. Hep. Iod. Lyc. Alercur. Natr. mur. Nitric acid. Nux vom. Phosphor. Samb. Sep. Stann. Sulph. Veratr. —fatty: Bryon. China, Merc. Selen. —staining the Unen: Ars. Graphit. Merc Selen. —yellow: Graph. Lach. Merc —semilateral: Cham. Chin. Nux vom. Puis. —smelling like juniper: Sep. —cold: Aeon. Amm. mur. Ant. tart. Arn. Ars. Bryon. Calcar. Camph. Cannab. Carbo veg. China. Cin. Coccul. Cupjr. Duh: Hell. Hep. Ign. Ipec Lach. Lyc AI. arct. Alercur. Nux vom. Puis. Rheum. Rhus. Sa- bad. Sec corn. Sep. Staph. Sulph. Veratr. —smelling like old cheese: Plumbum. —viscous: Aeon. Ant. tart. Ars. Bry. Cham. Daph. Ferr. Hep. Iod. Lyc. Alere Phosph. Phosph. ac: Plumb. See corn. Veratr. —red: Arn. Calc. Dulc. Lycop. Nux vom. —sour smelling: Arn. Asar. Bellad. Cham. Ferr. Hep. Ignat. Iod, Ipec Kali. Lyc. Merc Nitric ac. Rhus. Sep. Sil. Sulph. Veratr. —stinging: Cham. Con. —fetid: Ammon. mur. Baryt. Canth. Con. Dulc: Ferr. Fluor, ac. Graph. Hep. Kali. Led. Lyc Alere Nitric. ac. Nux vom. Phosph. Puis. Rhus. Selen. Sep. Staph. Veratr. —having an urinous smell: Canthar. Nitric ac. —smelling like onion: Bov. Lycop. —in the morning: Op. Nux vom. Plat. —with open mouth: Mosch. Op. —with distorted mouth: Bellad. Nux vom. Op. Stram. —followed by weariness: Bell. —at night: Bell. Calc. carbon. Calc. caust. Cham. Cin. Ign. Merc. Op. Sulph. —during new-moon: Calc. Caustic. Cupr. Sil. —falling down unconscious: Bell. Cupr. —after onanism: Calc. China. Coc- cul. Lach. Lyc. N. vom. Op. Staph. Sulph. Areratr. —with dilated pupils: Bellad. Calc. Cie Cin. —during the menses: Coccul. Cupr. Ignat. Nux vom. Plat. Puis. —with rattling breathing: Ipec. Lach. Nux vom. —in the back: BeU. Ign. Ipec. Op. Rhus. —faUing backwards: Bell. —with froth at the mouth: Chamom. Cupr. Hyosc. Ign. Lach. Nux vom. —with froth at the mouth, bloody: Lach. Op. Pyroearb. —during sleep: Bellad. Calcar. caust. Cin. Sil. —foUowed by drowsiness: Bell. Dros. Ign. Lach. Op. —after a fright: Bellad. Coffea. Ignat. Lach. Op. Nux vom. Veratr. —with a scream: Cina. Crot. Hyosc. Lach. Nux. vom. Op. Sulph. —followed by weakness: Bell. Calc. Cic. Sec corn, ATeratr. —with sticky sweat on the head: Camph. —tetanic: Aconit. Ars. Bell. Camph. Cic Cupr. Ign. Ipec. Laur. Op. loO i + KNERAL SYMPTOMS. Plat. Rhus. Secale com. Stram. A'eratr. —Saint A'itus' dance, chorea: Bell. Caust. Coccul Croc Cupr. Hyosc. Ign. Lach. Laur. Nux vom. Stram. ^ Zinc. —after an injury: Arn. Pulsat. Rhus. Sulph. —alternately red and pale: Ign. —with crying: Bell. Caust. Cuprum. Ign. Lach. Puis. —of lying-in females: Bell. Chamom. Coff. Hyosc. Ign. Puis. —caused by worms: Ca7c. Cin. Hy- osc. Alere. N. vom. Sulph. —dentition: Bell. Calc Coff. Cham. Ign. Merc. Sulph. —with gritting of the teeth: Cin. Coff. Hyosc. —with trembling: Cupr. Lach. —with twitching: Bell. Calc. Caust. Cham. Cina. Cuprum. Hyosc. Ian. Ipecac. Lach. Alere Op. Phimb. Rhus. See corn. Strum. Sulphur. A7"eratrum. SPIRITS OF CAAIPHOR, ill effects of: Coff. Op. STRAINING BY LIFTING, ill ef- fects of: Arn. Bryon. Calc. Coccul. Con. Graph. Lye Natr. Nitric ae. Nux vom. Phosph. Phos. ac. Rhus. Ruta. Sil. Sulph. Sulph. ac. SWEAT, ill effects of suppression of sweat: Aeon. Bell. Bry. Cham. Chin. Dulcam. Laeh. Nux vom. Pulsat. Sil. Sulph. TEA, ill effects of: China. Ferrum. Lach. THIRST: Aeon. Ars. BeUad. Bryon. Canth. Cham. Ipecac. Alere Nux I vom. Puis. Rhus. Sulph. Veratr. TOBACCO, ill effects of: Cham. Coccul. Nux vom. UNEASINESS, bodily: Aconitum. Anac. Ars. Asar. Bellad. Bry. Calc Cann. Carbo veg. Cham. Chin. Cof- 1'ea. Croc Cupr. Few. Graph. Hy- oscyam. Ign. Iod. Kali. Lycop. AI. austr. Alere Alur. ae Natr. N. vom. Op. Phos. Plat. Rhus. Samb. Sep. Sil. Staph. Strain. Sulph. Veratr. VASCULAR ERETHISM: Aconit. Ambra. Arn. Aurum. Bellad. Bov. Bry. Calc c. Carbo veget. Caustic. China, Con. Creos. Ferr. Hep. Iod. Kali. Lycop. Natrum mur. N. vom. Op. Petr. Phosph. Rhus. Sassap. Sepi«. Sil. Stann. Sulph. WALK, difficulty of learning to walk: Calcar. Alercur. Sil. Sulph. WEAKNESS, general: Agar. Amm. Anac. Arn. Ars. Bell. Brom. Calc. Carb. an. Carbo veg. China. Cocc. Conium. Ferr. Fluor, ac. Graphit. Ipecac. Kali. Laeh. Lycop. Alagn. mur. Merc Natr. Natr. mur. Nitric ac. Nux vom. Oleand. Op. Phosph. Phosph. ac. Plat. Puis. Rhus. Sec. corn. Sepiee Sil. Staph. Sulphur. Veratr. WEANING, ailments from: Bellad. Bry. Calc. Puis. WEARINESS : Arn. Ars. Bell. Calc Cann. Caust. Chin, Coccul. Coffea. Con. Croc. Ferr. Graph. Hep. Ign. Ipec. KaU. Lycop. Merc. Natr. Nux vom. Oleand. Phosph. Plat. Puis. Rhod. Rhus. Spong. Sulph. Tart. em. Thuj. Veratr. —consequences of: Arn. Bry. Coff. Rhus. Puis. WHITE, red parts turning: Arsen. Bor. Calc Ferr. Hell. Alercur. Ni- tric ac. Nux vom. Phos. Secale corn, Staph. Sulph. Sulph. ae. WOUNDS: Arn. Calendul. Hyper. BURNS: Arnica. Crtica. PAIN FROM BUKNS: Ars. Caust. INDEX. 889 INDEX. A Abdominal deformity....... 651 •' diet during 051 Abdomen pendulous........ 650 Abscess.................... 522 •' Treatment for........ 528 '' Causes of............. 522 Acclimation or Acclimatiza- tion ....................... Ill Acnae Rosacea............. 573 Acute critical cases of disease 91 " Bronchitis...........418-419 " " Treatment of... 422-424 " Contagious diseases... 526 Aconite, external application of........................ 94 Affections to which the pa- tient is liable........... 33 After pains................ 640 " Treatment of___ 640 Age, the, of patient......... 31 Ague and Fever............ 549 " " " Treatment of.552-556 Air, as a means of modifying disease................... 107 Aliments................... 102 Allopathic treatment, intro- duction to ............... 22 Amenorrhcea............... 376 Anaemia of the Brain ----- 124 "Sympt.of 125 "Causes of 125 "Treatm'nt of........................ 125 Angina..................... 217 " Catarrhal.............. 218 " Pectoris.......... 475 Antecedents of patient's fam- ily......................... 31 Anxiety as a symptom...... 61 '• Sensations of......... 6'" Aphtha*.................. 671 Apoplectic constitution.. . 28 Apoplexy.................... 54-126 Treatment of.....127-128 Apparel as a preventive of disease.................... 101 Apparent death............. 11- •' " from hunger... 112 " " a fall....... U2 '• suffocation... 113 '• " - lightning___ 113 Apparent death from drown- ing........................ 113 Apparent death fromfreezing 114 Apparent death from noxious vapors.................... 114 Arnica as an external appli- cation..................... 94 Art of feeling the pulse .. . 36 Arsenicum as an external ap- plication ................... 91 Asiatic cholera.............. 595 " Treatment of. .596-597 Asthma................... 451 " Treatment of.......452^54 Millaris............. 681 " " Treatment of.. 682 Atmosphere and other local inriuences................. 34 Atrophy of infants.......... 683 " "' Treatment of.684-687 B Back, crick in the.......... 489 " " Treatment of.489-490 Barbel's itch............... 512 " " Treatment..... 513 Bath, remarks on .......... 97 Bath, cold salt water...... 97 Bath, swimming............ 98 Bath, fresh water........... 97-100 Bath, hot fresh water....... 97-1C0 Bath, fresh water........... 99 Bathing.conditionsin which cold should be avoided.... 97 Bathing, when beneficial... 98 Bathing, indoor............. 98 Bathing, precautions to be observed in........... 99 Bathing, salt water or sea.. 99 Bed sores................ 5»4 Bilious constitution......... 2a Bilious complaints.. . ..... 239 Bilious complaints,treatni't.249-251 Black water........... . . . 27G Bladder, diseases of the. 352 Bladder, inflammation of the 352 Bladder, spasm of the......359-641 Bleeding at the nose........ 208 Bleeding at the nose, treat- ment..................... 209 Blindness ................. lbl Blindness, treatment........ 187 Blindness, sudden attacks of 187 810 INDEX. Blood, the condition of the. 41 Blood, spontaneous disch'g's of.......................... 42 Bloodshot eye................ 189 Blood, vomiting of.......... 265 Blood, vomiting of, treatm't 268 Blood, spitting of........... 414 Bloody urine................ 354 Bloody urine, treatment__355-356 Body, constitution, tempera- ment and habit of........ 86 Boils.......................518-547 Bottle nose.................. 513 Bones, diseases of the....... 481 Bowels, pain in the......... 62 Bowels, inflammation of___ 296 Bowels, inflammation of, treatment................298-299 Bowels, distention of the... 669 Brain, the, and its indica- tions...................... 54 Brain, diseases of.......... 116 Brain, hyperemia of........ 119 Brain, excess of blood in the 119 Brain, congestion of___ 119 Brain, active congestion of. 122 Brain, passive congestion of 123 Brain, anaemia of............ 124 Brain, lack of blood to the.. 124 Brain, inflammation of the. 135 Brain fever................. 135 Brain, dropsy of the........ 140 Brain, water on the ........ 140 Brain, affections of the...... 116 Breath in health............ 46 Breathing....... ........... 46 Breathing, variations and in- dications................ 46 Breasts, inflammation of the384-651 Breasts, inflammation of the, treatment.................386-652 Bright's disease.............. 345 Bronchial tubes, inflamma- tion of the............... 418 Bronchitis, acute........... 418 Bronchitis, acute, treatment422-424 Bronchitis, chronic......... 427 Bronchitis, chronic, treat- ment.....................428-430 c Calendula officinalis, tincture of.......................... 94 Cantharis or cantharides, tincture of................ 95 Cancer of the womb......... 387 Cancer of the womb, treat- ment..................... 388 Cancer of the breasts........ 388 Cancer of the breasts, home remedies.................. 390 Carbo vegetabilis............ 97 Cardialgia................... 270 Cardialgia, treatment of. .. 271-272 Carcinoma uteri........... 387 Carcinoma uteri, treatment of....................... 388 Carcinoma mamma?.......... 888 Catarrhal or rheumatic con- stitution ................. 29 Catarrh, with treatment 200-391-427 Catarrh, chronic nasal.......298-427 Catarrhal fever............. 891 Catarrh, of the sexual mucous lining..................... 367 Catarrh of the sexual mu- cous lining, treatment of. .368-369 Catarrh, chronic bronchial... 427 Catarrh, chronic bronchial, treatment of............. .428-430 Catarrh, epidemic............ 432 Catarrh, epidemic, treatment of...................... 433 Catarrh, of bladder.......... 852 Cataract................... 190 Catalepsy.................. 157 Causes of disease.......... 84 Causticum or lime water externally................. 96 Characteristics of individuals 38 Chest, sounds given by...... 75 Chest sounds, clear.......... 76 Chest sounds dull .......... 76 Chafing................. 680 Chafing, treatment for......680-661 Chicken pox................ 548 Chicken pox, treatment of... 548 Childhood, periods of ....... 32 Childbed fever............ 645 Childbed fever, treatment of 646 Children, stillborn........... 653 Chilblains...... ........... 524 Chill, as a symptom........ 68 Chills and fever... . ....... 549 Chlorosis.................... 612 Choleric temperament....... 30 Chorea.... ............... 163 Cholera morbus............. 284 Cholera, symptoms of...... 284 Cholera, cause............... 285 Cholera, treatment of.......285-286 Cholera Asiatica............ 595 Cholera epidemic............ 595 Cholera malignant.......... 595 Cholera causes of............ 595 Cholera, treatment for....... 596 Cholera, after effects of..... 600 Cholera, accessory measures 601 Cholera, preventive measures during the prevalence of.. 602 Cholera infantum............ 676 Cholera infantum, treatment of..........................677-679 Choice of a nurse........... 657 Chronic enlargement of the tonsils.................... 222 INDEX. 841 Chinchona tincture ........ 97 Cleanliness as preventative. 101 Cleanliness as a modifier of disease..................... 101 Climate, modifications of___ 103 Clothing and habits......... 80 Coldness of the extremities.. 67 Cold in the head............ 200 Cold in the head,treatment of 202-204 Cold in the head, home reme- dies for ...................201-207 Cold in the head, susceptibili- ty to...................... 206 Cold in tlie head of infants.. 665 Cold in the head of infants treatment of..............665-666 Colic.....................309-666 Colic, treatment of..........310-312 Colic, predisposition to...... 315 Colic, from worms........... 315 Colic, home remedies for... 315 Complexion, red, florid...... 75 Complexion, white.......... 75 Complexion, faint yellow___ 75 Complexion, pallid.......... 75 Complexion, patchy redness of.......................... 75 Complexion, blue or livid... 75 Constitution, the............ 27 Constitution, plethoric or san- guine...................... 27 Constitution, feeble......... 28 Constitution, bilious........ 28 Constitution, apoplectic..... 28 Constitution, nervous...... 28 Constitution, dry, wiry...... 28 Constitution, lax, lymphatic, or mucous. ............... 29 Constitution, catarrhal or rheumatic................ 29 Constitution, in which the skin is liable to become diseased (psoric).......... 29 Constitution, consumptive. 29 Condition of the blood...... 41 Consciousness, loss of...... 54 Convulsions................. 59 Condition of the patient ... 27 Consumption ............. 615 Consumption, treatment for 616 Confinement, treatment be- fore ................ ..... 634 Confinement, signs of...... 634 Confinement, home treat- ment...................... 635 Confinement, preparation of the breasts before......... 634 Confinement, preparation of the bowels before......... 635 Confinement, preparation of the bed before............ Wo Confinement, false pains be- fore....................... b36 Confinement, false pains, treatment for............. 636 Confinement, duration of... 641 Confinement, diseases fol- lowing ................... 642 Constipation with rush of blood to the head......... 316 Constipation, treatment for.316-318 Constipation, home remedies for....................... 318 Constipation, diet........... 319 Constipation, during preg- nancy .................... 626 Constipation, during preg- nancy, treatment for..... 628 Constipation, of infants --- 672 Constipation, mechanical measures for............ 6'3 Constipation, medical treat- ment for............... b"s Conditions which qualify the age....................... .,, Congestion of the lungs..... 4U Congestion of the lungs treat- ment of..................4 2™ Constitutional diseases ..... ^2b Constitutional diseases, treat- ment of ..................529"^o Copper-nose................ ^ Coryza.................• • "" oni Coryza, home remedies for.. 2ui Coryza, acute................ ^2 Corns........................ Corns,"palliative treatment.. 525 Costiveness ..............••• 49~3l° Cotton, raw for burns or scalds 96 Coughs, their indications--- < 2 Cough, short, dry............ 3o Cough, painful, hacking..... <«j Cough, predisposition to..... 73 Cough, chronic, dry......... ^4 Cough, whooping............ 485 Cough ..................... f99 Cough, treatment for........ 4UU Coxalgia.................... 492 Crick in the back...........• 489 Critical sweat............... ?& Crosseye—................. \™. Croup...............,........;. 4U4 Crying and wakefulness ot infants...................• 666 Crying and wakefulness ot infants, treatment of...... 667 Cystitis............• •........ 352 Cvstitis treatment ot........ 808 Cy stospasmus..........• • • • • 359 Cystospasmus, treatment for 359 D Dandruff................... §10 Dandruff, treatment for.... . on Death, verification of........ H5 842 INI EX. Death apparent.............. Deafness................... Deafness, treatment of......194- Decline, first period of....... Decline, second period of..... Deformity, abdominal....... Delirium, fainting, etc....... Delirium tremens.......... Delirium tremens, treatm't. Delivery, weakness after — Depression of spirits........ Diarrluea................... Diarrlnca, treatment of......277 Diarrhoea, of lying-in women Diarrhoea, of infants......... Diarrhoea of infants, treat- ment of...............674-075 Diet......................... Diet and regimen............ Diet during nursing......... Difficult breathing........... Digestive functions, indica- tions in................... Diphtheria................. Diphtheria, treatment of___228 Diphtheria, home remedies for ...................... Diseases to which the patient is subject.................. Diseases, acute, critical...... Diseases, chronic............ Diseases, of the ear ......... Diseases, of the nose........ Diseases, of the mouth and throat.................. Diseases of the stomach..... Diseases, of the intestines... Diseases of the liver......... Diseases of the spleen....... Diseases of the kidneys...... Diseases of the bladder...... Diseases of the sexual or- gans.......................361 Diseases of the respiratory organs.................... Diseases of the lungs........ Diseases of the pleura....... Diseases of the organs of circulation............... Diseases of the heart ..... Diseases of the arteries..... Diseases of the veins........ Diseases of the bones, muscles and joints................ Diseases of the skin--- ... Diseases, constitutional..... Diseases, acute contagious.. Diseases, epidemic and en- demic..................... Diseases, constitutional with- out definite infection___. Diseases peculiar to women. Diseases of infancy ....... 112 198 190 82 33 650 54 145 246 650 261 276 -2SU 649 674 -279 106 79 206 49 226 -231 33 91 93 192 200 214 239 276 331 339 342 -367 391 411 456 465 465 476 476 481 502 526 526 549 602 618 664 Disease, investi^alion of... 34 Discharges from the ears... 193 Discharges of blood from tlie lungs..................... ill Discbarges of blood from the lungs, treatment.........415-416 Diseases after confinement.. 645 Discomfort and anxiety as a symptom................. 61- 66 Diving bath................ 98 Doses..................... 84 Doses, division and solution of........................ W Doses, recurrence and sus- pension .................. 86 Doses, precaution to secure a proper.................... SM Drainage as a preventive of disease................... 108 Dry wiry constitution...... 28 Duration of confinement--- 641 Duration of suckling........ 659 Dysenteria, catarrhal....... 300 Dysenteria, epidemic....... 301 Dysenteria, treatment .....304-307 Dyspepsia .................. 239 Dyspepsia...................249-251 E Earache..................... Jp2 Ear, discharge from........19o-l.w Ear, inflammation of the... 192 Ear, bumming or buzzing in the ......................•• 199 Ear, humming or buzzing in as a symptom............ ?2 Eclampsia, infantum....... h>» Eczema..................... '^ Eczema, treatment of........ ol7 Empty pulse................ 39 Endemic disease............ ;j49 Enteritis..............:--- 296 Enteritis, treatment ot......298-299 Enteralgia................. 309 Enteralgia, treatment of... .210-812 Enuresis nocturna (wetting the bed).................. 3o6 Enuresis nocturna, treat- ment of...................3^"_i'J!S Epilepsy......................148-J63 Epilepsy, treatment.........loi-io4 Epidemic diseases........... -^ Epidemic cholera............ o9,J Epidemic cholera, treat- ment of...................59o-oy, Eplstaxis (bleeding from the nose)...,.....,..........• • 20» Epistaxis, treatment for--- 209 Eructations................•• 2^} Erysipelas.................. «J» Erysipelas, treatment.......uUb_£)U'( Erythema.................. °°- INDEX. 84.'" 1-vacuations, and their indi- cations.................... 19 i> conation................ 680 Excoriation, treatment for..680-681 Exercise, in infancy......... <>62 Exercise, as a preventive of disease.................... 101 Expectoration, as an indica- tion ....................... 78 Eye, the and its indications 70 Eye, dilated pupil of........ 70 Eye, contracted pupil of ... 70 Eye, squinting of........... 71 Eye, copious watering of.... 76 Eye, diseases of the......... 179 Eye, inflammation of the... 179 Eye, inflammation of the, of infants.................... 664 Eye, weeping or watery___ 188 Eye, bloodshot.............. 189 F Fainting, delirium, etc..... 54 Family, the history of the.. • 31 Face-ache or face-ague..... 173 Favus, scald head........... 520 Favus, treatment for........ 520 Feeble constitution......... 28 Feeble pulse................ 38 Felon...................... 524 Fever, Spotted.............. 116 Fever, general remarks on.. 287 Fever, gastric or Bilious..... 288 Fever, gastric or bilious, treatment of..............290-293 Fever, catarrhal............ 391 Fever, scarlet............... 532 Fever, scarlet, treatment for534-537 Fever and Ague.... ....... 549 Fever and Ague, treatment for.......................552-556 Fever, intermittent........ 549 Fever, inflammatory........ 560 Fever, typhoid.............. 562 Fever, enteric.............. 562 Fever, enteric, treatmentfor567-571 Fever, yellow—........... &85 Fever yellow, treatment.. ...590-592 Fever, milk...........----- 645 Fever, childbed.............. 645 Fever childbed, treatment of 646 Fever, puerpueral........... 645 Fistula lachrymales......... 188 Fits of little children........ 155 Fits.............<..........148-59 Flatulence.................. 50 Flatulence of infants........ 668 Flatulence of infants, treat- ment of........------...... 669 Flesh, excess of.........'. — - 77 Flesh, loss of.............-• • • -77 Flooding.........-........... 640 Flux, dysentery........... •• 300 Flux, dysentery, treatment of304-307 Food, supplementary for in- fants...................... 658 Food, (diet).................. 79 Food, allowed during treat- ment..................... 100 Food, prohibited during treat- ment...................... Ill Frequent pulse.............. 88 Freezing, apparent death from...................... 114 Frozen limbs............... 525 Full pulse .................. 38 Function of breathing, indi- cations.................... 46 G Gallstone................ 339 General habits ..... ........ 33 General investigation of the » patient.................... 27 Generalities................. 72 Genitals, itching of the...... 629 Genitals, itching of the, treat- ment of................... 630 Giddiness................... 66 Glands, inflammation of the parotid.................... 234 Glands, inflammation of the parotid, treatment of...... 235 Glands, diseases of the...... 499 Globules..................... 84 Gravel...................... 349 Gravel, treatment of......... 351 Green sickness.............. 612 Green sickness, treatment of 614 Groaning as a symptom...... 77 Gutta rosacea............... 513 H Habits, general..........--- 33 Habits and clothing........ 80 Habitation........ ......... 103 Haematemesis............... 265 Haematemesis, treatment---267-268 Hard pulse.................. 38 Head, diseases of the........ 166 Head, cold in the............ 200 Head, cold in the, of infants. 665 Headache................... 166 Headache, neuralgic ...— . 167 Headache, treatment........ 169 Headache, bilious or sick--- 261 Head, scald.................. 520 Head, swelling of the............ 654 Haemorrhoids........................ 319 Haemorrhoids, treatment for..322-323 Hearing............................... 72 Heat, and cold as a symptom 67 Heat, and cold sensations of 66 Heat, actual increase of....... 67 Heat, of stomach and chest... 67 Heat, fugitive....................... 67 844 INDEX. Heart, diseases of the............ 465 Heart, inflammation of the... 465 Heart, inflammation of the treatment for....................466-468 Heart, palpitation of the...... 472 Heart, palpitation of treat- ment for........................... 473 Heartburn..........................276-265 Helminthiasis, (worms)....... 323 Helminthiasis, treatment for324-325 Hematuria.......................... 354 Hematuria, treatment for.....355-356 Hemorrhage of the stomach 265 Hemorrhage of the stomach, treatment..........................267-268 Hemorrhage of the lungs..... 414 Hemicrania, (headache)......... 166 Herpes................................ 514 Hiccup................................... 60-664 Hives................................... 508 Hives, treatment for............ 509 Hoarseness, as a symptom.... 76 Hoarseness........................... 395 Hoarseness, treatment for..... 397 Homoeopathic medicines...... 8l Hydrocephalus, (water on the brain)................................ 140 Hysterics, or Hysteria......... 157 Hysterics, or Hysteria treat- ment................................158-162 I Indications of the urine___ 43 Indications of the breathing 46 Indications of digestion.... 49 Indications of evacuations.. 49 Indications of vomiting.... 51 Indications of appetite...... 51 Indications of thirst........ 52 Indications of tongue....... 53 Indications of delirium and fainting................... 54 Indications of motion, rest etc 56 Indications of the eye...... 70 Indications of the taste..... 71 Indications of hearing..... 72 Indications of smell......... 72 Indications of coughs....... 72 Indications of sweat........ 74 Indications of complexion.. 75 Indications of chest sounds. 75 Indications of voice.......... 76 Indications of sneezing..... 77 Indications of saliva........ 78 Indications of expectoration 78 Indigestion................. 230 Individual characteristics.. 33 Infants, bathing temperature for....................... 100 Infants, diseases of.......... 664 Infants, treatment after birth 653 Infants, observations on the suckling of................ 656 Infants, supplementary diet of........................ 656 Infants, crying and wakeful- ness of.................... 666 Infants, crying and wakeful- ness of, treatment for..... 667 Infants, diarrhoea of........ 674 Infants, diarrhoea of, treat- ment for..............674-675-279 Infants, constipation of...... 672 Infants, summer complaint of 676 Infants, when may they be put to the breast.......... 656 Infants, duration of suckling weaning.................. 659 Infants.sleep,sleeplessness of 660 Infantsj sleeplessness of, treatment for.............. 661 Infants, exercise of ......... 662 Infants, retarded strength of limbs of................... 663 Infants, inflammation of the eyes of................... 664 Infants, hiccup of........... 6(54 Infants, snuffles, cold in the head of.................... 665 Infants, snuffles, cold in the head of. treatment of......665-666 Infants, vomiting of milk... 668 Infants, vomiting of milk, treatment of............... 669 Infants, bloating of the bow- els of...................... 669 Infants, milk crust, milk scab. of.......................... 670 Infants, thrush, aphtha)..... 671 Infants, sore mouth of...... 671 Infants, chafing, excoriations of.......................... 680 Infants, chafing, excoriations of, treatment for..........680-681 Infants, asthma millaris..... 681 Infants, asthma millaris treatment of.............. 682 Infants, swelling of the breasts of................ 6S3 Infants, emaciation of....... 688 Infants, atrophy............. ^ Infants, marasmus............... 6S3 Infants,marasmus treatment of......................................684-887 Inflammation of the ear........ 192 Inflammation of the ear treatment of.....................194-196 Inflammation of the liver..... 831 Inflammation of the liver treatment of....................332-333 I nflammation of the spleen.. 889 Inflammation of the spleen, treatment for...................340-341 Inflammation of the bladder 352 Inflammation of the bladder, treatment for.................... 358 INDEX. 845 Inflammation of the testes... 361 Inflammation of the testes,. treatment for.................... 861 Inflammation of the breasts384-652 Inflammation of the breasts, treatment for...................386-652 Inflammation of the larynx. or upper part of the wind- pipe ................................. 394 Inflammation of the larynx. treatment for.................... 395 Inflammation of the bron- chial tubes........................ 418 Inflammation of the bron- chial tubes, treatment for..422 424 Inflammation of the lungs... 441 Inflammation of the lungs, treatment for....................445-450 Inflammation of the pleura.. 456 Inflammation of the pleura, treatment for....................459-463 Inflammation of the eyes..... 179 Inflammation of the eyes, treatment for....................180-185 Inflammation of the eves of infants...................-........664-184 Inflammation of the bowels.. 296 Inflammation of the bowels, treatment for....................298-299 Inflammation of the joints.... 491 Inflammation of the hip...... 492 Inflammation of the hip, treatment for...................493-494 Inflammation of the knee..... 495 Inflammation of the knee, treatment for....................495-497 Inflammation of the foot..... 497 Inflammation of the foot, treatment for................... 498 Inflammatory fever.............. 560 Inflammatory fever, treat- ment for........................... 560 Initiatory remarks............... 90 Introduction........................ 22 Intermittent pulse............... 39 Intermittent fever............... 549 Intermittent fever, treat- ment of............................552-556 Intestines, diseases of.--.239-276-392 Intestines, falling of the...... 329 Invermination..................... 323 Invermination, treatment of324~325 Investigation of disease....... 34 Investigation of the patient- 27 Iris, inflammation of............ 180 Irregularities after confine- ment................................ 648 Itch..................................... 521 Itch, treatment of................. 522 Itch, barber's........................ 5R Itching of the genitals.......... 029 ltching of the genitals, treat- ment of.............................. 630 Jaundice.............................. 836 Jaundice, treatment.............337-338 Jaundice, inflammatory........ 339 Joints, diseases of................. 481 Joints, diseases of, treatment of.....................................482-484 K Kidneys, disease of the....... 342 Kidneys, inflammation of the 342 Kidneys, treatment.............343-344 L Labor.................................. 637 Labor, the place of the phy- sician during..................... 638 Labor, care of the child during............................... 638 Lobor, attentions to the woman after..................... 639 Labor, general management child, etc., after................ 639 Lacramalis, fistula............... 188 Large pulse.......................... 38 Larynx, diseases of the.........391-394 Larynx, inflammation of the 394 Larynx, inflammation treat- ment for........................... 395 Laughter, indication of......... 76-77 Lax, lymphatic constitution. 29 Leucorrhcea.......................... 367 Leucorrhcea, treatment for..367-369 Life, manner of.................... 33 Limbs, frozen...................... 525 Limbs, swelling of the lower 628 Limbs, retarded strength of the.................................... 663 Limewater, or causticum ex- tern'Uy............................. 96 Liver, diseases of................. 331 Liver, inflammation of the... 331 Liver, inflammation of the... treatment for....................332-333 Liver, abscess of................. 335 Liver, complaint.................. 336 Liver, complaint treatment... 336 Living, the habit of.............. 102 Local influences.................... 34 Lockjaw............................. 142 Lockjaw, treatment for.......143-145 Lochial, discharge and irreg- ularities............................ 648 Lumbago.............................. 489 Lumbago, treatment for......489-490 Lungs, diseases of the.......... 411 Lungs, congestion of the...... 411 Lungs, congestion of the, treatment of.....................412-413 Lungs, discharge of blood from................................. 414 Lungs, discharge of blood from, treatment of......415-416-417 845 INDEX. Lymphatic constitution.......• 29 Lymphatic tumors................. 499 Lymphatic tumors tre itment500-o0l M Malignant cholera............... 595 Alalignant cholera, treatment of......................................596-o97 Aianner of life..................... 33 Afastitis................................ 384 Aiastitis, treatment.............. 386 Aiaturity, the period of......... 32 Measles............................... 526 Aleasles, treatment of...........529-531 Aleasles, aftereffects............ 532 Aledical eradicative resources Homoeopathic.................... 108 Aledical preventive resources Homoeopathic.................... 104 Aiedicine, when to take......... 8S Meciicine, rules for preserva- tion and management........ 89 Aiedicine,administration and repetition of..................... 90 Alelancholic temperament..... 30 Aleningitis cerebro spinalis... 116 Alenses, derangements atten- dant upon the appearance- 375 Alenses, suppression or delay of...................................... 376 Alenses, suppression or delay of, treatment.....................377-380 Aienstruation......................371-381 Alenorrhagia....................... 3g] Alenorrhagia, treatment....... 382 Alental derangement.......... 241 Alilk, secretion of the........... 642 Milk, secretion excessive..... 643 Alilk, secretion scanty......... 642 Alilk fever.......................... 64-5 Alilk, vomiting of, in infants 668 Alilk, vomiting of,in infants, treatment for.................. 669 Alilk crust........................... 670 Alilk scab............................. 670 Aliscarriage......................... 630 Aiiscarriage, to prevent........ 632 Aliscarriage, the actual at- tack................................... 682 Aliscarriage, treatment......... 633 Aiodification, accessory means of........................... 186 Alorbus divinas.................. 148 Alorbus herculens................. 148 Morbilli.............................. 526 Alorbilli, treatment ............529-531 Alotion and rest, their indi- cations..................... ........ ,-)6 Aiouth, diseases of the......... 214 Mouth, inflammation of the- 214 Mouth, inflammation of the, treatment for...................216-217 Aiouth canker of the........... 214 Mumps................................2s4-,s40 Aluseles, diseases of the........ 481 Muscles, diseases of the, treatment for....................182-481 N Nasitis................................. 207 Nausea and vomiting as a symptom.......................... i.\ Nausea................................ 260 Nearsightedness..................186-190 Nearsightedness, treatment.. 19] Nephritis............................ 842 Nephritis, treatment...........313-344 Nerves of the brain and sen- ses.................................... 54-217 Nerve pain........................... 173 Nervous constitution........... 28 Nervous irritation.............. 37 Nervous system, disea-e. of- lie Nervous cough..................... 399 Nervous cough, treatment of 400 Nettlerash........................... 508 Nettlerash, treatment of......~>08-509 Neuralgia............................. 173 Neuralgia in general............ 173 Neuralgia in general, treat- ment .................................173-175 Nipples, sore........................ 651 Nipples, preparations 01 ihe, before confinement........... 634 Nose, diseases of the............ 2)0 Nose, inflammation of the... 207 Nose, inflammation of the treatment of .................... 209 Nose, bleeding at the........... 20S Nose, bleeding' at the, 1 reat- ment of............................209-212 Nose, copper....................... 513 Nose, bottle.......................... 513 Numbness or deadness........ 68 Nurse, choice of................... 657 Nursing, diet during............ 657 Nursing, duration of............ 659 o Odontalgia.......................... 236 Ophthalmia......................... 179 Ophthalmia, catarrhal......... I7si Ophthalmia, purulent......... 179 Ophthalmia, simple.............. 181 Ophthalmia, treatment........181-185 Ophthalmia of infants.........184-664 Otalgia (earache).................. 195 Otitis (inflammation of the ear).................................. 192 Otorrhoea (discharge from the ear).............................. 193 Otorrhoea, treatment....... 194-196 Organs of circulation, dis- eases of.................. 465 INDEX. 847 P Pain as a symptom......... 81 Pain, absence of........;--- 63 Pain, intermittent.......'.-:'.. 63 Pain, remittent............ . 63 Pain, inflammatory......... 63 Pain, nervous.............. 64 Pain, spasmodic........• - . 65 Pain in back of bead ....... 65 Pain in forehead.........• • • 65 Pain i n loins .. ---....... 65 Pain in stomach............ 66 Pain, stitching or prickling. 66 Pain in the teeth........... 236 Palpitation of the heart, as a symptom...... •.......... 37 Palpitation of the heart... . 472 Palpitation of the heart, treatment.................. 473 Paralysis as a symptom-...... 60 Paralysis..........................- 131 Paralysis, treatment............131-134 Parotitis, (mumps)................ 233 Parotitis, treatment...........••• 235 Parturition.............*•............. 637 Parturition, care of the child during.............................. 638 Parturition, the attentions to the woman after............ 639 Parturition, general manage- ment, diet, etc................... 639 Parturition, pains after........ Patient, investigation of the. 27 Period approaching maturity 32 Period, first of decline.......... 32 Period, monthly of women... 375 Pertussis (whooping cough).. 43i Phalangitis.......................... 235 Phlegmatic temperament..... 31 Phrenitis (inflammation of the brain)......................... 135 Piles.................................... 319 Piles, treatment of...............322-323 Plaster, the soap................... 96 Plethoric or sanguine consti- tution.............................. . 27 Pleura, diseases of the.......... 456 Pleura, inflammation of the- 457 Pleura, treatment of.............459-463 Pleurisy (pleuritis).............. 456 Pneumonia........................... 441 Pneumonia,treatment for.. ..445-450 Potts' disease...................... 481 Potts' disease, treatment of...482-484 Potencies............---......... 8~> Poultices, application of....... 93 Predisposition to cold ...... 393 Preface. Publishers'........ 17 Preface, Authors'........... 1 •> Pregnancy.................• «J« Pregnancy, signs ot ..... oJ» Pregnancy,observations on. 619 Pregnancy, hygiene of..... 620 Pregnancy, air and exercise during.........,.......... 621 Pregnancy, employment of the mind...... ......... 621 Pregnancy, clothing during 622 Pregnancy, diet during..... 623 Pregnancy, gastric derange- ments during............ 623 Pregnancy, gastric derange- ments during, treatment for......................... 624 Pregnancy, heartburn du- ring................. .--- 625 Pregnancy, heartburn du- ring, treatment for........ 626 Pregnancy, constipation du- 626 ring...................... 626 Pregnancy, constipation du- ring, treatment for........ 627 Pregnancy,toothache during 627 Pregnancy, swelling of the lower limbs ............. 628 Pregnancy, urinary difficul- ties during................ 629 Pregnancy, urinary difficul- ties, treatment for...... 630 Preventives, exercise....... 101 Preventives, cleanliness ... 101 Preventives, ventilation ... 101 Preventives, apparel........ 101 Prolapsus ani............... 329 Profuse menstruation....... 381 Profuse menstruation, treat- ment..................... 382 Psoric constitution......... 29 Psoriasis (scaly tetter)...... 512 Psoriasis, treatment......... 513 Puerperal fever................... 645 Puerperal fever, treatment... 646 Pulse, indications of the....... 36 Pulse, the varieties of the..... 36 Pulse, average in health...... 38 Pulse, what it teaches of dis- ease...................................... 39 Q Quick pulse................. 38 Quinsy ..................... 220 Quinsy treatment...........2>2-223 R Bash nettle.................... 508 Bash nettle, treatment......... 509 Redness of the skin............ 502 Regularity of habits ....... 107 Remarks.................... 81 Remarks, initiatory.......... 90 Remarks, respecting exter- nal remedies .............. 93 Remedies.................... 84 Remedies bes+ to use after others' table of---........ 87 Benal calculi................ 349 848 IXDFX Renal calculi, treatment of.. 351 Repertory the............... 688 Restlessness................. 57 Respiratory organs, diseases of the...................... 391 Respiratory organs___ ..... 392 Retention of the urine......; 641 Retarded strength of the limbs.................... 663 Rheumatic constitution..... . 29 Rheumatism, acute......... 602 Rheumatism, chronic........ 603 Rheumatism, deforming ... 604 Rheumatism, of sciatic nerve 609 Rheumatism of sciatic nerve treatment of___...........609-610 Rhus Toxicodendron, exter- nally ..................... 94 Rickets..................... 485 Pickets, treatment for.....486-488 Ring-worm................... 515 Ring-worm, treatment for.. 515 Rupture of a bloodvessel___ 417 Rupture of infants.......... 655 Rupture in the groin....... 656 Rupture in the navel..... 655 Rupture, treatment for..... 655 s Saliva, as a symptom....... 78 Salt-rheum.................. 516 Sanguine or plethoric con- stitution .................. 27 Scald head.................. 520 Scarlitina................... 532 Scarlitina, treatment for.. .534-537 Scarlet fever.............. 532 Scarlet fever, complicated forms of............... 538 Scarlet fever, after effects of- 539 Scarlet fever, dropsical swel- ling during............. 540 Scorbutis................... 237 Secretion of milk........... 642 Secretion of milk excessive. 643 Secretion of milk, treatment642-643 Sensations and their indica- tions ...................... 61 Sense, organs of............. 70 Sexes, the................... 31 Sexual organs, diseases of the........................ 361 Sexual organs, diseases of, treatment for............. 362 Sexual organs, diseases of the female................ 367 Sexual organs, diseases of the, treatment for........368-369 Shingles..................... 514 Short sight................. 186 Sickness, green.............. 612 Sickness green, treatment of 614 Sight................... ■••• 71 Sight, double or half ........ 71 Sight, obstruction of the..... 71 Singultis (hiccup)............ 455 Skin, diseases of the........ 502 Skin, redness of the......... 502 Sleep, indications of........ 31-660 Sleeplessness................ 660 Sleeplessness, treatment of.. 661 Slow pulse.................. 38 Sluggish pulse............... 38 Smallpox.................... 540 Smallpox, treatment of......542-544 Smallpox, confluent......... 545 Smallpox, check of the erup- tion....................... 547 Smallpox, after-effects of.... 547 Smell indications of......... 72 Snuffles.......................665 Snuffles, treatment of.......665-666 Soap plaster................. 96 Sore nipples---............. 651 Sour stomach................. 688 Sour stomach, treatment of. 689 Spasm....................... rg Spasm, of the stomach....... 270 Spasm, of the stomach, treat- ment of...................271-272 Spasm, of the bladder........359-641 Spasm of the bladder, treat- ment of...................3">9-641 Speech, loss of ............. 76 Spermatorrhoea............. 362 Spermatorrhoea, treatment of 366 Spitting of blood............ 414 Spitting of blood, treatment415-416 Spinal cord................ 116 Spleen, inflammation of the 339 Spleen, inflammation of the, treatment for............•"41-341 Stammering ............... 76 Still-born children.......... 653 Stomach, diseases of the___ 239 Stomach, hemorrhage from the........................ 265 Stomach, hemorrhage from the, treatment for.........267-268 Stomatitis................. .. 214 Stomatitis, treatment for___216-217 Strabismus (cross-eye)...... 190 Strabismus, treatment for.. 191 Strong pulse................ 56 Sulphur as an eradicative of disease..................... 108 Supplementary diet of in- fants ..................... 658 Suckling of infants......... 659 Suckling, duration of....... 659 Summer complaint......... 676 Summer complaint, treat- ment of...................677-679 Sweat, indications of........ 74 Sweat, critical............... 75 Swelling of the head( infant) 654 INDEX. 849 Swelling of the breast(infant) 683 Swooning.................. 56 Sycosis mentagra........... 512 Sycosis mentagra, treatm't of 513 Synochia.................... 560 Synochia, treatment for--- 560 T Table of remedies best to use after others................ 87 Tarsus.................... 497 Tarsus, treatment for...... 498 Taste, and its indications--- 71 Taste, foul.................. 71 Taste, loss or absence of..... 72 Teeth, pain in the.......•••. 236 Teeth, pain in the, treatment of.......................... 236 Tearfulness and laughter___ 76 Temperament, the ....... 30 Testes, inflammation of the.. 361 Testes, inflammation of the treatment of............... 362 Tetter.......................514-520 Tetter, scaly............... 512 Tetanus..................... 142 The antecedents of patient's family................... 31 Thirst, its indications....... 52 Throat diseases of the....... 217 Thrush...................... 671 Thrush, treatment of........ 672 Tinctures___................ 84 Tongue, its indications...... 53 Tongue, thickly f urred,yellow 53 Tongue, clean, dry, red, glazed, swollen, or cracked. 53 Tongue, indented on either side........................ 54 Tongue, tremulous.......... 54 Tongue, blackish, dry, furred and tremulous............ 54 Tonsils, chronic enlargement of the..................... 222 Tonsils, chronic enlargement of the, treatment of....... 222 Toothache..................236-627 Toothache, treatment.......236-627 Toothache, during pregn'cy 627 Trance...................... 157 Trachea, diseases of the..... 391 Trembling as a symptom... 61 Treatment, palliative....... 88 Treatment, preventive...... 100 Treatment, eradicative...... 105 Treatm't, rules for dietunder 110 Treatment of infants........ 653 Tremens, delirium.......... 145 Triturations................. 84 Trismus..................... 14- Tumors, lymphatic........ 499 Typhoid fever............... 562 Typhoid fever, treatment for567-571 Typhus.................... 562 U Ulcers...................... 499 Unequal pulse.............. 39 Uterus, cancer of the....... 387 Urine, its indications....... 43 Urine, bloody.............. 354 Urine, painful discharge of. 62 Urine, retention of.......... 641 Urinary difficulties during pregnancy.............. 629 V Varieties of the constitution 27 Varieties of the temperam'ts 30 Various kinds of pulse...... 38 Variola (small pox)......... 540 Varioloid............ ...... 547 Varicose veins___.......... 628 Veins, diseases of the...... 476 Veins, dilation of the....... 477 Veins, inflammation of the. 476 Veins, varicose.............477-628 Ventilation................. 101 Voice the, its indications--- 76 Voice, loss of............... 76 Vomiting, indications of--- 51 Vomiting of milk (in inf 'nts) 668 w Wakefulness of new-born in- fants ...................... 666 Water brash..............625-276 Water, black................ 276 Water, use of, to modify dis- ease.....................•• 1JJ Watery eye................ 1&° Weakness after delivery--- 6o0 Weaning.................... 6£9 Weeping eye................ I«« Wetting the bed...........• 350 AVetting the bed, treatment +-or ....................357—ooo Wind'in stomach and intes- tines ..................... Windpipe, inflammation of the........................ rfy4 Wine, proof spirits of....... 96 Wiry constitution........... f£ AVhites......:•■••:■•>.......«fiR q«o Whites, treatment of.......<5bb_^ Whitlow..........••......... J** Women, diseases of..... • • • • «>?q Women, diseases peculiar to. 618 Womb, cancer of the........ *" Worms....................... 6f Worms, pin................... j^J Worms, long round.......... «"« Worms, tape................ *** Y Yawning, as a symptom..... " Yellow fever................ 5b& Yellow fever, treatment of ..592-590 INDEX TO REPERTORY, OR LIST OF SYMPTOMS. A Abdomen, morbid symp- toms in................... 37 Abscesses................... 127 Acne rosacea............... 17 Acid stomach............... 35 After-pains, abnormal..... 95 Aggravation of pains.......132-137 Amaurosis.................. 9 Amelioration of pains....... 137 Anaemia.................... 140 Aneurysm.................. 140 Anger, effects of............. 3 Anus, excoriated............ 77 Anus and rectum, affections of........................ 77 Anxiety and fright, effects of 3 Aphonia, loss of voice....... 56 Aphthae..................... 24 Apoplexy................... 140 Apparent death............. 140 Appetite, loss of............ 29 Arms and armpits.......... 102 Asthma..................... 45 Atrophy..................... 140 Aversion to various kinds of food and drink............ 29 Axillae, symptoms in...— 65 B Back, morbid feelings in re- gion of.................... 70- 71 Bad effects of food or drink. 30 Ball, hysteric............... 25 Bed sores................... 122 Black pores on nose......... 16 Blackness of vision, sudden 9 Bladder, affections of....... 85 Bladder, catarrh of the..... 85 Bladder, inflammation of... 85 Blotches.................... 122 Blue disease................. 140 Blurred sight............... 9 Bones, affections of.......... 140 Brain, concussion of......... 5 Brain, inflammation of..... 5 Breath and breathing, abnor- mal........................ 45 Burns........................ 140 c Calves of the legs, symptoms of....................... 121 Cancer of the breast......... 66 Cancer of the lips........... 21 Cancer of the nose........... 16 Cancer of the stomach....... 35 Cancer of the tongue........ 27 Cantharis, ill effects of...... 147 Cardialgia................... 38 Caries....................... 140 Cataract.................... 9 Catarrh...................... 42 Catarrh, accompanying ail- ments.................... 44 Catarrhal fever.............. 42 Chagrin, consequences of___ 140 Chapping of lips............. 21 Chamomilla, ill effects of__ 140 Chest, morbid symptoms of.. 61 Chilblains................... 121 China, ill effects of.......... 140 Cholera, Asiatic.............. 141 Cholerine.................... 141 Colic, various kinds of....... 38 Color, illusions of.......... 9 Comedones.................. 122 Confinement, ailments dur- ing and after.............. 95 Consciousness, loss of........ 1-2 Constipation............... 74 Contusions................. 141 Cornea, spots on............. 11 Coryza.................... 42 Cough, various kinds of..... 51-59 Cough, causes of............. 51-52 Cough, accompanying a i 1- ments of................... 53-56 Cracking of skin........... 122 Cracking of tongue......... 27 Cramp of the stomach...... 35 Croup, disposed to.......... 25 Croup, various forms of.....57- 58 Croup, gangrenous......... 25 Crusta lactea................ 19 D Deafness.................... 15 Debility, nervous.......... 141 Delirium.................... 2 Desire for certain ; kinds of food and drink............ 29 Diabetes insipidus........... 82 Diarrhoea................... 74 Dilation of pupils........... 12 Dreams..................... 131 Dropsy of the abdomen..... 39 Dry coryza of infants....... 141 Dysentery................... 42 E Earache..................... 14 Ears, inflammation of...... 15 Ears, pains in............... 15 Ecchymosis in eyes......... 11 Emotions, causing disease.. 3 INDEX TO r.El'ERTOItY. 851 Epistaxis......................... 16 Eructations................. 31 Erections................. 90 Eruptions on various parts.8-21-19 Erysipelas................. 125 Erysipelas of mammae...... 66 Erysipelas of scrotum....... 89 Eyelids, paralysis of........ 13 Eyelids, spasm of........... 13 Eyelids, inflammation of... 13 Eyes, affections of the...... 9 Eyes, inflammation of the.. 11 Eyes, swollen............. 12 Eyes, ulcerated............ 13 Exhaustion from mental la- bor........................ 2 Expectoration, various kinds 50- 51 Extremities, symptoms of.. 102 Extremities, lower, symp- toms of ................ 112 Extremities, upper, symp- toms of................... 102 Face, eruption in ........... 19-21 Face, swelling of............ 48 Fat, tendency to get......... 112 Fear, consequences of....... 142 Feet, symptoms of........... 116 Feet, dorsum, symptoms of.. US Feet, soles,symptoms of..... lis Females, diseases of......... 92 Fever, bilious................ 142 Fever, catarrhal............. 42-142 Fever, dentition............. 112 Fever, gastric............... 142 Fever, hectic................ 142 Fever, milk---............... 142 Fever, puerperal............. 142 Fever, rheumatic........... 142 Fever, wound .............. 142 Fever, yellow............... 142 Fever, particular symptoms of......................... 142 Figwarts at anus............ 78 Fig warts on private parts... 94 Fingers, symptoms of....... 109 Finger joints, symptoms of.. Ill Finger nails, symptoms of... 112 Finger tips, symptoms of— 111 Fitful........................ 1 Fistula lacbrymalis.......... 14 Fistula dentalis.............. 23 Freckles.................... 18-125 2 142 3 119 11 125 Forebodings- Freezing, consequences of... Fungi/articular, hsematodes, medullaris.....---•....... Fungus, ha3inatodes of eye.. G Ganglia Gangr- ene..................... 87-125 Glans, affections of the...... 87-S8 Glands, affections of.......59-60-145 Glaucoma................... 9 Goitre....................... 59 Gonorrhoea.................. s7 Gout ........................ 145 Gravel ..................... 86 Grief, ill effects of.......... 3 H Hemorrhage from ears...... 15 Hemorrhage from eyes..... 11 Hemorrhage from nose...... 16 Hemorrhage, uterine........ 94 Hands, symptoms of....... 107 Hang-nails................. 112 Hard hearing................ 15 Head, peculiar sensations in external .................. 8 Head, trembling of.......... 9 Headache.................\. 6 Headache, various forms of. 6 Hearing, defects of*.......... 15 Hearing, illusions of........ 16 Heart, inflammation of..... 67 Heart, affections of, aggra- vated by.................. 67 Heartburn ... .............. 32 Heels, symptoms of......... 115 Hemeralopia................ 9 Hemicrania................ 6 Herpes................... 123 Herpes in face.............. 19 Hip joint................... 118 Hoarseness.................. 57 Hunger, abnormal......... 30 Hunger, ill effects of........ 145 Hydrocephalus.............. 6 Hydrophobia............... 145 Hypochondria............... 145 Hypochondriac region, mor- bid sensations in the........ 87 Hysteria.............................. 4-145 Hysteric ball....................... 25 I Illusions of color.................. 9 Illusions of hearing.............. 16 Illusions, optical................ 10 Illusions of size, shape, dis- tance................................. 10 Illusions of things not pres'nt 10 Indurations......................... 14*1 Inflammations..................... 145 Inflammation of bladder...... 85 Inflammation of the bowels. 39 Inflammation of the ears..... 15 Inflammation of the eyes..... 11 Inflammation of eyelids...... 13 Inflammation of the heart-.- 67 Inflammation of the larynx 51 Inflammation of niaiiiniaj..... 66 Inllanimation of mouth........ 25 INDEX TO REPERTORY. Inflammation of nose........... 16 Inflammation of ovaries...... 94 Inflammation of palate........ 35 Inflammation of pharynx..... 26 Inflammation of the tongue- 28 Inflammation of trachea...... 57 Inflammation of urethra .... 86 Insanity..................• • 2 Intoxication................ 1 Ischuria.................... 83 Itch......................... 126 Itching of scalp............. 8 J Jaundice................«........... 18-144 Jaws, affections of the.......... 22 Jealousy.............................. 3 Jealousy, ailments from........ 144 Joy, consequences of............ 144 K Kidneys, affections of........... 86 Knee-joints, symptoms of...... 119 L Lachrymation....................... 11 Larynx, inflammation of....... 57 Larynx, morbid sensations in 56 Larynx, phthisis of............... 57 Lips, affections of the........... 21 Lips, cancer of the............... 21 Lips, eruptions on................ 21 Lips, rhagades of................. 22 Lips, swelling of.................. 22 Lochia, derangement of........ 144 Long-sighted......................... 12 Loss of blood between peri- ods.................................... 95 Loss of consciousness............ 2 Loss of voice, see aphonia..... 56 Lumbago, see small of back- 12 M Mamma?, cancer of............... 66 Mammae, erysipelas of........... fl6 Mamma?, inflammation of.... 66 Mammae, swelling of............. 66 Mammary glands, affections. of..................................... 66 Measles............................... 123 Memory, defects of............... 3 Meningitis........................... 5 Menses, character of............ 96-97 Mental derangements........... 3 Micturition, nocturnal......... 82 Micturition, abnormal.......... 83 Aficturition, at night in bed... 83 Aliliaria................................ 124 Alilk, defects of.................... 66 Mind, derangement and weak- ness of.............................. 1 Miscarriage.......................... 91 Moles................................... 125 Moles in uterus, see polypi... 94 Aiouth, affections of the......... 24 Mouth, inflammation of......... 25 AIucus, dropping of, from pos- terior nares....................... 72 N Nape of the neck, stiff.......... 60 Neck, stiff............................ 60 Nervousness........................ 145 Neuralgia............................. 146 Nipples, affections of............ 60 Nipples, sore........................ ^6 Nodes, gouty........................ 146 Noma.................................. 125 Nose, affections of................ 16 Nose, dry............................. 42-48 Nose, inflamed..................... 16 Nose, polypus of the............. 17 Nose, stoppage of................. 43 Nose swelling of the............. 17 Nose, ulceration of.............. 17 o Obscuration, see blackness.... 11 Onanism, consequences of.... 146 Opisthotonos........................ 72 Optical illusions................... 10 O vari es, affections of............ 94 Ovarian dropsy.................... 94 P Pains, spurious labor............ 95 Pains, wandering.................. 146 Palate, affections of.............. 25 Palpitation........................... 57 Paralysis.............................. 146 Paralysis of eyelids............... 13 Pellicle on the eyes............... 12 Penis, affections of................ 81 Perineum, affections of, see anus................................ 79 Pharynx, affections of.......... 25 Pharynx, inflammation of..... 26 Photophobia............................. 10 Phthisis laryngea, (see Ph- thisis of larynx)........... 57 Pimples in face............. 20 Pityriasis.................. 126 Placenta, adhesion of...... 95 Plethora.................... 146 Poisoning with various sub- stances.................... 146 Polypi of the nose........... 17 Pores, black................. 126 Pregnancy, ailments inci- dent to................... 146 Prepuce, affections of....... 88 Prosopalgia............... 20 Prostate gland, affections of. 90 Pudendum, affections of ex- ternal..................... 92- 93 Pupils, contracted.......... 12 INDEX TO REPERORY. 853 Pupils, dilated.............. 12 Ptyalism (see salivation)___ 27 Purple-rash................. 124 Pus, various kinds of___... 126 Pustules............ ........ 124 Q Qualmishness............... 33 R Rage........................ 4 Raphania................... 146 Rash....................... 124 Regurgitation, (see Rising). 32 Reports in ears............. 16 Rhagades of lips, (see Chap- ping) ..................... 21 Rhachitis................... 147 Rheumatism................ 146 Rickets...................... 147 Risings..................... 32 Rubeola..................... 124 Rush of blood............... 6 S Saliva, morbid. ............ 26 Salt, ill effects of............ 147 Scaly head.......................... 9 Scales on scalp..................... 9 Scapulae, morbid feelings in region of........................... 16 Scarlet-rash.................. 124 Scrotum, affections of....... 89 Scurfs on head.............. 9 Scurfs in nose............... 17 Scurvy..................■••• 142 Seasickness.................. 147 Sedentary habits, ill-effects of.......................... 147 Sediment in urine........... 81 Semen, morbid character of the........................ 91 Sexual desire, unnatural..... 92 Sexual instinct of females, Sexual intercourse of fe- males, aversion to......... 95 Sexual weakness............. 92 Shortsighted...............• 10 Shoulder-joints, symptoms of 104 Skin character of the....... 122 Skin, svmptoms of.......... 122 Sleep, character and accom- panying conditions ot.....128-129 Sleeplessness................ 130 Small of back, morbid sensa- tions in.................... "f Small-pox.................. 1-4 Sneezing.................... ™ Somnambulism............. 4 Sopor.......................... "" Sore nipples..............;.. Sore throat, see also Angina faucium................... 2o Spasms..................... 147 Spasm of the eyelids....... 13 Spasms, uterine ............. 94 Speech, impeded............ 28 Spermatic cord, affections of 89 Spine, curvature of.......... 71 Spots........................ 124 Spots on cornea................ 11-12 Squinting................... 12 Stammering.................. 28 Stiff neck.................... 60 Stomach, acid................ 35 Stomach, cancer of.......... 35 Stomach, cramp of the...... 35 Stomach, schirrus of....... 35 Stomach and pit of stomach morbid sensations......... 35-36 Stone in bladder............. 85 Stool, ailments accompany- ing ................................... 76 Stool, character of............... 73- 75 Stoppage of nose.................. 43 Stuttering.......................... 28 Styes................................... 14 Suffocative fits..................... 47 Suicide, disposition to......... 4 Sweat.................................149-150 Sweat, ill effects of suppress'd 150 Swellings............................. 127 Swelling of eyes.................. 12 Swelling of eyelids............... 13 Swelling of face................... 18 Swelling of lips.................... 22 Swelling of mammae............ 66 Swelling of the nose............ 17 Swelling of the ovaries......... 194 Swelling of tongue.............. 28 Sycosic warts....................... 125 T Tarsal joints, symptoms of- 118 Taste, morbid....................... 30 Tea, ill effects of.................. 150 Teeth and gums, affections of the.................................... 23 Teething.............................. 23 Temper, defects of............... 1 Tenesmus of anus................. 77 Testicles, affections of........... 88 Thighs, symptoms of........... 119 Thirst, abnormal...;.............. 30 Tibia, symptoms of.............. 120 Tobacco, ill effects of........... 150 Toes, nails and joints...........120-121 Tongue, affections of........... 27 Tongue, cancer of the........... 27 Tongue, cracked........... 27 Tongue, inflammation of.... 28 Tongue, swelling of........ 28 Trachea, inflammation of... 56 Trachea, morbid sensations in............:............ 57 Trembling of the bead...... 9 *■ 854 INDEX TO REPERTORY. Typhus, abdominal......... 142 Typhus, cerebral............ 142 Typhus, putrid.............. 142 u Ulceration of eyes.......... 13 Ulceration of the nose...... 17 Ulcers.................... 41 Urethra, affections of....... 85 Urethra, discharges from... 86 Urinary organs, affections of 79 Urinate, urging to......... 82 Urine, morbid sensations ac- companying the emission of......................... 83 Urine, quality of............ 79-82 Uterus, diseases of............... 93 Uterus, descension of........... 94 Uterus, hemorrhage from..... 94 Uterus, inflammation of....... 94 Uterus, putrefaction of......... 94 Uterus, spasms of................. 94 V Aragina, affections of............ 93 Aragina, inflammation of...... 93 Aranishing of sight, see black- ness.................................. 11 Araricella.............................. Varices................................ Avarices at anus.................... Arertigo................................ Vertigo, accompanying ail- ments of.......................... Vision, sudden blackness of.. Vomiting............................. Vomit, inclination to............ w Wandering of the mind...... Waking, see sleeplessness..... Warts.................................. Weakness, general............... AVerkback........................... AVeak digestion.................... Weakness, sexual................. Weaning.............................. Wounds...............................128- Wrath.................................. Wrist-joints, symptoms of.... z Zona.................................... 4\ ti.A? NLM 001QMA7T fl ; NLM001048798