NATIONAL LIBl vRY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy IMPORTER, BOOKSELLER, AND PUBLISHER, 322 BROADWAY, NEW-YORK. IMPORTATION OF BOOKS, ENGLISH AND FOREIGN, FOR COLLEGES, PUBLIC AND PRIVATE LIBRARIES, ETC., ETC. SINGLE BOOKS IMPORTED TO ORDER. Orders forwarded by every Steamer, and also by the Liverpool Packets, and answered promptly by the return of the first steamer after the receipt, if desired. W. R. would invite attention to his facilities for procuring English and Foreign Books for Colleges, Public and Private Libraries, Booksellers, and the Public generally, on at least as good terms, and with greater dis- patch than they have ever before been imported into this country by any other establishment. HOMOEOPATHIC MEDICINES. Wm. Radde, 322 Broadway, New-York, respectfully informs the Homoeo- pathic Physicians, and the friends of the System, that he is the sole Agent for the Leipzig Central Homoeopathic Pharmacy, and that he has always on hand a good assortment of the best Homoeopathic Medicines, in complete sets or by single vials, in Tinctures, Dilutions and Triturations ; also Pocket Cases of Medicines; Physicians'' and Family Medicine Chests to Laurie's Do- mestic (60 Remedies)— EPP'S (57 Remedies)—HERING'S (58 Remedies). Small Pocket-cases at $3, with family guide and 27 Remedies.—Cases con- taining 415 Vials with Tinctures and Triturations for Physicians—Cases with 240 Vials of Tinctures and Triturations to Jahr's Manual in 2 vols.— POCKET CASES with 60 Vials of Tinctures and Triturations —Cases from 200 to 400 Vials with low and high dilutions of medicated pellets.—Cases from 50 to 80 Vials of low and high dilutions, &c, &c. Homoeopathic Chocolate, Refined Sugar of Milk, pure Globules, &c, Arnica Tincture, the best specific remedy for bruises, sprains,"~wounds, &c, Urtica Urens for Burns, as well as Books, Pamphlets, and Standard Works on the System, in the English, French, and German languages. HOMOEOPATHIC BOOKS. THE HOMOEOPATHIC EXAMINER (Second Volume, New Series) was issued on the 15th day of August, 1846, and thereafter on the first of each month. Price, $5 in advance, or 50 cents each number. Forty-eight pages of every number will be constantly devoted to the translation of some standard work on Homoeopathy. In the 1st vol. we have given Ruckert's Therapeutics, which is completed in ten numbers, and have now concluded Stapf's Additions to the Materia Medica. Bonninghausen's Therapeutic Pocket-Book, which has been commenced in the last number, will be continued in the succeeding numbers of the Examiner. 2 volumes, well bound, $6 00. The Journal will hereafter be edited by Drs. Gray and Hempel. WM. RADDE, Publisher and Proprietor. 2 Homeopathic Books. In Press, A TRANSLATION OF JAHR'S NEW MANUAL, WHICH HAS RECENTLY BEEN PUBLISHED IN GERMANY, UNDER THE NAME OF SYMPTOME N-C 0 DE X. (digest of symptoms.) This work is intended to facilitate a comparison of the parallel symptoms of the various homoeopathic agents, thereby enabling the practitioner to dis- cover the characteristic svmptoms of each drug, and to determine with ease and correctness what remedy is most homoeopathic to the existing group of symptoms. Translated by C. J. Hempel, M D., of New-York, and revised by John F. Gray, M.D., of New-York, with a Preface by Constawtine Hering, M.D., of Philadelphia. This new Manual is distinguished from the old by many important and es- sential advantages. It is much more complete than the former editions of Jahr, embracing nearly three times the amount of matter contained in the old Jahr, and furnishing, moreover, the pathogenetic symptoms of several entirely new remedies, t>y distinguished provers. There are several thou- sand new Asterisks in the present Manual, and the number of empirical symptoms, which Jahr has been in the habit of designating by a cypher, is likewise considerably increased. The expression of the symptoms, as re- corded in the Materia Medica Pura, and in the isolated provings of recent observers, has been retained, and only unnecessary repetitions have been avoided. The editors have pledges of valuable assistance from Dr. Constantine Hering, of Philadelphia; Drs. A. Gerald Hull and James M. Quin, of New- York; Jacob Jeanes, M.D., C. Neidhard, M.D., W. Williamson, M.D.,and James Kitchen, of Philadelphia. The editors pledge themselves for the correctness of the translation, and invite the profession to subscribe to the present work with the fullest and most implicit confidence. Subscribers will be allowed a discount of 10 per cent, on the future retail price, which will be extremely moderate, notwithstanding the elegance and care with which the work will be got up. Each number contains 96 octavo pages. Price 50 cents. Subscribers, and all those who are friendly to our cause, are respectfully requested to distribute our Prospectusses among all those who may be in- terested in the publication of our work. Every number or volume is to be paid for on delivery. Names of subscribers may be sent in to William Radde, Publisher, 322 Broadway, New-York C. L. Rademacher, 39 North Fourth-street, Philadelphia. Otis Clapp, 12 School-street, Boston, Mass. Gray, Buttalo, N. Y.; John Paine, M.D., Belfast Main* • n r..,„„.. » -i „ V F. W. Weiss fc Roeder. Cleveland. Oh^^r^^F^XS^^!^}^^^-.1-- Bradley < burp. Pa Belding . 111.; Drs wneaion «c Kins, uetroit, Mich.; --- 8pvmnnr"ii~,'iLn" -■"■»/, v,..«.ng«, James Maiwell, Louisville, Ky.: Bruno & Virpns Macon ?™.Cr' Det™. Mi<*-! Columbus. Geo. ; Dr. Tan, New Orleans, L . T> Sfe™ L w° ^.TW' Louis, Missouri ; Morgan II Cracker, Nashville, Tennessee Von„Jf^T/8^1"^' St" bus, Mi»«ippi; Wid*Lyman fcCo, Montreal* CanadT ' 8 fc bBMth' Colan' Homeopathic Books. 3 JAHR, G. H. G., M.D. SHORT ELEMENTARY TREATISE UPON HOMCEOPATHIA AND THE MANNER OF ITS PRACTICE; with some of the most important effects of ten of the principal Homoeopathic remedies, for the use of all honest men who desire to convince themselves by experiment, of the truth of the doctrine. Second French edition, cor- rected and enlarged. Translated by Edward Bayard, M.D. Bound, 37i cts. JAHR'S NEW MANUAL OF HOMCEOPATHIC PRACTICE. Edited, with Annotations, by A. Gerald Hull, M.D. From the third Paris edition. 2 vols., bound, $6. HAHNEMANN, Dr. S. THE CHRONIC DISEASES, THEIR SPE- CIFIC NATURE AND HOMCEOPATHIC TREATMENT. Translated and edited by Charles J. Hempel, M.D., with a Preface, by Constantine Hering, M.D., Philadelphia. 8vo. 5 volumes. Bound. 1845. $7. HEMPEL'S HOMCEOPATHIC DOMESTIC PHYSICIAN. 1846. Bound, 50 cts. BCENNINGHAUSEN'S ESSAY ON THE HOMCEOPATHIC TREAT- MENT OF INTERMITTENT FEVERS. Translated and edited by Charles Julius Hempel, M.D. 1845. 38 cts. A TREATISE ON THE USE OF ARNICA, in cases of Contusions, Wounds, Strains, Sprains, Lacerations of the Solids, Concussions, Paralysis, Rheumatism, Soreness of the Nipples, etc., etc., with a number of cases il- lustrative of the use of that drug. "By Charles Julius Hempel, M.D. 1845. 18J cts. HAHNEMANN, Dr. S. MATERIA MEDICA PURA. Translated and edited by Charles Julius Hempel, M.D. 4 vols. 1846. $6. HOMCEOPATHIC COOKERY. Second edition, with additions, by the Lady of an American Homoeopathic Physician. Designed chiefly for the use of such persons as are under homoeopathic treatment. 50 cts. RUECKERT'S THERAPEUTICS; or, Successful Homoeopathic Cures, collected from the best Homoeopathic Periodicals. 1 large 8vo. vol., bound, $3 50. THE HOMCEOPATHIC EXAMINER. Dy Drs. Gray and Hempel. Vol. I., New Series. 1846. Bound in two volumes. $6 00. TRANSACTIONS OF THE AMERICAN INSTITUTE OF HOMCE- OPATHY. 1846- Bound, $150. WM. HENDERSON, M.D. HOMCEOPATHIC PRACTICE. 1846. 50 cts. FORBES, M.D. HOMCEOPATHY, ALLOPATHY, AND YOUNG PHYSIC. 1846. 19 cts. WM. HENDERSON, M.D. LETTER TO JOHN FORBES. 1846. 19 cts. {)EJ- The above three books, bound in one volume, $1. 4 Homeopathic Books. C. HERING, M.D. DOMESTIC PHYSICIAN. Third American, with additions from the fifth German edition. 1845. Bound, $2. C. NEIDHARD, M.D. AN ANSWER TO THE HOMCEOPATHIC DELUSIONS OF DR. O. W. HOLMES. 1SJ cts. HARTMANN. DR. F. PRACTICAL OBSERVATIONS ON SOME OF THE CHIEF HOMCEOPATHIC REMEDIES. Translated from the German, by A. H. Okie, M.D. First Series. Bound, $1. The second and last Series. Bound, §fl. EPPS, DR. J. DOMESTIC HOMCEOPATHY; or, Rules for the Do- mestic Treatment of the Maladies of Infants, Children, and Adults, etc. Second American from the fourth London edition. 1845. Bound, 75 cts. J. JEANES, M.D. HOMCEOPATHIC PRACTICE OF MEDICINE. $3. A. G. HILL, M.D. THE DOMESTIC TREATMENT OF THE CONVULSIONS OF INFANTS. 25 cts. DR. CURIE. ANNALS OF THE LONDON HOMCEOPATHIC MED- ICAL INSTITUTION. Reports of Cases. Nos. 1-21. 1842. #4. DEFENCE OF HAHNEMANN AND HIS DOCTRINES, INCLUD- ING AN EXPOSURE OF DR. ALEX. WOOD'S " HOMCEOPATHY UNMASKED." London, 1811. 50 cts. ORGANON OF HOMCEOPATHIC MEDICINE. By Samuel Hahne- mann. Second American from the British translation of the fourth German 'edition. With improvements and additions from the fifth, by the North American Academy of the Homoeopathic Healing Art. New-York, 1343. Price, bound, $1. LAURIE, DR. J. HOMCEOPATHIC DOMESTIC MEDICINE, with the Treatment and Diseases of Females, Infants, Children, and Adults. Third American edition, with additions by A. G. Hull, M.D. 1846. Bound, $1 25. RUOFF'S REPERTORY OF HOMCEOPATHIC MEDICINE, nosolog- ically arranged. Translated from the German, by A. H. Okie, M.D., trans- lator of Hartmann's Remedies. Second American edition, with additions and improvements, by G. Humphrey, M.D., etc. 1*14. Bound, $1 50. THE HOMCEOPATHIC EXAMINER, by A. G. Hull, M.D. 3 vols., 1840 and 1S41, and 1342-1845. $15. A POPULAR VIEW OF HOMCEOPATHY, by Rev. Thomas R. Ev- erest, Rector of Wickwar. With annotations, and a brief survey of the state and progress of Homoeopathia in Europe, by A. Gerald Hull, M.D. From the second London edition. Bound. Price $1. THE FAMILY GUIDE TO THE ADMINISTRATION OF HOMCE- OPATHIC REMEDIES. Third edition, after the second London edition, with additions. Price 25 cts. Homeopathic Books. 5 AN EPITOME OF HOMCEOPATHIC PRACTICE. Compiled chiefly from Jahr, Rueckert, Beauvais, Boenninghausen, etc. By J. T. Curtis, M.D., and J. Lillie, M.D. 1843. Bound, 87£ cts. JAHR'S PHARMACOPCEIA, and Posology of the Preparation of Homoe- opathic Medicines, and the Administranon of the Dose. Translated by F. Kitchen. $2. THE PRACTICAL ADVANTAGES OF HOMCEOPATHY, illustrated by numerous cases. Dedicated, by permission, to Her Majesty Queen Ad- elaide. By H. Dunsfokd, M.D. $1. THE BRITISH JOURNAL OF HOMCEOPATHY. Edited by J. J. Drysdale, M.D., J. R. Russell, M.D., and Francis Black, M.D. Lon- don. 1843-1845. Nos. 1-15. JAHR'S MANUAL OF HOMCEOPATHIC MEDICINE. Translated from the German. With an introduction and some additions, by C. Hering, M.D. 1838. Bound, $2 50. F. VANDERBURGH, M.D. AN APPEAL FOR HOMCEOPATHY; or, Remarks on the Decision of the late Judge Cowan, relative to the legal rights of Homoeopathic Physicians. 1844. 12| cts. M. CROSERIO, M.D., ON HOMCEOPATHIC MEDICINE. Illus- trating its superiority over the other medical doctrines, with an account of the regimen to be followed during the treatment of Homoeopathy. Translated from the French. 25 cts. SHERRILL'S MANUAL OF HOMCEOPATHY. 37* cts. HYDRIATICS, OR MANUAL OF THE WATER CURE.—Especially as practised by Vincent Priessnitz, in Graffenberg ; compiled and translated from the writings of Charles Munde, Dr. Oertel, Dr. B. Hirschel, and other eye-witnesses and practitioners.—Fourth edition, by Francis Graeter. Price 50 cents, with one plate or six engravings. 1844. ROKYTANSKY'S PATHOLOGICAL ANATOMY. Translated from the German, with additions on Diagnosis, from Schonlein, Skoda, and others, by Dr. John C. Peters. 1844. 75 cts. Opinions of the Press.—" Dr. Rokytansky's book is no more than it pro- fesses to be: it is morbid Anatomy in its densest and most compact form, scarcely ever alleviated by histories, cases, or hypotheses. It is just such a work as might be expected from its author, who is said to have written in it the result of his experience gained in the careful examination of over 12,000 bodies, and who is possessed of a truly marvellous power of observing and amassing facts. In the course of our analysis we have said comparatively little of its merits, the best evidence of which is found in the length to which our abstracts have been carried without passing beyond the bounds of what is novel or important. Nor would this fault have been committed though much more had been borrowed, for no modern volume on morbid Anatomy contains half so many genuine facts as this; it is alone sufficient to place its author in the highest rank of European medical observers."—British and Foreign Medical Review, January, 1843. 6 Homeopathic Books. ENCHIRIDION MEDICUM, or the Practice of Medicine ; the result of fifty years' experience. By C. W. Hufeland, counsellor of state, physician in ordinary of the late King of Prussia, professor in the University of Berlin. From the sixth German edition. Translated by C. Bruchhausen, M.D.; re- vised by R. Nelson, M.D. SeconofcAmerican edition. 1844. Bound, $2 50. Opinions.—The following lines from Dr. Manley, formerly President of the Medical Society of the State of New-York, contains his opinion in few words of the merits of the book : I am happy to have the opportunity of recommending to the medical pro- fession the Manual of the Practice of Medicine, by Hufeland. It is not often that books of this character, on perusal, make good the claims which their titles assume, but this is a well-marked exception: its descriptions of dis- eases, though concise, are comprehensive; its reasonings just and philosophi- cal, and its practice, as a consequence,intelligible and rational. The character of the author, and his experience of more than half a century, together with the unexampled popularity of the work in its original language, render in my opinion all individual recommendation superfluous. I hope that it may soon be found in the hands of every medical man, whether pupil or practitioner. James R. Manley, M.D. New-York, September 7,1842. Certificate of John F. Gray, M.D., formerly Resident Physician to the New-York Hospital, Lecturer on the Theory and Practice of Physic, Censor of the State and New-York Medical Societies, etc., etc. I am very glad to find the press engaged in diffusing a knowledge of the German medical literature in this country. At the head of the German books of practice stands this book of the good Hufeland. Mr. Bruchhausen and Dr. Nelson have laboured with diligence and good faith in rendering the Enchiridion; and so far as I have had leisure to compare their work with the original, I find no error of magnitude. Another edition will, no doubt, be called for soon, and then the worthy American curators can dispense with the somewhat meagre characteristic given to it by their too close adherence to the letter of the author. I heartily wish success to the good enterprise. John F. Gray, M.D. New-York, September 8,1842. The reputation of the venerable eclectic of Germany scarcely requires en- dorsement even on this side of the Atlantic. An independent and original thinker, Hufeland, laboured for the cause of medical science, and has ac- quired a universal renown, amply attested to by his " Journal of Practical Medicine," " Art of Prolonging Life," " System of Practical Medicine," and numerous Ewayi, besides personal contributions of humane and necessary in- novations in the treatment of "Inoculation," "Small Pox," and " Signs of Death." His last work, Enchiridion Medicum, concentrates the experience of his entire medical life, and fully maintains in its careful and concise de- scription and diagnosis of diseases all the evidence of the discriminating in- tellect of the Patriarch of German medical literature. A. Gerald Hull. M T» New-York, September 12,1842. 7 FRENCH BOOKS. CRUVEILHIER. ANATOMIE PATHOLOGIQUE DU CORPS HU- MAIN, ou Descriptions, avec figures lithographiees et coloriees, des diverses alte ations morbides dont le corps humain est susceptible ; par J. Cruveil- hier, professeur d'anatomie pathologique a la Faculte de Medicine de Paris, medecin de l'hopital de la Charite, president perpetuel de la Societe anato- mique, etc. Vouvrage complet forme 2 forts volumes, relU, grand in-folio avec 233 plan- ches-coloriees. $120. VELPEAU. NOUVEAUX ELEMENTS DE MEDECINE OPERA- TOIRE, accompagnes d'un Atlas de 22 planches in-4, gravees, representant les principaux procedes operatoires et un grand nombre d'instruments de chirurgie, par A. A. Velpeau, chirurgien de l'hopital de la Charite, profes- seur de clinique chirurgicale a la Faculte de medecine de Paris. Deuxilme idiiion, entierement refondue et augmentee d'un traite de petite chirurgie, avec 191 planches intercalees dans le texte. Paris, 1839. 4 forts vol. in-8. de chacun 800 pages et atlas in-4. $10. Avec les planches de l'atlas coloriees. $16. RASP AIL. NOUVEAU SYSTEME DE CHIMIE ORGANIQUE, fonde sur de nouvelles methodes 3'observation; precede d'un Traite complet sur l'art d'observer et de manipuler en grand eten petit dans lelaboratoire etsur le porte-obiet du microscope ; par F. A. Raspail, Deuxieme ddition, entilre- ment refondue, accompagnee d'un atlas in-4de 20planches de figuresdessinees d'apres nature, gravees avec le plus grand soin. Paris, 1838, 3 forts vol. in-8, et atlas in-4. $9. ENCYCLOPEDIE ANATOMIQUE, comprenant l'Anatomie descriptive, l'Anatomie generale, l'Anatomie pathologique, l'histoire du Developpement et celle des Races humaines, par G. T. Bischoft", J. Henle, E. Huschke, S.T. Soemmerring, F. G. Theile, G. Valentin, J. Vogel, R. Wagner, G. et E. We- ber, traduit de l'Allemand, Par A. J. L. Jourdan, membre de l'Academie rovale de medecine, Paris, 1843, 10 volumes in-8. prix de chaque volume, Prix des 2 atlas in-4. $3. G. H. G. JAHR —ELEMENTARY TREATISE UPON HOMCEOPA- THIA, and the manner of its practice, with some of the most important ef- fects of ten of the principal Homoeopathic remedies. Second French edition, corrected and enlarged. Translated by Edward Bayard, M.D. 1845. 50 cents. NOUVEAU MANUEL DE MEDECINE HOMCEOPATHIQUE, divise en deux parties, lo Matihre mldicale ; 2o Repertoire thdrapeutique et symptd- matologique ; par G. H. G. Jahr. Paris, 1840, 4 vol. in-12. $5. NOUVELLE PHARMACOPEE ET POSOLOGIE HOMCEOPA- THIQUES, ou de la Preparation des medicamens, homoeopathiques et de l'administration des doses; par G. H. G. Jahr. Paris, 1841,in-12, relie. $2. HOMGEOPATHIE DOMESTIQUE, comprenant l'hygiene, le regime a suivre pendant le traitement des maladies et latherapeutique homoeopathique, precedee d'une notice sur l'hopital homoeopathique de la Charite de Vienne ; par le docteur Bigel ; deuxieme edition, entierement refondue, par le doc- teur Beauvais (de Saint Gratien). Paris, 1839, in-18, de 624 pages. $1 50. CLINIQUE HOMCEOPATHIQUE, ou Recueil de toutes les observations pratiques publiees jusqu'a nos jours ; par le docteur Beauvais (de Saint Gra- tien). Paris, 1836-1839. Ouvrage Complet. 9 forts volumes in-8. $22. EFFETSTOXIQUESET PATHOGENETIQUES DES MEDICAMENS sur I'economie animale dans I'etat de sante, recueillis et mis en tableaux synoptiques, par le docteur Beauvais (de Saint Gratien). Paris, 1838. Cet ouvrage est public par livraisons de cinq feuilles in-8, accompagnees de ta- bleaux, (6 livraisons sont en vente.) $4. 6 French Books. EXPOSITION DE LA DOCTRINE MEDICALE HOMCEOPATHIQUE, ou Organon de l'art de guerir, par S. Hahnemann, traduit de I'allemand sur la cinquiime edition avec divers opuscules de l'auteur, et une traduction sur la cinquiime edition de la Pharmacopee Homoeopathique, de Hartmann; par A. J. L. Jourdan. Seconde edition, avec le portrait deHahnemann. Paris, 1834, in-8 de 672 pages. £2. MEMORIAL DU MEDECIN HOMCEOPATHISTE, ou Repertoire al- phabetique de traitmens et d 'experiences homoeopathiques, pour servir de guide dans l'application de l'homceopathie au lit du malade ; par M. Haas. Traduit de Tallemand par A. J. L. Jourdan, Paris, 1834, in-24. 75 cents. HAHNEMANN. DOCTRINE ET TRAITEMENT HOMCEOPA- THIQUES des maladies chroniques ; par le docteur S. Hahnemann ; traduit de I'allemand par A J. L. Jourdan, membre de l'Academie royale de Mede- cine. Paris, 1832, 2 vol. in-8. 15 fr. HAHNEMANN. TRAITE DE MATIERE MEDICALE PURE, ou de l'Action homoeopathique des medicamens ; par S. Hahnemann, avec des Ta- bles proportionelles de l'influence que diverses circonstances exercent sur cette action ; par C. Boenninghausen ; traduit de I'allemand par A. J. L. Jourdan. Paris, 1834, 3 forts vol. in-8. 24 fr. Les progrfes que fait chaque jour la doctrine m£dicale homoeopathique, le grand nombre de partisans qu'elle compte rendaient necessaire la publication d'ouvrages qui missent a me'me de pouvoir la discuter avec connaissance de cause et impartiality. C'c*t clans les ouvrages d'Hahnemann, son fondateur, qu'il faut l'etudier ; car si VExposition ou Organon de Part de guirir contient les principes generaux, c'estdansla Matilre midicalepure et la Doctrine des maladies chroniques qu'il faut en suivre l'application pratique: ces trois ou- vrages forment done l'ensemble complet, thiorique et pratique, de la doctrine ho- maopathique: la celebrit6 du docteur Hahnemann, la bonne foi qui signale ses production-, commandent de ne le juger qu'apres examen. CLINIQUE HOMCEOPATHIQUE a l'usage des medecins et des gens du mondc, par L. Malai>f, DM. 1837, in-8. relie\ $2 50. REVUE DE LA MEDECINE SPECIFIQUE, par MM. les docteurs Charge, Petroz et Roth, (Commencee en Janvier, 1840.) Lesannees 1840 et 1811, 3 vol. in-8. $10. JOURNAL DE LA DOCTRINE HAHNEMANNIENNE, public par le docteur Moli.v. Paris, 1840, 2 vol. in-8. $5. ARC HIVES DE LA MEDECINE HOMCEOPATHIQUE, publiees par une societe de medecins de Paris. Collection de juillet 1834 et 1835 formant 3 forts vol. in-8. relie. $6. ,oiu Suat,ri^me anl^' t(,meL7 et 8' Par MM- Leon Simon et Libert. Paris, 1838, 2 vol. in-8. relie. $5 50. ' ANNALES DE LA MEDECINE HOMCEOPATHIQUE, publiees par MM Leon Simon, G. H. Jahr et Croserio, docteurs en medecine. Ce iour- naI est pubhe depuis le ler mars, 1842, tous les mois, par cahier de 5 feuilles in-8. Prix de l'abonnement, pour un an, $5. it-uiues MANUEL D'HYDROSUDOPATHIE, ou Traitement des maladies par leau fro.de, la sueur l'exercice et le regime, suivant la methode de V Pnessnitz, employee dans 1 etablisseraent de Graefenberg ; par le docteur Bigel, 8U,vi d un memoire sur la chaleur animale ; par M. Pelletan, profes'eur & la faculte de medecine de Pans. Paris, 1840, grand in-18 relie' $1 50 EXPOSITION DES METHODES HYDRIATIQUES DE PRIFSSNITZ dans les diverse, c-i-eces de maladies, consi(lci,-«> en elles-m£m»<, «t 2 ,eesaveccellesde la medecine allopathique, par le doctcu™, H H™1*" hain et H. Ehrenberg. Paris, 1842, in-l^grand paPier $1 60 Heiden' C(> On donnera gratis un Catalogue complet de Livres de Medecine Chi rurgie, Anatomie, Physiologie, Histoire Naturelle, Phy>iq„e Chemi* Ph» ^ / , I *- HARTMANN'S /£' THEORY ACUTE DISEASES AND THEIR HOMCEOPATHIC TREATMENT. THIRD GERMAN EDITION, REVISED AND CONSIDERABLY ENLARGED BY THE AUTHOR. TRANSLATED, WITH ADDITIONS, AND ADAPTED TO THE USE OF THE AMERICAN PROFESSION, BY CHARLES J. HEMPEL, M. D. VOL. I. * ; . , , v ^ NEW-YORK: c ' WILLIAM RADDE, 322 BROADWAY. PHILADELPHIA:--C. L. RADEMACHER, 39 NORTH FOURTH-ST. BOSTON :--OTIS CLAPP, 12 SCHOOL-ST. LONDON:--H. BALLIERE, 219 REGENT-STREET. 1847. W 3 Y H335t v. \ o. / Entered, according to Act of Congress, in the year 1847, by WILLIAM RADDE, In the Clerk's OflSce of the District Court of the United States, for the Southern District of New-York. H. LDDWIO, PRINTS*, 70 t 11 V«S«Y-ST., H. T. ^NlM* THE TRANSLATOR'S PREFACE. The second volume of Hartmann's Acute Diseases will appear very shortly. We have nothing to mention in regard to the mode in which this work is to be used. It should be read and studied from beginning to end; that is all. As this work is intended for practitioners generally, begin- ners as well as those who are more advanced in our practice, it may be proper to give a brief explanation of the various modes in which our medicines may be administered. We have nothing to say about the frequency or magnitude of the doses, as the reader will find that subject fully explained and inquired into in the body of the work. All that we wish to do in this place, is to inform the beginner of the various modes in which the medicines may be given to the patient. Administration of the pellets.—Two or three pellets may be placed upon the patient's tongue, taking care, however, that the mouth should be well washed previously. If the complaint should be of such a nature as will evidently require more than one dose of the medicine, the pellets, seven or eight in number, may be dissolved in half a tumblerful of water, turning the so - lution some twenty times from one tumbler into another one backwards and forwards ; the tumblers should be well cleansed and dried before using them; nothing fuzzy should be left hanging about them. Never use the same tumbler for two dif- ferent kinds of medicine. Let not the solution be exposed to Xii. PREFACE. the light, keep the tumblers covered, and use a separate spoon for each medicine. Administration of powders.—If the patient should prefer taking the medicine in powders, use one drop of the medicine to about twenty or twenty-five powders; a powder should not weigh more than one grain. Administration of the tinctures.—The tinctures should al- ways be given in water, one or two drops in a tumblerful, stirring the solution well. Administration of the lower triturations.—No trituration below the third should be given in water, but always in one- grain powders. Hahnemann's favourite mode of administering the remedies was this: he dissolved a few pellets in a tumblerful of water, in the manner which has been indicated above, and then mixed a tablespoonful of that solution with another tumblerful of water, turning the solution twenty or thirty times from one tumbler into another backwards and forwards. This double mixing is very often required with the tinctures. A simple mixture of the tincture will frequently bo found inefficient, whereas a doubly-mixed tincture has the best effect, provided the remedy is the true one. Any medicine which is taken in water should be turned five or six times from one tumbler into another, previous to taking a new dose. CHARLES J. HEMPEL, M.D. THE AUTHOR'S PREFACES TO THE THREE EDITIONS OF THIS WORK, CONDENSED INTO ONE. Foil the last ten years the homoeopathic science and art of healing has been considerably perfected in all its branches; but no work has as yet been published which furnishes a systematic exposition of the treatment which ought to be adopted in the different dis- eases. This omission is probably owing in part to the inherent difficulty of the undertaking, and partly to Hahnemann having re- marked that no treatment can be based upon the classification of diseases as adopted by the old school. I have never despaired of succeeding in completing a work containing a systematic exposi- tion of the homoeopathic treatment of disease, so much more as the phenomena which constitute the diseases, as described in allopa- thic books, are contained among the symptoms obtained by the provers of drugs, such as: asthma Millari, cholera morbus, fever and ague, and its varieties. It is the very plan which has been adopted by the author of homoeopathy, of arranging the symptoms of a drug in one list, and of distributing them in groups, that has suggested to me the idea and arrangement of the present work. I trust I have rendered a service to beginners, by describing the general diagnostic characteristics of a disease at the commence- Xiv. AUTHOR'S PREFACES. ment of the chapter; the more particular indications for the special remedies have not been omitted. My remarks on diagnosis, prognosis, etiology, classification of diseases, are necessarily very brief, and may call forth censure on the part of allopathic physicians. My object has been to furnish an accurate account of the homoeopathic treatment of disease. As regards the generalities and the collateral sciences in ipedicine, 1 had a right to expect that every homoeopathic practitioner should be thoroughly acquainted with them. Some allopaths may find fault with the distribution of the work; to such critics I have simply to observe that the distribution of the work has been a matter of secondary importance, and that my main object in adopt- ing any classification of disease has been to establish points of reference which would facilitate the use of the work; the treatment and nature of diseases do not depend upon their classification. Certain diseases, which are considered chronic by allopathic phy- sicians, have been transferred to the acute forms of disease; my reasons for making this change have been stated in treating of those diseases. It is more than probable that indolent and indifferent practition- ers will avail themselves of this work as a means of avoiding study and labour. To all such I would repeat the words of Pfeuf- fer, which may be found in his " Deceptions at the Sick-Bed." " Every case of disease, in spite of the physiognomic character which it may possess in common with other diseases, is an indi- vidual existence or form, upon which the dogmatism of the schools will be frequently wrecked. The power to indi- vidualize distinguishes the true physician from the routinier, whose rules and principles diminish as he advances in his prac- tice." The present work purports to be the mere outline of a future system of therapeutics, although such a system can never be made complete enough to give the beginners fixed rules for the treat- author's prefaces. XV. ment of every case, inasmuch as every case ought to be considered a distinct affection which has never existed before in precisely the same form, and for which no remedy can be pointed out before- hand (except a few contagious and miasmatic diseases, such as: scarlatina, measles, smallpox, purple-rash, syphilis, etc.). This observation, which has been so frequently repeated by homoeopa- thic physicians, ought to convince allopaths that their opponents cannot cure disease unless they possess the power to investigate the symptoms and the perceptible character of a disease with great accuracy, which they cannot do without a profound know- ledge of anatomy, physiology, pathology, etc. Why then should homoeopaths be called ignorant, as has so often been the case ? According to homoeopathy, congestion, fever, inflammation, constitute the second phasis of a disease, which depends upon a morbid alteration of the nervous system. Starting from this ground I ought to have treated in the first place the affections of the nervous system ; I have preferred preserving the common division of diseases, in order to avoid all unnecessary and embarrassing innovations. In describing the symptoms of dis- eases I have observed the following order: those of the irritable sphere first; next, those of the reproductive and sensitive sphere; and, lastly, some affections of the sexual organs, to which the diseases of females have been added, including the diseases of the female sexual organs. The inflammatory affections of the male sexual organs will be found described in the chapter on blennorrhcea of the male urethra. No essential changes have been made in the three editions of this work, except some changes in the arrangement of the materials and practical observations derived from my own ex- perience and that of my friends. As regards the fundamental principles of our art, I can truly say, that I am more than ever convinced of their truth, and that I cherish particularly the great XVI. AUTHOR'S PREFACES. principle of selecting a remedy in accordance with the perceptible phenomena of the disease. I have, moreover, become convinced, that Hahnemann was right in exacting the most minute examina- tion of a case; although he has modified his original views in many respects, yet he has constantly insisted with an unyielding firmness upon the necessity of making a rigid examination. Homoeopathy would perish, if we were to neglect that most important part of the treatment. I have now practised homoeopathy for twenty-eight years, and my practice has been very extensive. This long period has afforded me abundant opportunities of becoming aware, that our knowledge of the internal character of disease is yet very imperfect, and that we have not even yet discovered a cor- responding simile for every disease. Nevertheless, I cannot chime in with the wild innovations of the pretended modern reformers of homoeopathy. We should prove all things and hold fast to those that are good; but, on the other hand, we ought not to abandon a single rule or opinion, without havinw become convinced by rigid and impartial investigation, that it is either useless or erroneous. F. HARTMANN, M.D. Lkipiic, Sept 21st, 1846. CONTENTS. Page INTRODUCTION. 25 Fundamental Principle,........"6 OQ Proving of Drugs, ........*° Investigation of the Symptoms,.......29 Causa Occasionalis, Necessity of Investigating the, . • .31 32 Examination of a Case,........ CLASSIFICATION OF DISEASES. 38 Diseases belonging to particular Ages,......39 «« " Different sexes,......39 » " Trades and Professions......40 " Sporadic,.........40 " Endemic,......... " Epidemic,......... " Annual,.......... " Stationary,........ Intermittent,......... Hereditary.........43 Congenital, ....••••• , - 44 Acquired,......... 44 Primary,......... 44 Secondary,.....• XV111. CONTENTS. Page Diseases, Contagious,.........^ " Miasmatic,........44 " Acute,..........45 " Chronic,.........45 " of the Mind,.........47 GENERAL THERAPEUTIC RULES. 50 Different Modes of Treatment,.......52 Treatment, Specific, ........52 " Prophylactic,.......52 " Palliative, ........53 " Derivative, ........ 56 " Empirical,...... 57 " Isopathic, ........ 58 Dose, Magnitude of, ......... 60 Dynamization, .......... 61 Modus Operandi of our remedial agents, . . . . .71 Division of our remedies into antiphlogistics and antipsorics, . 74 Repetition of doses, . . . . . . . . .77-79 Mixing the remedies,......... 78 Diet, General,......... 81 FEVER. GENERAL REMARKS. Common Symptoms of Fevers, ..... 85 Causes of Fevers, ........ gg Critical Phenomena, ••.... fig " Sweat, ••••-.. 07 " Rash,........ go " Urine,..........gg CONTENTS. XIX. Page Changeable Urine,.........°9 Critical Hemorrhage, .........90 Dangerous Hemorrhage in Fevers,......90-92 Critical Discharges from the Bowels,......93 " Vomiting..........93 " Expectoration,.........93 " Ptyalism,.........*94 GENERAL REMOTE CAUSES OF FEVER. 94 Atmospheric Air........... Contagia,...........95 OK Miasmata,........... Passions and Emotions,........96 Derangements of the Intestinal Canal.......9" Want of Necessaries,........9' CLASSIFICATION OF FEVERS. 97 97 Fevers, Synochal,......... " Synochus, ........98 « Typhoid..........98 " Torpor,........." Prognosis,........... Terminations,.......... TV ♦ .... 102 Diet, .......... 103 Temperature,.......... SPECIAL PATHOLOGY OF FEVERS. FIRST CLASS. Synochal Fevers......... Pathology,........ Treatment........... XX. CONTK\"Tr». Page Fever of Dentition, .... ..... 115 Teething, Pathology of, . . . .116 Diseases occurring during the period of Teething, . . . 11 g Spasms and Convulsions,........ 120 SECOND CLASS. Catarrhal Fever, ••••.... 123 " in Children, ...... 133 Influenza,....... ,oc GriPPe-...........136 THIRD CLASS. Simple Rheumatic Fever, . . 14fl FOURTH CLASS. Gastric Fevers, Status Gastricus, ... Saburral, Gastric, Bilious Fevers. ... 154 Mucous Fevers, '.........165 Status Pituitosus, . ,_Q loo Worm Fever, .........172 Tenia, ........ 179-182 Febrile Conditions resembling Cholera, . .^ Cholera, Sporadic, ....... . 184 " Asiatic, ........187* Dysentery, ...... • • . 202 " Inflammatory, 1 •••••. 206 Gastric, . 208 " Bilious, 209 CONTENTS. Xxi. Paga Dysentery, Pituitous,.........209 " Mucous..........210 " Worm,.........212 " Putrid..........213 Diarrhoea, .......... 214 " Stercoralis, ........ 215 " Aquosa, ......... 215 " Biliosa, ........217 " Mucosa,.........219 FIFTH CLASS. Typhus, ..........220 Diagnosis, .......... 221 Varieties of Typhus.........221 Typhus Cerebralis,.........221 " Abdominalis,........222 Pneumo-.........222 Remote Causes of Typhus,.......223 Prognosis, .......... 224 Terminations, ......... 224 Treatment, ..........225 Typhus Stupidus,.........234 " Gastricus,.........238 " Arisuig from other Diseases,.....245 Diet in Typhus, .........251 Typhus Putridus, ........252 " Contagiosus,.........254 " Pestilentialis, ........ 255 Yellow Fever,..........255 Typhus Lentus, 256 XX11. CONTENTS. SIXTH CLASS. Page Intermittent Fevers, ........258 Causes,..........261 Treatment, .........261 Endemic Intermittent Fevers, ......261 Intermittent Headache,........268 Drug-Diseases, .........269 China-Cachexia, ........r 269 i ERRATA. Page 47,11th line from the bottom—after originate add in psora. " 103,16th " " " top-for 25° read 57°, and for 45° read 77*. " " 17th...... " — " 35° " 67°, " '• 38° " 70'. It is now more than fifty years since homoeopathy was discovered by the profound and learned Dr. Hah- nemann. Its claims and merits are now universally appreciated, and in spite of the intrigues and invec- tives of its opponents, it has succeeded in gaining the rank of an acknowledged science. It owes its triumph to the fact that the principles of homoeopathy are generalizations established in the eternal and im- mutable household of nature. During the first twenty years of his discovery, Hahnemann was alone in cul- tivating and perfecting it; but after that period he formed disciples ; physicians from the old school, who at first considered homoeopathy a mere creation of the fancy, became converts to the new doctrine, and, at the present moment, it is triumphantly practised in every civilized country, and not only spreads farther and farther, but its intrinsic value is likewise being con- stantly enhanced by new discoveries. This success could only be accomplished by a mode of cure which is derived from the laws of nature, and is confirmed every day by the results of experience. But what will be the influence and extent of homoeopathy when its practitioners shall have increased by thousands, and shall devote all their energies to the development of their art; heedful of the warning of their master, that no created spirit can penetrate to the causative prin- ciples of nature without substituting in their stead speculative and hypothetical explanations and opinions and receding more and more from the paths of nature ? We may certainly hope, without being sanguine, that after the next fifty years, homoeopathy will be far 2 26 INTRODUCTION. i Viead-of.Any*'-other system of cure. Be it remember- ed, however, that, in order to attain such brilliant re- sults, all homoeopathic practitioners ought to devote themselves to calm inquiry and rigid observation, and that their efforts in the great cause ought never to slacken. However interesting it might be to our readers to glance in this place over a detailed account of the mode in which Hahnemann gradually arrived at the discovery and realization of his system, yet we prefer omitting the relation of facts with which our readers are abundantly familiar, and confine ourselves to stating the fundamental principles of homoeopathy; these form a complete system of general therapeutics, and a correct knowledge of those principles is essen- tial to the proper understanding and appreciation of the special principles of our treatment of disease. The fundamental principle of homoeopathy is ex- pressed in these words : " Similia similibus curantur," which means, that only such remedies are capable of effecting a permanent and real cure as affect the healthy organism in a manner similar to the natural disease. This fundamental principle of cure was dis- covered by Hahnemann while he translated Cullen's Materia Medica (Leipsic, 1790), where his attention was arrested by the statements about the febrifuge power of Cinchona. Upon proving this drug on healthy persons, a state similar to fever and ague was realized in the provers, beside many other symptoms which had never been mentioned by any writer before. From this fact Hahnemann inferred what was after- wards confirmed as a great truth, that medicines are only in so far capable of curing disease as they realize in a healthy persona morbid state similar to the natu- ral disturbance of the organism. Led by his experi- ence, Hahnemann established the following rule for the further development of his sysiem : Prove the drugs upon healthy jxrsons, in order to find out what systems and organs are principally affected by them and what are the symptoms characterizing INTRODUCTION. 27 < that affection. It is true that the necessity of such provings had been perceived by single physicians, and that partial provings have been instituted before Hah- nemann ; but they were never carried on systemati- cally with a view of obtaining a correct knowledge of the curative powers of drugs and applying them to the treatment of disease according to a fixed general principle. The road of pure experimentation was soon abandoned by those physicians as too tedious and too little productive in brilliant results ; their prejudices were likewise opposed to a systematic proving of drugs, and Hahnemann is therefore the first who has proclaimed and demonstrated the necessity of pure experimentation, who has furnished explicit and abun- dant rules for the proving of drugs, and who has fur- nished to the world the brilliant results of his own provings, which are the groundwork of homoeopathy and a beacon-light and model for all homoeopathic practitioners and pure experimenters. However laborious and painful the road of pure ex- perimentation may be, Hahnemann never dreaded the tortures and sacrifices which he encountered on that road, and, assisted by devoted disciples, he continued his provings and noted the symptoms which he ob- tained, with the utmost care. Provers of drugs ought to employ the greatest discretion and care in observing the drug-symptoms which they experience during the period of proving ; and they ought moreover to observe a rigorous diet during all that time, lest the action of the drug should be impaired and the symptoms should become impure and untrustworthy. In proving, Hah- nemann soon discovered that the drugs had a twofold effect, which he designates in his Organon by the terms of primary and secondary, and which had never been observed before by any physician. Without entering upon an explanation of that compound action, which may be found in the Organon and to which we therefore refer, we content ourselves with simply re- marking, in this place, that the primary effect of the drug is sometimes seeji in disease in the shape of a temporary exacerbation of the original symptoms. 28 INTRODUCTION. Such an exacerbation, however, is much less frequent than is supposed. Most of the pretended exacerba- tions which are recorded in our books have been noticed bv beginners in homoeopathy, who had too little knowledge of disease and the effects of the remedies to be able to distinguish a natural from a medicinal exacerbation of the symptoms ; or Hahne- mann himself was carried away by his own enthusi- asm, and his disciples were either too timid or too ignorant to correct the errors of his judgment; or the exacerbation might have been owing to the excessive magnitude of the dose or the non-homoeopathicity of the remedial agent. We know that exacerbations may exist, but they are less frequent now than they were in the beginning of homoeopathy, when every aggravation of the symptoms was supposed to be owing to the excessive magnitude of the dose. This error has frequently proved injurious to the patient inasmuch as it induced the omission of many things which ought to have been done and which are done by the present practitioners of homoeopathy whose know- ledge of the course, chances, transitions, and the gene- ral characteristics of disease, is much better than that of their predecessors. It is still more difficult to ac- count for the exacerbation which is said to be pro- duced by the recently-introduced highest potencies. The proving of drugs affords a two Ibid advantage. In the first place the proving physician sharpens his power of observation and accustoms himself to no- tice the minutest symptoms of disease, every one of which ought to be of sufficient importance to the physi- cian to embody it in his record of the case; and, in the second place, by proving the drug upon himself, he acquires a true perception of its curative powers, which, in his person,manifest themselves unbiassed and unmix- ed with the heterogeneous influences of other medicinal agents. How different is the homoeopathic materia medica from that of the old school, which is a mere as- semblage of impure and uncertain effects of drugs as observed at the sick-bed, and not of one drug at a time. but every drug being administered in company with a INTRODUCTION. 29 variety of other drugs, and the whole being adorned with strange speculative views about the chemical, dynamic, clinical, mechanical and specific virtues of a drug. No sort of reliance can be placed upon such statements. If the materia medica of the old school is to be used with confidence, it must be constructed like our own, and, in that case, it will be merged in homoeopathy; for the homoeopathic law is confirmed in all cases where the pathogenetic effects of our drugs and the curative results which have been ob- tained by means of them, are compared with one another. The investigation of the symptoms of a disease is the third fundamental rule in homoeopathy. The impor- tance of that investigation has been urged by Hahne- mann with great force, because the proper selection of the remedial agent, and consequently the success of the treatment depend upon it. He recommends that the symptoms of the disease be noted with the same care and completeness as were the symptoms of the drug, and that the former be counterbalanced and ef- faced by the latter. This proposition has been at- tacked on all sides, and has been strangely misappre- hended. It has been supposed, for instance, that Hahnemann neglected to take cognizance of the ex- citing cause, the causa occasionalis of the disease. The opponents of homoeopathy have frequently charged that neglect upon our practice; but unjustly so, for every homoeopathic practitioner knows, that, in many cases, the proper selection of the remedial agent de- pends exclusively upon a knowledge of that cause, in- asmuch as the symptoms of two entirely different dis- eases may apparently be alike, and the difference can only be recognised by tracing the symptoms to the ex- citing cause. We will illustrate this by a few ex- f amples : We know from experience that Arnica is most use- ful in diseases resulting from blows, contusions, wounds, strains, etc.—A man who has been drenched to the skin is frequently attacked with a variety of symptoms corresponding to those of Rhus tox., which 30 INTRODUCTION. it would be difficult to cure if the exciting cause were not known.—What physician would not give Loeeulus against a febrile state characterized by flushed cheeks and nightly sleeplessness, if he knew that home-sick- ness was 'the exciting cause ?—Fright occasions a great many symptoms for which we have specific remedies in our materia medica ; Ignatia for gnei. Aconite for a vexed and irritable mood, Opium tor fear.—Ignatia is a sure specific for symptoms result- ing from grief and chagrin ; Chamomilla, on the con- trary, is a specific for the consequences of chagrin, when accompanied with anger and vehemence.—It would be a long and difficult business to cure a de- rangement of the stomach, if the physician did not know the exciting cause; but it will be readily re- moved by a dose of Pulsatilla, if it had been occasion- ed by fat food, especially pork ; by Arsenic, if it owes its existence to a cold in the stomach, to eating cold fruit, etc.—Physical and mental weakness resulting from blood-letting, hemorrhage, waking, night-sweats, onanism, venereal excesses, etc., finds a specific in China, provided the weakness is the principal suffer- ing, and not a mere symptom of a more general and deeper-seated disease.—Diseases resulting from want of exercise, yield to Nux ; but could they be cured as readily if the exciting cause were not known ?—Dulca- mara is the specific for diarrhoea, with or without colic, occasioned by cold, and sometimes accompanied with swelling of the glands.—A homoeopathic physician who is acquainted with the pure effects of Chamomil- la, Mercurius, Sulphur, China, Valeriana, Iodine, etc., will never prescribe those remedies without inquiring in the first place whether the symptoms have not been occasioned by the excessive use of those substances, in which case he would administer suitable antidotes. —Would it be easy to cure the sufferings resulting from the excessive use of ardent spirits, if the exciting cause were not known? It would not, if the physi- cian were ignorant of the exciting cause, and of the pure effects of Nux vom., which correspond to the symptoms occasioned by spirituous drinks. INTRODUCTION. 31 These examples, which might be multiplied by many more, will suffice to show the importance of in- vestigating the causa occasionalis, and will at the same time silence the accusation of our opponents, that the investigation of the causa occasionalis is neglected by practitioners of our school. Homoeopathic physicians know just as well as the physicians of the old school, that the visible symptoms of a disease are accompanied with changes in the in- ternal organism, which are considered the essence of the disease by allopathic physicians. Homoeopathic physicians, however, do not believe, that we can have a sufficiently clear perception of those changes to base upon them our principles of cure. Homoeopathic practitioners are guided by the visible symptoms in selecting the appropriate remedial agent; without de- nying the existence of the first cause of the disease they observe with especial care the symptoms of the disease, and consider them sufficient indications of cure. Homoeopathy accepts the symptoms which we are now able to obtain by means of auscultation and percussion, and which aid us in establishing a correct diagnosis; by means of auscultation and percussion, and even by the investigation of the pathological changes, we obtain a more accurate knowledge of the internal phenomena of the disease, and avail ourselves of that knowledge wherever we can improve and complete, by its means, the application of our thera- peutic law. In order to apply this law to the patho- logical phenomena we shall have, in the first place, to ascertain what drugs will produce similar phenomena in the healthy organism. We need not to mind the re- proach of curing merely by symptoms ; years of expe- rience have sufficiently shown that a disease is cured when its symptoms cease to exist. The investigation of the symptoms of the disease re- quires to be made with the greatest care and correct- ness ; not even the slightest symptom ought to be omitted. On taking such a record of the symptoms, every case of disease will necessarily appear as a distinct, individual case which has never occurred be- 32 INTRODUCTION. fore. This explains why Hahnemann denied the validity of all nosological classifications, as a means of cure, and admitted their use only for the purpose of collecting the symptoms under one general denomina- tion. In the present work we have retained the pathological denominations, because we are persuaded that they facilitate the study of homoeopathy to the beginner ; we have indicated, however, with as much care as we were able, the specific remedies for the various groups of symptoms occurring in a disease; and we expect, therefore, that we be not blamed for having made this arrangement. Hahnemann insisted upon every record being taken in writing, lest symptoms should be forgotten by the physician. An examination instituted by a homoe- opathic physician is much more minute than an examination instituted by an allopath; this one neglects to take cognizance of various exciting causes which require the, administration of peculiar specifics in homoeopathic practice. " § 83. This examination of a particular case of disease, (says Hahnemann,*) with the intent of present- ing it in its formal state and individuality, only demands, on the part of the physician, an unprejudiced mind, sound understanding, attention and fidelity in observing and tracing the image of the disease. I will content myself, in the present instance, with merely explaining the general principles of the course that is to be pursued, leaving it to the physician to select those remedies which are applicable to each particular case. " § 84. The patient details his sufferings ; the persons who are about him relate what he has complained of, how he has behaved himself, and all that they have remarked in him. The physician sees, hears, and observes, with his other senses, whatever there is changed or extraordinary in the patient. He writes all this down in the very words which the latter, and the persons around him, made use of. He permits From the American edition of Hahnemann's Organon. INTRODUCTION. 33 them to continue speaking to the end without inter- ruption,* except where they wander into useless digressions, taking care to exhort them, at the com- mencement, to speak slowly, that he may be enabled to follow them in taking down whatever he deems necessary. " * Every interruption breaks the chain of ideas of the person who speaks, and things do not afterwards return to his memory in the same shape he would at first have described them. " § 85. At each new circumstance related by the patient or the persons present, the physician commences another line, in order that the symptoms may all be written down separately, and stand one beneath the other. By this mode of proceeding, he will be enabled to add to that which has, in the first instance, been re- lated to him in a vague manner, any thing he may subsequently acquire from a more accurate knowledge of the case. " § 86. When the patient and those about him have finished all they had. to say, the physician then asks for more precise information with regard to each indi- vidual symptom, and proceeds as follows :—He reads over all that has been communicated to him, and asks at each particular symptom, for example—At what epoch did this or that circumstance occur ? Was it previous to the use of the medicines which the patient has taken till the present time, or while he was taking them, or only a few days after he had discontinued their use ? What kind of pain, what particular sensa- tion was it that was felt in such or such a part of the body? Which the precise spot that it occupied? Did the pain come on in separate attacks at intervals, or was it lasting and uninterrupted? How long did it continue ? At what hour of the day or night, and in what part of the body, was it most violent, or where and when did it cease entirely ? What was the precise nature of this or that particular circumstance or symptom ? " § 87. Thus the physician causes all the indications which were given in the first instance to be described to him more closely, without ever appearing, by his •>* 3 INTRODUCTION. manner of putting the question, to dictate the answer,* or place the patient in such a position that he shall have nothing to replv but yes or no to his question. To act otherwise would only lead the person interro- gated to deny or affirm a tiling that is false, or only half true, or even wholly different from that which has really occurred, according as it may suit his conveni- ence* or for the purpose of gratifying the physician. An unfaithful description of the disease would then result, and, consequently, an inappropriate choice of the curative remedy. " * For instance, the physician ought never to say—' Did not such or such a thing take place in this manner ?' By giving this turn to his questions, he puts a false reply into the mouth of the patient, and draws from him a wrong indication. '• § 88. If in this spontaneous narrative no mention is made of several parts or functions of the body, and of the state of mind of the patient, the physician may then ask if there is not something more to be said re- specting this or that particular part or function, or relative to the disposition and state of mind,f taking care, at the same time, to confine himself to general terms, in order that the person who furnishes the ex- planation may, thereby, be constrained to answer categorically upon these various points. •' tFor example—Has the patient had an evacuation from his bowels 7 How does he pass water—freely or otherwise? How does he rest by clay and by night? What is the state of mind and temper of the patient? l» he thirsty? What kind of taste has he in the mouth ? What kinds of food and drink are most agreeable to him, and which are those he dis- likes ? Do the different articles taste as usual, or have they another taste that is wholly different ? How does he feel after meals? Have you any thing more to tell me relative to the head, belly, or limbs ? " § 89. When the patient (for it is to him we are to refer, in preference, for every thing that relates to the sensations he experiences, except in diseases where concealment is observed) has thus personally given the necessary details to the physician, and furnished him with a tolerable imat:e of the malady, the latter is then at liberty to question him more specifically if INTRODUCTION. 35 he finds he is not yet sufficiently informed on the subject.* " For example—How often have the bowels been evacuated, and what was the nature of the discharges? Did the whitish discharges consist of mucus or fseces? Were they painful or otherwise? What was the precise nature of these pains, and in what part were they felt? What did the patient throw up? Is the bad taste in the mouth putrid, bitter or acid, or what kind of taste is it? Does he experience this taste before, during, or after eating or drinking ? At what part of the day does he feel it in particular ? What kind of taste was connected with the eructation ? Is the urine turbid at first, or does it only become so after standing a while ? Of what colour was it at the time of emission ? What was the colour of the sediment ? Is there any peculiarity in the state of the patient when he sleeps? Does he sigh, moan, speak, or cry out? Does he start in his sleep ? Does he snore in inspiration or expiration ? Docs he lie on his back only, or on which side does he lay himself? Does he cover himself up close, or does he throw off the bed-covering? Does he easily awake, or does he sleep too soundly ? How does he feel on waking ? How often does this or that symptom occur, and on what occasion? Is it when the patient is sitting up, lying down, standing up, or when he is moving about ? Does it come on merely when he has been fasting, or at least early in the morning, or simply in the evening, or only after meals, or if at other times, when ? When did the shivering come on ? Was it merely a sensation of cold, or was he actually cold at the time ? In what part of the body did the patient feel cold ? Was his skin warm when he complained of being cold ? Did he experience a sensation of cold without shivering? Did he feel tfeat, without the face being flushed? What parts of his body were warm to the touch ? Did the patient complain of heat without his skin being warm ? How long did the sensation of cold, or that of heat, continue? When did the thirst come on? During the cold or heat ? Or was it before or after ? How intense was the thirst ? What did the patient ask for to drink? When did the perspiration come on? Was it at the commencement or at the expiration of the heat ? What space of time elapsed between the heat and the perspiration ? Was it when sleeping or waking that it manifested itself? Was it strong or other- wise l Was the perspiration hot or cold? In what parts of the body did it break out? How did it smell? What did the patient complain of before or during the cold, during or after the heat, during or after the per- spiration, &c. ? " § 90. All the answers being committed to writing, the physician then notes down what he himself observes in the patient,f and endeavours to ascertain if that which he observes existed or not when the latter was in health. » Nothin«- is more unpleasant for a physician, than an incomplete or even incorrect image of the disease. If he have an incorrect impresMon of the disease in the beginning of the treatment, he will find it difficult to correct that impressionVhile the treatment is going on He will never be abiTto select the proper remedy for the disease, and his treatment will necessarily fail.— Hartman.y. 36 INTRODUCTION. «t For example—How he behaved during the time of the visit. Y\ as he, irritable, peevish, quarrelsome, hasty, grieved, anxious. <*e^'nn&' s™ calm, or resigned? Did he appear overcome with sleep, or lostinreverie 7 Was he hoarse ? Did he speak low ? Was h.s d.scourso 'ncoherenU or how was it ? Of what colour was the countenance, the eyes, and the skm, generally ? What degree of vivacity was there visitj e in the face and eves? How was the tongue, the respiration, the smell from the mouth, of the hearing? Were the pupils of the eyes dilated or contracted? Did thev contract and dilate quickly in light and darkness, and ini what degree ?' What was the state of the pulse ? * What was the condition of the abdomen? Was the skin moist and warm, cold or dry, upon this or that part of the body, or was it so all over ? Did the patient he with his head thrown back, with his mouth wholly or half open, with his arms crossed above his head; was ho on his back, or in what position was he 7 Did he raise himself with difficulty ? In short the physician is to keep notes of every thing ho has observed that is strange and remarkable. After having taken down an exact record of the symptoms of a case, it is essential to investigate the causa occasionalis, be it a permanently existing, mate- rial or an immaterial, dynamic cause, having ceased to be present. We further require to consider the business of the patient (whether the disease be occasioned by it), his moral disposition, mode of life. We ought to inquire whether the patient is moderate in eating and drinking, in his amusements, or whether he has im- posed upon himself hurtful privations? whether he has injured himself by venereal excesses ? We have further to ascertain whether disappointed love, jealousy, domestic quarrels, chagrin, grief, abusive treatment, suppressed vengeance, humbled pride, loss of property, etc., have been instrumental in occasion- ing the disease ? A correct knowledge of the hereditary disposition, age and temperament of the patient is likewise of great importance. If the patient be a female, the physician has to inquire into the condition of the menses, whether the menstrual period is too long or too short, how many days the menses flow, whether they flow uninterruptedly or at intervals, whether they are copious or scanty, of what colour, whether they * The physician examines the pulse, the condition of the heart, whether it beats normally or abnormally, the chot, the abdomen, and does not neglect any of the manipulations or instruments by means of which the internal phe- nomena of the disease are more or less correctly ascertained.—Hartmann. INTRODUCTION. 37 are accompanied, preceded or succeeded by leucor- rhoea? Whether they are accompanied with moral or physical sufferings, and what are the peculiar pains and sensations which manifest themselves before, during, or after the appearance of the menses ? What is the appearance of the leucorrhoeal discharge, with what sensations it is accompanied, whether it is abundant or scanty, and under what circumstances or by what causes it is especially excited ? Whether the patient is sterile, or whether she has been pregnant and how often ? Whether she has miscarried ? What was the condition of her breasts, milk, etc. ? What is the strength of her sexual desire? In diseases of the sexual organs the physician ought always to in- stitute an examination of the parts both internal and external. Inquiry ought to be made about the diseases with which the patient may have been afflicted previously, both in acute and chronic diseases, especially, how- ever, in the latter, with a view of ascertaining whether preceding diseases have led to the present malady, or to what an extent they complicate it. An inquiry into the previous diseases of the patient sometimes leads us to a correct knowledge of the disease in chronic cases, and even helps us in selecting the remedies which we ought to use in the treatment of those cases. Although we do not admit that seven- eighths of all chronic diseases owe their existence to the-psoric miasm, yet it is undoubtedly true that the suppression of a previous cutaneous eruption, scabies, herpes, tinea, scrophulosis, etc. induces a vast number of chronic diseases which make their appearance shortly after the eruption had been suppressed, the as- sertions of many great doctors to the contrary not- withstanding, who pretend that the itch is a mere external disease which is caused by the acarus and can be cured by simply destroying that insect by any, even mechanical means. The homoeopathic physician can- not accept such theories, although he may, on the other hand, feel justified in believing that Hahnemann goes too far in considering the psoric miasm as a morbific 38 INTRODUCTION. principle which is coeval with mankind and has affected more or less every organism. One thing is certain, the influence which previous diseases may have upon the present one, has to be carefully investigated. If, in examining a patient, the physician should dis- cover symptoms pointing to the use of a certain drug which 'is frequently employed in domestic and allo- pathic practice, it'is the physicians duty to inquire whether large doses of that drug have not already been taken. Such drugs are : Valerian, Chamomile, Mercurius, and mercurial preparations used either in- ternally or externally, Iodine and Iodine ointment, Sulphur, Opium, China and Quinine, Digitalis, Prussic acid. Cathartics, etc. If any. especially an acute disease should prevail, its character or genius requires to be noticed with care, inasmuch as it will influence more or less the character of the disease which we are called upon to treat and may be a clue to the practitioner for the selection of the adequate remedial agent. To institute in every, even trivial case, such a rigor- ous examination as has been here described, would involve a useless loss of time and would be very fatiguing to the patient. Our intention has simply been to state what sort of an examination should be made in a complicated case, leaving it to the intelli- gent and conscientious physician to condense the ex- amination as much as a judicious appreciation of the case by means of his physiological, pathological and therapeutic knowledge will permit. A carefully in- stituted examination is the touchstone of a true artist in homoeopathic practice. This is perhaps the best place to say a few words about the CLASSIFICATION OF DISEASES. A classification of diseases has not so much value in reference to therapeutics as to the investigation of the character of the disease. INTRODUCTION. 39 We may divide diseases in reference to the individ- uality of the patients into (a.) Diseases belonging to peculiar ages (morbi aetatum), which may be either acute or chronic. Owing to the extreme irritability of the childish organ- ism, it is peculiarly liable to spasmodic sufferings ; the reproductive system being principally active in the child, it must be subject to diseases which are princi- pally seated in the lymphatics ; the disturbances which occur in the reproductive system, maintained and in- creased by the want of irritability and by the inac- tivity of the lymphatics, are characterized by con- gestion to the brain in the form of epistaxis, meningitis, hydrocephalus, typhoid symptoms of various kinds, scrophulosis, helminthiasis, etc. In a more advanced age, when the vitality of the thoracic organs is de- veloped in a superior degree, congestion of the lungs is a prevalent condition, inducing a correspond- ing predisposition to pulmonary diseases; in this age the sexual organs develope themselves and the pas- sions connected with that development begin to be felt, and, if satisfied to excess, lead to various diseases peculiar to this second ^period of life. The smallest number of diseases occurs in the period when the human organism is fully and harmoniously developed. As man advances in age, the abdominal organs are principally affected, hence atony of the intestinal canal, hypochondria, haemorrhoids, gout, etc. are the principal diseases of that period. Old age, when all the moral and physical energies of man are on the decline, is especially predisposed to paralysis of every kind, deafness, blindness, apoplexy, asthma, paralysis of the lungs, affections of the bladder, etc. Diseases affecting the organism during a transition period (which may be said to occur every seventh year,) are of a higher importance on account of the development which the organs undergo during that period. (b.) Diseases belonging to the different sexes (morbi sexus). The difference which prevails in the charac- ter and degree of the irritability, sensibility and re- production of the female and the male organism and 40 INTRODUCTION. in the physical as well as psychical tendencies of the two sexes, makes each of them liable to peculiar dis- eases. Suffice it to mention the various nervous dis- eases to which women are subject; the diseases depending upon the peculiar sensitiveness and irrita- bility of the female temperament; the various diseases affecting the reproductive system of the female organ- ism, such as tuberculosis, carcinoma, scirrhus, etc. (c.) Diseases belonging to particular classes and trades. Rich people, who are accustomed to rich and luxurious living and spend their life in idleness and ennui, are liable to derangements of the abdominal organs and consecutive diseases, such as gout etc, whereas the poor are affected with diseases result- ing from an impoverished reproduction. Tanners are subject to dropsies; type-founders, miners, potters to tabes metallica; tailors and workers in wool to scabies : compositors and printers to oedema of the feet and varicose conditions; chimney-sweeps to gangrene of the genital organs; stone-cutters, hair- dressers, millers to pulmonary phthisis ; washerwomen to dropsy ; literary men who lead a sedentary life, to diseases of the abdominal organs ; mariners and fish- ermen to scurvy, anasarca, etc. What has been said in the preceding paragraphs, is sufficient to show all the essential points which the physician ought to be informed about in order to ob- tain a correct knowledge of the origin and course of the disease, and even the internal changes which char- acterize it; that knowledge being indispensable to a sure and successful treatment. Diseases may also be classed according to the region over which they spread. We have (a.) Sporadic (morbi sporadici), or diseases which depend upon meteoric or telluric miasmata and affect only single individuals who happen to be predisposed for such diseases at the time when they are prevalent; (b.) Endemic (morbi endemici). These diseases are confined to a definite and often verv limited region ; they are distinguished from the former by being de- INTRODUCTION. 41 pendent upon the situation of a place and its sur- rounding region, upon the climate, the condition of the atmosphere, winds, soil and water, upon the mode of life of the inhabitants, food, social life. Every place may therefore have diseases which are peculiar to it; it is a remarkable fact that apparently identical dis- eases which prevail in places not very distant from one another, require the application of different reme- dies in the different places. (c.) Epidemic (morbi epidemici). These diseases are closely related to the former, with this difference, that they prevail at periods in a greater or lesser ex- tent of country, and affect all ages and sexes indis- criminately ; they depend upon a cause of atmospheric or cosmic origin, generally upon a miasm which be- comes contagious among crowded masses and then spreads so much more rapidly and over a larger surface. (d.) Morbi annul. These are diseases which pre- vail at particular periods of the year, in the spring, summer, fall or winter. In the winter inflammatory diseases are prevalent, whereas the prevalent diseases in spring are rather of a catarrhal nature. The fall diseases are characterized by gastric-pituitous symp- toms, and those of the summer-season have moreover a typhoid character. This class of diseases is evidently affected by sudden changes in the weather. (e.) Morbi stationarii. It is of great importance to a physician to know what peculiar character a dis- ease is disposed to assume in a place. This topical influence modifies the character of the above-men- tioned diseases more or less. It prevails during a shorter or longer number of years, abates gradually, finally disappears entirely and returns after an in- definite period. (f.) Morbi inter cur rentes. These are diseases which depend upon causes entirely different from those that occasion the prevailing disease; but they frequently ingraft their character upon the latter, and, by so doing, are apt to transform a naturally mild disease into a dangerous and malignant one. 4*2 INTRODUCTION. To this classification of diseases we shall add a few indications which are of great use in examining a patient. In invest iirating the symptoms ol an^epi- demic or sporadic disease, it makes no sort of differ- ence whether a similar disease has existed previously. The previous disease has no sort of influence upon the present epidemic, which requires to be thoroughly in- vestigated as an entirely new, unknown disease of a peculiar kind. Hahnemann teaches that even measles, smallpox, scarlatina, rubeola, etc. are not exempt from that rule ; these diseases depend, it is true, upon the same miasm, but the form of the eruption only re- mains the same. In all those diseases there is an essential difference as regards the systems which are principally affected, the concomitant symptoms, the prognosis, and the course and termination of the disease. The physician frequently requires to investigate two or three cases of an epidemic disease before he suc- ceeds in obtaining a correct idea of the totality of the characteristic symptoms which scarcely ever exist to- gether in one case ; but even an incomplete know- ledge of those symptoms will enable him to administer a remedy with more certainty than an allopathic physician could do. However, although he may feel sure that he has given a remedy which corresponds as nearly as possible to the symptoms so far as he knows them, yet he ought to make it his duty to observe every new case with the same unremitting attention, in order to finally complete his group of the character- istic symptoms of the disease and to be sure that he has selected the true specific remedy. In thus observing an epidemic disease, the general symptoms, such as loss of appetite, want of sleep, eructations, etc.,will be specially and correctly noticed, and the characteristic particular symptoms of the epidemic disease will be found to constitute a limited and rarely-occurring group. These; symptoms all originate in the same cause, but their totality can only be known by observing several patients of different constitutions and temperaments.* * See Organon, § 100-102. INTRODUCTION. 43 Stationary diseases likewise require a correct and thorough investigation of all the symptoms which can only be known by observing a number of patients and we will often find that the whole group of symptoms indicates a different remedy from what we might have selected after a merely superficial investigation of the disease. This scrupulous investigation is of essential benefit in intercurrent diseases, where the character- istic symptoms frequently point to the same remedy which corresponds to the symptoms of the stationary diseases in that region. According to their origin, diseases may be divided into . (a.) Hereditary (morbi hereditarii). These are dis- eases which have existed in a family for generations past. We have an hereditary scrofulous, haemorrhoid- al, phthisical, apoplectic, etc. disposition, which deve- lopes itself in spite of the utmost care in removing all hurtful influences, and frequently leads to the dissolu- tion of the organism, baffling the best directed efforts of the physician. If the physician should have reasons to suspect the existence of an hereditary disposition, he ought to in- quire whether any of the ancestors, parents, brothers, sisters have been alfected with a similar disease, or have died with it. If this should be so, he will be much better able to express a correct opinion in regard to the prognosis and to the chances of a cure. (b.) Morbi congenili. These diseases generally de- pend upon malformations with which the individual was born. (c.) ]\Iorbi acquisili. These are diseases for which the patient had no particular predisposition, but which he brought upon himself by exposing himself for a length of time to hurtful influences, for example: taking hurtful beverages and nourishment, indulging excesses of various kinds which gradually undermine health, being constantly deprived of the necessary means of subsistence, living in unwholesome, marshy regions, or in cellars and close apartments, being de- prived of exercise or open air, indulging excessive 44 INTRODUCTION. physical or mental exertions, being continualh agi- tated by unpleasant moral emotions, etc. No psoric miasm is required to develope such dis- eases. According to Hahnemann such diseases dis- appear of themselves if they have not excited a chronic miasm. . .. , . .,. (d.) Primaru diseases (morbi primarn, protopathici). The^e are diseases which result immediately from noxious influences, whereas the secondary, consecutive diseases (morbi secundarii, deuteropathici,) arise from a malady which is already existing. Ihis class of diseases requires no special definition, as their name indicates their character. (e.) Contagious and miasmatic, and non-contagious and non-miasmatic diseases. A contagium, whether it be originally formed in man or in any other kind of organic body, in animals or plants, is a material sub- stance, the original and exclusive product of a morbid condition of the organism and possessing the power of infecting other individuals of the same kind Avith an identical or at least very similar disease and of spreading in this way to remote regions. A contagium being dependent upon meteoric and telluric influences, it is most easily developed in times of war, famine and inundation, producing hospital, dungeon and yel- low fever, typhus, etc. A miasm, on the contrary, is a volatile deleterious substance, the chemical composition of which is un- known, which spreads through the atmosphere and incorporates itself with it with more or less tenacity. A miasm frequently arises from decayed organized bodies and from the exhalations of sick persons. People who are forced to live in such a deleterious atmosphere, are necessarily exposed to its influence. Considering the multitude of vitiated exhalations which are concentrated in many places where people have to live, it cannot appear strange that the number of miasmatic diseases should be very considerable. Miasm and contagium frequently go hand in hand, one producing the other, as is the case in smallpox. INTRODUCTION. 45 The division of diseases into local and constitutional is without any practical value. Every physician knows that the so-called local diseases are much more speedily removed by internal remedies than by exter- nal applications; we need but remind the reader of syphilis, sycosis, plica polonica, etc. The fearful dis- eases which frequently break out after the pretended local affection had been suppressed by external means, show that this apparently local symptom was a sort of vicarious concentration of the internal constitu- tional disease which was held in a latent state as long as the local symptom continued upon the skin. How is it possible that a simple ulcer on the finger should not only remain uncured under the merely external surgical treatment, but that it should even assume the dangerous form of a phagedenic ulcer, if it were not the local vicarious expression for an internal dyscrasia. It is self-evident that an apparently local affection which does not owe its existence to an external cause, must depend upon a coexisting disturbance of various organs and tissues; the local affection, even if it had been produced by a merely local external cause, can- not exist for any length of time without affecting the whole organism, as we see in the case of a burn, a toothache proceeding from a carious tooth, etc. The division of diseases into acute and chronic is of particular importance to us, for this reason, that we have made that division the basis of the arrangement which we have adopted in the present work. To each of those divisions we have devoted a special volume. Acute diseases are sudden disturbances of the vital force, characterized by the greater rapidity with which they run through their course and by the powerful reaction which takes place in the vascular system. In treating such diseases, it is a, matter of course that wherever we know the cause from which they arise we ought to remove it if we can. Chronic maladies frequently arise from a disturb- ance of the vital force, which is seated in the vegeta- 40 INTRODUCTION. tive system. A concealed dyscrasia affecting that system' is frequently the cause* of the obstinacy with which those diseases cling to the organism. Accord- ing to Hahnemann, chronic diseases invade the organ- ism, each in its own peculiar manner, the invasion being scarcely or not at all perceived in the com- mencement and gradually overpowering the vital force, so that it is only able to" offer an inadequate re- sistance, allowing the malady to increase, until it finally destroys the organism. Starting from the de- finitions which we have given of acute and chronic diseases, it will be found easy to draw a line of separa- tion between them, especially if we admit Hahne- mann's theory that all chronic diseases derive their existence from some miasm ; a theory, which seems to be somewhat inconsistent with Hahnemann's previous condemnation and rejection of all theories and specu- lations about the essence of disease and the rela- tion existing between it and the changes in the body. We have already stated above that a number of dis- eases may exist without depending upon a psoric miasm, and Hahnemann seems to have had a similar idea inasmuch as he designates them spurious or im- proper chronic diseases. He accepted three funda- mental forms of chronic diseases : psora, syphilis and sycosis; from these three fundamental chronic miasms all chronic diseases derive their origin, seven-eighths from the former, and the remaining eighth from the two latter. It is neilher our intention, nor is this the proper place to criticize Hahnemann's views ; we may however remark that the merely palliative effect which he frequently obtained from his remedies in chronic diseases, led him to the belief that these dis- eases depended upon some latent chronic miasm ; and it was indeed ascertained that many of them had been preceded by itch. Hahnemann was persuaded that the suppressed itch was the primary cause of those diseases. Observing that several of them had been cured by the use of mineral springs, his acute powers of penetration led him to suppose that the cure had been wrought by the medicinal substances which INTRODUCTION. 47 exist in those springs in minute and greatly divided quantities. He was confirmed in this view by farther observations and the successive results of his practice, and he therefore designated the medicines by means of which the cure of chronic diseases was effected, as antipsorics—that is, medicines directed against a chronic malady. It is now well known, however, that those antipsorics not only cure chronic, but also a host of acute diseases, and that they are employed for that purpose by all homoeopathic practitioners. Hahne- mann be praised for having made us acquainted with such efficient means to relieve the sufferings of our fellow-beings. It is an undoubted fact that the inveterate character of chronic diseases frequently depends upon some latent dyscrasia which has become rooted in the organism, and that those conditions have been re- moved by certain remedies which exercise a specific effect upon the organs invaded by a psoric miasm. It is for this reason that the general therapeutic rules remain the same for chronic as well as any other dis- eases. If such chronic diseases have already been treated with a variety of allopathic medicinal sub- stances, it is advisable that the homoeopathic practi- tioner should let some time elapse before he gives any medicine to the patient, that the organism may free itself as much as possible from the various influences which those drugs have left and may become more susceptible to the action of our small doses. According to Hahnemann, diseases of the mind like- wise originater" These diseases do not constitute as distinct a class of diseases as those which have been indicated above. In almost every disease of the body the mind is affected more or less, on which account the st ate of the mind is to be regarded as an important feature in the image of the disease. We know from experience that the condition of the mind in health is frequently the contrary of what it was in disease. If a certain group of symptoms indicate two different remedies, the state of the mind is frequently the only symptom by which we can decide which of those reme- 48 INTRODUCTION. dies ought to be selected : Aconite, for instance, will never effect a rapid cure in a person with a calm, even temperament; Nux will be found very little adapted to a mild and phlegmatic, or Pulsatilla to a cheerful, bright and obstinate temper: Ignatia is counter-indi- cated bv an unchangeable mind which is neither eiven to" fright nor vehemence. In all chronic diseases it is not only of the utmost importance to investigate all the physical symptoms, but the moral and mental condition of the patrent would seem to require our especial attention.* The physician will have not only to inquire into all the previous bodily diseases of the patient, but he will have to make particular inquiries about the disease which preceded the mental disorder previous to its in- creasing to a complete derangement. This informa- tion can, of course, only be obtained from the family. If the mental derangement (mania, rage) set in of a sudden, in consequence of fright, chagrin, abuse of spirituous drinks, then Hahnemann teaches that it is to be treated as an acute disease with Aconite, Bella- donna, Stramonium, Hyosciamus,Veratrum,]Mercurius, etc., and that the antipsoric treatment, with a properly regulated diet, ought to be instituted only after the acute symptoms have been subdued ; the antipsoric treatment is necessary to prevent a new outbreak of the disease which might easily become a permanent derangement. Diseases of the mind which are not yet fully de- veloped and do not arise from bodily affections but from bad habits, faulty education, immoral conduct, neglect, superstition or ignorance, may be improved by kind persuasion, consolations, remonstrance, reason- ing ; whereas those mental diseases which arise from bodily diseases, are made worse by such means, and become more inveterate. A physician ought never to lose patience or self-control, he ought never to indulge angry expressions or manners, lest he should lose the confidence and the affection of his patients, which are indispensable means of cure. * See Organon, § 217 scq. INTRODUCTION. 49 There is another class of mental diseases which we • observe in men who have been frequently a prey to grief, chagrin, insults, attacks of fear and fright. Those diseases emanate primarily from the mind, and the bodily affection is a mere result of the mental disturbance. If these diseases be recent, they are most easily removed by spiritual means, such as: kind persuasion, reasoning, confiding manners, some- times by a clever deception ; the mode of life ought not to be neglected, of course. Such means are fre- quently sufficient to restore the normal state of the mind. In all cases of mental derangement which can be cured by homoeopathic remedies it is essential not only to observe a rigorous diet, but to submit the patient to a proper treatment on the part of his relatives and physician. The raving maniac ought to meet a firm will and a bold and fearless expression of countenance ; the lamenting and disconsolate ought to be surrounded with silent and sympathizing grief; senseless prattle ought to be met by silence expressing a slight degree of attention ; disgusting and revolting conduct are to be left unheeded. The patients ought to be prevented from injuring or ruining the things around them, with- out rebuking, or, what would be still worse, pun- ishing or torturing them. The only compulsion to which the patient is liable, is to take the homoeopathic medicine, but even that kind of compulsion can be avoided by mixing the medicine in the beverage of the patient without his knowing it. It is a great mistake on the part of the physician or the attendants of the patients to contradict, censure, or scold them, or to treat them with yielding timidity ; it would be just as indiscreet to irritate them by de- rision, and ill-disguised deception. On the contrary, those patients ought always to be treated like sane persons, and everything by which their senses or minds might be disturbed, ought to be carefully re- moved from their presence. 3 50 INTRODUCTION. GENERAL THERAPEUTIC RULES. We have shown above that the first essential requisite of a cure is. a thorough investigation ot all the perceptible symptoms of a disease. This investi- gation is so much more necessary as. according to Hahnemann, the symptoms which reflect the internal disease in a visible and tangible form are the only part of the disease which we can perceive with our senses and therefore know. If the symptoms are re- moved the disease no longer exists. Wo do not en- tirely admit this proposition as may be inferred from our mode of examining the patient; but as our object is not to remark upon Hahnemann's theories, we have contented ourselves with showing the mode of arriving at a correct diagnosis and at a knowledge of the specific means by which the disease will be most per- manently and thoroughly cured. We doubt, however, whether such a cure is possible in every case. How often is our treatment baffled by disorganizations which have lasted a sufficient length of time io produce functional disorders and an exces- sive irritation of the sensitive sphere ; we may men- tion headache depending upon an exostosis of the cra- nium; epilepsy, occasioned by tubercles in the brain; dropsy, by organic degenerations ; organic difliculties about the heart; cardialgia, and chronic vomiting, de- pending upon tubercles, cysts in the oesophagus, or carcinoma of the pyloric orifice : metrorrhagia, occa- sioned by carcinoma; haemolysis, from disorganization of the lungs, etc. : all such affections are incurable under any treatment. Under this head belong ex- haustion of the vital energies by marasmus, profuse evacuations, excessive exertions; diseases which set in with a sudden and overpowering violence, such as: hospital-typhus, pest, violent cases of poisoning; and we may lasiiy class under this category the unavoid- able and permanent presence of hurtful influences, such as: grief from disappointed love, cares, chagrin, remorse, living in a climate which is injurious to the patient, etc. We have already spoken of the nec-ssity of inves- INTRODUCTION, 51 tigating and, if possible, removing the exciting cause of the disease, and we here allude to it again in order to impress that necessity upon the minds of our read- ers as emphatically as possible. Even when the ex- citing cause is no longer present and the disease goes on in its course, we ought to select our remedies with reference to it. To the examples which we have fur- nished above and which were principally intended to illustrate the fact that the remedial agent ought to be selected with a particular reference to the exciting cause, we subjoin a few more with a view of showing the necessity of submitting the patient to a particular diet, avoiding all those things which, although the patient may have been in the constant habit of using them, might injure the good effects of the specific remedy. If the physician is at the same time the friend of his patient—which he ought to be, inasmuch as the physician is initiated into all the secret cares and difficulties of his patient,—he may frequently do more good by a kind word, a consolation, or a friendly mediation, than by medicine ; at any rate, the medi- cine which is-administered by the hand of a friend, will do more good than a superficial, formal consulta- tion. In some eases the cure may be facilitated by transferring the patient to a more wholesome abode, by changing the bed-chamber, taking off the corset or any other hurtful piece of dress, etc. The physician ought likewise to insist upon his patient correcting all bad habits, such as sitting crooked, eating too fast, swallowing food which is too hot, eating hot and cold things in rapid succession, excessive use of tobacco and snuff, indiscreet bathing, washing the head and eyes with cold water immediately after rising, sitting in a current of air, etc. All injurious external influences have to be removed or neutralized before the real treatment of the disease can begin ; and this treatment is to be based upon the principle " similia similibus," which is the only true law of healing and has now been confirmed by the experience of a vast number of the most acute and intelligent practitioners. INTRODUCTION. The specific treatment as we understand it in our school, consists in selecting a remedial agent the patho- genetic effects of which upon the healthy organism are similar to the symptoms of the natural disease. This is the homoeopathic law of cure, a law which is founded in nature and is the only true guide for the administ ra- tion of such remedies as will secure a successful reac- tion of the organism. If we conceive the law "similia similibus '* in its true scientilie extent, we will at once be led to admit the necessity of not restricting the application of that law to the mere external symp- toms ; for there are diseases where those symptoms are wanting or so feeble that we are scarcely able to distinguish them, as may be the ease when organs that are but poorly provided with nerves and are therefore not very sensitive, are the seat of the disease ; or the symptoms of the original malady may be so deceptive that the concomitant sympathetic symptoms may be much more distinct than the former; or the symptoms of the principal disease maybe obscured by accidental violent complications. This shows that a mere compar- ison of the symptoms is not always sufficient to obtain a correct diagnosis and that it frequently requires a good deal of combination and reflection to attain a true and complete image of the disease with all its external and probable internal phenomena. The selection of our remedial agents in accordance with the symptoms of .the disease, is the great differ- ence which exists between the old and new school. The greater the similarity of the symptoms ; the more exactly the remedy corresponds to all the peculiarities of the disease; to the period when it makes its appear- ance ; to the exacerbation sand changes occurring in the course of the disease; to the mode how and the period when it disappears ; to moral emotions, etc.: the safer, and the more certain and permanent is the cure. In comparing the symptoms of the malady with those of the remedial agent, the general symptoms are of not so much importance as the particular characteristic symp- toms, for instance, whether lie- symptoms are aggra- vated or excited by motion ; whether they are excited INTRODUCTION. 53 or gradually increased by rest, and whether they dis- appear again by motion ; whether the symptoms are most violent in the morning, at noon, in the evening, night, etc. ; whether they are modified by the cool open air or by warmth ; whether a slight, apparently trivial occurrence, such as nausea, vomiting, a slight attack of rheumatism, etc., induces great prostration of strengt h, obliging one to lie down (we remind the read- er of Ars., Verat., Ipec, Sec), etc. It is of the utmost importance for the selection of the true remedial agent that all those points should be carefully considered. We are frequently led to a knowledge of the specific agent by considering the relation which it holds to the peculiar moral or physical disposition, the temperament or sex of the patient, (Nux vom., Ignat., Puis., Sep., Phosph., etc.) The prophylactic treatment is another species of treatment which the homoeopathic physician is fre- quently called upon to employ. The prophylactic treatment is generally employed in cases where diseases can be prevented by specific remedies, for instance scarlatina and hydrophobia by a few small dozes of Belladonna at suitable intervals ; purpura miliaria by Aconite ; varicella and measles by Pulsatilla; the consequences of chagrin by Chamomilla (or rather by Colocynth, which is in many cases suffi- cient to remove the most violent symptoms occasioned by chagrin) ; the morbid phenomena resulting from fright by Aconite, etc. These few examples sufficiently show that the ho- moeopathic method of cure is a better prophylactic method than the method of the old school. We inquire with much more minuteness into the natural susceptibility of a patient to this or that disease ; our knowledge of the curative virtues of drugs is not derived from unfounded theories, but it is based upon pure experience and careful observation ; such things as spring or milk-cures can never occur in homoeopathic practice. The homtropathic physician acknowledges also a sort of prophylactic hygiene which it is the business of 54 INTRODUCTION. the government to protect. Under this category belongs Hahnemann's remark in the preface to Ledum palustre.^ that this powerful substance is frequently mixed with beer by inter* sled and unprincipled brewers for the purpose of imparting intoxicating qualities to that beverage, thus making it very injurious to health. However strange it may appear to speak of palli- ative treatment in connection with homoeopathy, yet that treatment is employed under certain circumstances even by those who have practised homoeopathy for years past. A physician must be very unfeeling if he would refuse to palliate the troublesome or dangerous symptoms in eases where they are owing to the presence of an exciting cause, or when the ease is hopeless and the curative treatment is of no avail. Every good physician will endeavour to palliate his patient's sufferings until his death, in all cases where a cure is out of the question. This rule of conduct, which is deeply written in the human heart, is not only true in incurable but also in very painful diseases. This maxim prevails alike in the homoeopathic as well as the allopathic practice, with this difference, that in the latter practice palliatives are frequently re- sorted to for the purpose of subduing a single symptom, even if the totality of the symptoms should indicate a totally different remedy, (we merely mention the abuse which is made of opium, the sudden suppression of salutary evacuations, the pellentia and exsiecantia in chronic local affections, etc.) In treating a case, the homoeopathic physician employs remedies which not only correspond* to the troublesome symptom, but to the whole group. In palliating acute pain or incurable affections, the homoe- opathic physician ought constantly to act in accord- ance with that rule, lie will accomplish that pallia- tion by frequently repeating the suitable remedies, for instance: Belladonna, Chainom., Ignat.. Ipeo.', etc., in violent spasmodic diseases: Carbo anim., Staphys., Thuja, Secale corn., Puis., Bell., etc., in cancer of the • See Hahnemann's Materia Medica Pura, by Charles J. Hempel, M.D. INTRODUCTION. 55 womb. There are many more examples, all of which show that the principle " similia similibus," if employ- ed as the rule in the palliative treatment, accomplish- es the object of that treatment much better than the empirical practice of the old school. We invite our opponents to try our laiv of cure as a palliative means in organic malformations, and to compare the results thus obtained with the results obtained by their ordi- nary means. There is another kind of palliative means of which wo avail ourselves in our practice and which have not, it is true, any homoeopathic relation to the disease, but by no means interfere with the homoeopathic treatment. Who does not know that the troublesome dry cough in tuberculous phthisis is moderated by inhaling the vapour of warm water, or that spasms of the respira- tory organs may be soothed by warm fomentations of the chest ? Who is unacquainted with the bene- ficent influence of animal magnetism in asthmatic com- plaints and spasms ? Who does not use warm poul- tices of milk and oatmeal, bran, or linseed, to soften hard and painful abscesses, or to cover large ulcerated surfaces which are very painful and deprive the patient of his strength ? Who does not cover open abscesses with bands of linen slightly covered with an ointment of althea ? Do we not apply carrot and potato poultices to painful cancerous ulcers and to bed- sores which threaten to become gangrenous ? Do we not bathe inflamed portions of the periosteum during a long confinement in bed with washes of lemon-juice and dilute tincture of Arnica ?• Who does not give anxious patients, if they should wish to be relieved of an obstinate obstruction of the bowels, an injection of tepid water, or milk and water, milk and molasses, soap-water and linseed-oil, or mere cold water ? Do we not know that in typhus fever great relief may be afforded to the patient by washing certain parts of the bod}r with warm vinegar ? Have we forgotten the relief which may be obtained by rubbing with apiece of flannel limbs that arc affected with rheumatism ; is not the pain in acute rheumatism and ascites relieved 56 iMKoDL*eTro>- by friction with warm oil ' Arc not warm baths ex- cellent palliatives in many eases I Should it be contrary to our art to apply in many cases of ™W™* or perfectly developed encephalitis cold water, snow or ice to the head, knowing as we do that those applica- tions have a soothing and even curative etieet in the headache occurring in that disease and arising from violent congestion of blood ? Are not gargles o milk and althea-root boiled together, frequently uselul in angina faucium ? Is not the pain in violent inflamma- tion or suppuration of the internal ear relieved by the vapours of warm milk ? Is not the painful otalgia ot children relieved by twisting a sulphur thread around the external ear? Are not habitually cold feet relieved by bathing them in cold water ? Is not the agony in croup mitigated by applying a sponge dipped in warm water to the larynx ( '* The derivative method is a particular branch of the palliative system, and may be advantageously resort- ed to in many dangerous affections. We may men- tion the warm oatmeal poultices, the hand and foot baths with or without salt or ashes, in congestion of the superior organs and in delirium ; dry cupping at the pit of the stomach, in oppression of the chest, anguish and restlessness with an unequal and spasmodic pulse previous to an acute eruption breaking out upon the skin; the warm hand-baths in excessive secretion of milk; the application of warm vapours to the breasts of the lying-in woman in sup- pression of the milk ; the pitch-plasters between the shoulders, which were even recommended by Hahne- mann in chronic diseases arising from a suppressed eruption; the recommendation of Hahnemann to wash the external opposite side of the affected organ with the medicine which is homoeopathic to the symptoms. —What dangerous symptoms frequently arise from suppressed sweat of the feet I Is it not proper that * To these palliatire means we may add a current from the magneto- electric machine, which frequently relieves in a moment's time the most ex- cruciating pain in acute rheumatism, and other kinds of inflammation. UfMi'VI INTRODUCTION. 57 .the physician should endeavour to restore the sweat by wrapping the feet in cotton, wool, or wax-linen, or inserting them in warm sand ? There is no doubt that an illness depending upon a suddenly suppressed cu- taneous eruption, whether the suppression be spon- taneous or the result of indiscreet treatment, will be most speedily cured by him who first succeeds in restoring a similar eruption upon the skin. Who is not acquainted with the brilliant effects of cold fo- mentations and the internal use of Arnica in injuries of every kind, especially those of the head?—Is not the treatment which we resort to in cases of swoons, apparent death, suffocation, hanging, freezing, burns, etc., of the palliative kind?* We may here mention another method of treatment which is subordinate to the homoeopathic, and is based upon a knowledge of drugs obtained ex usu in morbis. Thus we use Antimonial wine, in drops, against accu- mulation of mucus in the chest, in the case of little children; Oleum jecoris aselli against scrofulous com- plaints and tubercles ; Mercurius in syphilis ; the bin- iodide of Mercury in old syphilitic ulcers, and syphi- litic diseases generally; Quinine in various intermit- tent diseases ; Sulphur in scabies and haemorrhoidal affections ; Iodine in mercurial herpetic eruptions and tubercles: Lichen Islandicus in pulmonary phthisis ; Secale cornutum to facilitate labour-pains ; the tinc- ture of Cinnamon in metrorrhagia, etc. We have similar specifics in the homoeopathic prac- tice ; but we have no right to reject remedies, the spe- cific curative effects of which we only know ex usu in morbis ; the use of such remedies is justified by the fact of their being specifically adapted to certain forms of disease. Not every diarrhoea from cold is relieved by Dulcamara, nor are all catarrhal diseases. Belladon- na is said to be a valuable remedy against hydropho- bia : but would a homoeopathic physician be willing to use it in practice without first examining its cura- tive virtues ? Colocynthis is known to be an excellent * Organon of the Specific Healing Art, by Dr. G. L. Eau. Leipsic, 1838. 3* 58 INTRODUCTION. remedy in colic with dysentery, but will a discreet practitioner ever use it in such a case without in- quiring whether it is specifically corresponding to it f Rhus is known ex usu in morbis to be a valuable remedy in many diseases which are aggravated in re^t. and Bryonia in many others which are aggravated by motion : 'nevertheles> we shall always have to con- sider whether either of those remedies is specifically adapted to the existing group of symptoms. The same remarks apply to Mercury in syphilis, Sulphur in sca- bies and hemorrhoids, China in intermittent fevers, Arnica in contusions. Ipecacuanha and Ignatia in spasms, etc. We ought not to omit mentioning the law of cure '• rcqualia equalibus," or the contagium of a disease! may be employed against it as a curative specific. This law, which was first discovered and promulgated by the veterinary physician, M. Lutz, in a pamphlet entitled the Doctrine of Isopathic Remedies, and pub- lished in Leipsic, IHXi. has been confirmed by the ex- perience of many acute observers. In making men- tion of this work in the second volume of the Homoeo- pathic Gazette, .No. 9, page 70, Dr. Gross tells us that he had made many experiments with isopalhic reme- dies. Since then several cures by means of isopathic remedies have been reported in the Homoeopathic Ga- zette ; but they do not always prove what the)- are in- tended to prove, and have appeared to us rather im- aginary. There is no doubt that single observations have been made the basis of the doctrine that the pro- duct of a disease is able to cure that disease, and that this erroneous conclusion has brought into use a num- ber of remedies which do not deserve that name. We know that contagia are not only capable of subverting the normal condition of the vital forces, but also of re- storing the natural play of those forces (we need but mention Psoricum, Lachesis, \ aceinin, Morbillin, Va- riolin); but those remedies have most frequently cured diseases entirely different from those from whose names those agents have derived their own. If all diseases could be cured in this manner the business of a physi- INTRODUCTION. 59 eian would not be difficult but very laborious, inas- much as he would have to dynamize the product of the disease in every single case ; for any other it would be without any value. Cures which are said to have been effected agreeably to the principle, " ae- qualia aequalibus," are in fact homoeopathic cures; for the patient is cured by means of a product of that disease in some other patient, which is dynamized in the usual fashion. Inasmuch as we have made mention of the various methods of treatment of which the homoeopathic prac- titioner may avail himself, we shall now say a few words of some other methods occurring in allopathic practice, and comprehended in one or the other above- mentioned methods of cure. Homoeopathy knows- nothing of the expectant method. Every manifestation of disease is treated according to its symptoms, by positive remedies. j\or does homoeopathy know anything of a particu- lar treatment for convalescent patients. The efforts of the homoeopathic physician are directed against the disease itself, without poisoning the organism, as is done in old-school treatment, by excessive doses of medicine, frequently ingrafting upon the organism an artificial disease that is much more violent, and lasts much longer than the natural disease. Homoeopathy does not use any depletory processes ; hence the pa- tient is not weakened by homoeopathic treatment, and there is no necessity for any of those medicines which are required for the debility consequent upon the em- ployment of the allopathic revulsive treatment. Suf- fice it to mention the cure of inflammation by repeat- ed bleedings, or the treatment of typhoid fevers with excitants and a variety of other drugs in large doses, the use of which is generally followed by a period of convalescence lasting as long as the original disease ; the treatment of febris pituitosa, which generally leaves a deranged state of the mucous membranes and dropsical conditions, etc. After these preliminary pathological and therapeutic 60 INTRODUCTION. observations we come to state the fourth cardinal principle of homoeopathic practice : (lire the spec [fie remedy in a sufficient quantity to ocite the curative re- action of the organism, without occasioning any un- necessary aggravation of the symptoms, which would only serve to impede the cure. According to Hahne- mann the homoeopathic dose may be ever so minute it will succeed in improving, curing, or even annihil- ating the disease. His idea was that the exciting causes of disease possess only a subordinate and limit- ed power to disturb the organism, but the remedial agents possess this power in an absolute, and, there- fore, supremo degree, at the same time as they are ca- pable of affecting the diseased organ in such a manner as will restore the harmony of the whole organism. A few hours after exhibiting his remedy Hahnemann frequently noticed new symptoms evoked by the medicine (medicinal aggravation); he therefore con- cluded that the dose was still too powerful for the disturbed organism, and was led in the course of time to carry all his remedies up to the 30th degree of dynamization. lie was rejoiced at witnessing the effect, the pure dynamis of his immaterial doses, and the power which even the highest potencies still pos- sessed to cure disease. He even thought that those highest dynamizations were frequently too powerful, especially in chronic diseases, and he therefore intro- duced the method of simply smelling a few pellets moistened with the medicine. Afterwards he thought that even olfaction was too powerful for certain deli- cate organisms, and he advised such patients to dis- solve a few pellets of the medicine in half a tumbler- ful of water, and of taking a tablespoonful every day, or every two or three days. According to Bocnning- hauscn's communication in the New Archive, lirst and second number, Hahnemann has carried his dyna- mizations still higher, and since his death the highest dynamizations have been vaunted in such extravagant terms that the student of homoeopathy must fairly lose his senses in that labyrinth of strange and unheard-of INTRODUCTION. 61 relations. There are as yet no fixed rules for the magnitude of a dose or the employment of particular potencies ; every physician uses those potencies which seem to him best, and if he succeeds in curing his pa- tient, he considers that potency the best which has ef- fected the cure, and advocates it as such, upon the ground of experience. Nothing positive can be said about a point of doctrine which has given rise to so many different opinions. It will not do either to contradict or to blindly believe the results said to have been ob- tained by other physicians. We ought to verify them in our own practice, although neither a few successes nor failures are a sufficient evidence either for or against the statements and inferences of other prac- titioners. If it were true that in treating a case of disease the principal thing is to give the homoeopathic specific, and that the dose is of minor importance, we might dismiss the subject without any further remark. The dose, however, is of some importance, and we therefore beg leave to express our own opinion in re- spect to doses, without desiring, however, to bias any practitioner's mind in favour of our ideas. In the first place we ought to have a proper under- standing of the term dynamization. Hahnemann gave this name to every attenuation of a drug, which he considered a development and increase of the power of the drug, until the material substratum should be entirely destroyed and the attenuated agent should act as a purely dynamic power. The term " dynamization or potentialization" is certainly the best that can be applied to the attenuations of mineral and metallic substances, inasmuch as the process of trituration dis- closes and developes their latent powers and raises the drugs to the rank of true curative agents. It is only by triturating those crude substances that they become like medicinal agents which, even in their natural state and divided into very minute parts, possess so great a power of disturbing the organism that it is not advisable to use them except highly diluted. The former substances are dynamized by 62 INTRODUCTION. trituration, the latter weakened by dilution. W e do not know verv positively how far crude chugs inquire to be dynamized before their medicinal virtues are properly disclosed: but we may suppose that this re- sult is obtained as soon as the triturated substance manifests the power of morbidly affecting the organ- ism. \ny farther attenuation of the drug would not be a dynamization but a dilution. If the successive attenuations of a drug were so many dynamizations, why does not the dynamic power of the drug increase by attenuation, whereas Hahnemann thinks that it decreases. However, our intention is not to criticize, but simply to state the view which we take of dynamization and dilution. We understand the thing differently from Hahnemann, but, if we mean to ob- tain a rational opinion of the power of his small doses we have to understand the attenuating process as he does. He supposed that the dynamic power of pon- derable bodies might be excited by peculiar manipu- lations like that of imponderable substances, and that the dynamic power of those substances might be separated from its material substratum and transferred to a neutral vehicle by means of which it might be made to act upon the affected organism like electricity, magnetism, etc. The correctness of the views which Hahnemann has promulgated about the dynamizing power of the processes of trituration and succussion, cannot be denied, nor will it be denied by any one who is familiar with homoeopathic practice, and has used the 30th, 40th, and 00th potency of Arsenic, Belladonna, etc., with the same happy results as we have done in our practice. Latterly, however, the process of dynamization has been carried much farther than it ever had been before, and with so much en- thusiasm that it is impossible to foresee its ultimate boundaries. The advocates of the doctrine of dynam- ization have now become convinced that the whole secret of the curative effects of one, two or three pellets is explained by the peculiar mode in which the medicine has been triturated and succussed. They INTRODUCTION. 63 carry a remedy up to the 800th, 1000th, and even 2000th potency,* and imagine that those high poten- cies still produce pathogenetic symptoms. If this game, which is particularly exciting to laymen, and in which physicians become so easily interested, is car- ried much farther, the end of it cannot possibly be foreseen, and it may become true what some of our opponents have said of us, that in homoeopathic prac- tice nature triumphs both over the disease and the physician ! We will not decide whether the introduc- tion of the highest potencies has or has not been a scientific progress ; but we confess that those poten- cies, which we have used in many cases with the honest intention of testing their real value, have not answered our expectations as well as they have those of Stapf, Gross, Boenninghauscn, and other enthusiastic ad- mirers. We still recollect the time when Hahnemann supposed that all chronic diseases originated in the use of coffee, until the psora theory furnished him a new clue for those diseases. Many homoeopathic physicians have implicit confidence in the psora-doc- trine. They likewise believed in the limit which Hahnemann had marked out in the preface to every remedy contained in the first edition of the Materia Medica Pura as the highest degree of power of which that remedy was susceptible. And who will deny that beautiful cures were wrought by these pretended highest potencies which were supposed to be the most suitable to the susceptibility of the disturbed organ- ism. But even at that time we frequently succeeded in curing with a lower potency where the higher had no effect. i\o one thought in those cases of ascending the scale, and an attempt made by Korsakoff to carry our remedies up to the 1500th potency was rejected as absurd by those who were satisfied with the results of their present experience ; it was supposed that those potencies had no curative power whatsoever, * Baron Gerstorff, one of the provers so frequently mentioned in the Materia Medica Pura, has told me that Arsenic has been carried up to the 10,000th potency.—Hempel. 64 INTRODUCTION. and that the patient who was treated with them re- ceived no medicine at all. It is but a lew years since the lowest potencies were recommended as tIn- most suitable in the treatment of disease, and em- ployed by a great number of physicians. What causes all those changes >. Have the drugs become more powerful ? Have the highest potencies been made or used improperly '. Have we obtained a deeper insight into the spirit of our doctrine ? Are we desirous of showing to the world that homoeopathy is yet susceptible of many improvements? Certainly homoeopathy is susceptible of improvement, but it strikes us that it ought to be effected by a different road than that of the highest potencies. The proba- bility is. that if Hahnemann had lived and had re- mained in possession of his vigorous intellect, he would have made changes in the preparation and adminis- tration of our medicines, and would always have re- commended the last (diange as the best. This is our opinion of the highest potencies ; they may afford advantages in certain cases, but will probably be superseded one day by a new method of exhibiting our remedial agents, which will be advocated with the same enthusiasm by its friends. As it is impossible that the same dose or potency should be suitable to all patients, the question natu- rally occurs : What dose will excite the curative re- action of the organism in a sufficient degree I Every physician must feel interested in the settlement of this question, as the dose is of the utmost importance to a successful treatment. The lowest potencies, tin; thir- tieth, and now the highest potencies, have been suc- cessively recommended as the normal doses. But we are convinced, from the. many trials which we have made with every one of those preparations, that neither of them can be considered normal, and that the dose depends in every ease upon the susceptibilities and the reactive power of the patient's organism. In Rau's Organon the conditions by which the dose ought to be determined have been accurately described, and we shall adopt them in the present work, so much INTRODUCTION. 65 more as the views of Rau on that subject coincide entirely with our own.* * Note by Dr. Hempel.—Dr. Hartmann's remarks on the highest potencies appear to me rather superficial. If a man uses the 60th potency with as much success as he pretends to do, there is no good ground for his being as- tonished at the curative effects of the 200th or even the 2000th. Dr. Hartman denies that succussion is a meant of developing the dynamic power of a drug; he thinks that attenuation by succussion is a simple process of dilution. In this I think he is grievously mistaken. How will Hartmann explain the fact that a drop of the tincture of Belladonna, when simply stirred in a glass of water, has frequently no effect, where a few pellets of the thirtieth potency will effect a speedy cure, or where a cure is effected by that same drop if it be mixed in a tumblerful of water by turning the solution some thirty or forty times from one tumbler into another, and then mixing a table spoonful of that solu- tion with another tumblerful of water and turning this second solution again thirty or forty times from one tumbler into a second one 1 I can affirm that I have effected many cures with a double-attenuated solution where a simple dilution of the tincture left me entirely in the lurch. As regards the highest potencies, I protest both against their exclusive use and against the injudicious neglect with which many practitioners treat them. I have used them in many violent cases with the most perfect and sometimes with in- stantaneous effect, and do use them now every day to my entire satisfaction. I have reported a number of cases in the Homoeopathic Examiner where the curative action of the highest potencies is so evident that no sane man can doubt it, and in many cases I have obtained results by means of the highest potencies where the lower potencies had entirely failed, even when adminis- tered by skilful hands. A lew weeks ago I was requested to take charge of a lady who had been suffering with consumption brought on by mismanaged pneumonia. Her most distressing symptom was a hard wheezing cough with most difficult expectoration ; she had a turn every five minutes. This lady had been treated homoeopathically for several months past, and the last medi- cine that had been given her was crude sulphur, of which she took three powders a-day, and had already swallowed twenty powders in all. The patient told me that her cough had been getting worse ever since she had taken those powders, and that her distress had become so excessive that she could not take the medicine any longer. Sulphur, however, was the remedy. I gave her two pellets of the 800th potency in water, a table spoonful every six hours, and when I saw her again, three days after, her cough was much less, the paroxysms were much less frequent and less violent. The lady re- marked to me, " What a comfort it is to be able to sit without coughing." In the second number of the Homoeopathic Examiner, Vol. IV., I have re- Eorted a case of neuralgic colic of upwards of three years' standing, which ad been treated for eighteen months by the first homoeopathic physicians of this city. When I took charge of the patient, she suffered the most agon- izing pain from morning till night, and the friends of the patient—a most in- teresting young lady—had given up all hope of ever seeing her relieved. I can affirm, as a man of honour, that that patient has not only been relieved but entirely cured, by the 200th potency of Ipecacuanha. I might adduce the written testimony of the patient's mother to show that the cure has been complete ; but 1 forbear on account of the flattering remarks contained in that paper. Among other cases where the lower preparations have failed entirely and where the highest potencies have effected a cure, I may mention the follow- ing:—A gentleman of thirty years had an inflammatory rheumatic fever which was treated allopathically ; in the course of the treatment he lost his appetite, his bowels became aflected, and after the treatment had lasted a whole year he concluded to submit to homoeopathic treatment. His symp- toms were : Constant uneasiness about the bowels, excessive qualmishness, constant desire to evacuate the bowels, which were very sluggish; violent 68 INTRODUCTION. The susceptibility to medicinal influences is greatest in very small children and is at its acme in subjects entering upon pubescence, a period when the more noble developments take place. These are epochs when (as a general rule— Trans.) the organism requires but minute doses of medicine which ought to be so much more minute as the medicine has a specific rela- tion to the organ. This observation is likewise appli- cable to females, who generally require smaller doses. The constitution of the patient is likewise to be taken into consideration. Phlegmatic and torpid temperaments require tin1 lower attenuations ; sensitive persons, on the contrary, with a sanguine or choleric temperament, the higher. Persons whose sensibility has become obtuse in consequence of the abuse of spirituous and heating beverages, spices, piquant dishes, require larger doses of medicine to excite the necessary organic reaction. This shows that the mode of life has a great influence on the constitution. Mental labour, the reading of novels which excite the imagination, a sedentary and elfeminate mode of life, and longsleeping, increase the sensibility ; heavy labour, country-air. substantial and nutritious food, living in apothecaries.or tobacco-shops,distilleries,etc.,diminish it. It is likewise certain that persons who have been treated with Lead, Mercury, Iodine, Cinchona, Valeri- ana, and other drugs, and are now suffering with a com- shooting pain from temple to temple through the forehead, occasionally a neuralgic pain in a small circumscribed spot of the left parietal bone ; but his greatest trouble was an abominable coating of the tongue, which was at least one line in thickness, and had a most horrid appearance ; when I saw it for the first time it positively sickened my stomach. That gentleman enjoyed for six months in succession the treatment of a distinguished homoeopathic physician, under which he got worse instead of better. I cured him with the 200th and 300th potency of Aconite, bowels, head, tongue and all; his tongue now looks as clean as any man's. Why should we close our eyes to such facts 1 No honest practitioner does, but alas! how few are there among us who are honest and devoted inquirers. Most physicians look upon themselves as accomplished artists, who cannot learn anything of anybody, and who ought to reject and deride the experi- ence of their fellow-practitioners if it should at all appear strange and some exertions should be required in investigating and \erifying it. How an ex- perimental science is to be benefitted by such want of application and by so much impudent conceit, is difficult to understand. Fortunately the interests of true medicine are not jeopardized by the neglect of a few men, and, be- sides, there are plenty of brave men in the homoeopathic ranks who will never shrink from fulfilling their high trust. 72 INTRODUCTION. 87 plication of the natural disease and medicinal poisoning, require larger doses than would have been necessary previous to such a poisoning having taken place.* Climate has also a powerful influence on the constitu- tion, and indirectly upon the magnitude of the dose, as we know from experience. The character of the disease, which we are called upon to treat, is likewise an important consideration in the selection of the dose. Erethism and torpor cannot possibly be treated with the same dose. In a state of erethism the vital functions are carried on with great rapidity, and require for their regulation the higher potencies ; in torpor, on the contrary, the vitality is very much depressed, and requires to be roused into,re- action by larger and st ronger doses. Inflammatory and spasmodic affections soon show a favourable reaction after the use of high potencies, etc. The magnitude of the dose is also determined by the seat of the disease, for the greater the sensitiveness of the affected organ, the smaller ought to be the dose, and vice versa. In general we may lay it down as a rule, that affections of the vegetative system, unless they are of a decidedly inflammatory nature, require larger doses, as do likewise affections of the mucous mem- branes. The intensity with which the drug of its own nature is prone to act, seems to require a particular consideration in determining the dose. It is true that in his later years Hahnemann and the admirers of the highest po- tencies have overlooked that rule. What a difference there is in respect to the intensity of action between Sambucus, Viola-odorata, Verbascum, Leontodon, Euphrasia, Dulcamara, Crocus, etc., and Belladonna, Arsenic, Rhus, Phosphorus, Corr. subl., Lachesis, Pso- rieum. and many more. Does not the affinity of certain remedies to cer- tain organs require a particular consideration? Un- doubtedly it does. The more homoeopathic the * The best means to relieve the organism of the influence of such medici- nal poisons, is the hydropathic treatment, which ought to precede the homoe- opathic treatment.—Hempel. 68 INTRODUCTION. remedv is to the disease, the smaller ought to be the dose. Sulphur is a specific to many diseases where its best effects arc exhibited by the high attenua- tions, whereas in scabies repeated doses of a lower po- tency do more good than the higher attenuations. In many catarrhal diseases to which Dulcamara is a specific, the lower potencies of that drug will do more good than the higher. Rheumatic paralysis for which Bellad. is indicated, requires a much stronger dose than encephalitis. In inflammatory fevers large doses of Aconite may be given when it is not homoeopathic to the local inflammation: whereas, if this homoeopath- icitv exist, the higher potencies of Aconite are re- quired. ^\\ some cases the higher potencies of the specific remedy are without any effect; this makes it necessary that we should employ the lower attenuations except when there is a peculiar idiosyncrasy toward one or the other remedy, as is known to be the case with \ux, Arnica, Crocus, China, Mercurius," of which the high- er attenuations are required in all such cases. If in prescribing a remedy, we consider carefully the various conditions which have been indicated in the foregoing paragraphs, we shall in most cases be enabled to give a dose which willbe just sufficient to excite the necessary curative reaction in the affected organ. From all this we see that the dose ought to be strong or weak according to the nature of the ease, and that even a weak dose may yet produce an exacerbation of the symptoms. This exacerbation, however, is not a necessary occurrence, si nee it frequently happens that the patients, instead of experiencing an exacerbation of the symptoms, feel a peculiar quietude, a disposition to sleep; sometimes even they fall into a sound sleep which lasts a longer or shorter space of time and is * I have had a female patient who could not take Aconite or Digitalis, which she required to take for a nervous disorder, without experiencing a most distressing nausea, which would sometimes be felt even alter taking the 200th potency. Whenever her nervous system had become excited by fright or by other causes which seemed to require the administration of Aconite, she expressed an utter aversion to Aconite. Coffea toothed her in a moment.—Hempel. INTRODUCTION. 69 generally very refreshing, and from which the patients sometimes wake cured, if the nature of the case admit of such a speedy change. Both the medicinal aggrava- tion and the soothing effect of the remedy are sure proofs to the homoeopathic physician that the remedy is well chosen. Although that remarkable phenome- non occurs both in acute and chronic diseases, yet it is seen much more frequently in affections charac- terized by a morbid excitement of the organic life, especially when the higher organs are involved, in ner- vous irritation, spasms of every kind, erethism of the vascular system, including pure inflammation, erethism of the lower organs, such as the mucous membranes, glands, bones, etc. (but much less frequent in the lat- ter), in irregularity of the sleep. Children, in whom the vegetative system prevails, are especially apt to sleep after taking the true homoeopathic specific* Since it is an established fact that a true homoe- opathic specific may either produce an exacerbation of the symptoms, or a curative sleep,I and we are un- able to determine the normal dose which will under all circumstances occasion those results, we therefore advise the beginning practitioner not to pledge him- self to any dose in particular but to use the whole s,cale of potencies to the best of his judgment. What has been most perplexing to the scepticism of the old school is the possibility that such small doses should have any effect upon the organism. This scep- ticism arises principally from the fact that old school plrysicians give their remedies every hour in a crude state and in large quantities, and have no idea of the dynamic power residing in a drug. However much the human understanding may be at a loss to account for the power of our small doses by any thing known in science, there is no doubt that the possibility of such action may not only be conceived according to natu- * See reflections on Sleep, which is in many cases a direct result of the action of homoeopathic specifics upon the affected organism ; by Dr. E. Stapf, Archive, Vol. V., No. 3, p. 1. t See No. 4 of Vol. IV.of Horn. Exam., in the case of typhoid meningitis re- ported by Dr. Hempel, where this curative sleep set in almost immediately after the administration of Hyosciamus 30. 70 INTRODUCTION. ral laws, but that it has been proven by the universal experience of all homeopathic physicians. To cure diseases, both homoeopalhs and allopaths,use medicines. All those substances which we use as dru-rs. must be able to disturb the organism by their direct action upon it. each in a specific manner. From a central point the morbid phenomena spread, invading successively other systems. If we consider the action of remedies from that position, we perceive at once that the homoeopathic agent is alone suitable in all dis- eases. It would seem as if we ought to stumble upon the truth that a medicine and a morbid action both of which are characterized by the same phenomena, must primarily act upon the same centre. On giving a homoeopathic remedy in a sufficient quantity to produce symptoms, the disease must necessarily be aggravated ; on the contrary, by giving the remedy in so small a dose that it cannot affect the organism medicinally, the remedy must necessarjlv act upon the vitality of the invaded centre, from which its in- fluence will successively extend over the organs which are eonsensually related to the centre ; the disease will therefore be cured without being first aggravated.* This is no proposition of the pure reason, but one de- rived from experience after numerous observations and experiments. Why should we disbelieve a latT on the ground of its having been wrongly accounted for, and why should we not do again what we. have done so many thousand times, in order to obtain again the same good results ! We do not deem it necessary to repeat in the present instance the many striking proofs which have been offered to the opponenls of homoeopathy, that striking effects are frequently pro- duced by spiritual, or dynamic forces. We will simply state that if the healthy organism can be influenced by atmospheric impressions, atmospheric vibrations upon which the perception of sound and light depends, and by other imponderable agenis, why should it be denied that an organism invaded by disease can be * See Ideas on the Formation and Cure of Disease by D Drcchslcr of Diiben, in the Med. Annals of Altenburg, March, 1S15. INTRODUCTION. 71 acted upon by minute doses of highly refined thera- peutic agents when it cannot be denied that those agents possess a dynamic power. We refer the reader to Hahnemann's beautiful treatise : " How is it possible that small homoeopathic doses of a highly attenuated medicine, should still possess power, great power ? "* We likewise recommend Dr. Trink's excellent treatise in opposition to Hahnemann: Reflections on Doses,f and Dr. Gross' reply .J We beg leave here to record our own opinion about the action of our doses, which is sometimes of long duration, and sometimes is not perceived at all. Of that action Hahnemann says in the Chronic Diseases : § '" This is not one of those propositions which can be comprehended ; nor do I ask that it should be blindly credited. I do not comprehend it either, but the truth is as I have stated. This is a matter of experience in which 1 have more confidence than in my own com- prehension." The experience which we possess of the power of the doses, may be deemed sufficient, and, it is all that we shall know about it for some time to come. However, we, no more than others, have been able to resist the desire which is inherent in the human mind of explaining every phenomenon which interests man; and inasmuch as it cannot be denied that the power with which homoeopathic doses act, is a most interesting and remarkable occurrence, we have tried to explain it to our mind as satisfactorily as possible, although we admit that our explanation to- gether with all others, rests upon a hypothetical basis, having more or less probability in its favour. It is well known both to allopaths and homoeopaths that the human organism cannot be invaded by a morbid force, be this either spiritual or material, unless the organism is in a state of adaptation to that force or in a state of susceptibility to its influence. This fact can be illustrated, by examples. Epidemic scarlet-fever, erysipelas, measles, etc., do not attack anybody who has • Materia Med. Pura, by Dr. Hempel, Vol. IV. t Annals ofHom. Cliniq le, Vol. Hi., No. 2, p. 127. Allg. horn. Ztit , V( 1. I., p. 43. Chronic Diseases, Vol. 1., by Dr. Hempel. 72 INTRODUCTION. not vet had those diseases; we frequently see one or two indiViduals in a family where either ot those diseases prevails, remainin- free from the disease, but they are attackcdbv it when the disease occurs a second time and and when "the oriranisms of those individuals are more susceptible to it than they were during the first invasion of the epidemic. Xot all persons who expose ^hem- selves to the contagium of itch or syphilis, will be infect- ed by it : such an infection will only take place in persons whose organisms are predisposed to the recep- tion of the miasm. If the predisposition of the organ- ism were not necessary to its infection by a conta- gium. how could wo account for the fact that of ten persons who are bitten by a mad dog, only two or three become affected with hydrophobia. A sick organism is much more vividly affected by external disagreeable impressions than an organism in a state of perfect health, which may be left entirely undisturbed by those impressions. The sick organism beinjr so easily irritated by the least disturbing causes, it requires on the other hand very little to affect it favourably. It is upon this fact that we account for the efficiency of homoeopathic doses. The homoeopath- ic agent and the morbid force disturbing the organism in a similar manner, their disturbing influence must be directed primarily against the same central point in the organism, and, in disease, that central focus must therefore be readily influenced by the homoeopathic agents, so that the natural irritation will be easily, thoroughly and permanently counterbalanced and ef- faced by the artificial influence. Although Hahnemann has shown that the inherent power of a drug is only properly developed by the dy- namizing process, yet we believe that the real dy- namic force of the remedial a^ent begins to act only when it meets the central focus of the disease, to which the homoeopathic agent conjoins itself as the seed does to an appropriate soil ; if that central focus be not met, the dynamis of the homoeopathic agent remains in a latent state and the disease goes on in- creasingly ; or else the remedy may develope its own INTRODUCTION. 73 pathogenetic symptoms, which become engrafted upon the disease without any benefit to the patient. This "takes place in cases where the remedy is not homoe- opathic to the disease, where it covers a few symptoms only without corresponding to the fundamental charac- ter of the disease, or where the dose was too powerful or the patient's sensibility too great. To avoid either of those results the homoeopathic physician ought to possess a perfect knowledge of disease, in order to be able to distinguish essential from accidental symptoms, but he ought likewise to possess a complete knowledge of the symptoms of our drugs, in order to be sure that the remedy he selects is the true homoeopathic specific. If those conditions are • fulfilled, the curative reaction of the organism will seldom fail to be excited in such a degree as will lead to the restoration of the patient's health in the most ex- peditious and safest manner. We, no more than Hahnemann, comprehend how medicines can act for so long a period; and yet we sometimes let them act much longer than Hahnemann did, and sometimes we give them more frequently, even the antipsorics, than he advises in the Chronic Diseases. On that subject we beg leave to record our opinion as follows: It has already been mentioned that the action of the? homoeopathic agent is seen most brilliantly when it bears directly upon the central focus of the disease, which must always occur when the remedy is the true homoeopathic specific. If the remedy be homoeopathic to the disease, the organic vital forces will be power- fully roused in opposition to the heterogeneous influence of the drug. The vital reaction being once excited and having succeeded in overcoming the artificial dis- turbance, it does not at once compose itself to a state of rest, but it continues active until the normal condi- tion of the affected organs shall have been restored. Itis for this reason that the curative reaction sometimes continues for weeks and months, provided the remedy was perfectly homoeopathic to the disease. The cura- tive reaction lasts much longer in a chronic than in an 1 74 INTRODUCTION. acute disease : the former being more deeply rooted than the latter. The duration of the curative reaction may be illustrated by the vibrations of a musical cord, which continue long after the cause which excited them has ceased. It may likewise be illustrated by the fact that a long and progressively increasing dis- ease may be excited by a momentarily existing cause ceasing the moment after its influence upon the organ- ism has been established. As regards Hahnemann's views about the selection of the remedy, they have been considerably changed by experience. He thought that the medicines which he had proved first were more suitable to acute and the so-called antipsorics to the chronic diseases.* Experi- ence however, which is the safest guide in medicine, has convinced Hahnemann and all homoeopathic phy- sicians that such a division of our remedies into antiphlogistics and antipsorics is not founded in .Nature, inasmuch as the antipsorics are frequently used in acute diseases, such as Phosphorus, Acidum phosp., Carbo veg. in cholera morbus, and the anti- phlogistics in chronic, such as Chnmomilla in eardial- gia, Acidum hydro*'.. Verbascum in chronic affections t;f the larynx. Hahnemann being convinced that his former views on that subject required modification, he incorporated a number of his first remedies in the second edition of his Chronic Diseases. In regard to the treatment of Chronic Diseases we refer to some observations which have been communi- cated in the second number of the eighth volume of the Archive, p. 3:5, and which are still valuable to the practitioner. We there read : " Every physician knows that chronic affections in their incipient stage are so little troublesome to patients lhat thev do not consult their physicians until, after a very grad- ual and sometimes scarcely perceptible develop- ment, the affection breaks forth in an acute form, acute rheumatism, acute gout, etc. Although these * By antipsorics Hahnemann understands those remedies which he proved after the discovery of his psora theory and which arc contained in the Chronic Diseases. INTRODUCTION. 75 acute-chronic afFeelions depend no doubt upon a chronic miasm, yet it would not be advisable to treat them with antipsorics from the very commencement, for this reason, that the antipsorics frequently occasion a considerable aggravation of the symptoms in the first two weeks, which it is very difficult to counter- balance by other remedies. The vehemence of the acute attack ought in the first place to be allayed by a remedy which does not properly belong to the class of the antipsorics, and after the disease has been reduced again to its former condition, then the antipsoric treat- ment ought to commence. After having instituted a number of experiments in regard to the best mode of treating chronic diseases, we have adopted the follow- ing views in reference to that subject: Do not begin the treatment of every chronic disease with an anti- psoric, but sometimes with one of the former remedies, especially when the disease had been successfully, and, as may hence be inferred, specifically treated with one of those remedies previous to the antipsorics being known. Among them the principal are the polychrests, some of which are equal to the antipso- rics in the treatment of chronic diseases; we may mention Belladonna, Nux, Rhus, Staphys., Asa., Dulc, Me/.ereum, Sarsap., Ars., Coloc, Hcpar, Anac, Clem., Puis., Ignat., etc.* The reviewer of my first edition objects to the last proposition and would like to see it altered. Numer- ous experiments, however, have convinced me that my opinion is not altogether incorrect. Even before me many physicians have objected to any rigorous line of demarcation being drawn between antipsorics and the remedies for acute diseases; they have proposed that remedies should be administered with reference to the symptoms independently of that division. I propose the same thing, viz. that no remedy which has been known to act as a specific curative in a given disease, be discarded until we know a substitute for that remedy which will act still more specifically. * Dulc, Me/. , Sarsap., An, Coloc, Hcpar, Anac, Clem., belong to the antipsorics.—Uemi'el. 7b' INTRODUCTION-. It is an acknowledged fact that antipsorics are the best remedies for disorganizations and such affections as could not be cured by any of the non-antipsoric remedies, or when these are not indicated in the pre- sent case. In all such cases, the treatment ought to be commenced with Sulphur, the best preparation,be- ing the tincture of Sulphur, one dose a-day for 1, 6 or 8 clays in succession, provided the Sulphur is at all in- dicated by a few or more symptoms, or the patient, has ' a distinct recollection of having had the itch. The Sulphur may be continued until several symptoms make their appearance which the patient has not yet felt on any former occasion. After the action of the Sulphur has been distinctly perceived, it ought to be discontinue^* and, as soon as the Sulphur has ceased to act, the patient ought to be given another antipsoric which is most homoeopathic to the symptoms. This will act with so much more certainty and success after the Sulphur has been given. This second anti- psoric has likewise to be repeated, but loss frequently than the Sulphur ; the frequency of the repetition has to be left to the judgment of the physician. If a well- chosen antipsoric should not act as well as the phy- sician had a right to expect, he then may again recur to a few doses of Sulphur to secure a more favourable reaction, and afterwards give the next suitable anti- psoric ; in this way the Sulphur may have to be re- peated two, throe or four times during an antipsoric treatment. In spite of this truly scientific proceeding in the treatment of inveterate diseases,especially when disorganizations have already occurred, the physician sometimes fails in accomplishing anything, and the disease goes on in its course. Under these circum- stances the dose has to be increased, which is some- times the only means left to benefit the patient.* In the treatment of acute diseases, success depends entirely upon the proper selection of the homoeopathic agent; but there are cases in which the ordinary specifics have no effect. This deficient action of the * Under these circumstances the most marked success has been obtained from the highest potencies.—Hempel. INTRODUCTION. 77 remedial agents frequently depends upon an impover- ished vital force, or upon an excess of vital energy in one or the other part of the disturbed organism, owing to which the curative reaction is either entirely or at least partially prevented; in such cases the pa- tient is first to be mesmerized, after which the homoe- opathic specific, which would not act before, will be- come a most efficient agent. Sometimes the want of action depends upon a latent dyscrasia having been excited by'the acute disease, which requires a suitable antipsoric to be again reduced to a latent state. Sul- phur is generally the best antipsoric to be employed for such purposes, it removes the symptoms which had appeared in company Avith the acute disease, or, at any rate, it restores the original character of the acute disease, and enables the previously employed remedy to exhibit its full action. The following observations relative to the treatment of acute affections may conclude our general remarks about the homoeopathic treatment of disease. If no change of symptoms occur two, or at most four, hours after the dose has been taken by the patient—provided the dose was of sufficient magnitude—this is a certain sign that the remedy is not homoeopathic to the disease, and that another more suitable remedy requires to be selected. But if an improvement commences a few hours after the taking of the first dose, if the conscious- ness becomes freer, the sleep is more quiet, the skin moist, no other dose or remedy ought to be given until the improvement censes. In acute diseases where life is in the most imminent jeopardy, the- medicine may be repeated every fifteen minutes, half hour, hour, or every two, or three hours, provided the physician is sure of having selected the proper remedy. This frequency of repetition is espe- cially admissible in inflammatory affections, asthmatic complaints, typhoid fevers, dysentery, cholera and dis- eases of a similar kind, etc. The attenuation ought, of course, neither be too high nor too low. We now come to mention the fifth fundamental principle of homoeopathy, which is just as important as 7S INTRODUCTION. it is characteristic of our practice ; it is this, that no more than one remedy at a time ought ever to be given. Bv mixing several remedies together, in old school fashion, the peculiar elfecls of each are easily disturb- ed, or even neutralized, or a compound effect results from that mixture which it is impossible to determine a priori, and which wo can only ascertain by proving the mixture upon the healthy organism. This, how- ever, will probably not be undertaken as long as there are simple remedies left of which the physiological action upon the organism remains yet to be ascertain- ed. If the homoeopathic physician were to recom- mend, in company with the homoeopathic agent the use of herb-tea, herb-bags, fomentations, injections or ointments composed of medicinal herbs, he would commit the same mistake which we censure in old- school practice, and he could not rely upon the effect of the small homoeopathic doses. Some homoeopathic physicians have tried to mix two remedies, one of which seemed homoeopathic to one portion of the symptoms, and the other to flit' remain- ing portion ; but the results did not answer their ex- pectations, and all good homoeopathic physicians were soon convinced ihat such a course would have occa- sioned the ruin of true homoeopathy, and would have degraded our practice far below the practice of the old school. It would be as pernicious both to our patienls and praclice, to mix our remedies, as it is useful in many complicated eases, to uipire a good deal, his linen ought to be changed several times a-day, always observing the usual precaution. The patient ought never to have on too much covering, lest an unnecessary perspiration should be induced. In order that the patient may not be obliged to have his breast constantly covered with the bed-cover, and may be allowed to keep his arms upon the cover, he ought to wear a vest over his night-shirt, which is to be made of cotton in summer, and of wool in the winter. SPECIAL PATHOLOGY OF FEVERS. FIRST CLASS. FEVERS AFFECTING PRINCIPALLY THE CIRCULATORY APPARATUS. § 23. Synochal or simple inflammatory fever. A better knowledge of human diseases and an al- most boundless experience have convinced modern physicians that a pure synochal fever either does not * The Germans are in the habit of using feather-beds as a covering, which ought not to be tolerated in the sick-room, except when the patient com- plains of excessive cold, in which case a very light feather-bed may be u*ed. SYNOCHAL FEVER. 109 exist, or at any rate that it does riot exist long without affecting a special organ, and that it occurs especially as an accompanying symptom of inflammation. Xot being an idiopathic disease,it is not subject to any fixed therapeutic rules. We have long meditated on the subject whether a pure synochal fever ought to be men- tioned in a work on pathology. In treating of the special diseases we found ourselves frequently obliged to repeat certain general remarks, and we therefore concluded to devote a few pages to the pathology and treatment of that class of fevers, in order to be able to refer to that chapter whenever occasion should require. The synochal fever occurs not only as an accompany- ing symptom of inflammatory diseases, but also in young, vigorous, plethoric subjects, after wounds, burns, etc., in the shape of a febris irritativa, and as such requires the attention of the physician. The simple, benign, acute, ephemeral fever requires no medical treatment, except when the fever assumes -a different form in consequence of the reaction of the organism having been interrupted by the indiscreet conduct of the patient. Another fever arising from an irritation of the organism, is the fever of dentition, which is more closely related to a synochal fever than is any other kind of fever. According to Sehcenlein the synochal fever is of the species of phlogosis ; he places it under the head of arteritis and phlebitis. Our opinion is that Schoen- lein's view is confirmed only in a few cases, and that the synochal fever is scarcely ever sufficiently de- veloped to deserve the appellation of either arteritis or phlebitis. All the symptoms of an inflammatory fever show that the irritable sphere is principally affected, the heart and the blood vessels are irritated, their power being apparently increased, and the temperature of the body being considerably elevated. The nervous system and the digestion are less affected, hence it is that the sensations of the patients are correct,definite and clear, and that he is fully conscious of his com- plaints and feels his sufferings intensely. When the 110 SYNOCHAL FEVER. cerebral irritation is considerable from the very com- mencement and the delirium is more continuous.there is ground for apprehending a typhoid fever. The fever commences with a violent chill, followed by continual heat, the pulse is hard, full, accelerated, not easily compressible, the tongue is dry, slightly coated, and the skin is dry ; the dulness and heavi- ness of the head, which exist in the commencement of the paroxysm, soon pass into an aching and pulsating pain, especially in the forehead; the face becomes red, hot, the eyes shining, and, in sensitive subjects, the erethism increases even to spasms and delirium. The breathing is hurried, anxious, the breath hot and dry ; the arteries throb, the secretion of urine is di- minished and the urine itself is red and fiery; the thirst is excessive. The restlessness and anxiety in- crease, alternating with interrupted slumber and stu- por. The appetite disappears, but the heat and dry- ness of the mouth occasion an increasing desire for cold water. Perspiration affords relief, but the skin is generally dry and hot. The symptoms are worse in the evening; their violence begins to abate after midnight, and is least in the morning. A general inflammatory fever seldom exists with- out some local inflammation, especially when there is a congestion of blood to a special organ in the com- mencement of the disease, in which case the pulse is contracted, small, but hard. These fevers are fre- quently accompanied by bleedings, especially from the nose, which, however, afford a good deal of relief. Synochal fevers seldom last long unless they have become complicated by the supervention of some other affection, or have passed into a different form of fever; they frequently terminate after a short dura- tion by a critical sweat, and a turbid urine depositing a sediment. § 24. The prognosis of an inflammatory fever is fa- vourable. Such a fever is never fatal of itself. It may become so, however, by passing into another dis- ease or by terminating in exhaustion, which is the case when the fever becomes complicated with in- BYNOCHAL FEVER. Ill flammation of a noble organ, of the veins or arteries, or when a typhoid condition supervenes. In giving a prognosis the physician has to consider the peculiar character of the disease in the case of his patient, and the individuality of the latter. Among the exciting causes we may notice the fol- lowing : the tendency to epidemic diseases and the peculiar character which diseases are disposed to as- sume, more particularly in spring and winter when north-westerly winds prevail; the excessive use of stimulating and heating food, producing a correspond- ing excess of animal life ; suppression of the activity of the skin and of other secretions, echauffement, vio- lent exercise, abuse of spirituous drinks, contagia, wounds, burns, dry and cold air, not to forget violent emotions, such as fright, fear, chagrin, anger ; or the violent irritation which children suffer during the pe- riod of dentition. § 25. In treating these fevers we have, in the first place, to consider their character and course. At the commencement of the fever, it is not very difficult to select a remedy. The business of the physician is to allay the fever before the local inflammation has developed itself. There is no better remedy to allay the lever than Aconite. The physician is scarcely ever sent for during the chill, as it is supposed that this chill, which sets in suddenly and without any pre- cursory symptoms, is a merely transitory symptom the end of which ought to be awaited first before sending for a physician. If the physician were sent for during the chill, it would not be advisable that he should administer a remedy before the second stage has made its appearance ; for in that stage it is much easier to select a remedy, inasmuch as the symptoms of the ease, have become more numerous and more charac- teristic. In general it is not advisable to exhibit the homoeopathic remedy during the chill, as we have abundant evidence of the fact that, by so doing, the disease is considerably increased. The essential sphere for the action of Aconite are the erethic fevers, the inflammatory erethisms of the 112 BYNOCHAL FEVER. vascular system, and the first stage of catarrhal. rheumatic, and traumatic inflammations; hence that sphere extends from the simple ephemeral erethisms up to the synoeha, and from the simple catarrhal and rheumatic fever up to the most intense phlogo- sis, without any marked local affection. Aconite is a true universal remedy, our most charming an- tiphlogistic, superior to venesection, leeches, and cupping: it cures without depletion, and in a much shorter time than those violent means which weaken the organism and reduce its vital energy. Any one who is acquainted with the physiological effects and the true character of Aconite, must certainly know from experience that Aconite can only do good in the sphere of action which we have assigned to it, pro- vided the dose is proportionate to the susccptihilily of the patient's organism and the intensity of the disease. Aconite is a specific remedy in inflammatory fevers with congestion to the chest or head, the pain which the patients suffer, appears intolerable to them, they are exceedingly nervous and restless ; this is especially the case with young, lively, plethoric subjects leading a sedentary life. Aconite is especially useful in fevers which are occasioned by raw north-westers or by a current of air, and which are characterized by the following symptoms: great general heat, especially about the head and face ; vivid redness of the checks, great thirst, stinging, beating headache and excessive painfulness of the whole head, vertigo and nightly delirium, restlessness, moaning, anxiety, tossing about in consequence of the limbs feeling bruised and para- lyzed ; alternation of chilliness and dry, burning heat, with shortness of breath and dry, hacking cough : in- tolerance of noise, ill humour, despondency even unto weeping; glistening eyes, roaring in thecals, great irritation of all the senses ; dryness of the lips, mouth and tongue : hasty and tremulous speech, burning un- quenchable thirst, bitter taste with empty eructations and with a qualmish feeling in the pit of the stomach; scanty secretion of a highly-coloured, hot urine. The dose should be adapted to the age and constitu- SYNOCHAL FEVER. 113 tion of the patient. In the commencement of the dis- ease and in young and delicate patients, the higher attenuations are sufficient; full-grown, vigorous patients, and the later periods of the fever, require stronger doses, sometimes even a drop of a lower at- tenuation. This kind of fever generally resolves it- self into a sweat, which is extremely salutary and beneficient in those affections, and is so much more decisive as its appearance has been speedily induced by the homoeopathic agent. It is highly improper to elicit the sweat by artificial heat, whether externally or internally applied. The best means to cause the sweat to break out is a suitable dose of Aconite, which may be repeated at proper intervals and whose action may be assisted by giving the patient as much cold water as he desires. If the sweat breaks out, and the urine becomes more watery, the fever is broken and no farther medication is required. If the synochal fever be merely an accompanying symptom of a local affection, our first duty is to mode- rate the fever, unless we know a remedy which covers both the fever and the local affection. Even in most of these cases, Aconite is the principal remedy, corre- sponding both to internal inflammations and to in- flammatory cutaneous diseases. We refer the reader to the second division of the first volume, where both classes of diseases are treated in detail. There are several other remedies, besides Aconite, which may be used for the cure of synochal fever, but they are much less important than Aconite, and can only be employed when the fever assumes a particular form from the commencement, when it is not very vio- lent, when the orgasm is confined to certain regions, and when secondary symptoms occur. The principal remedies, next to Aconite, are : Bell., Bryon., Mercur., Canthar., Cham., Arnica ; other remedies which have been placed in the same category with the preceding, do not properly belong here, as they are given in dis- eases where the fever is merely a sympathetic affec- tion. , Belladonna is the principal remedy, and ought to be 114 SYNOCHAL FEVER. given after Aconite, in cases where the cerebral sys- tem is principally affected, and the following symptoms occur: burning heat, especially of the head and face, the latter being red and puffed; strong, quick, full pulse, violent burning thirst, intense delirium, espe- cially at night, vertigo and aching in the forehead as if it would burst; red, shining eyes, anxiety and rest- lessness, and tendency to start. Bryonia is indicated when the orgasm of the blood is principally confined to the organs of the chest, ac- companied with great erethism of the vascular and nervous system; burning, dry heat mingled with chills, violent thirst, headache as if the whole contents of the head would issue through the forehead, anxious sleep, disturbed with moans, short cough and oppression of the chest. In a synochal fever of that sort gastric symptoms frequently supervene and change the syno- eha to a synochus ; for many complications of that kind Bryonia is likewise the specific. Mercurius acts similarly to Bryonia, with this dif- ference, that it is not so much indicated by local symp- toms as Bryonia, and it is principally required in in- flammatory fevers characterized by erethism of the nervous system, a disposition to profuse sweat, an accelerated, irregular pulse, and excessive thirst with desire for icy-cold water. These symptoms are accompanied bydulness of head, and a pressure in the parietal regions from within outwards, undulations and beatings in the sinciput. The supervening gastric- bilious symptoms likewise indicate a complication or rather the transition of the pure synochal into a gastric fever, for which Mercurius is likewise a specific. Cantharides are indicated in violent burning fever, especially at night, with accelerated, strong pulse, general redness of the skin, violent thirst and dryness of the mouth, accompanied by painful sensations in the right side of the body, great anxiety, delirious talk about business, etc.* Neither Cantharides nor Chamomilla can be said to Especially when there is a frequent desire to urinate—Hempel. FEVER OF DENTITION. 115 be indicated in pure inflammatory fevers ; the fevers for which those remedies are indicated consist rather of attacks of heat having the character of a synochal fever; the fevers indicating Chamomilla are charac- terized by heat mingled with occasional chills, by bright redness of the cheeks, tremulous and anxious palpitation of the heart, great irritability of temper and excessive sensibility of all the senses, etc. Chamo- milla corresponds especially to those fevers which have been occasioned by anger and chagrin (giving first, however, a few doses of Aconite), and are generally accompanied by spasmodic symptoms. Arnica corresponds only to such inflammatory fevers as have been occasioned by contusions, tearing of muscles, and wounds of any kind ; the violence of the orgasm requires in the first place to be moderated by Aconite. If the injuries are very considerable, dilute tincture of Arnica maybe used externally, in the shape of a wash or a poultice. § 26. Fever of dentition. The cutting of teeth is no disease of itself, but a natural occurrence in the period of evolution. It is a stage in the physical development which marks at the same time the commencement of the intellectual life of the child. At that period the child begins to utter articulated sounds and to exhibit signs of rationality.* Life, in this period, is liable to the same dangers as in the other periods of development. If the irritation produced by the cutting of teeth be very violent, which will generally be the case when several teeth are cut together, a febrile condition is induced resembling so closely a synochal fever that we deem it expedient to speak of it as belonging to that class of diseases. In order not to scatter the various ailments occurring during the period of dentition, through separate parts of this work, we shall describe them all in this chapter. * The great French philosopher, Charles Fourier, author of the Doctrine of the Universal Association of Capital, Labour and Talent, says, in his great work on that subject, that the period of dentition is the time when the soul truly conjoins itself to the body ; previous to that time the organism merely vegetates and exists from the same general vital principle that sustains the life of the planet. 116 FEVER OF DENTITION. Not all the morbid phenomena occurring during the period of dentition, are directly occasioned by the rup- ture of the gums: these phenomena as well as the teething itself are developments which belong to one another, and are characteristic signs of a new period of life upon which the child has entered : the child's individuality becomes more marked and the child is less dependant on the mother. Upon reviewing the whole life of man we will find that every new period of life is characterized by striking bodily phenomena, in which not only the nervous system but also the mind is interested more or less, in such a manner, however, that neither the physical nor the mental phenomena can be said to be either essential or accidental, prima- ry or secondary. The same remark applies to the cutting of teeth and to the phenomena accompanying that process. These phenomena are at times of a nervous, at times of a febrile nature, sometimes they are mixed. But whether nervous or febrile, they, as wtdl as all other infantile diseases, art1 easily recognised by the parents or the physician, and the symptoms are generally so well marked that it is much easier to select a specific remedy for the diseases of children than for those of full-grown persons, which may partly be owing to the children's mode of life being much more simple than that of full-grown persons. The phenomena of teething occur in the period from the fifth to the fifteenth or sixteenth month. The border of the jaw which requires to be pierced, gradually enlarges and becomes indented as it were, the child's mouth fills with water, the hand is frequent- ly and quickly carried into the mouth, or hard sub- stances are pushed into it to bite them, the mouth is hot, the child does not like the inner mouth to be touched, utters frequent and sudden cries as if in dis- tress ; the gums are swollen, whitish, especially so along the edges, as if a tooth were shining through, they become hot and painful. These symptoms are most frequently accompanied by diarrhoea, which, how- ever, is a natural derivative means, and the best pre- FEVER OF DENTITION. 117 ventive against fever, cerebral affections, spasms; in some cases constipation occurs instead of diarrhoea ; fever, cutaneous eruptions, heat of the head, cough, rattling, difficult respiration, spasms, convulsions, in- flammation of the brain or lungs, may likewise occur. In order to be able to judge correctly whether the phenomena accompanying dentition constitute an es- sential portion of that process in the case which we are called upon to treat, the physician ought to pos- sess a correct knowledge of the course and the cha- racter of the teething process. It is of course to be, presumed that every physician possesses that know- ledge ; however, in order to be complete, we will give a short description of the phenomena of teething in the subjoined paragraph. The teeth begin to be formed a few months before the child is born. The tooth forms by a process of crystallization out of a jelly-like substance contained in membranous sacs in the jaws. The formation of the teeth generally commences in the fifth month. This is the internal development of the tooth which is not perceptible to the senses, its internal growth, extension in every direction and consequent nervous irritation. First appears the middle pair of the inci- sors ; the outer pair appears later ; the first molar teeth are cut towards the end of the first year; the cuspidati at the end of the second year, and lastly the second molar teeth. The more regular, successive and retarded the cutting of the teeth, the less are the sufferings of ihe patient. The corresponding teeth on both sides are not cut at the same time, generally the lower teeth are cut first.—The symptoms abate and then recur again at intervals, they cease entirely as soon as the tooth is cut, increase in violence if the cutting do not take place, and frequently become fatal, convulsions, apoplexy and suffocation supervening. § 27. The ailments occasioned by a natural denti- tion do not require any medicine ; parents who are disposed to be very anxious, might perhaps be desi- rous of having some medicine given to their children. The erethism which generally accompanies dentition 118 FEVER OF DENTITION. is most easily subdued by a few doses of Coflea cruda. This remedy may however remain without any effect if the mother or the child should have been in the habit of using coffee as their daily beverage. In such a case Aconite and afterwards Chamomilla would de- serve the preference. A flow of saliva, loose stool or diarrhoea, which generally accompany the cutting of teeth, do not require any treatment : those symptoms disappear as soon as the cutting is accomplished. Children in whom the irritation consequent upon dentition, continues for a long time, and who lose strength or flesh in consequence of it, are relieved by a few doses of Calc carb., which ought to be given at tolerably long intervals; this remedy is generally suf- ficient to remove all the troublesome symptoms ac- companying teething without any other remedy being required afterwards. Teething is sometimes accompanied with a febrile condition, appearing and disappearing at intervals, and constituting a sort of synochal fever, the paroxysms of which recur every day. This is the real fever of dentition, and deserves especial consideration when it occurs in plethoric, fleshy children, in whom it in- clines to become a local affection. This fever is treated as every other affection, except that the suc- cessful treatment of that fever requires the utmost re- gard to the irritability etc of the patient, which is uncommonly increased at that period of life. All the diseases which occur during the period of dentition, as well as the morbid phenomena accompanying dentition, require the utmost care on the part of the practitioner. All that the physician can do is to subdue the irrita- tion of the various systems, and the disease is thus frequently cut short in the most striking manner. Aconite is the best remedy, by means of which that irritation is accomplished. In general, this remedy is of great importance in the diseases of infancy, where the least vascular erethism is easily increased to a synochal fever, on account of the greater activity pre- vailing in the vascular system previous to the develop- ment of the organs being accomplished. i\o remedy FEVER OF DENTITION. 119 is better adapted than Aconite to allay that fever; in cases where the febrile orgasm had been prepared and increased by the daily use of coffee on the part of the mother and the child, Aconite is indispensable prior to any other remedy. The slighter degrees of increased irritability in the vascular or nervous system, indicated by an increase of temperature ; thirst, sudden screams and grasping at the mouth, startings during sleep as if in affright, etc, are sometimes relieved with Coffea or Aconite, Chamomilla or Nux; Coffea and Chamomilla are especially indicated when the symptoms of a morbidly irritated sensibility prevail; Aconite is preferable when the principal irritation exists in the vascular system ; \ux is the best remedy when those symptoms are accompanied with a short and dry cough and cos- tiveness. If the excessive irritability and sensibility of the nervous system is accompanied with great sen- sitiveness to the pain occasioned by the breaking of the gums, with thirst, heat, and redness of one cheek, and sweat about the head, especially with a catarrhal cough, hoarseness and rattling of mucus in the trachea, in that case no remedy surpasses Chamomilla. Chamomilla is likewise the best remedy when the child has been brought up without the breast, and the fever is continuous, and accompanied with great agi- tation of the nervous system, as manifested by anxiety and restlessness, starting on hearing anything fall, or upon hearing the least noise, starting without after- wards being able, to compose one's-self, convulsive twitchings of the limbs while falling asleep. If Chamomilla should not be sufficient, if the patient be plethoric and fleshy, if the symptoms be worse in the afternoon or at night; if, for instance, convulsions or spasms be renewed by the least contact; if the child's limbs or head be very restless and in constant emotion ; if the sleep be interrupted by screams, moans, convulsions or jerks through the whole body resem- bling electric shocks ; if the patient suffer violent, burning heat, great thirst; if the skin be red, the limbs tremble; if there be anxiety, a short, quick, noisy 120 FEVER OF DENTITION. respiration, visible oppression of the chest, red eyes; in this case no remedy is better adapted to the symp- toni< than Belladonna. § 2S. Although we shall afterwards treat in detail of spasms and convulsions, yet we will here make cursory mention of the epileptic fits which some- times occur during dentition. To the convulsions oc- casioned by teething we have already alluded in the former paragraph. In many cases we observe, at first, the same symptoms as have been indicated in the preceding paragraph: in other cases the precursory symptoms are diarrhaeic stools for several days : in others, again, the fits are preceded for a few days by great paleness of countenance, faint eyes almost with- out any lustre, little appetite ; the child rests its head upon the shoulder of the nurse, and wants to lie down all the time. As long as these indefinite symptoms prevail, Chamomilla is the best remedy, by which more serious accidents are sometimes averted. If these precursory symptoms be left unheeded, the epileptic fit frequently sols in with great force : for a few minutes the child lies in a state of rigor, rolls its eyes, distorts the features, is attacked with convulsions, toss- ing of the limbs, clenching of the thumbs, the whole body bending backwards and sideways ; the breathing becomes wheezing and rattling, with foam at the mouth, and vivid redness and puffiness of the counte- nance; in short, all the symptoms of an epileptic fit set in, lasting from a few minutes to half an hour, after which the child, evidently suffering with congestion of the brain, falls into a sopor, at the termination of which the" convulsions either return immediately or after a short interval. Although no fever may be present when the fits first commence, yet it appears shortly after, as a secondary affection, in the shape of an inflammatory typhus; this, however, is not to be regarded as the principal affection, although a remedy ought not to be chosen without due regard to the febrile symptoms. Belladonna is probably the best specific against an attack as described above, especially when the chil- FEVER OF DENTITION. 121 dren start from their sleep as in affright, cast anxious looks around them, or stare at an object with wild eyes and dilated pupils, all the muscles of the body being spasmodically stretched, the whole body being in a state of rigor, the forehead and hands burning hot, and, in some cases, involuntary discharges of urine taking place An excellent remedy in that disease is Ignatia amara, which has been used with great success by most homo'opal hie physicians. The fits which correspond to Ignatia are generally preceded by precursory symp- toms which are not as clearly marked, it is true, as those indicating Belladonna, but are sufficiently char- acteristic to point to Ignatia. The moral symptoms are especially characteristic; the children are head- strong and irritable, are not satisfied with anything ; they are peevish and out of humour, and ery when the least thing they ask for is refused ; those symptoms are sometimes accompanied with sudden flushes of heat over the whole body, red cheeks, burning ears, absence of thirst; besides all this, the children are very un- manageable. These premonitory symptoms sometimes exist for many days, until the fit sets in suddenly with suffocative anguish, foaming at the mouth, rigor of the neck, reclining of the head, redness of the face, dis- tortion of the eyes, loss of consciousness. Sometimes such a fit sets in without any premonitory symptoms, and without any apparent cause, except that the chil- dren had been naughty, and, after having been punish- ed, were laid to bed; this is generally a bad practice. \ext to Ignatia, Ipecacuanha is the best remedy. Ipecacuanha is preferable to Ignatia when the fit arises from overloading the stomach with pastry. The precursory symptoms of the Ipecacuanha fit, accom- panied with symptoms of teething, generally resemble those of dyspepsia and the ailments arising from it; per- manent characteristics of that'condition are: paleness of countenance and cool skin, violent cries, and grasp- ing at the mouth. The true Ipecacuanha fit is dis- tinguished from the Ignatia fit by the following symp- U 122 FEVER OF DENTITION. toms : extension and rigor of the whole body, occa- sionally interrupted by spasmodic jerks through the arms ; constant spasmodic motion of the facial muscles. in which the lips and eyelids are involved. We have to mention one other remedy which is frequently incbcated against epilepsy, especially when the lit was occasioned by fright, and consecutive fear. The Opium fits—for that is the remedy—commence with a convulsive, spasmodic trembling of the limbs, which is interrupted only by jerks of the body and twitchings of the limbs, accompanied with a croaking scream, and giving way, after a while, to a soporous state, during which the child snores with an open mouth, and from which the patient cannot be roused. The Opium fits only appear at night; this is character- istic. Besides the above-mentioned remedies, the following remedies may be used for epilepsy, which will be described in detail when we come to treat of that dis- ease : Cina, Rhus, Arsenic, Cuprum, Calc carh.. Causlicum, Arnica, Ilyosciam., St ram., Cicuta, Secale c. Stannum, Zincum, and others. There is another kind of epilepsy to which those children are liable who are nursed by females addict- ed to the use of spirituous drinks. That kind of epilepsy likewise occurs during the period of dentition. It yields to a few doses of Nux, provided ihe nurse abstains from the use of spirits, or, if this should be impossible to her, weans the child. That kind of epilepsy is perhaps more dangerous than any other, because the organism of the child is entirely ruined by the vicious habits of the nurse. Nevertheless, the physician is bound to attempt a cure, and, if Nux should be of no avail, he may try Arsenic. It would seem as if a delicate crealure like woman could not be guilty of such conduct, were she even born in the meanest hovel. We thought so until we were con- vinced of the contrary by actual facts. Not malice, however, and rarely habit or the love of vice, induces the misconduct which we here censure ; the liquor is CATARRHAL FEVER. 123 generally drank for the purpose of procuring the child rest and sleep; it is the success in accomplishing this which leads to the vicious habit. Children who are brought up without the breast are liable to another kind of epileptic fit. This is generally induced by overloading and deranging the stomach. If the precursory symptoms are: inclination to vomit, retching, the vomiting ought to be brought on by tickling the velum pendulum palati and the fauces, after which the patient ought to be given a few tea- spoonfuls of black coffee, followed by Ipec, Puis., Bryon., Nux, or any other suitable remedy. SECOND CLASS. FEVERS, AFFECTING PRINCIPALLY THE MUCOUS MEMBRANES. § 29. Catarrhal fever. An intense irritation of a greater or lesser portion of the mucous membranes induces a febrile state. The symptoms of that febrile condition are those of a catarrhal fever which may be principally seated in the mucous membranes of the respiratory and repro- ductive, or (dse in the genital and uropoetic system. Generally speaking, we understand by catarrhal fever an affection of the respiratory organs. It is a sort of synochus of the lighter kind, continuous and remitting, and commencing towards evening with a slight chill, rather resembling a creeping over the bones, accom- panied by a soft pulse which is not very much accele- rated, thirst, restlessness, and sometimes great lassi- tude. In company with this fever the mucous mem- brane of the throat, chest, nasal, maxillary and frontal cavities appears more or less inflamed. At first the mucous membrane thus irritated does not secrete any fluid, or only a watery, acrid humour, which is after- wards transformed into a viscid, thick, slimy sub- stance : the tongue, at the same time, exhibits a white coating, the smell is gone, the taste altered, the diges- tion is disturbed, the urine is red, turbid, generally de- positing a profuse, slimy sediment, and a dull aching 124 CATARRHAL FEVER. pain is experienced in the headT especially in the fron- tal cavities. The irritation sometimes extends over the mucous membranes of neighbouring organs, or even of the whole organism, occasioning a variety of unpleasant and painful sensations, and increasing the intensity of the fever. The conjunctiva is red and turgid, the eye is either dry or secretes an abundance of tears, and is very sensitive to the light. The affection of tin- mu- cous membrane lining the nasal cavities is charac- terized by creeping and frequent sneezing, and by an aching pain over the eyes (coryza). Sometimes the affection extends to the larynx and trachea, causing an alteration of the voice, roughness and hoarseness; the affection of the tracheal mucous membrane shows itself by the oppressive breathing and the dry cough. § .'{«). A catarrhal fever may be caused by a sudden suppression of the perspiration by a current of air, by a sudden change of temperature, or by a dry, sharp and cold air. Most of those fevers which depend upon a contagious miasm, generally commence with a catarrhal fever; catarrhal fevers maybe occasioned by contagia and occur principally at times when the measles and whooping-cough are prevalent among children ; they may likewise occur in consequence of the respiratory organs having been irritated by violent inspirations during physical exertions, such as dancing, screaming, singing, running ; and lastly, they may be caused by the inhalation of acrid vapours, especially in individuals who are very sensitive to external at- mospheric influences, and had been frequently affected with catarrh before. § 31. In simple catarrhal fevers the prognosis is fa- vourable. They are frequently cured spontaneously by an increase of perspiration and the discharge of a turbid, clayish-looking urine; the local affection, how- ever, lasts somewhat longer and disappears only gradually through the secretion of a profuse, thick, yellow, inoffensive mucus. The secretion of that mucus is to be considered a favourable crisis. A ca- tarrhal fever is least dangerous when the inflamma- CATARRHAL FEVER. 125 tion affects the nasal mucous membrane only; the prognosis is more doubtful when the mucous mem- brane of the lungs and larynx is involved; in that case there is danger of the local affection increasing to an inflammation of those organs, or of disorganiza- tions being induced by careless treatment. A violent catarrhal fever is to be treated as a pure synochal fever; the local irritation increases of course in pro- portion to the intensity of the fever. A catarrhal sy- noeha is a continuous fever, characterized by great heat, restlessness, thirst, and a full, tight, hard pulse, without any mucous discharge. § :*2. Slight catarrhal fevers get well of themselves in a few days with good care, leaving at most only a mild fluent coryza. None but very sensitive patients send for a physician in such cases. Some cases of ca- tarrhal fever are so mild that individuals of a robust constitution are not even obliged to be confined to their rooms,but are able to attend to their business as usual. Such patients have been known to get well by taking a glass of grog or punch in the evening ; this would excite perspiration in the night, which was ky)t up next morning by remaining in bed a little longer than usual, and was found sufficient to restore the^equilibrium of the functions. A glass of grog is no homoeopathic remedy, of course ; we allude to it merely as a palliative means which has been success- fully used in a great many cases of mild catarrhal fever. The danger increases if the local irritation and con- sequently the fever be more intense and the mucous discharge more difficult. In such cases the local irri- tation requires our principal attention in selecting a remedy ; whereas the febrile symptoms are the most important if the local irritation have an inflammatory character. The homoeopathic physician should be on his guard in this, as in every case, against being carried away by one or two symptoms instead of care- fully observing'the whole group. This kind of routine or symptomatica! treatment, which is justly condemn- ed even by the old school, is unfortunately practised 126 CATARRHAL FEVER. by more than one among our ranks ; but it is a mis- chievous mode of treatment, and accomplishes in a round-about way. by a variety of remedies, what one single remedy*would have done if selected in accord- ance with the whole group of symptoms. All good homoeopathic physicians will agree with us that the symptomatic method would be the grave of homoeo- pathy, and will not blame us for not giving a detailed description of the treatment which ought to be pur- sued in every little variety of a disease ; we shall fur- nish general indications for the selection of the proper remedy in every case. One of the principal remedies against catarrhal fevers is Aconite, especially when they are occasioned by a cold, by dry and cold weather, north-westerly winds or by a current of air, and when the following symptoms occur: Creeping chills with burning skin, hot forehead, great thirst, especially in the evening, ac- companied with a sensation of dryness and scraping, slight burning and soreness in the throat, especially in the region of the larynx, or extending even through the whole chest, inducing continual turns of a short, dry cough, which is rather rough and hollow in die night, and interrupts the sleep; this is moreover dis- turbed by vivid fancies, especially after midnight. Another remedy, which is frequently indicated, is Nux vomica; it corresponds to the following symptoms: inclination to chilliness, erratic shiverings, as if passing over the bones, now in one, now in another part of the organism, mostly during motion, alternating with flushes of heat, coming on in the afernoon and in- creasing progressively. These ailments are relieved by remaining quiet, near a warm stove. They are some- times accompanied with a scraping sensation in the pharynx, which is particulary experienced in the morn- ing hours, and induces a roughness of speech obliging the patient to hawk frequently or to cough. One of the characteristic symptoms of Nux is the titillation which is caused by the scraping sensation below the larynx ; the scanty expectora'ion of tenacious mucus, the light scraping cough in daytime, less in the night, CATARRHAL FEVER. 127 and more frequently in the morning hours, are like- wise characteristic of Nux. Nux is likewise the prin- cipal remedy when the dry, wearing cough is accom- panied with a painful feeling as if bruised in the umbilical region, which is moreover sensitive to pressure. . . , , (!onium maculatum, middle attenuations, is the best remedy for fevers characterized by the following symp- toms : internal dry heat with much thirst, great lassi- tude, scraping, itching, and creeping in the throat, inducing an almost uninterrupted dry cough with titil- lation. The urine is whitish and turbid, the sleep unrefreshing, disturbed by many anxious dreams ; the patient dreads every little noise or talking on account of the sensitiveness of the head, which is either excited or aggravated by it. Dulcamara corresponds to catarrhal fevers which have been evidently caused by a cold, by a sudden sup- pression of the perspiration, and are characterized by roughness and hoarseness of the throat, cough with mucous expectoration, violent fluent coryza, great heat, dryness and burning heat of the skin. In many cases of epidemic catarrhal fever Dulcamara is like- wise indicated by a dry, rough cough. Drosera is one of the best remedies in catarrhal fevers, when the patient is attacked with a sensation as if all his limbs were bruised and paralyzed, and when the usual catarrhal symptoms are accompanied with frequent shudderings over the whole body, cold hands, and ho; countenance. The catarrhal symp'om indicate Drosera when the larynx is principally affect- ed, when there is hoarseness, cough excited by a sen- sation of roughness and scraping in the fauces; some- times the inmost parts of the chest are irritated. Euphrasia is to be employed in catarrhal fevers, when the chilliness is more frequent than the heat, when the heal is merely an incidental symptom, and when the following symptoms occur: inflammatory irritation of the mucous membranes of the eyes, lachrymation, photophobia, nightly agglutination, heat 128 CATARRHAL FEVER. in the head, and painful sensation as if the head were bruised, sensation as if the skull would burst, frequent fluent coryza. painfulness of the inner nose, sneezing, violent cough with expectoration, especially iti the morning. Similar sjmnptoms indicate Mercurius sol. : it is not always easy to decide which of the two remedies. Eu- phrasia or Merc, is preferable ; a sensation of fulness in the head, pulsations in the head reaching as low down as the nose, general heat to which the chilliness is mere- ly incidental, indicate Merc, rather than Euphrasia.' Mezereum may be employed against the following group of symptoms : violent fever consisting of alter- nate chills and heat, the chill being more violent out of the bed,the heat more violent when the patient is in the bed, great sensitiveness to cold air, acrid discharge from the nose, cough arising from a burning irritation in the larynx and trachea, and difficulty of throwing off the mucus. Every observing practitioner is acquainted with the god effects of Chamomilla in catarrhal lever, espe- cially when the following symptoms prevail: synochus, both the chilliness and heat being moderate; the chil- liness consists of slight chills which are experienced only in certain portions of the organism, generally in those parts which the patient uncovers; hence, the chills are frequently experienced when the patient lifts the cover of his bed; sometimes the chilliness and heat are mixed: while one portion of the body feels cold as ice, the other is burning hot, the heat being principally felt on the cheeks. The sleep is, of course, disturbed by the febrile condition; starting from sleep as if in af- * Such colds are very obstinate in this region of onr country. When the nose has not yet commenced running, and feels swollen internally, Hahne- mann advises Nux as a preventive. If the JMercurius be rcquin-ii. one dose of Merc. 200, will be found to hv sufficient in some cases ; in others, however, we have to use Mercurius 3, in powders, one every three hour*. Mv rule then is, to continue these powders until every vestige of the cold has disap- peared,■which sometimes requires 10,15,oreven 20pnwd<-rs in succession. To speed the cure the patient ought to live as low as possible, on gru<-l, weak tea, toast, etc., and avoid all stimulating dishes. The saying, " Feed a cold and starve a fever," implies a vulgar and foolish practice.—11 impil. CATARRHAL FEVER. 129 fright, and shrieking while sleeping, are character- istic indications for Chamomilla, especially when those symploms occur during the period of dentition. The catarrhal irritation is principally perceived in the mu- cous membranes of the respiratory organs, nose, and frontal cavities—hence, the violent dry cough, espe- cially at night, occasioned by a constant titillation in the larynx, accompanied with hoarseness and rattling of mucus in the trachea. When this cough, arising from a titillation in the larynx, exists only in the night, it is generally relieved by Hyosciamus. If it continue night and day without change, Ignatia is the best remedy. Among the symptoms of Heparsulphuriswe discover a catarrhal fever, characterized by internal chilliness, and ill humour, or heaviness in all the limbs. This remedy is on a par, and constitutes a group, with Eu- phrasia and Nux ; it is most frequently indicated when the mucous membrane of the eyes is affected, when the patient experiences a painful pressure in the eyes, when the conjunctiva looks puffy and red, and the lids are swollen. Ilepar is likewise-indicated when the respira- tory organs are affected, the patient suffers with a moist cough and rattling of mucus in the chest,whenthe cough. is accompanied with an intense pain in the larynx and roughness of voice, and when the patient complains of weakness of the chest which scarcely allows him to speak. The vascular and nervous systems are but moderately irritated. f achesis is said to cure a kind of catarrhal fever characterized by heat, fulness of the head, drawing in the teeth and facial bones, glistening eyes as when one feels exhausted, irritable disposition, restlessness, mal- aise, some discharge from the nose. We have used this remedy with success in a few cases, when, after the slightest and scarctdy perceptible cold, a violent fluent coryza would set in with sneezing, confusion of the head, great warmth in the internal parts of the forehead, hot nose, and general disagreeable warmth over the whole body, with great heat of the hands and feet. In using Lachesis for those symptoms, we have 130 CATARRHAL FEVER. even seen the great sensitiveness for external at- mospheric influences disappear entirely. One of the most distinguished remedies in violent catarrhal fevers is Arsenic The Arsenic fever is characterized by great heat, intense thirst, yawning, stretching, and a prostrating sensation of weakness through the whole body, lancinating pains in the limbs and head, oppression of the chest. The local irritation of the mucous membrane frequently ceases during the night, especially if the patient perspire some ; next morning, however, it returns, a profuse quantity of watery mucus flowing from the nose, with burning from the nose and a sensation as if the nose were en- larged, and as if it were swollen in the region of the root; accompanying those symptoms the patient ex- periences a feeling of dryness and burning in the larynx, the irritation occasioning a continual dry cough. No less important in catarrhal fevers than any of the other remedies is Ruta graveolons, when the following symptoms appear: general shuddering over the whole body, even near the warm stove, with coldness of the hands and feet to the. touch, dulness and warmth in the head, violent thirst which disappears, however, after drinking. Ruta is moreover indicated by the sneezing, lachrymation, and by a pain in the eyes, as if they had been fatigued by exerting them too much; a charac- teristic symptom Of Ruta is a contusive pain in the region of the larynx and a crowing cough which wakes the patient about midnight, is randy accompanied with expectoration and then only in small quantity, induces vomiting when it lasts too long, and excites a pain in the sternum. Pulsatilla corresponds to catarrhal fevers charac- terized by the following group of symptoms : huski- ness,* scraping in the throat, occasioning a dry, spasmodic, titillating cough, which is especially violent toward evening and when lying down, is very debili- tating during the night, prevents sleep, abates when sitting up, commences again after lying down, and sometimes increases unto suffocation, retching, and even vomiting. The chilliness is principally felt to- CATARRHAL FEVER. 131 ward evening; the heat appears only by dint of coughing, and then becomes excessive and continues all nVht, even after the cough abates. Rhus is likewise useful in those fevers when the titillation and cough are not felt in the larynx, but in the bronchial ramifications, when the cough shortens the breathing and is especially violent in the morning, thereby prevenling the patient from falling asleep again. In general Rhus is indicated when the catar- rhal affection extends over a large extent of the bronchial ramifications. As regards the fever, this remedy corresponds to Pulsatilla, except that the evening exacerbation is characterized by a predomi- nance of heat, drawing and stretching in the limbs, and slight creeping chills. Bryonia corresponds to catarrhal fevers accom- panied by cough, which produces retching, and some- times vomiting of the ingesta, with sensation as if the chest would fly to pieces, and with profuse, violent fluent coryza, and pain in the forehead which is re- lieved by pressure upon the forehead; the right side of the body is colder than the left, and the patient complains of great thirst. Ammonium carbonicum should be resorted to in catarrhal fevers characterized by hoarseness and pro- fuse fluent coryza, especially when an acrid, burning water flows from the nose; by morning cough with titillation or retching, and with alternation of chilli- ness and heat. Causticum may be used when a sen- sation of soreness and excoriation is experienced in the trachea (All. horn. Zeit. XXVI. 93). Sepia is indicated in catarrhal fevers where the chilliness is continual and occurs upon every move- ment in the warm room ; the heat is merely inciden- tal ; the Sepia catarrhal fever is moreover charac- terized by a nightly spasmodic cough, which increases even unto vomiting and suppression of breath; sneez- ing, violent fluent coryza, ulcerative pain in the occiput ami drawing in the hips and thighs are likewise present. Among the remedies which we have so far indicated 132 CATARRHAL FEVER. for catarrhal fevers, the following require particular consideration, when the dry cough is accompanied by a sort of spasm in the larynx which does not abate until the patient has thrown off a quantity of mucus after a good deal of gagging: Ipec. Nux, Pulsaf., Rhus, Bryon., Bellad., Sepia, Ammonium earb.. 1 Irosera, Mercurius. The whole group of symptoms is some- times at once removed by the homoeopathic specific ; or, at any rate, the cough is changed to a simple ca- tarrhal cough which will be easily removed by one of those remedies which have been mentioned in the preceding paragraphs. For a dry, spasmodic cough, or a cough occasioned by a simple irritation of the throat, the principal re- medies are: Hyosciamus, Drosera, Laeiuea virosa, Conium, Ipec, Bell., Magnes mur., Phosphorus, Ambra, Iodine. Such an intolerable, racking, spasmodic cough, arresting the breathing on account of a titillation in the upper part of the windpipe which is unencum- bered by phlegm, and rousing the patient from sleep at 11 o'clock in the night, has frequently been cured by a single dose of Belladonna. The hoarseness accompanying catarrhal fevers, no matter whether there is a cough or not, or whether it is dry or moist, yields to: Puis.. Mercur., Drosera, Spong., Dulcam.. Sulp., Tart, emet., Manganuin earb. or acet., Lachesis, Phosphor., Natrum mur., Sepia, Carbo veg.; the latter remedies are especially indi- cated if the hoarseness increase in the evening hours. Nux is very useful for a morning cough with titilla- tion and difficult expectoration, remaining after a catarrh; Iodine and Kal. hydriodicum will still more frequently be found useful. Chronic catarrhs are akin to phthisis, and require the same care as the latter ; there is no essential dif- ference between chronic catarrhs ami phthisis, for the same remedies are used for either : we therefore take this opportunity of referring to the phthisical affec- tions in the second volume, where we shall treat of them more in detail. We will here simply state, that the following remedies have been found useful in CATARRHAL FEVER. 133 chronic catarrhs, the last of them principally, when Ihe expectoration seemed loose and yet could not be thrown off:—Tart, emet., Drosera, China, Dulcamara, St annum, Manganum, Carbo veg., Iodine, Bromine, Amm. mur. According to Goullon, Lycopodium cor- responds to those obstinate catarrhs where a lemon- coloured and frequently bitter phlegm is thrown off, accompanied by a violent tearing beating pain in the frontal cavities, with afternoon or evening exacerba- tions. It is well known that catarrhal fevers frequently unite with gastric or typhoid symptoms, inflammations, and cutaneous eruptions; in such cases the remedy has to be chosen in accordance with the symptoms of that affection which are most marked. § 33. Catarrhal Fever- in Children. We ought not to omit mentioning, on this occasion, a catarrh or catarrhal fever of children which can only be observed by the physician, but cannot be investi- gated by questioning the patient. The pathology and treatment of this fever do not differ essentially from the one above described. It is characterized by sneez- ing, running of the nose and eyes, cough, hoarseness, and in small children rattling arising from the mucus,« which they have not strength enough to throw off. Aconite, two or three doses a-day, is the principal remedy when the following symptoms occur: burning heat of the whole body, accelerated pulse and breath- ing, thy, short cough, the infant screaming sometimes as if it would manifest pain. If the heat be less marked, the cough loose with constant irritation in the air-passages, and if rattling be present, we know of no better remedy for those symptoms than Antimonial wine, one, two. or three drops a-day; this remedy fre- quently removes the symptoms more rapidly than Chainoniilla, which is likewise indicated. In catarrhal fevers, Euphrasia suits children frequently better than full-grown persons, the profuse running from the nose being frequently accompanied by a considerable red- ness of the whites-of the eyes, lachrymation and slight 134 CATARRHAL FEVER. agglutination. As regards other remedies, we refer to those indicated for the catarrhal fever of full-grown persons, reminding our readers particularly of Bella- donna and Pulsatilla. The dry coryza is still more troublesome than the fluent; the former hindering the infant's taking the breast and causing it to scream and to be restless. This condition arises from the suppression, in consequence of cold, of a fluent coryza, causing a disagreeable dryness of the nose, which brings on the difficulty of taking the breast. This affection frequently lasts a long while, becomes worse in warmth, and decreases in the open air, where the running from the nose is generally restored. It befalls not only small, but even larger children, inducing a habit of breathing with an open mouth. The trouble is frequently removed by rubbing the dorsum of the nose with a greasy substance, such as hen's grease, almond oil, or thick cream ; or by causing the vapour of warm milk to pass into the nose. Inas- much as the trouble is chiefly owing to the nasal mucus not being secreted in a sufficient quantity, it is certainly a good plan to replace the natural mucus by an oily substance, say almond oil, with which the inner walls of the nose may be lined by means of a fine feather. If this palliative means should not be sufficient to remove the trouble, an internal remedy will then have to be resorted to, and will have to be selected in ac- cordance with all the concomitant symptoms. A small dose of Nux will prove the best, if the dry coryza increase in the evening, accompanied by great dryness of the mouth, whereas the fluent coryza pre- vails in the daytime. Other physicians pretend to have removed the trouble by repeated doses of Sambucus. In some cases, where the obstruction of the nose was accompanied by a profuse discharge of mucus, Chamomilla proved curative ; Dulcamara is the best remedy when the dry coryza increases in a cool and decreases in a warm temperature. Carbo veg. deserves consideration in obstinate cases, with INFLUENZA. 135 evening exacerbation ; Graphites, when great debility and prostration prevail. If the dry coryza set in while the children are still at the breast, or if the mother be affected with it, the latter may take the medicine alone. § 34. Influenza. The influenza is not an indigenous disease with us (in* Germany); the grippe still less so; when the cholera appeared amongst us, both affections frequent- ly appeared in company with it, and have ever since become stationary diseases, the grippe at least. Both grippe and influenza are varieties of a catarrhal fever, being subject to the same therapeutic rules as the fever, and every other disease. For the benefit of be- ginning homoeopathic practitioners we here record our experience of the treatment of those affections; what we shall say is derived from the most careful observa- tion. The influenza, like every catarrhal fever of a certain degree of violence, commences with striking debility and drowsiness; subsequently shiverings and even chilliness over the whole body make their appearance. The usual catarrhal symptoms are : sensitiveness of the eyes, lachrymation, pressure in the eyes, with slight redness ; aching pain in the forehead, fluent coryza, in some cases dry coryza; short turns of dry cough, which fatigues the chest, are not wanting; they are accompanied with want of appetite, and a white-coated but dry tongue; dryness of the throat, and afterwards a dry, burning heat, with great thirst. Many cases of influenza, especially those which are characterized by constipation, are often relieved by a dose of Nux in a few hours, provided the dose was proportionate to the intensity of the disease and the patient's individuality; sometimes, however, Arsenic is more suitable, especially when debility, diarrhoea, great thirst and a paralytic sensation in the limbs are the prominent symptoms. Causticum has been found very useful, which was followed a few hours after by Camphor. Both those remedies were administered by 136 GRIPPE. olfaction. Of the latter remedy Hahnemann remarks: * " If the Siberian influenza attack one of us (in Germany), and the heat have already set in, Camphor may be used as a palliative, on account of the disease having but a short run ; it is an excellent palliative when ad- ministered in frequent and progressively increased doses. Camphor does not shorten the course of the disease, but diminishes its violence, and removes all danger until its termination." § 35. Grippe. Another species of catarrhal fever is the grippe, which prevailed at the commencement of the year 1833.f The symptoms of grippe are much more varied and complicated than those of influenza; and the disease, when invading the organism suddenly, was much more dangerous, and sometimes led to fatal re- sults. If a patient, whose chest was affected, had an attack of the grippe, consumption was generally the result of that complication; in very few cases only it was possible to save the patient's life. Generally, an attack of the grippe came on suddenly—in a few cases only the disease developed itself gradually ; it was distinguished from any other catarrhal disease by an unusual lassitude, heaviness and a bruised feeling in the limbs, especially the lower. At times this prostrate feeling of the limbs was accompanied with headache and an inclination to vomit, at times with sore throat and some hoarseness. Sometimes the dry coryza be- came very violent, and was accompanictl with a violent and frequently intolerable tearing pain in the forehead, affecting the facial bones, with pressure in the remaining portion of the head, vertigo, otalgia, painful swelling of the parotids, etc. The disease had many peculiar features, for instanoe : in persons who were not entirely well, it would excite the former symptoms which had become latent, thus making the cure so much more difficult; it would attack the * See Hahnemann's Materia Med. Pura, by Charles J. Hempel, M. D., Vol. I., preface to Camphor. t SeeAll.hom. Zeit, Vol. II, p. 187, etc.; also, Archir, Vol. XIII, 2, p. 88. GRIPPE. 137 same person several times, but always under another form ; sometimes it would last a considerable while in a mild form, but the symptoms, although easily yield- ing to suitable remedies, would be excited again by the least error in diet, sometimes even the next day. Another peculiarity of the grippe was its tendency to unite with other diseases, modifying their course and aggravating the whole condition. Dr. Bosch (see Hygea, XIX, p. 328), found that fetid sweats and erysipelatous eruptions constituted critical phenomena in grippe, and therefore proposes to designate the dis- ease as a febris erysipelacea epidemica. As soon as the first symptoms of the disease made their appearance, it was an easy thing to suppress it by smelling a few times of Camphor ; after some time it broke out, nevertheless. This was not the case in an epidemic grippe which broke out afterwards, and for which the first attenuation of Camphor taken internally proved the most sovereign remedy (see All. horn. Zeit. XXV. 61). When an inflammatory con- dition of the thoracic organs was a predominant symptom, Nux was always found an excellent remedy after Aconite. Merc. sol. or Merc vivus was prefer- able when the head, throat, and chest were violently affected, and when a dry, racking cough, which after- wards became loose, was present; when the patient complained of pains in the pleura, with profuse sweats which did not afford him any relief; when the con- dition of the liver exhibited inflammatory symptoms, the pain being rather dull, and the pulse not very hard ; a few doses of Mercurius a-day were sufficient to remove and even to suppress the disease in the very beginning. Phosphprus was the best remedy when the trachea was irritated or inflamed, and when the intense pain prevented speech, or when the voice was very much altered. Sometimes the disease assumed the form of sporadic cholera ; in that case the catarrhal symptoms were inconsiderable, but the debility so much more marked. Veratrum was the specific for that group of symptoms. If, in the course of the disease, typhoid symptoms set 138 GRIPPE. in, as was frequently the case in the later periods of the epidemic; if the patient became delirious, had a wild, staring look, complained of great sensitiveness of the abdomen, with a full, hard pulse. Aconite was given with great effect; the remaining symptoms yielded to Pulsatilla. This remedy frequently re- moved the papescent, insipid taste which sometimes remained a long time, accompanied with slimy coating of the tongue and want of appetite. An exceedingly distressing symptom in that disease was the violent pressing, aching pain in the forehead ; this pain, together with the accompanying cough, and the loose and slimy expectoration, yielded to Bryonia, which was likewise the principal remedy when the liver was distended, and the region of the liver was painful to the touch, or when the pain was excited by coughing or taking a deep inspiration. Bryonia was also the specific remedy for the cough when it readily excited vomiting, or occasioned a pain in the epigastric region (in which case Bryon. and Nux were equally indicated), and a pain as if bruised under the short ribs, obliging the patient, while coughing, to press his hands against the region where this pain was experienced. Bryonia was given alternately with Carbo veg., in a form of grippe with which old people were sometimes attacked, and which was characterized by great distress in the chest and coldness of the limbs; this form frequently terminated fatally in paralysis of the lungs. If the cough was dry, spasmodic; if the headache became in- tolerable, if it was increased by walking, talking, bright light, movement; if the patient had a staring look, and saw all sorts of fanciful images'on closing the eyes, Belladonna was the remetly ; and after using it for a couple of hours, the symptoms, although bordering upon encephalitis, had disappeared. Rhus was indicated if the grippe had come on in consequence of getting wet,and the attack was charac- terized by oppressive anxiety,frequent turns of involun- tary, deep breathing, restlessness of the body, and if the patient was constantly changing his place of rest. Sabadilla was the remedy when the grippe took the GRIPPE. 139 form of an inflammatory affection of the organs of the chest, accompanied with violent chilliness and external coldness. Chijja removed the cough which commenced vflth, and seemed to arise from a rattling behind the sternum, as if mucus had accumulated in that region. An exhausting cough, with difficult expectoration,- and every paroxysm being followed by yawning, yielded to Opium, a number of other remedies having previously been tried in vain. The alcoholic tincture of Sulphur was found useful towards the termination of the disease, when the fever was abating, and when the patient experienced the stitches in the chest only during a deep inspira- tion, or a violent paroxysm of cough, oppression of the chest as if a heavy load pressed upon the chest, being likewise present. The spasmodic cough which remained a long while after the disease had left, and which frequently tor- mented the patient for hours, almost always yielded to one or two doses of Hyosciamus, in single cases to Belladonna ; if, however, the nightly paroxysm did not cease till the patient had vomited a quantity of frothy mucus, mixed with tips of yellowish pus, Conium was the principal remedy ; if the cough appeared after every meal, and the food was vomited up again, Ferrum aceticum was the specific remedy; If the grippe left behind a troublesome cough, with gray, saltish, sweetish expectoration, wheezing and rattling in the chest, Kali hydriod. proved an incom- parable remedy. When the grippe threatened to develope a previously existing phthisical disposition, a few doses of Stannum in alternation with Carbo veg. were frequently suf- ficient to remove the symptoms before phthisis had been fully developed. Consecutive symptoms of the grippe sometimes were obstinate inflammation of the eyes, with ulcers of the cornea, and violent photophobia; the only remetly which removed them permanently was Arsenic; repeated doses of Belladonna were sometimes given with success, but the relief was not permanent. 140 THIRD CLASS. ELVERS WITH LOCAL IRRITATION OF THE FIBROUS AND SEROUS TISSUES. § 36. Simple Rheumatic Fever. When an affection of the serous and fibrous tissues, sheaths of muscles, articular membranes, in company with the drawing, tearing, burning pains in the joints or trunk—the character of the pain varying according to the nature of the tissue which is the seat of the affection—is accompanied by a more or less violent, continuous remittent fever, we term this a rheumatic fever. The accompanying rheumatic pains may come on before or after the commencement of the fever, or may appear during the course of the disease. The pain which is experienced during those fevers has no definite and permanent character; it is sometimes tearing, stinging, boring, sometimes drawing, digging up, jerking; nor can we consider swelling and red- ness of the locally affected part characteristic symp- toms, inasmuch as they are wanting in many rheu- matic affections, such as lumbago, rheumatic affection of the intercostal muscles, etc. As the fever abates, the local affection diminishes likewise, leaving in a few cases a chronic trouble behind. The fever is a synoeha, with evening and night exacerbations, which are accompanied by an increase of the local affection. An inclination to sweat is a characteristic symptom of that fever : the sweats, however, have no critical im- portance. The pulse is full, rather hard, accelerated, sometimes even quite hard, often unequal, especially so when the pericardium is affected, in which case the fever is very violent; the urine is scanty, yellow, red- dish, and finally becomes cloudy and deposits a reddish, brick-dust sediment. The thirst is increased and the appetite diminished ; sometimes the tongue is covered with a more or less thick coating of a yellowish white mucus, the taste is bitter, the patient inclines to vomit, the bowels are confined. The 7th, 14th, or 21st day is the critical day, the fever terminating in a copious, general sweat; t^e SIMPLE RHEUMATIC FEVER. 141 duration and the commencement of the crisis are not always marked by definite periods. Schaenlein does not recognise any rheumatic fever; he terms the rheumatic affection acute rheumatism, which is dis- tinguished from a rheumatic fever by the greater violence of the local affection, interesting the attention of the patient and the physician more than the fever ; in acute rheumatism the redness and swelling occur more frequently than in rheumatic fever, especially if the affected part be near the surface of the body. The pain in acute rheumatism is more acute, more seated, the fever is more violent, and strictly continu- ous. It is undoubtedly improper to draw a marked line of demarcation between a rheumatic fever and acute rheumatism ; if such a thing were possible, the homoeopathic treatment would not be affected by such a division. § 37. These fevers depend principally upon atmos- pheric changes, which generally communicate to those fevers an epidemic character. They occur frequently at the end of winter, at the commencement of spring, and during the damp and wet fall weather. Exciting causes are : getting wet to the skin, exposure to a current of air, repelled perspiration, etc. § 38. In most cases the prognosis is favourable as long as the disease remains a simple rheumatic fever. The prognosis is less favourable when the fever is accompanied with inflammation of important internal organs, or when the articulations of the spinal column are involved. The prognosis is likewise unfavourable when the fever lasts a long time, and the pericardium or the heart itself is involved in the disease; or when the fever settles upon the brain, and, in general, when the local affection easily changes its seat. § 39. The treatment of these fevers is just as varied as that of any other disease ; it depends in every case upon the characteristic symptoms of the disease. Aconite is required only in very few cases. According to our experience it ought to be given when the fever is intense ; when the inflammation, hot swelling, red- ness, and intense pain& in the affected parts increase 142 SIMPLE RHEUMATIC FEVER. rapidly; in such a case Aconite is always indicated by other accompanying symptoms, such as: intense dry heat, burning dry skin; full, accelerated, not hard pulse ; great thirst, flushed face, or else alternate red- ness and paleness of the face, anxiety and restlessness, moaning and tossing about, sleeplessness, or else sleep disturbed with anxious dreams. For such a group of symptoms, the lower attenuations of Aconite, fre- quently repeated, will prove the best remedy. Rheumatic fevers which are characterized by such symptoms, belong rather to the class of acute rheuma- tism, whence it appears that Aconite is indispensable in that disease. Bryonia is superior to Aconite when the nervous and vascular erethism is accompanied by tearing, tensive, stinging pains in the red and shining swelling of the articulation, becoming insupportable during movement and during the night's rest. This remetly has likewise to be repeated in such fevers, the repetition being pro- portionate to the violence of the fever which had re- mained after the exhibition of Aconite.* Belladonna is a specific in rheumatic fevers when the brain and nervous system are greatly irritated, and the rheumatic pains wander from one part to another; swelling and light redness are always present, and the burning, stinging pains in the affected parts are most violent at night and when the parts are touched ever so lightly ; if the patient should go to sleep, he is fre- quently roused by startings of the affected parts, or a painful drawing in the limbs prevents him from falling asleep. Belladonna is an excellent remedy when the nape of the neck, the spinal column and the small of the back are involved, when those parts are painful, stiff and swollen, when the rheumatic affection pre- vents every movement of those parts, and movement occasions the most violent pains ; one knee-joint is likewise affected, the patient has to keep it bent and * A great rival of Bryonia in inflammations of the serous membranes is Cantharides, especially when there is a frequent desire to urinate. In rheu- matic inflammations where Bryonia is indicated and will not help, Canthari- des ought to be given, and if neither be sufficient alone, they ought to be given alternately.—Hemfei. SIMPLE RHEUMATIC FEVER. 143 quiet, the least movement making the pain intolerable to such an extent that it will extort shrieks from the patient. (When these symptoms occur Bryonia may be used when the fever approaches more to the erethic form.) The rheumatic fevers to which Belladonna corresponds, are sometimes accompanied with tearing pains having the character of an ache, and proceeding from the inmost parts of the bones, or else darting like an electric shock towards the neighbouring artic- ulation, where they occasion a dull pressure, which is relieved by counter-pressure, aggravated by motion, and increases in intensity during the night. The fever has generally the form of a synoeha : violent burning heat over the whole body, strong, full, accelerated pulse, a good deal of thirst, loss of appetite, accom- panied by a tensive, aching pain in the forehead, with pressure from within outward, the pain being increased by moving the head ; the urine is turbid and deposits a reddish sediment. There is one remedy which has been too little used heretofore in rheumatism : it is Colchicum. It deserves especial consideration at a time when rheumatism is a prevailing disease, and is of still greater importance when the rheumatic influence prevails in the transi- tion periods from winter to spring, fall to winter, or during a damp and cold, foggy weather. This remedy has been principally used in the chronic forms of rheu- matism and gout, probably owing to the limited num- ber of febrile symptoms which we possess of that drug. In a case of synochal rheumatic fever where Aconite seemed to be required, but was given without the least benefit, we were induced to .exhibit Colchicum alter- nately with Aconite every three hours. The result was brilliant beyond belief. Since then we have used Colchicum on several occasions, and have noted the following symptoms as indicative of its use: the fever is a continuous remittent fever, with afternoon exacerbations ; the patient, during the exacerbation, complains of a progressively increasing dry heat over the whole body, accompanied with palpitation of the heart and thirst, sweat breaking out upon the skin 144 PIMPLE RHEUMATIC FEVER. suddenly, and disappearing as suddenly : lancinating pains in the affected parts, increasing with the fever, being most violent in the night, abating in the morn- ing, when they generally wander to some other part which becomes inflamed rapidly, whereas the part just left by the pain exhibits a simple pale swelling, which disappears entirely in the course of that day. For such symptoms we give Colchicum, third attenu- ation. Mercurius is the remedy for rheumatic fevers which are characterized by the following group of symp- toms : constant alternation of chilliness and heat, or internal heat accompanied with a continual chilly creeping over the aflected parts; these parts have to be moved all the time, either on account of an internal uneasiness in the parts, or on account of the drawing- tearing pains which are experienced in them. A cha- racteristic indication for Mercurius is profuse sweat which affords no relief, rheumatic pains in the head, limbs and joints, which are especially violent at night, the slimy coating of the tongue with slimy or saltish taste in the mouth, complete aversion to any kind of nourishment, great painfulness of the region of tin; liver, the epigastric region and the pit of the stomach, frequent evacuations of green mucus, accompanied with tenesmus. The remedies which we shall now mention, corres- pond rather to those rheumatic fevers which belong to the class of the erethic fevers, the rheumatic pains be- ing indeed continuous, but the inflammation of the ligaments, tendons and synovial membranes, being less intense. First in rank is Rhus toxicodendron. It is indicated by tensive, drawing and tearing pains in the limbs, which are most violent when the patient is in a slate of perfect rest, accompanied by a sensation of numb- ness in the aflected parts, and as if they had gone to sleep, this sensation being especially experienced in those parts upon which he is lying ; the pains are felt during the paroxysm of chilliness ; the chilliness al- ternates constantly with the heat through the whole SIMPLE RHEUMATIC FEVER. 145 course of the disease ; at night only the patient expe- riences heat with drawing in the limbs which occa- sions a desire to stretch them. Rhus deserves a pref- erence over every other remedy when the attack has been brought on by wet, penetrating either to the whole surface of the body or only to single parts. Pulsatilla is the remedy, when the patient, after having suffered with lassitude for several days, wakes in the morning with a chilly feeling and a tingling sensation in the parts upon which he had been lying, as if they had gone to sleep ; the chilliness continues after rising, and drawing, jerking pains now in one, now in another limb, especially in the long bones, or a painful swelling of the nape of the neck supervene the patient feels relieved about noon, the chilliness re • turns with increased violence in the afternoon and evening, the pains become more permanent, the affect- ed part begins to swell and to become red, the pains suddenly pass to some other part. If such a fever oc- cur after an abuse of Mercury, Pulsatilla is so much more necessary. Sometimes such fevers commence in the night with an oppressive headache, great restlessness of the body which does not allow any sleep, chills creeping over the back, and sweat breaking out as soon as the pa- tient covers himself: little by little the chilliness spreads over the whole body, assumes the form of a sensation of internal coldness which is not perceptible to the touch, except on the hands and feet, which are icy-cold; gradually heat supervenes in certain parts of the body ; the head, for instance, feels hot, Avith in- crease of the headache and distended veins ; drawing, tearing pains in the small of the back, in the back, knees and thighs, set in as the characteristic signs of the rheumatic fever, occasioning a lameness or weak- ness of the affected parts, and being aggravated or re- produced by contact; those symptoms are sometimes accompanied by bilious symptoms, such as: bitter taste with yellowish coating of the tongue, bitter eruc- tations, nausea, vomiting, thirst, costiveness. When the above-mentioned group of symptoms occurs, China 7 116 SIMPLE RHEUMATIC I l.'VEK. is the specific remedy, which requires to be repeated more or less rapidly according to circumstances. The Arsenic rheumatism set? in with peculiar symp- toms which are frequently so confused that the physi- cian is easily led astray by them, and is exposed to the danger of misapprehending the disease, unless tin- general character of the prevailing sickness reveals the real character of the attack. We find for instance paroxysms of anguish without any previous cause, ac- companied with pressure and burning in the pit of the: stomach, stitches in the side, tension and fulness of the abdomen ; after a shorter or longer interval those symptoms are followed by a shivering, and, after quenching the thirst, by real chilliness, which is after- wards accompanied by a drawing and a burning tear- ing in the limbs, preventing the patient's resting upon those parts, but being relieved by warming or moving the affected part. After some time a dry, burning heat with anxiety supervenes, during which the rheu- matic pains become more violent, and which is ac- companied with great thirst. A characteristic symp- tom of Arsenic is that the pains abate as the sweat breaks out, whereas in other rheumatic fevers, for which other remedies are indicated, the sweat affords no relief. There is another kind of sub-inflammatory fever which is characterized by drawing, tearing pains, sen- sation of lameness or numbness, the tendons, ligaments or bones, are principally affected, there is no swelling, night exacerbation; the spinal column and the head are involved in the attack, the pains extend like la- bour-pains from the small of the back into the thigh*, making the least movement impossible, and the night intolerable : such an attack yields to Chamomile. Dulcamara is closely allied to Rhus as a remedial agent in rheumatic fevers. It deserves a preference over Rhus, if the fever was not occasioned by wet, but by a sudden retrocession of sweat in a draft of air or some other kind of exposure. A peculiar exciting cause is not always required to make the exhibition of Dulcamara necessary ; the exhibition of that remedy SIMPLE RHEUMATIC FEVER. 147 is justified when rheumatism is prevalent in the com- munity, and the following group of symptoms occurs: sticking, drawing, or tearing pains in the limbs, with bloatedness of those parts and a sensation as if they had gone to sleep ; violent fever with great heat; dry- ness and burning of the skin; badly smelling sweat which affords no relief, restless tossing about in the sleep, occasioned by a painful sensation of swelling in the nape of the neck and occiput, which does not al- low one to lie quiet; drawing pain in the whole, or only in parts of the head, involving the ears. Ranunculus bulbosus is another remedy in rheuma- tic fevers which has been too little considered hereto- fore, and is related to China in this respect, that the lancinating pains and the pains as if bruised are readi- ly excited by contact, movement, or change of position, and that they are sometimes aggravated by the con- tact of a cool current of air. The fever, which is a continuous remittent fever, has evening exacerbations with a full hard pulse which should not induce the practitioner to interfere with the action of Ranunculus by exhibiting another remedy. The rheumatic fever for which Ranunculus is the specific, wanders from one part to another without affecting any particular- ly ; it has, however, one peculiarity, which consists in the heat affecting only one side, with cold hands and feet. Rhododendron chrysanthum is closely allied to Ra- nunculus. The Rhododendron fever is not very intense, for it does not even amount to an erethism of the vas- cular system, and consists of alternate chilliness and heat, accompanied with pressing pains in the head from within outward, and drawing in the limbs ; at night a dry heat of the body sets in, with sleepless restlessness ; towards morning the pains abate, and a slight general sweat makes its appearance. Charac- teristic indications for Rhododendron are a nightly drawing tearing in the periosteum, which is aggra- vated by bad, changing weather, at night when in bed and during rest; these symptoms disappear under the use of Rhododendron, as we know from experience. 148 SIMPLE RHEUMATIC FEVER. Sulphur corresponds to rheumatic fevers which are characterized by a drawing sticking or a drawing tearing both in the limbs and joints, the latter being slightly swollen ; the pains abate by external warmth, and grow worse in cold: the pains are relieved by motion, excited by rest; Sulphur is particularly useful when the pains are seated. Sulphur corresponds par- ticularly to rheumatic fevers with alternate chilliness and heat, an apprehensive oppressive sensation in the pit of the stomach, pains in the head and nape of the neck, violent stitches in the small of the back; the night-sleep, which is of itself restless, is moreover dis- turbed by the violent headache, which cannot be re- lieved by any change of position. The accompanying fever is a continuous remittent fever, with exacerba- tions every evening, consisting of a slight chilliness which commences a few hours before falling asleep, and is not relieved by the warmth of the bed, no mat- ter how much covering the patient may put on. Not until a few hours have tdapsed, great Avarmth makes its appearance, Avhich results in a sourish-smelling sweat towards morning, (lenerally the fever is accompa- nied with entire loss of appetite, or with inclination to nothing but sour things, great thirst, with feeling of dryness in the mouth, sour eructations, bloatedness of the abdomen and pit of the stomach, with sensitive- ness to pressure of those parts, and insufficient, hard stool. Characteristic indications for Arnica in those fevers are a tearing with tension in the parts which are af- fected by the rheumatism, but especially a lameness, and pains as if bruised, redness and swelling of the af- fected part, aggravation of the pains by the slightest motion, which is ne\'ertheless made necessary by the uneasiness experienced in the affected parts, owing to which the same position cannot long be endured. Ar- nica is especially applicable in those febrile rheumatic affections of the thorax, which are relieved by move- ment, and resemble the pains, especially in the poste- rior portion of the thorax, which are experienced in consequence of a bruise or fall. Chilliness and heat SIMPLE RHEUMATIC FEVER. 149 exist simultaneously, if one part feels warm, the other feels cold. Coeculus corresponds to those rheumatic fe\Ters where only one side of the body is affected, and a par- alytic drawing, with painful stiffness in the joints, is experienced, A\rhich is aggravated by every movement, even of a part which is not affected. Coeculus is a distinguished remedy in rheumatic affections of the chest, characterized by stinging, and a pain as if sprained in the articulations of the chest and dorsal vertebrae. If the paralytic drawing pain affect the back, the pain is generally worst early in the morn- ing, is aggravated by walking, stooping, or talking, and is not relieved till the patient has been lying down for some time. The fever consists of frequent parox- ysms through the day of alternate heat and chilliness, with congestion to the face, which constantly remains pale. Nux is a good remedy for drawing, tearing pains, especially in the dorsal, lumbar, sacral, and abdominal muscles, in the latter muscles a sensation of numbness and as if bruised being experienced at the same time ; those pains are distinguished by nightly exacerbations, and do not admit of the slightest movement, or else require a constant change of position ; they are accom- panied Avith a feeling of heat over the whole body which deprives the patient of sleep, with excessive sensitiveness to all external impressions, costiveness, and shifting of flatulence in the abdomen. As regards the following remedies, Ave content our- selves Avith merely mentioning their names, leaving it to the physician to consult the Materia Medica for a more accurate knowledge of the symptoms. A most useful remedy in such cases, especially after an abuse of Mercury, is Lachesis. This remedy is indicated in pain and stiffness of the joints, Avith swelling ; the pains are aggravated by movement and contact, evening and night; sweat affords no relief. Indigo promises to become useful in rheumatic fevers. Caustieum maybe consulted when the pains are drawing and tearing. 150 SIMPLE RHEUMATIC FEVER. Euphorbium, Avhen the pains are tearing or sticking, with sensation of pressure ; they are aggravated by rest. relieA'ed by moA'ement. Carbo vegetabilis, when the pains are drawing. tearing, Avith sensation of lameness, and arrest of breathing, characterizing the affection of the chest, flatulence. Mezereum for tearing, drawing, and tensive pains in the long bones, with night exacerbation, and especi- ally if Mercurius in allopathic doses have been previ- ously given for syphilis. This latter indication applies likewise to Carbo vegetabilis. Valeriana is excellent in rheumatic fevers, when the joints are principally affected. There are other remedies for rheumatic feArers, which avc do not men- tion on account of the little use which has been made of them in practice. The most frequent metastasis occurring in rheumatic fevers is to the pericardium ; as Ave shall treat of that affection more in detail hereafter, we content our- selves with barely mentioning in this place the prin- cipal remedies for it, viz., Belladonna, Spigelia, Arsenic, Cannabis, Bryonia. Rheumatic as well as catarrhal fevers may exist simultaneously with other acute affections, compli- cating them and making the use of other remedies beside those here mentioned necessary ; fretpiently, however, one of the above-mentioned remedies is like- wise indicated by the complication of the symptoms.* * * An interesting remedy for rheumatic fevers, which Hartmann hag omit- ted to mention, is Guajacum. In the second number of the Examiner, Vol. IV., we have recorded a most remarkable case of rheumatism which Dr. Schellhammer cured by two doses of Guajacum. The symptoms were : violent stitches in the outer side of the right calf, which soon extended as far as the right ankle joint, and became to violent that the patient fell down, and was, since that period, no longer able to walk. By mismanagement, the patient was reduced to the brink of the grave, until Schellhammer eH'ectod a complete cure. When Schellhammer was called, the symptoms were: violent tearings and lancin.itions in the whole of the aflected side, exporting constant shrieks day and night; cough, with expectoration of fetid pus; aversion to food; nausea and vomiting every morning; spelling of the limb, it was drawn up, still'and immoveable; interstitial distention and soften- ing of the tibia aud tarsus; hot skin, tongue coated, \ehemcnt thirst — Hempel. 151 FOURTH CLASS. GASTRIC FEVERS, § 40, The fever is a continuous remittent, the diges- tive apparatus being principally affected.; the fever differs according as it depends upon overloading the stomach, morbid action of the mucous membrane of the stomach, disturbed secretion of bile, or derange- ment of the whole intestinal canal. This fever is generally ushered in by premonitory symptoms which may be successfully combated by homoeopathic reme- dies, thus preventing the fever altogether. The fever commences with violent heat, restlessness, oppression and anxiety; the patient feels ill and weak, complains of violent headache. Frequently, but not always, the epigastric region is sensitive, especially when touched, and the following symptoms are present: coated tongue, eructations, disagreeable taste, vomit- urition and nausea, increased alvine evacuations, or else constipation; dark, brown-red, saffron-coloured urine, sometimes depositing a sediment, want of appe- tite, increased thirst. We shall offer the following classification of those fevers, which has no reference to the seat, course, and terminations of the disease, for these are frequently modified by epidemic or the prevalent morbid influ- ences ; nor has it any reference to the intensity of the fever, which may be of an inflammatory or even typhoid character. §41. Status gastricus, biliosus et pituitosus; gastro- ataxia saburralis, biliosa et pituitosa, of Schcenlein; a gastric condition witltout fever. Premonitory symptoms of a gastric, bilious, and jntuitous fever. This condition is characterized by the following symptoms : pressure and fulness in the region of the stomach, inclination to vomit, constant disagreeable eructations, bitter or slimy taste in the mouth, dryness of the mouth or confluence of saliva, aversion to food, coated tongue, debility; weight and draAving, or else an aching pain in the region of the forehead; also, in 1.VJ GASTRIC FEVERS. the limbs, altered complexion, restlessness. IoAv-spirit- edness, coldness of the hands and feet. All these symptoms are distinct indications of a derangement of the digestive functions. Persons avIiosc digestive powers are naturally Aveak are predisposed to such a state, which may be brought on by oAer-eating. by heavy or spoiled food, unwhole- some drinks, bail, damp air, great heat, anger, chagrin, grief, etc. It is not difficult to treat that affection homaeopath- icallv. provided the exciting cause is known. The proper and limtdy use of remedial agents shortens the course of such diseases, and prevents their running into corresponding acute affections. If the gastric derangement be evidently owing to overloading the stomach, ihe best medicine is fasting. The patient ought to content himself Avith a little water-gruel, and afterwards take some black coffee. If the stomach have been deranged by fat meat or fat food of any kind, with rancid taste and eructations, the patient ought to fast and take Pulsatilla; in a1'cav hours he will feed better, especially in the stomach. If the gastric derangement be characterized by dictations tasting of the ingest a, by nausea, loath- ing, inclination to vomit, Nature is frequently compe- tent to relieve itself; but the efforts of Nature, which, if unassisted, are frequently unsuccessful and torment- ing, can be facilitated by tickling the velum pendulum palati, fauces and pharynx, Avith a long feather; if anything should remain in the stomach, a little black coffee is sufficient to carry it off by the route of the intestines. If the stomach should have been overloaded to such an extent that the power, or even the inclination, to throw off the contents spontaneously should have been suppressed, occasioning great pains in the epigastric region, the dynamic irritability of the stomach is restored by swallowing a spoonful of black coffee at successive intervals, after which the contents of the stomach, were they ever so excessive, will either be throAvn off by the mouth, or carried off by the rectum. GASTRIC FEVERS. 153 If those means should be insufficient to remove the contents of ihe stomach, or if, after their remoAal, loathing, nausea, inclination to ATomit, should remain, these symptoms yield to Antimonium crudum.* If the gastric derangement be occasioned by some dynamic cause, Adolent emotions, etc., the treatment differs. If any of the above-mentioned symptoms of gastric disturbance arise from violent chagrin, a small dose of Chamomilla is sufficient to remove them. If those symptoms and the stilt continuing chagrin be accompanied by chilliness and coldness of the body, Bryonia alba is the remedy. Gastric disturbances arising from A'iolent fright and chagrin, are entirely removed by Aconite Avithin the space of three or four hours.f Gastric derangements frequently occur in persons who are constantly bowed doAvn by grief and chagrin, other morbid symptoms beside those of the gastric affection being likeAvise present. An indispensable requisite for a permanent cure is the removal of the causes Avhich have brought on the disease. The humane physician Avill do all in his power to cheer up the patient, and to afford him every opportunity for rational amusement. If these conditions can be ful- filled, Avhich is not ahvays possible, owing to the limit- ed means of the patient, Ignatia amara Avill be found sufficient to remove the trouble about the stomach ; if one dose should not be sufficient, another one may be taken in two hours, either Aveaker or of the same strength. If the gastric symptoms arise from taking cold, or from exerting the mind or body immediately after a meal, were it even moderate, Nux vomica is the best remedy. If those symptoms owe their origin to-cold- ness of the stomach, occasioned by a cold drink or * 1 '.specially if there remain a taste of the food in the mouth ; Nux vomica is in many cases superior to Antimony. The spasmodic vomiting of mucus, which sometimes remains for hours after the contents of the over- loaded stomach have been thrown off, is stopped by Nux vomica.—Hempel. t The most prominent symptom of a gastric derangement, arising from violent chagrin, is sometimes a deep sopor, from which the patient can only be roused by shaking him violently; this condition yields to Opium 18.— Hempel. 7* 154 GASTRIC FEVERS. fruit, Arsenic and sometimes Pulsatilla are the best remedies : a gastric derangement Avhich is character- ized by a good deal of flatulence, and arises from eat- ing cabbage, and other kinds of food containing watery particles, yields to Bryonia. If the usual symptoms of a gastric affection be ac- companied by the gulping up of an acrid acidity from the stomach/or if the acidity exist without the other symptoms as a chronic affection, Avhich is usually termed heartburn, Nu\-is the best remetly. provided it corresponds to the remaining symptoms ; for chronic heartburn, Sulphuric acid is perhaps more frequently suitable, provided all the accompanying symptoms correspond. The above-mentioned symptoms, denoting a disturb- ance of the gastric functions, may all be brought on by the fault of the patient; but they may also occur as a sporadic or epidemic disease Avhile the patient is under treatment for some chronic affection. Under those circumstances the above-mentioned remedies have to be employed, but in as weak doses as possible, lest the treatment of the principal chronic affection should be entirely interrupted.* § i'-i. (lastric fevers ; saburral, gastric, bilious fever. We have alluded to the precursory symptoms of * There are other symptoms, and also other remedies, for gastric affections, which Hartmann has not mentioned. We recommend Calcarea earb., Carbo veg., China, Capsicum, for acidity of the stomach and heartburn, each of those remedies to be chosen in accordance with the symptoms. Carbo animalis is an excellent remedy for sour stomach, with scalding sen- sation in the throat. Lycopodium for acid risings from the stomach, constipation, cuttings from the liver to the epigastrium. Arsenic for burnings in the pit of the stomach, oesophagus and pharynx, with constrictive or suffocative sensation in the throat, and constant thirst; or for sensation as if the stomach were torn to pieces. Digitalis for excessive debility in the region of the stomach a* if this would die; accompanied by irregular pulse. Ignatia for great weakness in the epigastric region, with a burning pricking. Spigelia for a strange sensation of weak soreness in the pit of the stomach ; the patient cannot bear the pressure of the clothes; this pain is frequently accompanied with soreness of one eye-ball, and pain on turning it or looking down; twitchings in the lid, sensitiveness to light. Lachesis for excessive rolling of wind from the stomach upwards. Nux vomica for gastric derangement arising from abuse of coffee or spiritu- ous drinks. Merc for soreness as of an abscess in the pit of the stomach.—Hempf.t.. GASTRIC FEVERS. 155 those fevers in the preceding paragraphs. If the pre- cursory symptoms be not relieved, and the gastric fever become fully developed, then the fulness and pressure in the region of the stomach increase, that region be- comes distended, although it remains soft and is not sensitive to pressure ; it is filled with gas, as may be ascertained by percussion, accompanied with inclina- tion to vomit, rising of fetid air, sometimes vomiting of food and tenacious, bile-coloured mucus; the tongue is covered with a thick crust of dingy-yellow mucus, the abdomen is soft, the bowels are either constipated or else the patient discharges a quantity of fetid stool, consisting of badly-digested food. A peculiar kind of headache is almost always present, a sort of pressure in the forehead, commencing in the frontal sinus and thence spreading over the orbital region ; general feel- ing of debility; wretched, disfigured appearance, with yellow tinge of the whites of the eyes; the chilliness is more or less violent, succeeded by heat and dryness of the skin; the pulse is irritated, quick, soft, some- times intermittent, or at any rate unequal, the urine is turbid, smells like horse-urine. If the bilious symptoms be particularly prominent (in Avhich case the fever is called febris biliosa, or in the language of the older physicians, causus) all the symptoms are then generally more violent, the heat is very great, there is great burning and turgescence of the skin, the restlessness and the thirst are great, the patient has a great desire for sour drinks, and the prevalence of the bilious symptoms is visible all over. The tongue has a lemon-coloured coating, which be- comes gradually brown, taste and eructations are bit- ter, the patient vomits a greenish, bilious matter, the bowels are confined, or else there are yellowish, green or brown discharges from the bowels, the countenance looks livid, and somewhat jaundiced ; these symptoms are sometimes accompanied by senshrveness, hardness, tension, warmth, burning in the region of the liver and stomach; the urine is dark-brown, tinged with the colouring matter of bile, the pulse is frequent, full, in- termittent or double-beating. l.'ij GASTRIC FEVERS. § 43. The gastric fe\'er is liable to be confounded with typhus, from Avhich it is distinguished by the ab- sence of all nervous symptoms (which may exist. hoAV- ever, Avhen the fever is of a torpid character), and of the aching pain in the occiput: nor are the senses of sight and hearing disturbed Avith illusions; in typhus the region of the stomach is not distended, but is pain- ful to the touch ; there is no pain in the region of the caecum, which is a constant characteristic of typhus; the characteristic typhus evacuations from the bowels are likewise wanting in gastric fever, nor is the spleen enlarged. Individuals with weak stomachs, suffering with dys- pepsia and great irritation of the mucus membrane of the stomach, are particularly predisposed to gastric lever. Cold and wet weather in the summer-season faA-ours the occurrence of gastric fevers, which are even epidemic at such periods ; they may bo likewise occasioned by injurious and heaAy food, stimulating medicines and bitters, overloading the stomach, by chagrin, anger, cold on the stomach. Epidemic bil- ious feAer is sometimes developed out of an epidemic fever and ague. The course of the disease is sometimes very rapid, tAventy-four or seventy-two hours, sometimes it lasts fourteen or twenty-one days. A successful termina- tion of the tlisease is generally accompanied AA'ith pro- fuse evacuations of some kind, either A'omiting of bad- ly tasting, bilious substances, or fetid stools, profuse sweats, clear urine, Avith earthy, lloeeulent sediment ; in a few cases miliary eruption makes its appearance upon the skin in the region of the abdomen : an erup- tion upon the lips is frequently present. The fever may leave chronic derangements in the digestive sys- tem, or may pass into typhus or intermittent fever. If the so-called typhoid symptoms supervene during the course of the gastric fever, the abdomen becomes dis- tended, meteorism sets in, a constant sensation of pres- sure is experienced in the region of the stomach, there is a constant inclination to vomit, the coating of the tongue is browner than usual, the tongue is dry, the GASTRIC FEVERS. 157 extremities are cold, the pulse is frequent, wiry, small, the urine is brown, decomposed, emitting a strong am- moniacal odour, the patient becomes delirious; invol- untary discharges of faeces and urine, sopor, and the usual typhoid symptoms set in. Death rarely takes place by local disorganizations, inflammation and ul- ceration of the mucous membrane of the stomach ; death is more frequent by the gastric fever passing in- to typhus, and paralysis taking place in consequence. Should a chronic inflammation and subsequent suppu- ration of the mucous membrane of the stomach set in, the physician's attention will necessarily be directed, by the obstinate duration of the gastric symptoms, to such a process of disorganization having commenced ; and he will find that the fever, which gradually in- creases again, has become a slow, chronic, secondary affection, depending upon the incipient degeneration. In most cases the prognosis is favourable; the com- plication with typhoid symptoms makes it more doubt- ful. The convalescence is generally very short. § 44. The homoeopathic treatment of simple gastric fevers is generally very easy, and, in most cases, suc- cessful. The lighter forms of those fevers, such as saburral fevers, frequently terminate in tAVO or three days. The following remedies deserve a preference in the treatment of those fevers : Puis., Bryo., Nux vom., Ipec, Tart, emet., Antim. cr., Chamom., Coloc., Acid, phosp., and Arsenic. What Ave have said of the treatment of the premon- itory gastric state, is likewise applicable to the sim- plest kind of gastric fever, the saburral feA'er. The same remedies will generally be found sufficient. Pulsatilla is a specific remedy in that affection when the patient is out of humour and disposed to Aveep, and Avhen the following symptoms are present: great chil- liness, absence of thirst, aversion to food, especially Avarm, meat, bread, milk and tobacco ; slimy, sour, bit- ter taste, eructations, vomiting of food, pressure at the stomach, and sensation as if the food Avere in the in- testines undigested, rumbling in the abdomen, nightly green stools, restless night sleep, disturbed Avith dreams. 158 GASTRIC FEVERS. Pulsatilla is adapted to individuals Avith excessive ve- nosity. Avhen a throbbing is experienced in the pit of the stomach, Avhen the patient is periodically aflected with stinging pains in the stomach, and the fever ex- acerbates in the forenoon. Pulsatilla is likewise suit- able in that form of gastric fever, Avhich was desig- nated by the older physicians as a febris gastrico-ve- nosa. If a sense of illness, debility, a chilliness in the body, and a want of appetite, should remain after the exhibition of Antimonium crudum, these symptoms will yield to Pulsatilla ; the symptoms remaining after An- timony may likeAvise indicate Nux or some other remedy. Nux \romica is especially suitable to irritable, live- ly, plethoric and hypochondriac indiAiduals, Avhose di- gestive powers havt* been Aveakened by mental exer- tions, a sedentary mode of life, abuse of coffee and spirituous drinks. Nux is likewise indicated Avhen the gastric feAer arose from a Aiolent commotion of the mind by surprise, fright, quarrelling, etc., and the proper specific Avas not at once resorted to, alloAving the fever time to establish itself in the system. If the gastric disease Avas occasioned by frequent chagrin, and the symptoms occasioned by those mental disturb- ances do not yield to the specific remedy, Nux ought to be employed (Pulsatilla rivals Nux under those cir- cumstances). Nux may likeAvise be administered for the following group of symptoms: considerable heat in the face, burning heat in the eyes, dry lips, great thirst, violent lancinating pain in the fort head or hemi- crania, broAvnish or slimy coating of the tongue, acid taste in the mouth, nausea, tension and distention of the region of the stomach and of the abdomen, Avith fulness and pressing towards the chest, oppression of breathing, anxiety, violent, spasmodic pains in the stomach, Avith sensation of griping and tearing aAvay, rumbling and pinching in the abdomen, constipation, flatulence, yellowish tinge around the nose and mouth, general restlessness, great sensitiveness of the organs of sense. If there should be an excessive tendency of the vital GASTRIC FEVERS. 159 action upward and downward, Avith vomiting and diarrhoea, cutting pains in the whole of the abdomen, Avith fetid flatulence and discharges of undigested food, Antimonium crudum is the best remedy even in the most obstinate and dangerous cases. Ipecacuanha corresponds more to a gastric derangement brought on by general causes, such as: weather, etc. (in opposi- tion to a gastric derangement occasioned by specific influences, such as: fat food, etc.), wrhen inclination to vomit is present, or Avhen the nerves of the stomach are excessively sensitive and irritable, and the intro- duction of the least quantity of food into the stomach brings on the vomiting. Remedies that affect the healthy organism in a similar manner, must necessarily correspond to similar morbid conditions ; this is especially the case with remedies Avhich antidote one another. It is for this reason that Tartarus emeticus, which antidotes both Ipec. and Puis., is a useful remedy in gastric fevers. This remedy deserves a preference when the folloAving symptoms make their appearance : great drowsiness with the fever; reddish, itching rash on the trunk, especially the chest; Adolent vomiting and nausea day and night, yellow-brown diarrhaeic stools, with exces- sive cutting in the bowels. Bryonia is a distinguished remedy .in gastric feAers, AAdiich depend upon a double cause, cold and chagrin. It is indicated when the gastric derangement is accom- panied by great febrile heat, mingled with slight chills, great debility, nightly exacerbation of the symptoms, Avhen the patient is irritable and out of humour, and complains of a pressing pain in the forehead from Avithin outward. These symptoms are accompanied by dry mouth and tongue, violent thirst, desire for a.eidulated drinks, pressure at the stomach, stinging in the liver when touching the region of that organ, or Avhen coughing and taking a deep inspiration ; empty retching, continuing for some time, and gradually in- creasing to a bilious Amounting after a good deal of hickuping (this slum's that Bryonia is a good remedy in bilious fevers), accompanied with pinching, cutting 160 GASTRIC FEVERS. colic, constipation being sometimes present. Bryonia deserves consideration when the gastric fever is com- plicated with rheumatism, and when the synochal fever threatens to assume a typhoid character. Colocynth is on a par Avith Bryonia. It deserves a preference when the gastric fever was brought on by a fit of indignation, by deep mortification in conse- quence of humiliating treatment, and when it is ac- companied with sleeplessness. A'iolont heat, Avith a hot, dry skin, and a full accelerated pulse. The colocynth fever is likewise characterized by a pressing pain in the forehead, which is more Aiolent in the recumbent posture than in Avalking. The gastric symptoms are not as intense as those indicating Bryonia. If vomit- ing be present, it is copious, and the ingest a are throAvn off; the colic is generally very violent, is occasioned by eating the slightest quantity of food, and generally consisls in a violent cutting, with chil- liness and tearing in the lower limbs, and frequent yellow-greenish diarrhoeic stools. Colocynth is an excellent remedy, not only in gastric, but also in bilious feA'ers. Acidum phosphoricum is an excellent remedy in such feA'ers, Avhen they arise from grief, deep and gnaAving sorrow, anxiety and care, and are accompa- nied by great restlessness, a pushing and tumult in the blood, and profuse sweats. The fever generally con- sists of alternate chilliness and heat, slrong, irregular pulse, and extreme apathy. The pressing headache is likeAvise present, but more in the vertex than in the forehead, and is accompanied Avith a sensation as if the brain were bruised. The whites of the eyes are of a dingy yelloAv, the eyes are faint, Aviihout lustre, sunken, surrounded Avith bluish circles, and making the face look pale and sunken. The thirst is greater than the appetite, Avhich is constantly accompanitd with nausea ; after every meal the patient experiences a painful pressure in the pit of the stomach which is in- creased by contact. Characteristic indications are the burning in the abdomen with sensation as if it Avere distended, especially in the umbilical region, CASTRIC FEVERS. 1G1 and the discharges by the rectum of Avhite-grey mucus. One of the principal remedies in gastric feA'ers, and indeed in many other affections of the mucous mem- branes, is Arsenic. It is indicated by an excessive prostration of strength which is by no means propor- tionate to the intensity of the other symptoms, by great dry and burning heat, and panting for drink ; a number of other symptoms Avhich do not generally belong to gastric fevers : such as tearing, burning pains in the extremities, spasms, pressing headache, loss of appe- tite, evanescent SAvcats, anguish, etc., are likewise present and, by a process of metaschematismus, invade other parts and internal organs. Arsenic deserAes especial consideration Avhen the gastric symptoms are accompanied Avith violent burning pains in the stomach and pit of the stomach, swelling and pain of the liA'er and spleen, meteorism. The following remedies which are likewise useful in some forms of gastric fever, will be spoken of more in detail in the subsequent paragraphs : Veratrum, Belladonna, Coeculus, Mercurius, Staphysagria, Digi- talis, China, Taraxacum, Asarum, Ignatia, Colchi- cum. § 45. If the bilious symptoms be the most promi- nent, Chamomilla is a principal remedy, especially if the fever originate in violent chagrin or vehemence and be characterized by great general heat, burning of the face and eyes, violent thirst, bitter bilious taste in the mouth, A'omiting of a substance Avhich is bitter as bile, thick, yellow coating of the tongue, tension of the abdomen, and the hypochondria, colicky pains in the abdomen accompanied Avith rumbling, Avatery, green, yellow eA'acuations, startings as if in affright, tossing about during sleep, salloAAr, yellowish com- plexion, excessi\-e irritability and sensibility to pain, painful pressure at the stomach as from a stone, Avith shortness of breath and anguish. Only in case Cham- omilla should have been used as a tea preA'ious to the arrival of the physician, it ought not to be administer- UV2 GASTRIC FEVERS. ed as a remedy.* In such cases Coflea, Ignatia, Nux, Coeculus, Pulsatilla are better indicated. Ignatia is preferable to Chamomile, when the bilious fever has arisen from concealed chagrin and when the usual Chamomilla symptoms are moreover accom- panied with silent grief and shame. If the fever was occasioned bv chagrin with indignation, Staphysagria is the remedy. Staphysagria is likewise indicated when the disease commenced Avith fainting fits. Mercurius deserves especial consideration, Avhen the gastric-bilious condition is accompanied with frequent diarrhceic stools of green mucus which is sometimes acrid and streaked Avith blood, the discharges being almost always preceded by a painful pressing in the rectum and an anxious tremor xvith colic ; the patient is moreover affected with a jaundiced colour of the skin, yellow-coated tongue, bitter taste and eructa- tions, desire for sour things, great sensitiveness of the region of the liver which is painful and distended, the urine is dark and has a putrid smell. China deserves consideration in cases of debility oc- casioned by the use of cathartics and emetics, (it will therefore have to be frequently employed in gastric fevers which had been treated in the usual old-school fashion) and when the following group of symptoms occurs: Dulness and want of clearness in the head, vertigo when raising the body, tearing headache, especially at night; restless, unrefreshing sleep, clay- coloured, yellowish tinge of the skin, and whites of the eye : yellow coating of the tongue, dry lips, want of appetite, bitter eructations and taste, retching and pressure at the stomach, oppression of the chest, frequent Avhitish or greenish-yellow stools, emission of fetid flatulence, which affords no relief; dark red urine, slight thirst, gnat debility, disposition to be vehement and out of humour; enlargement, and indu- ration of the liver and spleen. * As a general rule ; but there are cases of bilious fever or bilious colic where Chamomile tea has been used without effect, and where the homoe- opathic preparation of that drug effected a cure. Such cases have occurred in my practice at any rate.—IIcmpel. GASTRIC FEVERS. 163 If the gastric and bilious symptoms be accompanied with violent cutting pains in the abdomen which appear at intervals and seem to proceed from flatu- lence ; if there be an entire want.of action in the rectum, constipation or else greenish-yellow diarrhoea with loud rumbling and frequent emission of flatu- lence ; if the abdominal pains be so violent that the patient is on the point of losing his senses, and the body becomes cold; if the patient have an anxious, irritable, hypochondriac mood: Veratrum album is frequently the best remedy. § 46. We sometimes meet a peculiar form of gastric fever, which was formerly termed febris venoso-gas- trica. This kind of fever is almost always preceded for a time, often even for years, by the symptoms of predominant venosity and abdominal plethora, which is easily increased by an error in diet, or by other hurtful influences, and, in that case, gives rise to febrile phenomena and to derangements in the digestive and the portal system. The fever is obstinate and remit- ting, the patient's countenance is red and puffed, he is anxious, out of humour, melancholy, the bowels are slow, the tongue is coated, the appetite is gone, there is nausea, changed taste, without, however, any evidence of undigested food having remained in the intestinal canal, the pulse is mostly hard, small, not frequent, the urine is either not altered or else dark and smells like horse urine, there is not much sweat, and sometimes the sweat is cold. After the fever has lasted about a fortnight, the patient discharges a con- siderable quantity of fetid, bilious, or slimy substance; these discharges relieve the patient and generally break the fever. We have already mentioned that Pulsatilla is a chief remedy in such fevers; but Digitalis is likewise recommended. It is especially suited to individuals Avith sanguine temperament and soft, flabby muscles, slow pulse, weak stomach, nausea, bitter mouth in the morning on Avaking, vomiting of the ingesta, spasmodic griping, tearing pain in the stomach, sensitiveness of the pit of the stomach to pressure, vertigo, aching pain in the fortdiead over the eyes, great debility as if one 164 GASTRIC FEVERS. could not stand upon one's feet, little sleep and anxiety. Among the other remedies, avc distinguish Nux vom., especially when the small of the back is Aveak, and a pain as if bruised is experienced in that region, Yerat. album, Belladonna, Bryonia, Chamomilla, Rhus tox., Capsicum, Arsenicum, and especially Sulphur : this latter remedy is a specific remedy in this disease arising from chronic abdominal plethora, Avhich is fre- quently accompanied by hemorrhoidal affections. Coeculus and Belladonna deserve a particular men- tion in the treatment of this class of fevers. Coeculus is especially adapted to gastric-bilious fevers which arise among other causes from chagrin and abuse of chamomile, and are aggravated after every eating and drinking, sleeping, talking, smoking, coffee ; the aggra- vation frequently amounts to a fainting fit, after Avhich great debility and trembling of the limbs remain. The feA'er consists principally in a sudden, pretty violent flush, Avith thirst, small, hard pulse, cold feet, and ex- cessive sensitiveness of feeling. The gastric symptoms are : change of taste, aversion to food or drink. Avith heat and redness of the face, frequent bitter eructations followed by lockup, oppression at the stomach, and pain in the hypochondria ; constipation. Both Coeculus and Bellad. are particulary adapted in such fevers to children and females. Belladonna is particularly useful Avhen the fever occurs after a cold, in lymphatic and scrofulous subjects. The fever it- self is a violent burning heat, Avith strong,quick pulse, great thirst, profuse dark urine, the sleep is disturbed by frightful dreams; the mind is agitated, the blood rushes to the head, Avhich aches intensely, the cheeks are hot and red. These symptoms are frequently accompanied by a slimy and bilious vomiting, a burn- ing, griping tearing in the umbilical region, and fre- quent but ineffectual urging for stool. § 47. In robust and plethoric young individuals the febrile phenomena are sometimes very strongly marked and intense, requiring the exhibition of Aconite, Avhich is so much more advisable as Aconite has proved a specific against the consequences of fright, anger, MUCOUS FEVERS. 165 chagrin, especially when the circulation and the func- tions of the liver were disturbed by those causes. Aconite is particularly indicated by violent chills fol- lowed by a general dry and burning heat, hard, full, bounding, accelerated pulse, great thirst, and a general profuse sweat succeeding after the heat. If typhoid symptoms should set in, or if the fever should become a real typhus, the remedies Avhich Avill be more particularly described in the chapter on typhus, such as Bryonia, Belladonna, Rhus tox., Phosphorus, Arsenic, etc., require to be used. Arsenic is suitable even in purely gastric fevers when the following symptoms are present: blackish, diarrhoeic stools, accompanied with violent colic, vomiting, great inter- nal burning heat, dry lips and tongue, unquenchable thirst, excessive debility and prostration, great anguish, nightly restlessness, burning and beating in all the blood-vessels, clammy sweats, apoplectic symptoms. The diet requires to be carefully regulated, of course. HoAvever, errors in diet need scarcely to be apprehended, as the patients have an aversion to food, especially warm food. The best beverage is fresh water, in a very few cases some other drink may be given. § 48. Mucous fevers, erethism of the mucous mem- brane of the intestinal canal. This fever is essentially a catarrhal affection of the greater portion of the mucous membrane of the chylo- poetic canal; sometimes the mucous membranes of the other systems and organs are likeAvise affected. The precursory symptoms which sometimes set in a long while btdbre the fever breaks out, are: loss of appetite, flat taste or entire absence of taste, white slimy coating of the tongue, loathing, great repletion of the stomach, irregular evacuations, pale counte- nance and debility, and other symptoms AA'hich have already been mentioned among the precursory symp- toms of gastric fever. All those phenomena are generally mild, sometimes the patient feeling rather comfortable, chilly. As a general rule the develop- 166 MUCOUS FEVERS. ment of the disease takes place in a concealed manner, the symptoms have a mild character and the disease is on'that account, easily neglected and overlooked. As the disease proceeds, the patient throws up a tasteless white mucus, the stomach is distended by the introduction of the least quantity of food, a tension and pressure being experienced at the same time ; the tongue which had been so far covered uniformly with a white mucus, now becomes dark-red at the tip and on the edges, which indicates the setting in of a ty- phoid condition. On the other hand we sometimes see the tongue remain white during the whole course of the disease, but it becomes dry especially in the even- ing ; the taste is unpleasant, Avith sensation as if the mouth were filled Avith mucus, which is sometimes visible and lines the mouth and palate like glue ; in the morning long threads of a thick, tenacious mucus are either hawked or gaggetl up. The bowels are generally sIoav or confined ; only when the affection spreads over the mucous membrane of the lesser in- testines, the patients have fromtwoto six stools a-day, accompanied with rumbling and pinching, the dis- charges consisting in white, jelly-like thready mucus. mixed with undigested food, the colouring matter of bile and pieces of worms ; the urine is straw-coloured, loamy, flocculent, and depositing a Avhitish sediment. In the commencement the fever has distinct remissions which afterwards become almost imperceptible, the pulse is seldom frequent, rather soft, more so than full and irritated ; thirst and sweat are moderate,sometimes howeA'er the patient has a great desire for drink, the skin is slightly warm, the patient feels Aveak. Drow- siness, aching of the forehead, restless night sleep, dim eyes Avithout lustre are almost constantly present, the patient is generally indifferent, peevish, in a state of apathy. § 49. The mucous fever which is frequently con- founded with gastric fever and typhus, is sufficiently characterized by the peculiar symptoms of the mucous membranes which make their appearance in the very commencement of the disease, by the copious secretion MUCOUS FEVERS. 167 of a tenacious, albuminous, thready mucus, by the coating and the peculiar colour of the tongue, by the mildness of the fever, with a pulse which is but slightly or not at all accelerated, and by the absence of pain in the ileo-ccecal region, of the characteristic typhus evacuations from the bowels, of enlargement of the spleen, etc. Predisposing causes are : youthfulness, female sex, scrophulosis, worm affections, disposition to chronic blennorrhcea of the abdominal organs, especially the stomach. The outbreak of the disease is favoured by wet and cold or damp summer weather, and by con- fining one's self to a vegetable diet, consisting princi- pally of indigestible, heavy food; these causes are often sufficient to make the fever epidemic. The course of the disease is always slow; in the most favourable circumstances it lasts a fortnight, sometimes much longer, as the patient is liable to re- lapses and temporary aggravations. As the disease progresses, the symptoms frequently change ; some- times the increased secretion of mucus spreads over the mucous membrane of the whole abdomen, the respiratory, urinary, and genital organs ; or the fever assumes the so-called typhoid character, with mutter- ing delirium, humming in the ears, dull and stupid feeling of the head, hardness of hearing, subsultus tendinum, grasping at flocks. Very often a rash, in the shape of white crystal-coloured vesicles, makes its appearance, accompanied with profuse, fetid, exhaust- ing sAveats. Sometimes aphthae form in the mouth with fetid, cadaverous smell from the mouth, and ptyalism; the aphthae may even affect the mucous membrane of the whole abdomen, as may be inferred from the existing tenesmus and the shreds which are discharged from the rectum. The disease is rarely complicated with other dis- eases ; in young, plethoric individuals, however, the mucous membrane may become inflamed and ulcer- ated. Post-mortem examination has shown the following 168 MLCOU.x FEVERS. results: the mucous membrane of the ehylopoetic canal is covered Avith thick Aiscid mucus, the mucous mem- brane itself is interstitially distended, of a dingy grey colour, reddish, and softened to such an extent that it can be pulled off or even wiped off, like pap ; the criptae mucosa? are enormously enlarged, distinctly A'isible ; some parts look as if the mucous membrane had been cut off, Avithout redness, sAvelling, or inter- stitial distention about the edges. The prognosis is not unfaA'ourable CA'cn Avhen the disease is perfectly developed, or the treatment has been neglected. Slimy diarrhoea, supcrA'cntion of typhoid or putrid conditions, Avith rash and aphthae, discharge of decayed Avorms make the prognosis very doubtful. Recovery is generally characterized by the folloAving appearances : mild sweat (a rash making its appearance Avhich afterwards scales off), straAV- coloured urine, Avith a thick clayish sediment, and calm sleep, but it is almost always slow, and the patient is , greatly inclined to have relapses. Death either takes place by the formation of aphthae covering the mucous membrane of the abdominal and respiratory organs and becoming gangrened, or in consequence of the non-appearance or the retrocession of the rash, or by paralysis of the abdominal nerves causing meteorism, hrvoluntary discharges of cadaverous stools, small, weak and trembling pulse, and sopor, or lastly the brain may become paralyzed. § 50. It is of great importance in this disease to employ suitable remedies before the fever is fully de- veloped ; this Avill frequently enable us to cure the patient in a a-cry short time, whereas, if the precursory stage be neglected, the disease becomes very obstinate. The principal remedies for the precursory symptoms of mucous fever are: Pulsatilla, Ammonium muriati- cum, Nux vomioa, Ipec, Merc, Dulc. Ignat., Staphys., Senega. Pulsatilla deserves a preference over every other remedy in individuals of a flaccid, lax, venous-lym- phatic constitution, who, by eating too much fat and MUCOUS FEVERS. 169 rich food, have brought on a total want of appetite, flat, slimy taste, coated tongue, chilliness, ill humour, and a want of muscular tonicity. The physiological effects of Ammonium correspond perfectly to the symptoms of the status pituitosus. For centuries past Ammonium has been recommended for those morbid phenomena which it produces in the healthy organism in the most striking manner. White slimy coating of the tongue, constant hawking, occa- sioned by a quantity of viscid mucus in the throat; a disagreeable, pappy taste in the mouth, with con- fluence of water, aversion to food, loathing, empty eructations, gulping up of bitter, sour water, malaise and warmth in the stomach, discharge of glassy, tenacious mucus by the rectum, etc., indicate the use of Ammonium. Nux vomica is suitable when the patient has been irritated by chagrin, and when the following symptoms occur: dry tongue, coated Avith white mucus, disposi- tion to acidity of stomach, dyspeptic symptoms after every meal, heartburn, distention of the pit of the stomach, constipation, dull and obtuse feeling about the head. Dulcamara is recommended when the fever has heen occasioned by a cold, and when it is charac- terized by the following group of symptoms : flat, soap- like taste, great thirst, dryness of the tongue, increased secretion of saliva, aversion to any kind of food, dingy white coating of the tongue. Another distinguished remedy is Mercurius, which corresponds both to the precursory symptoms and to the disease itself, when it has reached a certain de- gree of development. Mercurius is indicated by the following symptoms : increasing diminution of appe- tite, tongue coated Avith white mucus, excessive and painful dryness in the throat when swalloAving, putrid taste and smell, loathing and nausea, tearing burning pains in the temples, pressure and tension in the pit of the stomach, in the region of the stomach and liA'er, regurgitation of an acrid fluid into the mouth, turbid, slimy urine depositing a sediment, irregular evacua- tions, with frequent tenesmus, pale, livid, yelloAvish 8 170 MUCOUS FEVER*. countenance, debilitv, want of irritability; character- istic symptoms are: "thick coating of a dirty mucus on the tongue, flat, pappy taste as of soap, great desire for piquant dishes dryness of the mouth and throat, sluggish stools or tdse constipation, or diarrhonc stools of tetid mucus, great mental and physical prostration. In the commencement of the disease, ignatia is sometimes useful, especially when the symptoms are changeable, and when the following group of symp- toms Occurs : great indolence, inclination to lie (lo\vnt> weight and pressure in the fortdiead. pain in the pit of the "stomach, alternate redness ami paleness of the face, dry and chapped lips. Avhite-coated tongue, flat. insipid ta>te, great aversion to food and drinks, re- gurgitation of a bitter substance, frequent discharges of white mucus ; sudden flushes of heat over the whole body are frequently present, with small, acceler- ated pulse. Staphysagria may likewise prove useful in the first commencement of the disease, and competes Avith Ignitia when the disease has been occasioned by moral emotions. But even in the highest degrees of pituitous fevers. Staphysagria is an excellent remedy, cA-en when typhoid and putrid symptoms have made their appearance. The attending physician will easily discover the symptoms indicating Staphysagria Avith- out our mentioning them. All that we intended to do was tt> point to Staphysagria, and likeAvise to Senega, which is indicated for many affections of the mucous membranes, especially when the patients are of a \ phlegmatic, passive disposition. In cases Avhere Senega is indicated the fever is not very violent, there are merely slight shiverings and heat, accompanied by a beating pain in the head, laboured breathing with anxiety, stitches in the chest, tin Avhole body feels bruised, the pulse is frequent, and the thirst increased ; the stools are rather less frequent, in a few cases more frequent than usual; there is an accumulation of viscid mucus in the throat, occasioning constant hawk- ing. The following remedir. ha- e likewise been found MUCOUS FEVERS. 171 useful in practice: Bryo., Rheum, Cham., Dig., Anti- monium cr. and Tart, emet., Cina, Bellad, Ac. sulphur., Ars., Phosph., Sepia, China, Rhus, Spig., Mezereum. Digitalis especially is a distinguished remedy in fully- developed mucous fevers when the A'ital forces are greatly depressed, when the pulse is slow, the patient is very feeble, complains of pressure and fulness in the pit of the stomach, constant loathing, nausea and fre- quent vomiting, thirst, diarrhoea, \ertigo, aching in the forehead over the eyes, restlessness, and scarcely any sleep. Sepia may likeAvise be ranked among the remedies for pituitous fever; it is frequently adapted to fevers of that kind which have a long run without being characterized by any violent symptoms. We take this opportunity of remarking that Sepia is an excel- lent remedy for plethora venosa abdominalis, provided the symptoms correspond. If the fever assume a torpid character and typhoid symptoms make their appearance, Bryonia will be found an excellent remedy as long as the typhoid symptoms have not reached a high degree of violence and when the following group of symptoms occurs: violent congestion to the head, dry, burning heat, dry lips, dry, red tongue, pressure at the pit of the stomach, constipation, wandering looks, slight delirium, etc. Rhus corresponds to similar symptoms when the pulse is very much depressed. Belladonna deserves a preference when the brain is principally affected and A\7hen the following symptoms occur: quick, hard pulse, dry skin, great thirst, parched tongue. If the increased secretion of mucus spread over the respira- tory organs and the intestinal canal, if expectoration of mucus, rattling in the trachea and diarrhoea be pre- sent, if the patient lie still Avith open mouth, dry, parched, black lips and tongue, if the respiration be oppressed and delirium and floccilegium be present, Phosphorus is the suitable remedy. If rash threaten to break out, which is almost alAvays accompanied with a peculiar sighing breathing, Ipecacuanha is particularly suitable. If the rash should have actually 172 WORM FEVER. broken out, or should have receded, Arsenic may still save the patient's life. The characteristic symptoms in such a case are: sopor, cold sweats, blackish lips and teeth, dry, trembling tongue, unquenchable thirst, meteorism, inA-oluntary discharges of feces and urine, snoring, oppressed, and excessively hurried breathing, small, trembling, very frequent pulse, automatic move- ments of the hands, nightly muttering delirium. (Aci- dum phosp., and Carbo veg. ought to be thought of AA'hen those symptoms occur). Arsenic is likewise in- dicated Avhen aphthae form in the mouth, no matter Avhether it be a simple or putrid ulceration, and affect the Avhole intestinal canal. For simple aphthous ulcer- ation Mezereum may likewise be indicated, especially Avhen a A'iolent burning in the fauces and stomach is present, and the aphthae look flat and flaccid ; Mer- curius, Acid. nitr. and sulp. may also prove curative. If gangrene threaten to set in, Arsenic is the first remedy, China, Ac. mur., Carbo veg. and Baryta are the principal remedies next to Arsenic. The diet is of the utmost importance both in the pre- cursory stage, in order to prevent the full deA'elopment of the feA'er, and in the stage of convalescence, in order to preAent a relapse. The object of diet in the pre- cursory stage is to arrest the excessive secretion of mucus; in the stage of convalescence the object of diet is to invigorate the patient by suitable nourish- ment without exposing him to the danger of having a relapse for which there is a great disposition. The patient ought to take small quantities of liquid food with a good deal of drink, the convalescent patient may add a few drops of Avine to his drink. § 51. Worm fever; helminthiasis. Worm affections, with or without fever, are evi- dently chronic diseases. Entozoa are no disease, but the product of disease, which may however react upon the organism as a morbific cause. We class worm fever and even the chronic condition which is termed helminthiasis, among the acute diseases lor this reason, that a worm fever is very similar to gas- WORM FEVER. 173 trie and pituitous fevers, and that it generally sets in only Avhile the organism is under the influence of some other affection Avhich makes the contents of the bowels unpleasant to the worms ; when this is the case, the worms writhe and twist themselves about in the intestines, irritating the mucous membrane of these organs. Physicians have mentioned so many symptoms as indicating the presence of worms that it is difficult to offer a well-marked image of a worm fever. Many of those symptoms are extremely changeable ; they are occasioned by the temperament, sex, individuality, or mode of life of the patient, or may characterize the gastric, pituitous, or other similar affections of the patient. Nevertheless there is a sufficient number of characteristic symptoms which leave no doubt about the true nature of the affection; these are the pheno- mena which reveal the characteristic irritation of the mucous membrane of the intestines. But eAren of these symptoms, no single symptom has any decisive A'alue as a diagnostic symptom ; it is the simultaneous oc- currence of a number of such symptoms which decides the character of the disease. The discharge of one or more worms or pieces of A\rorms is no certain proof that the existing fever is occasioned by those animals, since it is a Avell-known fact that worms may even exist in the healthy body, and probably do exist more or less in every child. The following are the more permanent symptoms of a worm disease: pains in the abdomen, almost ahvays proceeding from the umbilical region, and being frequently a mere sensation of pres- sure or constriction, which is sometimes A'ery violent, amounting to colic ; if the affection arise from asca- rides, the pain is generally local, accompanied with the following symptoms : troublesome itching of the anus, especially in the eA-ening, dysuria, stranguria, tenes- mus, apparent haemorrhoidal sufferings, discharge of mucus by the rectum, bladder, vagina; uncommon periodic sadness, gloominess, and irritability of temper; when taenia is present, the patient frequently experi- ences a sensation as if something Avere crawling or 174 WORM FEVER. twisting itself from the left side of the abdomen to- wards the stomach and even the oesophagus •, or a sensation as of the undulating movement of a cool ball in one or the other side, sensation as if something Avere sucking in the abdomen, vertigo, tingling and numb sensation in the fingers and toes, they are dis- posed to go to sleep ; the pain is always p< riodical, not continuous, it occurs principally in the morning and when fasting, and is generally relieA'ed by eating ; the quality of the food influences the pain greatly: it is increased by milk, sugar, and other sweet things, by acrid and salt food, ham, cheese, and by the so-called anthelmintica. The abdomen is not painful when pressed upon, it is soft, sometimes distended, the taste in the mouth is unpleasant, the smell from the mouth is offensive, the appetite is irregular, now canine hun- ger, and then again aversion to food ; the tongue is frequently coated Avhite, and the mouth is filled Avith water. The boAvels are at times confined, at times there are loose and slimy stools. If the worms be lodged in the duodenum and stomach, there is pressure and a gnawing pain in the pit of the stomach, eructa- tion, Aomiting, sometimes even Aomiting of worms. Other symptoms are : itching, tingling, and bleeding of the nose, frequent sneezing; pale countenance, sunken eyes surrounded with blue margins, squinting, dilated pupils ; restless sleep, during which the patient starts frequently; ruminating, grating of the teeth, talking in sleep; indolence; emaciation of the extremities; bloatedness of the countenance. The febrile erethism is characterized by a little chilliness, a small irregular, and even intermittent pulse, clammy sweat, turbid urine, smelling like horse urine. The febrile pheno- mena, as a general rule, are vague and uncertain, sometimes they are very violent, the heat being very great and accompanied with sopor, shrieking and trembling. Less permanent symptoms are: jactitation of the muscles, spasms, vertigo, fainting t urns, illusions of sight and hearing, oppression of the chest, palpita- tion of the heart, hickup, paralysis, stupor, sopor, cerebral diseases, hemorrhage, blennorrhea, ischury, WORM FEVER. 175 strangury. Worm affections almost always increase and decrease Avith the moon; when the moon is on the decline, a quantity of worms is frequently passed. § 52. The formation of worms occurs most frequently in childhood. Sometimes the worms are hereditary (they have even been found in the foetus); they occur rarely in infants at the breast, most frequently in the period of dentition, very rarely in the age of adoles- cence (except taenia, which is most frequent at that age), and rather more frequently in the declining age ; they are more apt to be found in females, and in per- sons of a leuco-phlegmatic constitution, with disposi- tion to excessive formation of mucus and blennorrhoea. Exciting causes are: bad food, vegetable diet in pref- erence to meat, uncleanliness, and a damp, tepid at- mosphere, which may convert helminthiasis into an endemic or epidemic disease. Helminthiasis may easily be confounded with hy- drocephalus, especially when the so-called nervous symptoms, sopor, spasms, dilated pupils, vomiting, are present; but in helminthiasis the abdomen is soft and distended, whereas in hydrocephalus it is flat and drawn in; in hydrocephalus the head feels hot to the touch, and the symptoms occur in a certain succes- sion, whereas in helminthiasis the symptoms are changeable, and occur at uncertain periods. Worm diseases have a slow run, and are A'ery much disposed to occur again, or the patient is apt to have a relapse. Other diseases, such as chronic inflamma- tion of the mucous membrane of the intestines, result- ing in perforation, mucous fevers, epilepsy, hectic feA*er (occasioned by the disordered process of nutrition), may arise from Avorm affections. The prognosis is favourable ; it is most favourable in diseases arising from asearides, least favourable in taenia on account of the symptoms being more obsti- nate and the cure more uncertain. If the worms be lodged in the large intestine, the cure is ahvays more easily accomplished than when the worms are lodged in the lesser intestines or the stomach. § 53. The surest way to cure worm diseases, is to i;n WORM FEVER. remoA'e that morbid condition of the digestive organs Avhich ahvays precedes and faA'ours the formation of AA'orms. According to Hahnemann's a'Ioav it is not re- quired to remove the AA'orms, inasmuch as they result from a general constitutional illness, and an unwhole- some mode of life ; if the constitutional disturbance, which has generally a psoric origin, be cured homoeo- pathically (which can be done easily in childhood), few or none of the AA'orms will remain, or, at any rate, the children -will not he troubled by them, Avhereas the worms are reproduced in quantities after the bowels have been purged A\'ith cathartic medicines, eA-en Avhen mixed Avith Cina. However, not to men- tion the circumstance that the organism is in a more or less anormal condition as long as Avorms are pre- sent, eA-en if there should be an appearance of health, it is certainly true that the entire removal of the Avorms, either living or dead, is most desirable, and is, in some respects, the chief object of the treatment, in- asmuch as it is the most certain proof that the reme- dies have effected a cure. As long as no troublesome or dangerous symptoms make their appearance medi- cal aid is seldom resorted to against Avorms, nor is it required. We know very AA-ell that lumbrici and as- earides may live on the contents of the bowels of children Avithout irritating these organs in the least. Worms, taenia excepted, require medical treatment so much less, as they exist only for a limited number of years in the organism ; after that period the worms disappear of themselves, owing to the changes which take place in those A'ital secretions upon which the existence of the Avorms depended. At any rate a pal- liative treatment -will be sufficient in such cases to ef- fect a cure. We ought to observe, that notAvithstand- irg the considerable number of remedies which avo possess in our practice for curing Avorm affections, in Avhich we succeed in most cases, there exist no specific remedies, and, indeed, there cannot exist any for the ii mediate removal of the Avorms ; if this be desired v e have to resort to large doses of the so-called an- tlelmintica. This, however, is entirely unnecessary; WORM FEVER. 177 for we know for certain that the small homoeopathic doses of a properly-selected remedy are entirely suffi- cient to destroy the worms, which are afterAvards car- ried off by the rectum. The following are the general remedies against worm diseases : Aconite, Bell, Cina, China, Dig., Fer- rum, Asar., Calc c, Graph., Ignat., Marum verum, Merc, Nux v., Filix mas, Sabad., Spigel, Stram., Stann., Silic, Valer., Yerat., Sulphur, and others. If the symptoms arise from the presence of asearides in the colon and rectum (they are scarcely ever found in any other part), Aeon., Ferr., Ignat., Merc, Nux a'., and Valeriana are the best remedies. Against the in- tolerable itching and the feeling of excoriation and soreness, Ignatia, Tinct. sulph., and Marum verum are especially useful; Mercurius is indicated for the violent diarrhoea and tenesmus; Ferrum for the vomiting and the confluence of water in the mouth, Valeri- ana for the nightly itching and the muscular spasms and sleeplessness arising from it. The morbid phenomena denoting the presence of lumbrici, generally correspond to Nux v., China, Cina, Bellad., Merc, Spigelia. Nux v. is especially useful against great distention and sensitiveness of the ab- domen and the region of the stomach, heat in that region, hard stool, inclination to vomit, excessive general irritability and sensibility, aggravation of the symptoms early in the morning. China is indicated Avhen the symptoms are aggra- vated principally at night, Avhen after eA'ery meal the patient experiences a painful pressure below the um- bilicus, fulness of the abdomen, heartburn Avith con- fluence of Avater in the mouth, cardialgia and retching ; Avhen the nervous system is excessively sensitive, with spasmodic jactitation of the muscles in various parts, tremor and debility (Aaler. may proA'e useful when those symptoms occur). Cina is a principal specific against AA'orm affections of children, Avhen arising from the presence ofoxyurides vcriniculares and asearides lumbricoides, and Avhen the group of sA'mptoms is constituted as folloAvs: 8* 178 WORM FEVER. eAening chilliness, small rather hard, frequent pulse, little sleep, tossing about, shrieking and starting in sleep, ill humour, imbecility, transitory paroxysms of delirium, Aveight in the limbs, alternate paleness and coldness, and then again redness and heat of the face, dilatation of the pupils, continual rubbing of the tip of the nose, stoppage of the nose, lying on the back Avith open mouth, coating of tenacious mucus on the tongue, offensive eructations, vomiting, hot, distended abdo- men, colic, difficulty of evacuating the boAvels, and costiveness, itching of the anus, the asearides crawl out at the anus, the urine, Avhich is emitted involunta- rily, is white, turbid, cloudy, (compare Ignatia and Grap.) Belladonna is most suitable Avhen the cerebral functions are disturbed, and when the folloAving symp- toms preA'ail:. somnolency, spasms, illusions of the senses, great thirst, starting during sleep as if in affright, paralysis of the anus Avith involuntary dis- charge of faeces and urine, retention of urine. Spigtdia corresponds to those symptoms Avhich are especially A'iolent after dinner, Avhen the patient com- plains of pinching pains in the abdomen, Avith coldness and diarrhoea, canine hunger and thirst, morning nausea Avith sensation as if something Ave re craAvling out of the stomach into the throat, biting in the nose, pale countenance, palpitation of the heart, anguish. If convulsions should set in, Cham., Ignat., Strain., Hyosc, Avill proA-e useful next to Belladonna; if there should be a violent A'ascular erethism, Aconite may be given before any other remedy. If the cutting pains in the abdomen should be accompanictl Avith partial spasms of the abdominal muscles, and painful ineffectual pressing upon the rectum, Stramonium is recommended ; Cicuta A'irosa is indicated for a febrile condition, with violent colic and convulsions. If the symptoms Avhich characterize the Avorm affection, be Avorms discharged or not, are of a gastric, bilious, or pituitous nature, the remedies Avhich have been indi- cated for those fevers Avill have to be used. In scrofidous individuals Avorm fevers have been WORM FEVER. 179 several times cured entirely by Silicea. That Silicea is a useful remedy in those fevers, is evident from the power which it possesses to occasion febrile and gas- tric conditions, and from the fact that the pathogenetic symptoms of Silicea are more marked at the time when the moon changes, which is likewise the case in worm fevers. The most powerful remedy in eradicating the dispo- sition for Avorm diseases is Calcarea; it is entirely adapted to children of a lymphatic, fleshy constitution, with disposition to blennorrhea and excessive secre- tion of mucus,* to feeble individuals whose assimila- tive functions are impaired, with pale, cachectic com- plexion, bloated countenance, weak feet, chronic dys- pepsia, diarrhoea, and when scrophulosis and rickets are present. Next to Calcarea ranks Sulphur, which is especially adapted to lymphatic and leuco-phlegma- tic constitutions, when a disposition to catarrh and blennorrhoea is present, and when the following symp- toms occur: bitter, slimy taste in the mouth, aversion to meat, irresistible desire for sugar, alternation of canine hunger and loss of appetite, frequent regurgi- tation of food with heartburn and Avaterbrash, hickup, gagging, vomiting, rumbling in the bowels, intolera- ble itching of the rectum, with raw and sore feeling of that organ, etc. Puis., Ipec, Merc, Antim., and other remedies, may likeAvise prove suitable for such symptoms. Worm affections cannot be cured unless the diet and mode of life of the patient are strictly regulated; the diet ought to be nourishing and substantial, the principal food being meat; A'egetable food, milk, flour, and, above all, pastry, ought to be carefully avoided. § 54. This seems to be a proper place to add a few Avords relative to the treatment of taenia. Hahnemann says, in his Organon, that the morbid phenomena de- noting the presence of taenia can be speedily removed, or rather quieted, by the smallest portion of the tincture of Filix mas ; the taenia being calmed, it no longer ir- • The German term is " Verschleimung,'" which conveys the idea as if every thing were turned into phlegm. 180 WORM FEVER. ritates the boAvels of the patient. Hahnemann advises a sort of palliatiA-e treatment, until the radical cure is completed by means of the antipsorics. SoA'eral ho- nneopathic physicians agree Avith Hahnemann : among whom \A'e may particularly mention the name of Hering. Avho advises to keep the tamia. Avhich he does not consider as a very great plague, rather than to ex- pel it by violent means, lest some other more danger- ous affection should appear in the place of the taenia. HoAA-ever, not to mention ihe insufficiency of this pal- liative treatment. Avhich every physician -will be fre- quently obliged to resort to. it is absolutely necessary that avc should consider the express Avisb of the pa- tient to have the monster expelled. If avo do not comply with his Avishes. he AA'ill resort to nostra and the pernicious expedients of old women and quacks. We are so much more justified in attempting the expul- sion of the taenia, as the antipsoric treatment is A'cry slow and very problematical Several homoeopathic physicians have, therefore, been induced to attempt that expulsion, and have indeed been successful. Cross recommends particularly Graphites, Calcarea, Sabadilla ; also Fragaria vesea ; Hering recommends Sulp., Merc, and Calc ; besides these remedies, the folloAving deserve to be mentioned : Carbo anim. and veg., Kali earb., Magn. mur.. Natr., Phosp., Petrol, Plat.. Stann., Tend). Stannum is recommended by a number of homoeopathic physicians as a great reme- dy in avorm affections; at any rate it is an excellent palliative for the symptoms of taenia and lumbrici. Among the remedies Avhich have effected the expul- sion of taenia in a short period and directly, the first is Filix mas. Bicking has been successful in almost every case. He directetl the patient to drink a quan- tity of cold water, to use cold water injections, and to apply cold Avater douches to tin; abdomen. This be- ing done, he gave the patient a saturated decoction of rihx mas (half an ounce per diem); he admits, how- ever, that the taenia was frequently reproduced, but speed.lv expelled again by similar means, without ever reappearing. Lobethal affirms that the daily use of a WORM FEVER. 181 few drops of the concentrated tincture of Filix mas has been quite sufficient in his hands. In the Horn. Gazette, vol il, p. 67, a case of a frightful worm colic is reported, which Avas speedily cured by a single drop of the tincture of Filix mas; eight days after the colic, fifty yards of taenia were discharged without the dose haA'ing been repeated. The same results have been obtained by means of Pu- nica granatum. Lobethal recommends that remedy in very obstinate cases. J. O. Miiller (Hygea, vol. x., pp. 137, 193,) mentions the following symptoms as having been removed by Punica granatum : convulsive move- ments, catalepsy and epilepsy, fainting turns, emacia- tion, notwithstanding a constant appetite, sudden waking, hallucinations, hypochondria, vertigo, stupor, trembling before the eyes, dilatation of the pupils, yel- low complexion, grating of the teeth, confluence of water in the mouth, variable appetite, gulping up of fc a watery fluid, vomiting, sensation in the stomach as if a body were ascending in it, distended abdomen, colic, chronic palpitation of the heart, etc. The expulsion of the taenia frequently succeeds in a very peculiar manner, and the cases of cure which will be recorded in the following paragraphs confirm Hahnemann's rule: " Remove the perceptible phe- nomena of disease, and health will be restored." A lady suffered with irregularity of the menses ; they occurred either too early or too late, Avere either too profuse or too feeble, the menstrual blood being always thick, coagulated, black. Several times she had been affected with the most A'iolent symptoms of inflammation of the liver, after Avhich a jaundiced complexion had remained. For some time past she had been complaining about intense pain in the region of the liver and umbilicus, recurring at intervals, ac- companied with nausea, gagging, A'omiting of tenacious mucus, yellowish grey complexion. After having em- ployed the remedies Avhich Ave thought were indicated, Avithout any success, Ave exhibited the second tritura- tion of Argentum nitricum crystallisatum, three times a-day, -each dose consisting of as much of the tritura- 182 FEBRILE CONDITIONS tion as Avould cover the point of a pen-knife. Eight days after haA'ing taken the medicine, she passed a quantity of fragments of taenia, all her troubles disap- peared, and have not returned ; it is noAV tAvo years. We Avere guided in the selection of the remedy by the profuse menstruation, as Kopp advises. Another lady had been aflected Avith taenia for the last seven years. The fragments AA'hich she had occa- sionally passed during that period Avere evidences of the continual presence of the animal. The lady had gh'en birth to two children, one of Avhom was still alh-e, but she had never been pregnant since, owing to the presence of the taenia. She had gone through various kinds of treatment for taenia, including the cold-Avater treatment, but AA'ithout any success; she Avas now de- termined to try homtropathy. The peculiar pain Avhich she experienced in the stomach, the constipa- tion, the irregular menses, Avhich Avere scanty, and at t times appeared too late and then again too early, the jaundiced tinge around the mouth and nose, seemed to , require Nux, third attenuation ; this xvas given, and the condition of the patient soon improved to such an ex- tent that tin1 cure might be looked upon as terminated. Some time after she had a violent chagrin, which brought back all her former troubles, and required Chamomilla, first attenuation, which effected an essen- tial improvement, but left the constipation as it Avas. This circumstance leading us to suppose that the alternate use of those tAvo remedies would remove the trouble, avc put the patient on Chamomilla and Nux, giving her tAvo doses of the former in the morning and one dose of Nux in the evening. Four days after taking the medicine, the entire taenia was expelled ; soon after she became pregnant, and expects soon to be delh-ered. We may here observe that the real taenia, bothrio- cephalus latus, occurs very seldom in Germany, the taenia lata solium more frequently. § 55. Febrile conditions resembling Cholera. Many will say that the various kinds of feve* which RESEMBLING CHOLERA. 183 * we have treated in the preceding paragraphs are very much like the febrile conditions which we shall speak of in this chapter, and that the treatment, at any rate, is very nearly the same. Although we are willing to admit that the febrile conditions Avhich we have alluded to in the heading are not essentially different from one or the other of those feAers. yet AAre think that we ought to be as explicit as possible in this work, were it only for the sake of beginners in homeopathy, for whom this Avork is more particularly designed. It is for this reason that we Avill make particular mention of a kind of cholera fever Avhich is very much related to a gastric or bilious fever, and frequently occurs as a sporadic disease in some parts of Germany. After that Ave will likeAvise give a minute account of the treatment of the Asiatic cholera, which having ap- peared once, is likely to appear again amongst us some time or other. The sporadic cholera generally appears suddenly and Avithout any precursory symptoms. If there exist precursory symptoms, they resemble those of a sabur- ral, bilious, and pituitous gastroataxia, or the pre- cursory symptoms of saburral, bilious, and pituitous fevers, such as: general malaise, heaAiness and indo- lence of the body, yellowish complexion, yellow slimy coating of the tongue, the root of the tongue being more thickly coated than the tip; these symptoms are frequently accompanied Avith a slimy, bitter taste, and beside this, nauseating bitter eructations are some- times present; there is likeAvise a pressure, a crampy drawing and fulness in the pit and region of the stomach, with anxiety ; flatulency, nausea, distention of the abdomen, rumbling and colicky pains in the boAvols, the urine causes a burning in the urethra, has a fetid smell, and deposits a reddish sediment. If these symptoms be not speedily removed by suit- able homoeopathic remedies, or if the disease have no precursory symptoms, the symptoms of the disease itself set in. In the commencement the patient Aomits suddenly and repeatedly, until the ingesta have been removed from the stomach, after this a watery, slimy, 184 FEBRILE CONDITIONS and at last a bilious fluid is throAvn off in a larger or smaller quantity : the substance which is throAvn off is yelloAv,green, broxvii, sometimes blackish, frequently fetid, causing reneA\-ed paroxysms of nausea all the time. This vomiting is accompanied with frequent and A'iolent diarrhoea, consisting at first of frees, and afterwards of a Avatery and bilious fermenting liquid; the diarrhoea is generally accompanied Avith violent burning, cutting colic, especially in the umbilical region. If the disease last longer, the folloAving symptoms superA'ene : fulness in the pit of the stomach, hurried respiration Avith anguish, violent cardialgia, spasmodic and sometimes scarcely perceptible pulse. When the disease has reached its acme, the above-mentioned symptoms attain their highest deA'elopment, the pulse and strength of the patient collapse speedily, and other spasmodic pains in the bladder and the extremities, cold sweats, fainting turns, and hippocratie counte- nance, are sometimes present. § 56. We have already stated that the sporadic cholera is most frequent in our country (Germany). In hot summers, hoAvever, it may likeAvise break out as an epidemic disease, Avithout having the character of the Asiatic cholera. Predisposing causes of sporadic cholera are, un- doubtedly, intense heat continuing a long while ; catching cold suddenly in hot Aveather; an irritable constitution and temperament, as is fretpiently seen in hypochondriac and hysteric females ; childhood, especi- ally during the period of dentition ; violent emotions, such as fright, anger, vehemence ; cold in the abdomen, or by the feet ; cold food and drink, unripe, sour, Avatery fruit, such as peaches, melons, grapes ; ice and pastry ; acrid, sour, non-fermenting drinks ; fat, rancid food; spawn of perch, pike, and of caviar; acrid med- icines and poisons, like the resinous and acrid emetics and cathartics, jalap, colocynthis. mineral acids, zinc, and sulphate of copper, tartar emetic, mercurial salts, arsenic, etc. ; suppression of cutaneous eruptions, gout and menstruation. § 57. These kinds of cholera are of the milder kind. RESEMBLING CHOLERA. 185 The precursory symptoms, if there be any, can be easily remoA'ed by the well-selected homoeopathic agent. If the characteristic symptoms of the disease have made their appearance, the physician has to select his remedy with great care, lest it should not correspond to the symptoms. The cases of sporadic cholera which arise from overloading the stomach, from eating sour food, or taking sour drinks, from gen- eral or partial catarrhs, cannot terminate unfavour- ably unless the treatment is entirely mismanaged. In making such an assertion, the age and constitution of the patient are of course taken into consideration ; it is self-evident that children, Avhose nervous system is extremely irritable, and who, on that account, are more predisposed to spasms, are more easily carried away by an attack of sporadic cholera than full-grown, robust persons. It is for similar reasons that cholera is particularly dangerous for old people and females. § 58. The treatment of a disease ought always to correspond to the exciting cause. As in most cases of sporadic cholera it is impossible to assign a specific cause for the disease, we will commence with the treatment of this class of cholera cases and afterwards speak more in detail of those few cases AA'here the ex- citing cause is well known. The precursory symptoms which Ave have mentioned aboA^e, yield in most cases to a dose of Chamomilla more speedily than to Ipecacuanha, even in cases where one or two diarrhaeic stools, with colic in the umbilical region have already taken place. Chamo- milla would be inferior to Ipec, if vomiting and a con- stant desire to vomit, with diarrhoea, had already set in ; in this case Ipec. may be repeated in from one to three hours, if the first dose should not ha\'e been suf- ficient to remove the disease. If either of those remedies should fail, and the cha- racteristic symptoms of the cholera should make their appearance, or if the physician should have been called Avhen the disease had already broken out, it is advisable to administer at once Veratrum album, which is the specific remedy. 186 FEBRILE CONDITIONS If the characteristic symptoms of cholera should be accompanied in the Aery beginning with an excessive prostration of strength altogether disproportionate to the Aomiting and diarrhoea, Avith great anguish, violent, unquenchable thirst, diarrhaeic and sometimes san- guineous discharges from the boAvels, occurring almost every moment, A'omiting, excessive colic, and the like, Arsenic will be found the best remedy if administered in suitable doses. Arsenic is likeAvise the best remedy if Yeratrum had no effect and the disease threatens to pass into the third stage ; even when the hippocratic countenance has already set in, and the pulse is scarcely perceptible, Arsenic may still save the pa- tient's life. § 59. Cholera symptoms A\'hich have been occasioned by chagrin are most speedily relieved by Chamomilla, provided the physician is called in time. In many cases, especially Avhen the alvine evacuations consist principally of mucus, Pulsatilla is indicated, unless Colocynth should correspond more accurately to the symptoms. Avhich might be the case, since, as has been stated above, Colocynth is even a better specific against the consequences of chagrin than Chamomilla. The cholera symptoms to A\hich hypochondriac and hysteric persons are liable do not require any different treatment from the one Avhich, is required by cholera arising from cold or errors in diet. If the symptoms should have been occasioned by poison, such as arsenic, and the patient should not yet haATe A'omited, the Aomiting must be excited by artifi- cial means, in order to remove the deleterious substance from the stomach as soon as possible, and to prevent its passing into the circulation. The most expeditious means of bringing on vomitintage vary, like those of the first, both as regards intensity and duration. In some cases the principal symptoms set in at once, in- creasing steadily until death has taken place; the first and third stage apparently do not set in. In other cases the symptoms increase more progressively and slowly, sometimes they seem even to remain stationary, and the patient improves, or, at any rate, seems to im- prove. This improvement, Avhether real or apparent. soon gives xvav to a new and so much more violently increasing aggravation, Avhich may be considered the third stage. Some practitioners have observed, that the degrees of violence occurring in the second stage depend principally upon the nature of the locality Avhere the epidemic prevails. This observation may be of importance in the treatment. The second stage is generally characterized by the folloAving symptoms : sudden Aomiting. sometimes pre- ceded by short nausea, but very seldom by real Aomit- urition; the food, Avhich happens to be in the stomach, solid or liquid, is thrown up Avith a sudden jerk ; after the first vomiting the patient sometimes feels a certain relief. Either simultaneously or a few minutes after the vomiting, diarrhoea sets in; this is papescent and partially liquid, the first three or four diarrhoeic stools being intermixed with faeces and half feculent, undi- gested food, slime and a watery fluid, accompanied with rumbling in the boAvels, sometimes Avith pinching and real colic, which is very seldom violent, and some- times entirely wanting. The Aomiting very soon je- turns, the diarrhoea likewise, the substances which are evacuated both by the mouth and rectum becoming more and more fluid, and quite Avatery. In many cases both kinds of evacuations are so frequent that the patient is scarcely able to rise from the chair ; sometimes the debility is so excessive that the patient is unable to leaA'e his bed, and has to be assisted in bed every fifteen minutes or more frequently, the aver- age number of stools in twenty-four hours being from thirty to forty, together with as many vomitings. It ASIATIC CHOLERA. 193 Is considered a symptom of the worst kind, and of ap- proaching dissolution, if the diarrhoeic stools diminish in number Avhile the strength of the patient and the pulse decrease proportionately. Generally speaking the number of the evacuations by the bowels or mouth varies; sometimes the evacuations are more nume- rous than in sporadic cholera, sometimes, and this is the more frequent, they are less in number; there have been cases of Asiatic cholera where only a few extremely copious and watery evacuations took place in the very commencement of the attack, occasioning excessive prostration. After the second, third or fourth evacuation all suc- ceeding evacuations are watery, or of the consistence and nature of a.n albuminous serum, or a serous mu- cus, or like rice-Avater; generally they are clear or somewhat Avhitish, inodorous and tasteless, with albu- minous, cheesy, blackish flocks, floating in the midst of the liquid. As a general rule the abdomen caves in after the first diarrhoea; the Avhole body, in fact, sinks and becomes emaciated after the evacuations have continued one or two hours. This alteration is espe- cially visible in the countenance. It is remarkable that there should not be any bile either in the evacu- ations upward or doxvmvard; even after death no trace of bile can be discovered in the intestinal canal. The want of bile is a characteristic phenomenon in the Asiatic cholera; not till the disease is on the decrease and an improvement sets in, do we perceive a tinge of bile in the alvine evacuations. These evacuations, which become painless as they continue, and finally take place Avithout any sensation, are accompanied with a sense of exhaustion increasing to utter prostra- tion. Restless and anxious, the patient is all the time endeavouring to change his position, even if he should faint in the effort. Shortly after, slight twitchings of the muscles, or only a draxving and tension in the muscles of the upper and lower limbs, sometimes make their appearance; sometimes these twitchings amount to violent and continuous spasms in the limbs, which are extremely painful, and are characteristic phenome- 9 PJ4 ASIATIC Clioi.LK.V. na in cholera. These spasms first commence in the toes, fingers and hands ; afterwards in the cah'es, etc Sometimes the spasms are tonic or tetanic, in which case they are the most painful, and make the limbs immoA'eable, and stiff and hard as wood ; generally the spasms assume the form of chronic convulsions. The spasms affect most frequently the calves, forearms and hands. These spasms are accompanied by an increasing but not suffocath-e oppression of the chest, and tight- ness of breathing, increasing anxiety, vertigo, and prin- cipally a sudden collapse and excessive smallness of the pulse which frequently disappears entirely a long time before death, or is, at any rate, scarctdy percep- tible. The same statement applies to the beating of the heart. The sudden collapse of pulse is one of the most remarkable, and, at the same time, one of the most essential symptoms of this epidemic. This col- lapse of pulse appears to be dependent upon an arrest of the circulation rather than upon spasm. Simultaneously Avith these symptoms, or before, the patient experiences a disagreeable, painful burning in the epigastric region, or in the region of the stomach doAvn to the umbilicus. According to Annesley, this burning, which is sometimes experienced behind the sternum, and is one of the most constant, most distress- ing, and most alarming, symptoms, is so characteristic of cholera—that, Avhenever it exists in connexion with the anxious look, Avith sighing and anxious breathing, one may safely infer from it the existence of cholera. The burning remains frequently a long while after the vomiting has ceased, accompanied with a burning and tormenting thirst, the patient expressing a particular desire for cold water, which he swallows with great avidity, and throAvs up again immediately. Simultaneously with the spasms, and sometimes a little before, the whole surface of the body becomes cold; first the lower limbs and then gradually the whole body. This coldness increases to a coldness as of a dead body (frigus marmoreum). It resists the most persevering means of warming, and spreads ASIATIC CHOLERA. 195 over the face and lips, Avhich become pale, blue and cold, and OA'er the cheeks and eyelids; even the buccal cavity, the breath and tongue, become cold. The tongue is either little or not at all coated; more frequently it is dry, reddish or whitish, with brown edges ; it becomes shrivelled when getting cold (this shrivelled appearance of the tongue is considered a particularly fatal symptom), Avithout being insensible, and becomes entirely bloodless. The skin is covered with a cold, clammy sweat, which is frequently very profuse. The whole body becomes flaccid and sunken, and assumes a shrivelled appearance, especially on the hands, fingers and toes, as if these parts had been soaked in warm water, with a livid, bluish hue. The face is excessively disfigured, sunken, pale or livid, cadaverous, with cold, bluish tip of the nose; cold sweat, the eyes having retreated deep into the orbits, half-closed, dim, having very often a reddish, and sometimes a blue, tinge, they are turned upward, and are surrounded with grey-brown margins. This expression of countenance is termed facies cholerica ; it reflects anxiety and sadness; the patient has a staring and vacant look, and appears to be complete- ly absorbed in reverie. The facies cholerica is one of the most striking characteristics of the higher de- gree of the disease, and is indeed a frightful and ghost-like appearance. The peculiar alteration of the voice is likewise re- markable. The voice of a cholera patient is feeble, fine, somewhat hoarse, hollow, or Avithout resonance ; the patient, being extremely averse to talking, uses his voice only to complain of the burning in the pit of the stomach, and to ask for water. The urine either ceases to flow from the very com- mencement, or the patient passes only occasionally a feAV drops of a turbid or brownish urine. This is not retention of urine, but the secretion of urine ceases entirely. This cessation of the functions of the blad- der is a striking and constant symptom of the cholera. Not until the violence of the disease decreases, and the circulation becomes freer, is the urine secreted 196 ASIATIC CHOLERA. again, which may ahvays be considered a favourable symptom. The secretion of mucus is not changed, only less copious ; the saliva is more viscid ; the nasal mucus is generally Avanting. This stage lasts from tAvo to three,up to eight, tAvelve, or tAventy-four hours, sometimes tAvo or three days. The third stage cannot Avell be separated from the former, for this stage either passes into the highest degree of the disease, the stadium lethalc, or into the stage of convalescence. The fatal stage is simply an aggravation of the symptoms which avc have described as belonging to the second stage ; sometimes vomiting, diarrhoea, spasms, abate shortly before death, the patient falls into a kind of sopor, the heart ceases to beat, the eyes become glassy, etc. If an improvement set in, the pulse becomes fuller and more equal, the animal heat returns, and the spasms cease ; the expression of countenance becomes more natural cheerful, anxiety is no longer depicted in it; the look is firmer and more animated ; there is a warm exhalation from the skin ; the Avatery diarrhoea diminishes, the vomiting ceases, the alvine evacuations again assume a bilious, sometimes greenish tinge ; the urine is secreted again. § 62. The prognosis is quite different from that of sporadic cholera; the course of the Asiatic cholera being extremely rapid. Generally the attack termin- ates in asphyxia after tAvo or three hours ; very seldom the disease lasts two or three days. If its course should be slow, and if the disease should pass into a typhoid fever, this may likewise be fatal. It is true the homoeopathic treatment of Asiatic cholera is much more favourable than that of allopathic physicians ; nevertheless, the physician has to be constantly watch- ful lest he should overlook the dangerous moment. A chronic weakness of the nerves, and particularly of the digestive organs, frequently remains. According to Hahnemann, and several other physicians, the best remedy to prevent the complete development of the disease is Camphor. For this purpose one part of ASIATIC CHOLERA. 197 Camphor is dissoh'ed in twenty parts of alcohol, and the patient should take one or two drops of the solu- tion every tAvo or five minutes upon a piece of sugar, or in a spoonful of water, according as the disease is more or less A'iolent. As the symptoms abate, the Camphor is given at longer interA'als, of course. Ac- cording to some, Camphor simply palliates the symp- toms, especially in those cases Avhere the evacuations have existed for some time previous to the attack. The external application of Camphor by fumigation, friction, and injection, is not only inexpedient, but positively injurious, inasmuch as Camphor would anti- dote almost all the vegetable medicines which the phy- sician might have to use in case Camphor should not be sufficient. The highest potencies of Veratrum and Cuprum, one or two pellets alternately every four days, have been recommended as preventives against the Cholera. A number of homoeopathic physicians recommend Veratrum exclusively as a preventive. While either of those remedies is used, wine, coffee, strong tea and any kind of spice are to be aA'oided. Besides Camphor the folloAving remedies have been found curative in this epidemic: Veratrum, Cuprum, Arsenic, Nux v., Aconite, Ipec, Chamom., Secale cor- nut., Tartar, stib., Acid, phosph., Phosphor.,Cicutavir., Laurocerasus, Merc, sol, Carbo veg., etc. According to all accounts, Veratrum is the principal specific for Cholera, even where no evacuations have previously existed. It has to be repeated every 15 minutes, or every half hour or hour, according as the disease is more or less violent. Even when the im- provement has commenced, it is still necessary to repeat the remedy, except at longer interA'als. If the patient should have a second attack, the same course of treatment is to be pursued as during the first attack ; sometimes however another medicine is re- quired, as the second attack scarcely eA'er is like the first. Arsenicum is indicated when the attack sets in from the commencement Avith the most violent symptoms, 198 ASIATIC CHOLERA. and the patient complains of a most A'iolent burning in the epigastrium, in the boAvels and throat, accompanied with a painful oppression of the chest, burning thirst. excesshe debility, a constant tossing to and fro; great anguish, irresistible dread of death, hoarse cries about violent pains in the pit of the stomach and ab- domen. Arsenicum as avcII as Veratrum ought to be given at someAA'hat longer intervals than Camphor. Ipecacuanha is an excellent remedy Avhen the vomit- ing is more considerable than the diarrhoea. Ipec. will never be found suitable Avhen the disease has reached the acme of its paroxysm, but it will arrest the vomiting which may yet continue after the violence of the disease shall have been broken. Ipec. has to be repeated at least as frequently as Veratrum ; this remedy is frequently indicated after Ipec. \ux may be found suitable, if Ipec. should have arrested the A'omiting and the following group of symptoms should have remained : symptoms of spasm in the stomach, a kind of weight in the stomach with anguish emanating from the pit; pains in the bowels Avith frequent small evacuations, and a continual desire to evacuate the bowels, accompanied with headache, especially a pressure in the sinciput, slight febrile shiverings, coldness more internal than external. The Russian physicians have found Ipec. particularly use- ful Cuprum has to be repeated the same as every other remedy. It is particularly applicable when the mus- cles are affected with violent spasms, Avhen there is restlessness, coldness of the prominent parts,such as the face, distortion of the eyes, sometimes accompanied with abdominal spasms; there is no A-omiting. When those symptoms occur, it is sometimes expedient to exhibit Cuprum alternately Avith Veratrum. When tetanus or trismus is present, Camphor is said to be superior to Cuprum. Tartarus emeticus may likeAvise be recommended as a remedy for Asiatic cholera. Among its physiological effects we notice the following cholera symptoms : spasmodic movements, spasmodic jactitation of the ASIATIC CHOLERA. 199 muscles, trembling of the limbs, debility as if one would fall over, fainting sort of weakness, trembling pulse or collapse of pulse, the peculiar paleness of countenance occurring in cholera, croaking \oice, cramps in the calves, and above all other symptoms, the gastric de- rangement which characterizes an attack of cholera. It deserves consideration in cases Avhere feculent substances are still discharged from the bowels, in cholera biliosa, or at the first onset of Asiatic cholera, or else towards the termination of the attack, when the vitality of the abdominal organs is still depressed. Cicuta virosa is said to be an excellent remedy when the following symptoms occur: violent spasms in the muscles of the chest, continual vomiting, little diar- rhoea, the eyes are turned upAvard, and a soporous condition prevails. Rummel employed this remedy in a case characterized by similar symptoms, after he had previously given two doses of Hydrocyanic acid. Ci- cuta corresponds more particularly to neglected cases, and is therefore more suitable to the secondary affec- tions of cholera than to the cholera itself. When the symptoms which have been mentioned in this para- graph occur, Stramonium may likewise prove valuable. Carbo vegetabilis; according to Rummel in the 12th, and according to others in the 30th potence, is said to be an excellent remedy after the peculiar cholera symptoms have been subdued, when the spasms and the vomiting have entirely ceased, congestions of the chest or head set in, the oppression of the chest is a prominent symptom, a slight sopor is present, the flushed cheeks are covered Avith clammy SAveat, or the patient lies in a state of complete asphyxia. One or tAvo doses of Hydrocyanic acid sometimes require to be given prior to the Carbo. An hour after the Acid the Carbo may be given, the good effect of which is recog- nized by the return of the pulse, and sometimes of the true cholera symptoms ; these then yield to Veratrum or Cuprum. We may infer from these indications that ihe Carbo is less suitable to real cholera than to neglected or protracted cases of that epidemic, or 200 ASIATIC cnOLERA. AA'hen the cholera threatens to pass into secondary typhoid affections. Laurocerasus is gh'en by some physicians Avhen the following symptoms are preAalent: small and slow pulse, Aertigo, stupefaction, convulsive spasms of the muscles of the face, etc. According to our OAvn judg- ment this is not a good remedy in cholera ; it is our opinion that a good deal of Aaluable time is lost by resorting to that remedy in cholera. The symptoms previously mentioned do not indicate Laurocerasus, but rather Veratrum or Cuprum. According to Rummefs experience, a distinguished remedy in cholera is Secale cornutum, loAver potencies, from one to three doses, Avhen the folloAving group of symptoms exists:, the A'omiting has either ceased entire- ly, or for the most part; the colour of the stools remains unchanged, and there is every indication that no bile is poured into the intestinal canal Soon after the use of Secale cornutum, yellow and green stools make their appearance ; as soon as this takes place, the patient may be considered out of danger. The pains in the extremities likeAvise abate during the exhibition of Secale. This remedy seems to be an excellent remedy in the so-called cholerine, for Avhich Camphor, Merc, sol, Phosphorus, and Acidum phosphor, are likeAvise re- commended. The last of those remedies is said to be indicated Avhen the tongue is thickly covered Avith mucus. The Russian physicians have made frequent and successful use of Merc sol in the treatment of cholera. Every homoeopathic physician Avill easily distinguish the symptoms for Avhich Aconite is indicated ; they do not require any further notice. If cholera patients have been treated allopathically before the homoeopathic treatment commences, it is in- dispensable to give them, in the first place, repeated doses of Camphor, partly to excite the reactive power of the organism, and partly to neutralize the large doses of allopathic drugs. ASIATIC CHOLERA. 201 § 63. The following remedies have been used for the secondary affections of cholera : Aconite, Belladonna, Bryonia, Rhus, Nux v., Tinct. sulph., Cantharides, Acid, phosp., Phosph., China, Hyosciam., Stramonium, Carbo, Opium, etc. The secondary affections of cholera generally take the form of malignant typhoid fevers, of which we shall treat hereafter. If there be a predominance of congestive or inflam- matory symptoms, one or two doses of Aconite ought to be given first. If there be a good deal of cerebral congestion, if it be characterized by sopor, with the eyes half open and turned upAvard, by inability to wake, and to recollect things, to such an extent that the patients sometimes forget to draw in the tongue Avhich they protruded a moment ago; by grating of the teeth, distortion of the mouth, excesshe restlessness, painful stitches in the side or abdomen ; Arery quick, and more or less full, but not hard pulse ; burning heat and red- ness, Avith great desire for cold drinks, Belladonna is particularly serviceable. Next to Belladonna Cantha- rides is the best remedy, especially if the following symptoms prevail; rumbling in the abdomen, some- times bloody stools preceded by tenesmus, heat in the bowels, and sensation of violent burning in the hypo- gastrium, great restlessness ; the bladder is frequently affected. In congestion of the chest and lungs, Aconite, Bryon., Bellad., Phosph., Sulph., Carbo anim., and Rhus, are the principal remedies ; these, together with Mercurius and Nux, are likeAvise the principal remedies when the stomach and boAvels are chiefly affected. For typhoid fevers consequent upon cholera, the fol- loAving remedies have been employed with success, if exhibited in accordance with the symptoms: Acid phosp., Rhus., Bryo., Bellad., Hyosciam., Stram., Carbo anim., Opium. General debility remaining after the cholera has been generally relieved by China. Weak- ness of the intestinal canal, which is characterized by continual liquid stools, is most certainly removed by the tincture of Sulphur, and Phosphorus. During the period of convalescence in gastric fevers, 9* 202 DYSENTERIC FEA'ERS. which is ahvays characterized by a Avant of appetite, the folloAving remedies deserve careful consideration : Rhus, Cyclamen, Veratrum, Arsenic Acid, nitricum ; if an immoderate appetite, a kind of bulimy, be present, Rhus, Calc. earb., Lycop., Xatrum mur. are indicated. The best beverage during an attack of Asiatic cholera is ice-AArater; this is the only beverage Avhich will stay with the patient. Warm drinks do not agree with cholera patients. Injections of ice-Avater are likewise useful; in some cases injections of starch are said to have done good. If the cholera should im-ade a district, the mode of life should not be changed suddenly ; on the contrary, it is advisable that every body should continue his ordinary mode of life, and should simply avoid irregu- larities. Acids, stimulating drinks, indigestions, colds, debilitating exertions, and depressing emotions, are prejudicial, and should be carefully avoided. § 64. Dysenteric fevers ; dysentery. Authors have made a mistake in classing those fevers among chronic diseases. The dysenteric fever ought to be considered an acute disease for this reason, that it may be either endemic or epidemic, and, Avhen- ever it appears, has either one or the other of those tAvo forms ; that it generally depends upon cosmic and tel- luric, or atmospheric influences of some kind, and that its outbreak is favoured by errors in diet. Moreover, the disease is characterized by a sort of catarrhal irritation in the mucous membranes of the intestines, and especially the large gut, Avhich, like the irritation in the bronchi, may assume an inflammatory character and occasion a sort of erethic fever which accompa- nies every inflammatory irritation of the mucous membranes. A dysenteric fever might also be char- acteristically designated as a febrile catarrh or rheu- matism of the large intestines. Diagnosis: constant urging, tenesmus, with violent cutting colic, without any evacuation of faeces, properly so called ; the patient merely discharges mucus and blood, and complains of fever. These are constant DYSENTERIC FEVERS. 203 symptoms. This shows that the disease is not charac- terized by diarrhoea, but by constipation, and that dysentery and diarrhoea are, so to say, opposite dis- eases. In diarrhoea we have discharge of decayed contents of the boAvels; in dysentery those contents are retained. Diarrhoea frequently gets well of itself; dysentery very seldom. If feculent substances are again discharged from the boAvels, and the pains and fever abate, then the dysenteric patient may be said to be recovering (Hufeland). If the disease should set in with great violence, which is sometimes the case in young, vigorous, or sensitive individuals—in Avhich case it may assume the form of a synochal fever— the precursory stage is either entirely wanting or is very short. The precursory stage is mostly met in torpid, phlegmatic individuals, or when the disease is sporadic ; in such cases the fever has the erethic form. If there be no precursory stage, the course of the disease is short; if a precursory stage exist, the dis- ease has a long run, and frequently passes in'o a chronic dysentery. The precursory symptoms are : want of appetite, pressure in the region of the stomach and dull colic, loathing, nausea, inclination to vomit, dirty coating of the tongue, bad taste, flatulency, diarrhoea ; general laxness and debility ; malaise, rest- less sleep ; draAving in the limbs, increased sensitive- ness to cold air, shherings, slight chills, accelerated pulse. The first commencement of the disease is a cessation of the bilious stools, and setting in of an unsuccessful urging, resulting simply in the discharge of some mucus (dysenteria alba). Little by little the most violent cutting and colic are experienced in the umbil- ical region, with sensation of burning, thence extend- ingover the whole abdomen,and immediately preceding every succeeding evacuation. As the irritation in- creases, the slimy evacuations appear mixed with blood. The most intensely painful symptom now is the tenesmus, a sensation as if the bowels would protrude, occasion- ing a constant renewal of the stools, which often be- come excessive in twenty-four hours, and spread a 204 DYSENTERIC FEVERS. peculiar smell The fever is proportionate to the de- gree and A'iolence of the disease, and generally does not make its appearance until the permanent symp- toms of dysentery have all set in. That fever is a continua remittens. haA'ing in most cases a rheumatic, catarrhal, or bilious character ; it commences with a succession of moderate chills, followed by moderate heat. The exacerbation generally takes place in the evening, and is accompanied Avith a perceptible aggra- vation of the local symptoms. § 65. The disease is occasioned by various remote causes, the principal being the suppression of some kind of cutaneous action, Avith increase of acrid bile. This is the reason AA'hy dysentery prevails almost ex- clusively towards the end of summer, in the months of August and September, Avhen the days are very hot and the nights very cool At that season of the year dysentery is almost always epidemic. The disease is endemic in Ioav, damp, marshy regions, where inter- mittent fevers are likewise prevalent; in such districts dysentery occurs almost every year. In epidemic dysentery the putrid emanations from the stools fre- quently develope a contagium by means of Avhich the disease spreads rapidly and over a large extent of country. Other exciting causes are: unripe, acrid, Avatery fruit; A'egetables coA-ered with mildew ; corrosive poisons, Avorms, haemorrhoidal congestions, metastasis, difficult dentition. The prevailing type or character of disease becomes easily ingrafted upon the dysen- tery, and may convert it into a catarrhal, rheumatic, gastric, bilious, or typhoid dysentery, although every one of those A'arieties may likewise be occasioned by the individuality and constitution of the patient. Children and females are principally affected by that disease. Chronic affections are sometimes roused by an at- tack of dysentery, and may in their turn complicate the disease, and make the prognosis more or less doubtful ; although the termination of the disease does not de- pend exclusively upon the complication, but also upon DYSENTERIC FEVERS. 205 the greater or lesser intensity of the dysentery itself. As the disease increases, inflammation superA'enes, an excessive quantity of putrid bilious substances is ex- pelled from the system, and the patient is extremely debilitated. All these symptoms may occasion death if the patient be not carefully treated, and the most unfavourable prognosis has to be given if a sudden ces- sation of the intense pain, sunken countenance, cold- ness of the extremities, a small intermittent pulse, fetid evacuations, which the patient passes Avithout con- sciousness, indicate the setting in of mortification. The post-mortem examination shows that the disease is seated in the mucous membrane of the large intes- tines. This membrane is swollen, red and injected, softened (the softened parts being red and bleeding) ; a serous exudation is perceived in the shape of a fine miliary vesicular eruption, which results in the scaling off of the epithelium of the inner walls of the large intestine. These appearances characterize the lower degrees of dysentery ; in the higher degrees larger sur- faces are affected, and the mucous membrane is covered Avith a dingy grey, glutinous exudation, accompanied with prominences which are formed by a copious serous infiltration of the submucous cellular tissue. This degenerative process increases until a dark red or black brown sanguineous exudation has resulted from it, Avhich, in the highest form of the disease, becomes a black, friable, tearable, and almost carbonized mass. § 66. We now pass to the treatment of dysentery, commencing with naming the remedies Avhich have been used against the various kinds of the disease generally. The principal remedy is Mercurius corro- sivus, next to Avhich Ave rank Mercurius solub. H., and other mercurial preparations ; Colchicum autumnale, Capsicum, Carbo veg., Colocynth, Ipecac, Aloes, Can- tharides, Acidum nitric, and Sulphur; Flores and Hepar sulph., Rhus, Staphysag., Nux vom., Bellad., Pulsat.. Chamom., Arsenic, China, Tart, emet., Sepia, Plumbum, Veratrum. Those kinds of dysentery which authors have deno- minated catarrhal rheumatic, and which do not occa- 206 DYSENTERIC rEVERS. sion any great derangements in the digestive functions, offer a Aariety of rheumatic complaints, together with the characteristic symptoms of dysentery, such as : drawing and shooting stitches in the muscles and ex- tremities, tearing in the nape of the neck, in the head and shoulders. The feA'er is a continua remittens; the local intestinal affection which sets in simultane- ously Avith the fever is not very violent, the evacua- tions generally consist of mucus, and are streaked with blood. This kind of dysentery is generally epidemic, but it sometimes exists as a sporadic disease, and generally accompanies catarrhs, rheumatisms, and diarrhoea ; it is principally occasioned by variable, alternately warm and cool and damp weather, and is frequently endemic in those districts where climate and locality make fever and ague likeAvise endemic If the attack have been occasioned by atmosphere and climate, and marshy emanations be the principal and most striking cause, China will remove the whole disease in a very short time, especially if the fever haA'e the character of an intermittent. If, on the con- trary, the rheumatic symptoms should be the most prominent, a few doses of Aconite will be found suffi- cient to cure the disease. If Aconite should not suf- fice, or if it should not be indicated, Chamom., Rhus or Pulsat., Avould be the best remedies, especially if the stools consist of blood-streaked mucus. Other reme- dies may likewise be indicated. (See the remedies for catarrhal and rheumatic fevers.) The pure inflammatory, or the bilious inflammatory, dysentery, sets in Avithout any precursory symptoms; it is characterized by all the symptoms of a local in- flammation. The feA-er is a synoeha; it sets in with a A'iolent chill, folloAved by a dry, burning heat, Avith great thirst, dry tongue and skin, and fiery urine. The local symptoms of this kind of dysentery are as clear- ly marked, and are very much like those of enteritis; both in dysentery and enteritis the abdomen is very sensitive to the touch, hot and distended, the patient DYSENTERIC FEVERS. 207 is tormented with retching, A'omiting of the ingesta, and coldness of the extremities. Inflammatory dysentery is very rare, sometimes sporadic, but scarcely ever epidemic; it prevails most- ly at the end of summer and the beginning of autumn, when the days are hot and the nights cool The first thing we have to attend to in the treatment of inflammatory dysentery, is to remove the synochal fever, which we accomplish by means of a few doses of Aconite. This remedy is frequently sufficient to subdue the whole disease. If the disease should not be subdued entirely, Belladonna has to be used. To confirm our assertion we will mention the symp- toms of the disease more in detail. Without dwelling upon the febrile symptoms themselves, which have been described with sufficient completeness, under the head of synoeha, we Avill at once proceed to treat of the local affection, premising that Belladonna deserves consideration if the dysenteric patient be of a pletho- ric constitution, and have a lively, ardent tempera- ment. The exacerbation commences in the afternoon and lasts until midnight, when the fever remits ; neA'er- theless the patient is prevented from sleeping by a vio- lent restlessness, and a great desire for cold drinks and baths. There are moments when the patient is de- lirious, especially on Avaking from a light slumber ; his face is then red, and the head hot; gradually he falls into a Avhining mood, which cannot be subdued except by emphatic remonstrances, or which alter- nates with a firm resolution to jump out of the bed, and to look for the chamber. The tongue is lined with a whitish fur; the tip, which is not coated, in- clines to be dry; the patient has lost all appetite, or has a positive aversion to food ; the pains in the boAV- t Is are either spasmodic and colicky, or else cutting- burning, the abdomen is somewhat distended in the umbilical region, there is a constant urging for stool, and small discharges of a bloody mucus. In other cases Nux or Mercurius is indicated. Nux is indicatetl by discharges of a sanguineous mucus, mixed with single hard lumps of feculent matter, and 208 DYSENTERIC FEVERS. accompanied Avith A'iolent cutting in the umbilical re- gion, and pressing in the rectum. Mere, is a princi- pal remedy Avhen, after the removal of the inflamma- tory symptoms, frequent discharges of bloody mucus, or liquid feculent matter, remain, accompanied with cutting and tenesmus, Avhich causes burning and sore- ness of the anus ; every evacuation is preceded by a cold SAveat in the face, as from anguish and excessive uneasiness. § 67. The gastric dysenteries, together Avith the ca- tarrhal-rheumatic, are the most frequent, and are cha- racterized by the fetid smell and putrid bilious nature of the evacuations. According to authors there exists in the first place a bilious dysentery, Avhich is apt to occur when the nights are cold and the days hot. and which sets in Avith all the symptoms of a bilious fever; the stools are frequent, consisting from the commence- ment of a fetid, green or brown bile ; colic and tenes- mus are very A'iolent, accompanied Avith great restless- ness and oppression of breathing. The bilious dysen- teries resemble, to a certain extent, the inflammatory variety; spontaneous A'omiting affords relief. They occur most generally as an epidemic disease, towards the end of very hot summers, and at the commence- ment of the fall, after a continuous heat. In this variety likeAvise, the treatment ought to com- mence with the remoA'al of the inflammatory symp- toms by means of Aconite, after Avhich the specific remedy in this variety, Mercurius corrosivus, may be exhibited. This remedy is indicated by a succession of small muco-sanguinolent evacuations, continuing day and night, with constant cutting pain in the bowels, and an insupportably painful tenesmus in the rectum; or Avhen the stools are mixed with fetid green or brown bile; the patient has lost all appetite, suffers Avith an unquenchable thirst, his tongue, the etlges of which have a whitish coating, inclines to dryness, he feels anxious, hot, and is deprived of sleep in consequence ; the pulse is small, feeble, frequent. The Colocynthis dysentery has the following symp- DYSENTERIC FEVERS. 209 toms. The greenish-yellow and frequent evacuations, consisting of a watery slime streaked with pure blood, are accompanied Avith the most violent colicky pains in the region of the hypogastrium ; these pains disap- pear with every evacuation, and the tenesmus is en- tirely wanting. The appetite is not entirely lost, but all desire to eat is counteracted by the offensive, bit- ter taste in the mouth; there is a great desire for drinks without much thirst; every time the patient eats or drinks the colic and the evacuations are ex- cited again. The temperature of the skin is moderate, the pulse is full and not too quick. Bilious dysentery, especially when epidemic, may assume a form requiring the use of Colchicum autum- nale. This remedy is extremely valuable in dysente- ry consisting, of a mere white mucus, with violent spasms in the sphincter ani, these spasms setting in frequently when there is no evacuation, in which case the patient experiences slight chills over the back. Bilious vomiting leaving a bitter taste in the throat, and an aversion to food, generally belongs to the Col- chicum dysentery. The perspiration Avhich exists in the commencement of the disease, disappears after- wards, and the pulse becomes accelerated and small. Veratrum has been employed by us several times with success, where portions of faeces were distinctly seen in the Avatery-sanguineous, flocculent discharges. These evacuations were more frequent at night than in the day-time; they were accompanied and succeed- ed by colic, but not so much tenesmus; chills were likeAvise present. Veratrum is still more suitable when the dysentery is accompanied with vomiting of the ingesta, great debility, as if one could not support one's-st If, bland delirium, and lentescent fever. It is of the utmost importance to repeat the remedy in that disease, provided the remedy Avhich had been selected Avas homoeopathic to the symptoms. . In pituitous dysentery the inflammatory character disappears more and more; the phenomena denoting an irritation of the mucous membrane become more and more prominent, establishing a similarity betAveen 210 DYSENTERIC FEVERS. the dysenteric disease and a mucous fever. The pre- cursory symptoms of mucous dysentery are the same as those of a mucous fever. The disease itself is sloAver than any other kind of dysentery, if the reme- dies be not Avell-chosen; the febrile symptoms, as well as the local affection, are indeed violent, but not as violent as in the other varieties of dysentery; the fre- quent evacuations from the bowels are Avithout colour or smell This kind of dysentery is principally occasioned by catching cold in the damp, A\et, and cold fall weather; hence it is that the pituitous orAvhite dysentery occurs more frequently as an epidemic and endemic, than as a sporadic disease : it prevails in October and NoA'em- ber, Avhereas bilious tlysentery is more prevalent in August and September. Mucous dysenteries are cured the most easily in the precursory stage; Mercurius, Pulsatilla, and Dulca- mara being the principal remedies. Pulsatilla is fre- quently the best remedy even when the d\sentery has become fully developed. Colchicum autumnale seems to correspond principally to mucous dysenteries ; Merc corr. is likeAvise an excellent remetly for that disease, if the stools be mixed Avith blood. The preparations of Sulphur ought to be resorted to after the character- istic symptoms of dysentery have been greatly sub- dued, but xvould not yield beyond a certain point, or became worse again after a temporary improvement had been effected. In many cases of that description Acidum sulph. will suffice, unless Sulphur should be more specifically indicated. It is principally adapted to those forms of dysentery Avhere the symptoms an; more violent in the night, and the patient passes blood, mucus and pus, accompanied with fever, loss of appetite, cutting colic, and a desire to lie down ; the colic is frequently so A'iolent that it causes sickness of the stomach, and the patient is drenched Avith sweat. The fever consists of a dry heat, generally flushes of heat, without any particular thirst. Hepar sulph. comes next to Acidum sulph. Aloes is undoubtedly one of those remedies which DYSENTERIC FEVERS. 211 will prove valuable in dysentery, inasmuch as it pos- sesses the peculiarity of causing violent colic, with bloody stools. Ipecacuanha is useful in gastric dysenteries, in the commencement of the attack, if the diarrhoea be ac- companied with vomiting, and a pinching pain in the abdomen. Cantharides is indicated when the patient discharges a white mucus from the bowels, which looks as if it had been scraped off the bowels; the discharges are accompanied with burning pains in the abdomen and bowels, occasioning moaning and lamentations. The fever is generally very violent, burning, with dryness of the mouth, thirst, anxiety, and a small, hard, and intermittent pulse. Capsicum deserves especial consideration after the violent cutting pains have been removed, and an in- tensely painful feeling of pressure remains in the region of the stomach and duodenum, accompanied with discharges of a greenish frothy matter, or flocks of bloody mucus; the pulse is full, strong, and par- ticularly frequent from evening until midnight. Carbo. xeg. ought likewise to be recommended for dysenteric discharges of bloody mucus ; it ranks next to Cantharides, as regards the pain in the abdomen, especially about the umbilicus, and is distinguished from Cantharides by the burning pain being accompa- nied with cutting. Carbo veg. is indicated in dysen- tery when the folloAving group of symptoms occurs, af- ter the evacuation from the bowels: pushing in the direction of the small of the back and the bladder, with pressure on the rectum, and burning in that part; feeling of emptiness, want of tonicity, anxiety, tremu- lous weakness ; frequent attacks of burning heat, es- pecially at night, disturbing sleep. A distinguished remedy in that variety of dysentery is Rhus tox. It is especially suitable when the disease is slow to get well, and, in spite of some slight im- provement, all the original symptoms are yet remain- ing ; when the patient appears Aveak and falling aAvay, the plasticity of the blood is greatly diminished, the 212 DYSENTERIC FEVERS. organic activity threatens to become extinct, and typhoid symptoms set in. The symptoms indicating Rhus being very A'arious, Ave content ourselves Avith barely mentioning that fact, leaving the reader to compare the symptoms of the ease Avith those record- ed in the Materia Medica. Next to Rhus, Staphysagria deserves to be men- tioned. It is employed in dysentery with frequent dis- charges of a yelloAv mucus, tenesmus, cutting pain in the abdomen, the Avhole body feels painful as if bruised, and the muscular tone is greatly diminished. Nitri acidum is probably the best remedy when there is a constant pressing in the rectum without any eA-acuation : or else the patient evacuates mere mucus, after which the tenesmus continues, folloAved by a pain- ful tension, Avith pressure in the Avhole of the head, constant heat, great dryness in the throat, violent thirst, and an unequal intermittent pulse. Plumbum corresponds to dysentery of the most vio- lent kind, the patient discharging nothing but blood ; the accompanying symptoms are, violent fever, severe cutting in the stomach and abdomen, burning in the anus during the evacuation, and continuation of the tenesmus eA'en after stool. The worm dysentery is different from the worm feA'er and the worm colic ; the symptoms vary sudden- ly, and seem dangerous Avithout any real danger be- ing present. That kind of dysentery can only be looked upon as a secondary affection, Avhich must necessarily disappear with the cure of the primary worm disease. The term " dysentery " is not a proper appellation for that disease, inasmuch as the charac- teristic symptoms of dysentery are not sufficiently prominent; it might be considered a sort of dysenteric diarrhoea. As regards the treatment, we refer to our remarks on worm fever. For the sake, of completeness, we Avill likewise mention the putrid variety of dysentery. According to authors, it is both secondary and primary. The secondary variety results from the slow development of pituitous dysentery ; its existence is recognized by DYSENTERIC FEVERS. 213 great debility, profuse, colliquative, and excessively fetid stools; dry, brown, cracked tongue, extremely rapid and scarcely perceptible pulse. A secondary putrid dysentery cannot possibly occur under homoeopathic treatment, unless the physician be utterly incompetent. If a pituitous dysentery be properly treated, it ought to improve four or five days after the treatment has commenced, it ought never to last three weeks, or even a fortnight, as is stated in pathological books. A primary putrid dysentery has all the symptoms of an epidemic and contagious malady. Beside the pathognomonic, symptoms of dysentery, there is this peculiarity, that its phenomena set in with the utmost rapidity and violence, and with a considerable sinking of strength. At first a putrid dysentery has an in- flammatory character ; the stools are not so frequent as afterwards, but are so much more painful, and are accompanied with violent colic At this stage of the disease it ought to be treated like an inflammatory dysentery. If the symptoms of a local affection of the intestines should become more prominent; if decayed, fetid masses should be discharged from the bowels without any very great pain, and sometimes involun- tarily ; if the patient should frequently vomit bile or mucus, and should complain of great loathing, and a putrid taste and smell; if the symptoms of a general status putridus should develope themselves, such as : hemorrhages, aphthae, petechiae, blue spots and serous vesicles on the skin, a burning hot skin; turbid, floccu- lent urine, having a cadaverous smell; sunken, stupid expression of countenance, indifference to surrounding things, soporous condition, etc., Nux, Arsenic, Petro- leum, Carbo veg., Acid sulp. and nitr., Kreosot, China, are the best remedies to be used; these remedies, especially Sulphur, Nitric Acid, and Petroleum, ought likewise to be employed when the disease improves but slowly in spite of the best selected remedies, or when it threatens to get worse again after an im- provement of some days ; in one word, when the dis- ease is protracted, which is usually the case in persons 214 DIARRHCEA. with a depressed vitality, debilitated, nervous, sensi- tive, scrofulous, and disposed to chronic maladies. In this disease the diet is of the utmost importance. Errors in diet may be extremely detrimental to the patient. The patient ought to abstain from fruit and green vegetables, both during and for some time after the malady. Slimy soups and beverages are the most suitable nourishment, especially salep, oatmeal-gruel, and the \yhite of an egg Avith sugar and water; and lastly, boiled xvater, which agrees with the patient better than anything else, and aids in restoring the process of sanguification to its normal standard. We know from pathological anatomy that the blood under- goes a morbid change in dysentery, which, in its turn, favours the development of the disease. § 68. If typhoid symptoms should be developed in the course of a pituitous or putrid dysentery, which happens in the colliquative stage, the same rules apply which have been laid down for the treatment of a secondary putrid dysentery. A typhoid dysentery never exists as a primary disease, and has to be treated with remedies which correspond both to the typhoid and dysenteric symptoms. (See the chapters on typhoid fevers.) § 69. Diarrhoea. Diarrhoea is generally a symptom of some more general disease, or a salutary crisis. However, diarrhoea may likewise occur as a primary disease of the reproductive system, accompanied Avith fever. The essential character of diarrhoea is an increased and looser discharge from the bowels, the colour being more or less different from the natural. It is frequently preceded by the precursory symptoms of a gastric affection. Colic is not always present; sometimes, however, it is very violent (diarrhoea torminosa) ; tenesmus is scarcely ever present. The disease lasts from a few days to several months, and even years. The discharges vary likewise, fecu- lent, fluid, mucous, bilious, purulent, bloody. Diarrhoea may be without any danger, getting well of itself, or DIARRHOIA. 215 it may become dangerous by its continuance, or danger may actually be present when diarrhoea sets in. A diarrhoea which is not manifestly dangerous ought not to be arrested suddenly ; danger may be supposed to exist Avhen the discharges are quite watery (although this is not always a symptom of danger),* and great debility after every evacuation, sometimes amounting to syncope. The selection of the remedy depends upon the form and nature of the discharges. We distinguish the fol- lowing kinds of diarrhoea:— Diarrhoea stercoralis, being generally a consequence of overloading the stomach with heaA'y, undigestible fat, rancid, sour food and drink. It is preceded by offensive eructations, aversion to food, colic, distention and tightness of the stomach and abdomen, nausea, and sometimes vomiting; after these symptoms have set in, a quantity of flatulence is generally emitted, accompanied with loose, fetid, papescent stools, some- times corroding the anus and causing a burning and pain in that part. As regards the treatment, the same rules apply which have been laid down for the treatment of the precursory symptoms of gastric and bilious fevers. This kind of diarrhoea gets well of itself, as nature is competent to remove the noxious substances. In some cases a cup of black coffee will haA'e to be used for that purpose, or, if this should not be sufficient, one of the aboA'e-mentioned remedies may be employed. Diarrhoea aquosa serosa is a second form of diarrhoea. This diarrhoea is occasioned by a cold either of the feet or abdomen, and is sometimes a prevailing or even epidemic disease in the latter part of summer, or in the fall season. It is sometimes accompanied with a lancinating pain in the boAvels and spasms in the ab- domen, retching, and nausea. The discharges take place in rapid succession, they are watery, serous, have A'ery little smell, sometimes, however, they are * I am now treating; a gentleman who has hecn suffering with watery diarrhoea for the last six years, from three to eight discharges a-day. He is as strong and healthy as any man — Hxmfel. 216 DIARRHCEA. bilious; every discharge is accompanied Avith a ucav and A'iolent attack of colic. The diarrhoea of children, occasioned by dentition, is of a similar kind, it is some- times accompanied Avith heat, fe.A'er. and loss of appe- tite. If such diarrhoeas should be A'iolent, and last a long AA'hile, serum and eA-en fibrin are passed,occasion- ing sudden prostration. Dulcamara, frequently repeated, is the best remedy for most cases of this form of diarrhoea, when it takes place in the summer season, consists of green or yel- Ioav mucus, has a sour smell, the evacuations being preceded by colic, followed by debility and remission of the pain, and generally taking place in the evening. If the diarrhoea be not so much accompanied Avith pain in the bowels, but debilitating ; if it be a kind of lienteria, Avhere the evacuations take place shortly after a meal, and especially at night, Avith or Avithout cutting in the bowels ; if they contain undigested food, China Avill proA-e serviceable ; in many cases Bryonia will haAe to be given, especially if the diarrhoea have been occasioned by a cold, if the evacuations occur almost inAroluntarily, have a fetid smell and brown colour, if they be liquid as in infants, accompanied xvith flatulence or fermentation in the bowels. This kind of diarrhoea is sometimes controlled by Rheum, especially when it affects children of any size, during dentition or afterwards, they look pale, grumble and quarrel a good deal, Avith heat all over; the evacua- tions are feculent, papescent, smell sour, and are ac- companied A\'ith a constrictive pain in the boAvels. Mercurius solubilis will afford help if the discharges of green mucus should be accompanied Avith a pinch- ing and cutting pain, and should be so acrid that they cause a burning and itching of the anus; the rectum sometimes protrudes, and the stools are streaked with blood. Chamomilla is the surest remedy against diarrhoea which occurs during dentition and is occasioned by a cold; it is generally Avatery, green or like chopped eggs, smells like putrid eggs and is accompanied with pinching colic. If the diarrhoea should set in with DIARRHOEA. 217 sudden prostration and a A'iolent cutting pain in the bowels, the surest remedy is a small dose of Arsenic. Many homoeopathic physicians recommend Arsenic as the best remedy for diarrhoea from dentition ; it seems however that latterly the tincture of Sulphur has been employed with more success than Arsenic. Charac- teristic indications for Pulsatilla are the greater fre- quency of the diarrhoea at night, especially before midnight, or immediately after getting up in the morn- ing, the discharges being watery, green, bilious ; Rhus is indicated when the jelly-like, yellow, and still more or less feculent discharges take place only after mid- night and are preceded by violent colic which dis- appears after the eA'acuation. Calcarea acetica, several doses, has been successfully employed by some homoeopathic physicians against that kind of diarrhoea, if it was of long standing, or a xvatery, acrid diarrhoea, corroding the anus, and accompanied with vomiting of the ingesta soon after a meal, Ferrum metallicum is an excellent remedy. Acidum phosp. and Phosphorus are still more important, when the disease is one of long standing. These two remedies are particularly adapt- ed to chronic, painless, half-liquid diarrhoeas, under- mining the general health but slowly; or to diarrhoeas occurring from suppressed scarlatina, or to such as occasion a general nervous weakness with excessive emaciation. A third kind of diarrhoea is the diarrhoea biliosa. This kind of diarrhoea is a little more complicated than the two preceding varieties. It is generally occasioned by moral emotions, anger, chagrin, some- times by catching cold in hot and damp weather; this frequently makes it an endemic or epidemic disease. Its accompanying symptoms are: Avant of appetite, bitter taste, yellowish complexion, coating of yellow mucus on the tongue, bitter and disagreeably sour eructations, aversion to food, nausea, and sometimes vomiting of bile ; the evacuations are bilious, yellow, green, and are accompanied Avith A'iolent colic. The diarrlnea from dentition is sometimes characterized by similar symptoms; in this case the sour-smelling, 10 218 DIARRHtKV greenish stools do not ahvays depend upon an effusion of bile, but upon acidity in the primae viae ; they fre- quently hax'e a chopped appearance or look like stirred eggs; in some cases the anus is corroded by the stools. The remedies for bilious diarrhoea are the same which have been indicated § 40, and the following. The diarrhoea xvhich is occasioned by acidity in the primae viae, and is most frequently met Avith in children, is cured by Chamomile or Rheum. Sometimes such a sour-smelling diarrhoea becomes chronic ; in such a case Magnes. earb. will remove the trouble in a very short AA'hile. If the anus, genital organs, and inner surface of the thigh should be very sore, and if the whole body, but especially the thighs, should be cover- ed Avith a miliary eruption, Sulphur is the best remedy. If the children should be still at the breast, the dose had better be given to the mother or nurse, recommending a strict homoeopathic diet. This diet is likeAvise nocessary, Avhen the child is brought up without the breast or is already Aveaned. In very many cases the little being is stuffed Avith pernicious things or an excessive quantity of food, pap, etc., to keep it quiet. In cases where Chamomilla is indicated, the physician ought to inquire very carefully whether Chamomile-tea had been given ; for the diarrlura fre- quently arises from an abuse of that drug. In that case the symptoms ought to be antidoted by Coffea or Pulsatilla before another remedy is given. Besides the remedies already mentioned avc refer to Mercurius, Hepar sulp., Sepia, Calcarea, and Gra- phites. We have seen this diarrhoea in children several times, who looked like a piece of raw flesh all over the body, lamented a good deal at night, and were prevented from sleeping by the pain. This condition depends generally, but not exclusively, upon syphilis in the parents. There is nobetterremetly for thatgroupof symptoms than Mercurius ; this either effects a cure or modifies the symptoms so that they will yield to Hepar s., Sulp., or Graphites. The remedies Avhich we have indicated in the pre- DIARRHQ3A. 219 ceding paragraphs, but especially Calcarea, are es- pecially adapted to such diarrhoeas when occurring in scrofulous patients ; the secondary symptoms, Avhich, however, are not ahvays very prominent, will point more distinctly to one or the other of those remedies. A fourth class of diarrhoea is the diarrhoea mucosa, pituitosa. This diarrhoea sometimes arises from a mis- managed watery or feculent diarrhoea. Or it may be occasioned by a cold in damp, wet and cold fall-wea- ther, and in low and marshy regions ; when such causes prevail, the diarrhoea may become epidemic or endemic. Weakly, nervous, dyspectic persons are most easily affected. The disease is ushered in by dis- tention and hardness of the abdomen, pressure and feeling of repletion in the abdomen, flatulence, loss of appetite, slimy coating of the tongue, etc. The dis- charges have various colours, generally they are slimy,' and sometimes streaked with blood. They are de- bilitating, and induce emaciation unless soon arrested. This kind of diarrhoea is, in most instances, a conse- quence of existing affections, especially of mucous fevers. As a general rule, mucous diarrhoeas are treated like mucous fevers. It is a remarkable fact that such diarrhoeas, together with their accompanying symp- toms, generally correspond to Pulsatilla, especially if the colour of the stools vary. If the diarrhoea should be greatly debilitating, Colocynthis may be given. If the evacuations should be slimy, green, sanguineous, accompanied by tenesmus, Merc. sol. is the remedy. If the disease should be one of long standing, Petroleum Avill sometimes cure it, provided it corresponds to the secondary symptoms ; Acidum phosp. or Phosporous are sometimes the best remedies. According to Dr. Gross, the best remedy in painless diarrhoea is Ferrum metallicum. Lately Secale cornutum has been fre- quently given for mucous diarrhoea, especially AA'hen the tongue Avas coated Avith mucus, and the patient complained of papescent taste and rumbling in the abdomen. It may be remarked that all those reme- dies have to be given repeatedly. 25jO typhus. We do not speak of diarrhoea verminosa, diarrhoea sanguinea, diarrhoea urinal is. and diarrhoea purulenta ; these are secondary affections which have to be treat- ed in company Avith the primary disease. Slimy kinds of food and drink, such as sago, salep, rice, vermicelli, gruel, barley, oatmeal, etc, are to be recommended in this kind of diarrhoea; if the diarrhoa be chronic and yield only for a few days to the reme- dies Avhich are given for it, the patient mav eat Avhortleberrics, either raw, dried, or stewed. Fresh- drawn milk, not. boiled, is an invaluable remedy for diarrhoea of children Avhich does not yield to medicine. FIFTH CLASS FEVERS AFFECTINC, PRINCIPALLY THE NERVOUS SYSTEM. § 70. Typhus. As in synochal and erethic fevers the vascular sys- tem is principally excited, so is typhus characterized jy great erethism of the nervous system, especially the ganglia and brain. Typhus is characterized by great variability of all the symptoms, an apparent contra- diction between the symptoms themselves, and be- "Aveen the symptoms and the disease, for instance: dryness in the mouth and no thirst ; no pain even when causes are at Avork Avhich tend to produce pain ; violent illness and no great feeling of illness, the patient asserting on the contrary that he feels wtdl The moral symptoms are of the utmost importance in typhus, as the selection of a remedy frequently de- pends upon them exclusively. It would be a fruitless attempt to give an accurate and never-changing description of typhus, which is an assemblage of the most varied phenomena. In the following chapter we give a general description of the characteristic symp- toms of typhus, and shall furnish the parti;' dar indica- tions for the remedies which are used in typhus, when Ave come to speak of the varieties of that disease. Recently it has been ascertained that the mucous membranes and the lymphatic glands, especially those of the ileum, are the principal seat of the disease, whence it has been termed typhus abdominalis; for- TYPHUS. 221 merly the dynamic character of the disease, the de- pression of the nervous system was principally con- sidered and, in accordance with that character, the disease was named febris nervosa which could noAv be properly applied only to typhus cerebralis. The more precise appellation of this fever has led homoeopathic physicians to the discovery of many valuable remedies for typhus, Avhich it might have been difficult to dis- cover without the pathological seat of the disease having been first ascertained by post-mortem examina- tion. § 71. General symptoms of typhus; diagnosis. There is no violent chill in the commencement, but slow chills alternating with heat. The brain and nervous system are principally affected from the com- mencement, as may be inferred from the following symptoms : dulness and tightness of the head, gloomy mood, headache, A'ertigo, sometimes syncope, tremb-. ling, subsequent delirium, sopor, spasms of every kind, both external and internal; convulsions, great debility and prostration ; small, feeble, soft, easily compress- ible, moderately frequent, sometimes slow, very vari- able pulse, which does not harmonize with the respira- tion ; for instance, is rapid Avhen the breathing is calm (Hufeland). There are three kinds of more or less distinct forms of typhus: 1. Typhus cerebralis, affecting principally the brain, spinal marrow, or the nervous system generally. This variety of typhus is principally characterized by s) mptoms which denote a deep alteration of the functions of those organs without any inflammation being present ; there Avill always be delirium, sopoi, or paralysis of the organs of sense, when the irritative stage—great hurriedness' in all the movements and manifestations of the senses—has passed oA'er. At fhis stage of the disease there is the most remarkable difference in the quantity of blood contained in the brain and spinal marrow and their membranes, from extreme congestion to anaemia; sometimes those organs 222 TYPHUS. are compact and tenacious, sometimes they are inter- stitial ly distended. 2. Typhus abdominalis, where a portion of the ab- dominal organs is the principal seat of the disease. This A'ariety contains a great number of shades and has a slow course. The brain is only gradually invad- ed ; the cerebral disturbance manifesting itself with a certain rapidity in full-groAvn persons only. Avhere the organs, Avhich are the principal seat of the typhus, haA'e attained a normal size Avithout showing any striking changes in the reproductive functions. We now knoAv from post-mortem examinations that the principal seat of the typhus abdominalis is the mucous membrane of the ileum which exhibits various forms of degeneration, congestion, infiltration, ulceration, in- duration, interstitial distention, softening, exanthe- matic spots, gastro-enteritis, open or cicatrized ulcers. Little by little the mesenteric glands and the spleen are likewise affected, becoming considerably enlarged, and from the spleen the affection frequently extends to the mucous membrane of the cul-de-sac of the stomach. 3. Pneumo-typhus, the organs of the thoracic cavity, especially the lungs, being principally aflected. This variety of typhus frequently sets in in the shape of a catarrh, or of an imperfectly-developed and therefore not distinctly marked pneumonia ; the heart and the larger vessels are sometimes affected. The patient complains of great anxiety, hurried, incomplete, labor- ed breathing, Avith short, croaking, exhausting cough ; the expectoration has a bad colour, is purulent and blood streaked ; certain regions in the chest are more or less painful. A post-mortem examination reveals the folloAving appearances: degeneration of the lungs by inflammation and gangrene, hepatization, adhtsions, effusions in the mucous membrane of the bronchia and the parenchyma of the lungs ; the heart is flaccid, pale or of a dingy-red. The diagnosis is not very difficult. The excessh'e prostration, the violent and universal ir- ritation of the sensus communis, the appearances about TYPHUS. 223 the head (the humming and buzzing about the ears) the tendency of the fever to become continuous, inform the physician that the disease is not a simple catarrh but that there is an approaching typhus Avhich although it may be kept in check for a time, will break forth in all its violence on the seventh day. The physical signs resemble those of croupous (catarrhal) pneu- monia ; the percussion-sound becomes more and more dull; auscultation reA'eals crepitation which, in the stage of hepatization, is changed to a consonant rat- tling. The course of typhus is very irregular and un- certain ; the precursory symptoms sometimes exist for days, even weeks, such as tightness and dulness of the head, vertigo, tremulousness of the extremities, head- ache, sleeplessness, dreams, even visions. Typhus may last from 21 to 28 days, and even longer; the convalescence is slow and the patient is liable to relapses. § 72. Typhus is divided into varieties according to its intensity, its type and complication. We distinguish a typhus mitior and gravior, a typhus continuus and remittens, a typhus simplex, inflammatorius, putridus, gastricus, rheumaticus, catarrhalis. In homoeopathic treatment such a classification has no practical A'alue, as the selection of the remedy depends upon the symp- toms of every case in particular, not upon the charac- teristic symptoms of the genus. Full-grown persons are more liable to typhus than children and old people. The remote causes of typhus are : privation or bad quality of the necessary food, (hunger, famine, bad nourishment) ; air which has become vitiated by crowding a number of men into close rooms, or by uncleanliness ; depletion by venesection, hemorrhage, etc.; exhaustion of the nervous power by excessive ir- ritation, excessive exertions of the body or mind, venereal excesses, excessive heat, etc.; depressing emotions: chagrin, sadness, grief, care, disappointed love; nervous or putrid contagia, dampness, cold, an at- mosphere which does not furnish sufficient sustenance 224 TYPHUS. to the Aital forces and favours the development of an epidemic typhus ; such an atmosphere arises from* a continuance of Avet Aveather and easterly winds. § 73. The prognosis depends upon the form of ty- phus, the typhus in our climate is loss dangerous than the pest or yelloAv fever : also upon the stage in which Ave find the fever, a typhus Avhich has been continuing for a time, is more uncertain than an incipient one ; upon the course, the more regular the course, the more fa\'ourable the prognosis: upon the violence of the symptoms, constant delirium, floccilegium, subsul- tus tendinum, constant sleeplessness, colliquative se- cretions, sopor, difficult sAvalloAving, are very unfa- vourable. Typhus generally terminates by some imperfect crisis, metastasis, metaschematismus. miliary eruption (which may also be one of the symptoms), furuncles, abscesses, deafness, blindness, etc. Death takes place by paralysis of the nerves, or by some local alfeetion, inflammation of the bowels, or by colliquation, putrid decomposition. It is very difficult to measure the exact extent of the danger, oAving to the deceptive feelings of the pa- tient, the uncertainty, and the variability of the symp- toms, and the opposition Avhich seems to exist between the apparent symptoms and the internal condition. The pulse likewise cannot always be relied upon, in- asmuch as a rapid pulse is not always proportionate to the intensity, nor a calm and regular pulse to the unimportance of the disease. The urine indicates an improvement, if the turbid urine become (dear, or the clear urine moderately turbid ; if a sediment should form at the bottom of a lemon or straw-coloured urine, this is a sign of recovery. The danger increases in pro- portion as the head is more stupified, insensible, sopo- rous, the patient feels well, the local paralysis spreads over an increasing number of parts ; the tongue, for instance, feels paralyzed Avhen talking, or a\ hen pro- truding it from the mouth ; there is difficult deglutition, incontinence of urine, involuntary stool, violent con- vulsions. The greatest danger occurs when the skin TYPHUS. 225 is unequally warm, dry, or else covered with clammy sweat, or Avhen a symptomatic miliary, eruption, and petechia?, break out upon the skin prematurely. Col- liquative phenomena are likewise dangerous. What is remarkable is, that deafness is generally a good sign (Hufeland). § 74. The treatment depends upon the individual nature of every case, and the remedies haA'e to be chosen in accordance with the symptoms. The fol- lowing remedies have proved efficient in the treat- ment of typhus: Bryonia, Bellad., Rhus, Phosphorus, Nux, Aconitum, Arnica, Arsenic, Ignatia, Acid, phosp., Hyosciamus, Stramonium, Chamomilla, Ipec, Carbo veg,, Cina, Pulsat., Coeculus, Lachesis, Mercurius, Camphor, Opium, Hellebore, Valeriana, China, Acid. mur., Spir. nitr. dulcis, Digitalis, Secale cornutum, Staphysagria, Spigelia, Lycop., Natrum mur., Magnes. mur., and others. Typhus frequently commences as a synochal feA'er, with congestion of the head and chest. The slight chills on the first and second day, in connection with loss of appetite, debility of the limbs, restless sleep, with frequent "starting as if in affright, the elevated temperature of the skin shortly increasing to a sting- ing, burning heat, with a good deal of thirst, a full, accelerated, rather hard, pulse, and the scanty secre- tion of urine, point to a deep-seated affection, which will not get AveII without the interference of art. Only in a very few cases do we succeed in cutting the dis- ease short; the difficulty of accomplishing this is pro- bably oAving to the vagueness and uncertainty of the symptoms, Avhich make it impossible to hit upon a «er- tain remedy. Frequently, hoAvever, the physician is sent for too late to prevent the development of the dis- ease ; the patient or his friends are not sufficiently ac- quainted with the nature of the symptoms to be aAvare of their dangerous character. If typhus should set in Avith the symptoms of a synoeha, such as : violent dry heat, burning skin, al- ternale redness and paleness of the cheeks, great ere- thism of the nervous system, restlessness, moaning, 10* 226 TYPHUS. tossing about, apprehensive anxiety, painful conges- tion of blood to the head, vertigo, nightly delirium. dry cough, Avhich racks the abdomen: Aconite is to be exhibited, and should be repeated as the intensity of the fever requires. If there should be no abate- ment of the fever, or if other dangerous symptoms should make their appearance during the use of Aco- nite, the continued exhibition of this remedy Avould be highly improper, and would involve an irreparable loss of A'aluable time. Sometimes Belladonna is indicated at the very com- mencement of the disease by the folloAving group of symptoms : the disease is occasioned by fright or cha- grin ; convulsive tAvitehings of the limbs are present ; the patient complains of constant uneasiness in the limbs, especially in the hands and feet, sometimes in the head, inducing a constant movement of those parts, and change of position ; or the disease sets in Avith fainting turns, after Avhich an excessive sensi- tiveness and irritability of all the organs remains, this being the first commencement of typhus ; or the fever may commence with a continual drowsiness, increas- ing to lethargy, Avith snoring, during which the counte- nance changes frequently from cold and pale to red and hot, similar changes of temperature being ob- served in other parts of the body; if the consciousness should remain active during the sleep, the sleep is fre- quently disturbed by starlings as if in affright, by frightful, anxious dreams, Avith vivid fancies, the fan- cies continuing in the waking state, Avith inability to collect one's senses. In the Avaking state we observe in thetpaticnt A'arious disturbances of the mind and senses, Avhich do not justify the expectation of a sudden dis- appearance of the symptoms; the patient is disposetl to whine,he is fearful, anxious and restless, he moans, groans, starts out of his bed, complains of internal heat, Avith headache and vertigo ; or else he is in- different, is not disposed to talk, and is frequently subject to illusions of the senses and the fancy. As the disease progresses the erethic fever increases, the delirium becomes more furious, the patient has TYPHUS. 227 visions in the waking state, startings as in affright, with internal, burning heat, without thirst, distention of the veins of the head, A'iolent throbbing of the arte- ries of the head, especially in the forehead and temples, violent pressing pains in the temples, from within out- ward, which become intolerable by movement, con- versation, light, walking through the room, and are ac- companied by A'h'id fancies and delirium ; the patient stares, the whites of the eyes are red; in his rational moments the patient complains of buzzing in the ears, scintillations, and blackness before the eyes ; the lips and buccal cavity are dry, the tongue is red, burn- ing-hot, parched ; the appetite is gone, the patient complains of a violent burning thirst, with difficult deglutition, on account of the violent dryness ; disten- tion of the abdomen, with sensitiveness to the touch and frequent small diarrhaeic stools. The scanty urine is generally dark-red, becomes turbid, and deposits a reddish sediment. When these symptoms occur, re- peated doses of Belladonna are the best remedy. In typhus, with erethic congestions of the head, Bryonia is likewise a most valuable remedy, when the \, following group of symptoms occurs: after a slight cold the patient complains of a pain as if bruised in the Avhole body, everything upon which he is lying is too hard for him ; the beating, pressing pain, in the forehead, from within outAvard, is especially distress- ing to the patient Avhen looking up or moving his eyes ; the scalp is painful to the touch, and the head burns like fire, in spite of Avhich the forehead is sometimes covered with cold SAveat; debility, weariness and weight in the limbs, which obliges him to sit or lie doAvn, AA-ith dread of the open air ; the night's rest is disturbed by erethism of the circulation, heat and anxiety, especially in the hours before midnight; the patient moans during sleep, and is waked by anxious and frightful dreams, Avhich continue even after Avaking. A characteristic symptom in the commencement of i the Bryonia typhus is the alternation of heat and chilli- ness, the former in the morning, the latter in the after- noon, and on going to bed ; the thirst is moderate, but 228 TYPHUS. there is A'ertigo, increase of headache, and excessive erethism of the nervous system. Gastric symptoms are manifestly present ; the patient complains of bit- terness in the mouth, dryness and yellow coating of the tongue, aversion to food, nausea, with inclination to A'omit, pressure and stinging in the pit of the stomach, sensation in the hypochondria as if they were distended, difficult stool. As the disease progresses the A'iolent heat becomes permanent, and is accompanied Avith violent delirium, without the patient complaining much of his illness ; the distortion of the features, and the grasping at the head, are the only signs of the continuance of the vio- lent headache ; the continued moaning, even Avhen the patient is aAvake, points to an approaching rash, which frequently breaks out in the shape of a Avhitc miliary eruption, and sometimes in the shape of pete- chiae. The delirious talk of the patient in most cases turns about the patient's business, a\ Inch gives him so much anxiety that he endeavours to escape. The thirst becomes more intense, the tongue drier and parched; the face is red, bloated, the dry lips are cracked ; the alvine evacuations cease entirely, and the urine looks broAvn-red. Bryonia ought to be re- peated every two or three hours. Mercurius is an important remedy when the fever has the character of erethism from the commence- ment. Mercurius is best adapted, especially in the commencement of the disease, to puffed leuco-phleg- matic individuals Avith soft and spongy flesh and pre- dominant inclination to catarrh and profuse sweats, and affected Avith bodily and mental Aveakness. If is certain, that Mercury deserves a preference over many other remedies Avhen catarrhal and rheumatic fevers turn into typhoid. Mercurius is indicated by the following symptoms: a long Avhile beiore the typhoid symptoms set in, the limbs go to sleep Avhen the patient sits or lies doxvn, with numbness, insensi- bility, and tingling in the same; the patient finds it hard to drag his limbs along, sAveats or is affected with palpitation of the heart upon the least move- TYPHUS. 229 ment; nevertheless the uneasiness which he expe- riences in his limbs, compels him to move his limbs constantly. Although the patient does not yet com- plain of any thing in particular, yet he is so debili- tated and feels so ill all over that he is obliged to lie down; he is scarcely inconvenienced by any thing, except slight heat, erethism of the blood and trem- bling, which occasions a constant starting and jactita- tion of the limbs during sleep ; frequent watery stools, with moist and coated tongue, bitter, putrid, pappy taste, slight thirst, sensitiveness to pressure in the pit of the stomach, in the umbilical and hepatic region, distention of the abdomen. The mental and physical debility gradually increases, fainting turns supervene, and the patient is attacked with paroxysms of spas- modic contraction of the limbs occasioned by the sud- den paroxysms of vascular erethism; henceforth he finds it impossible to leave his bed. If, in the progress of the disease, the following symptoms should occur, Mercurius is still indicated: general erethism of the nervous system ; the delirium is not altogether inconsiderable ; the chills which, in the commencement of the feA'er, were interrupted by flushes of heat, have yielded to a constant burning heat with excessive desire for iced water. The pa- tient complains of fulness, painfulness in the epigas- trium ; symptoms of a general plethora, especially in the portal system, make their appearance; frequent bleeding from the nose, from which we may infer, that tin; blood begins to be decomposed ; excessive restlessness, anxiety, vascular erethism, pulsations, A'iolent headache, as if the head Avould burst, prevent- ing sleep and fretpiently interrupting it by causing the patient to start. Little by little the patient becomes more indifferent, he is desponding, does not care about lift; ; he is frequently unable to collect his senses, he loses his memory, Avhich loss is probably a continu- ance of the previous dizziness and dulness of the head. His face becomes livid, the eyes groAV pale, the nose blackish, the gums savcII and bleed readily; a putrid smell from the mouth makes its appearance, 230 TYPHUS. and colliquative secretions of A'arious kinds occur, among xvhich the Avatery, copious, colourless, serous or A\hite flocculent stools are the most characteristic. Under certain circumstances Mercurius corresponds to all the A'arieties of typhus, from typhus erethicus to typhus putridus. We haA'e now mentioned the principal remedies which correspond to the typhus innammatorius, Avith- out, hoAvever, intending to convey the idea, that they cannot be used in the succeeding stages of typhus. This would be contradicted by the symptoms Avhich show, that all the above mentioned remedies may be serviceable in any stage of typhus. We shall noAV indicate the remedies which correspond more espe- cially to the nervous phenomena in typhus, Avhether it exist as a primary disease, or a disease Avhich has been developed out of other diseases. First in rank, is Rhus toxicodendron. Upon the setting in of the precursory symptoms, the patient complains of chilli- ness even near the Avarm stove, Avith colic and diar- rhoea, pains as if bruised in A'arious parts, as if the flesh were beaten off the bones ; the tongue is coated white, the patient feels an inclination to vomit, result- ing in A'omiting of mucus, he complains of vertigo; the parts upon which he lies, go It) sleep and let I numb, he complains of an exceedingly troublesome stinging, draxving, and rigidity in the nape of the neck and back; he feels worst Avhen resting and at night, for at such a time he experiences a lameness and stiffness in the limbs, beside the other symptoms. As the disease progresses, he feels extremely Aveak to such an extent, that he is unable to remain out of his bed, from which an apprehensh-e anxiety and a disagree- able feeling of heat constantly impel him to escape ; his sleep becomes restless ; lit; tosses about and un- covers himself constantly, the uncovered parts feeling so chilly, that it makes him wide awake, and sleep is prevented by the excessive erethism of the circulation and by a variety of fancies ; if he should, however, fall asleep, his sleep is disturbed with the most trou- blesome dreams. TYPHUS. 23h As the fever progresses, a typhus abdominalis be- comes more and more marked ; the evening chilli- ness, which is followed in bed by several hours', dry heat and thirst, cutting as with knives in the abdo- men, and diarrhoea, disappears entirely andis changed to a continuous heat with violent delirium, pains in the limbs, excessive weakness, dry, blackish tongue and lips, burning-red cheeks, subsultus tendinum, floccilegium, sopor with muttering and snoring, small accelerated pulse. When the delirium abates, the greatest anguish is depicted in the features, which takes place more frequently before than after mid- night, and is accompanied with prostration of strength. If the patient should be on the point of falling asleep again, he is constantly prevented from so doing by starting as in affright. The following are some of the accompanying symptoms : Redness and lachryma- tion of the eyes, which are no longer susceptible of any impression from without, dryness of the nose, collapse of countenance, fetid odour from the mouth, involuntary discharge of stool and urine ; the urine is whitish and turbid during emission, before any col- liquative symptoms had set in, and becomes much more so by standing ; oppression of the chest is a characteristic symptom for Rhus; this oppression continues from the commencement to the end of the disease, whether terminating in death or recovery. Rhus is one of the most distinguished remedies both in the commencement and the progress of the disease, in typhus versatilis as well as in stupidus (especially in the latter) ; it is likewise of great value during the stage of convalescence, Avhen the improve- ment is very sIoav, the pulse continues feverish, there is an appetite, but more for particular things,than for natural simple food ; there is yet some inclination to diarrhoea, and the oppression of the chest is not en- tirely removed. Next to Rhus is Phosphorus, Avhich is principally indicated, when typhus arises from onanism or from a slight cold. This kind of typhus has a long precurso- 232 TYPHUS. ry stage, commencing Avith rheumatic pains in the upper and lower limbs, and accompanied by a capri- cious sensitheness ; those pains are generally very intense early in the morning and evening, in bed, they increase when a current of cool air comes in contact with the limb, and are frequently accompa- nied by other symptoms, such as : rheumatic draAving in the nape of the neck, stiffness of the affected limbs, toothache. AAeariness, and a bruised feeling in all the limbs, vascular erethism Avith dulness and tightness of the head, palpitation of the heart, stitches in the pit of the stomach, cutting pain in the boAvels, and a general sick feeling. If these symptoms should continue for any length of time without any change for the better being effected by the medicine, the dis- ease reaches a higher degree characterized by the following symptoms: The continuous heat is accompanied by a small, hard, quick pulse, throbbing of the carotids, profuse night-sweats; the sleep is interrupted by shrieks, constant fancies, moaning, tossing about, Avant of breath, stitches, rattling in the chest, oppressive cough with bloody expectoration (pneumo-typhus) ; upon waking the patient complains of great heat, dry mouth with thirst, painfulness of every part of the body. These symptoms are accompanied with sensi- tiveness and rumbling in the coecal region, especially when making pressure upon it, burning feeling in the abdomen and anus, frequently accompanied by half liquid, bloody stools; vertigo Avith stoppage of the head; the stupefaction and beating pains in the head are very great, there is a gauze before the eyes, hard- ness of hearing, frequent discharge of blood from the nose when bloAving it, and heat in the face. The tongue and lips are dry and parched ; the appetite is entirely wanting; the patient, when conscious, com- plains of bitter taste. (Phosphorus is frequently in- dicated when the patient lies in a state of stupor.) The urinary discharges are copious, at times deposit- ing a reddish, at times a white flocculent sediment. TYPHUS. 233 A striking symptom is the excitation of the sexual organs, which occurs in both sexes, and frequently in- creases to satyriasis and nymphomania. Phosphoric acid is closely related to Phosphorus, but more so to Pulsatilla. Phosphorus may, under certain circumstances, be employed against any form of typhus ; Phosphoric acid has a more limited, but at the same time more definite sphere of activity. Even the precursory symptoms of a phosphoric acid typhus are so Avell marked that there can be no doubt as to the selection of the remedy. The symptoms are frequently occasioned by long grief, chagrin, care, and increase to such an extent that they become dangerous to life. The precursory stage almost always commences with a gastric derangement, which is even characterized by the peculiar eruption about the mouth; there is a striking rising of air, with nausea, which compels him to lie down, and then frequently increases to a consid- erable vomiting, xvith extreme sensitiveness of the stomach and pit of the stomach, Avhich increases more and more as the vomiting continues, and extends over the whole abdomen. The appetite is entirely Avanting, the thirst is great, the patient has a particular desire for acid, juicy drinks. Diarrhoea supervenes with borborygmi in the distended abdomen; the frequent light-yellow stools require more particularly the ex- hibition of Phosphoric acid. If these symptoms be accompanied by intense pain in the inmost parts of the lower abdomen, which is even aggravated by the contact of the shirt; if a red miliary eruption make its appearance in various parts ; if the pulse be fre- quent, weak, sometimes intermittent; if the patient be unable to collect his senses; if muttering delirium, si 11 por, burning heat of the skin, a dry, parched state of the buccal cavity, and permanency of the recumbent posture be present, frequent doses of acidum phosphoricum will effect the desired improvement. This remedy is always most suitable in the commencement, as well as in the progress of a typhus stupidus, whether this arise from a gastric or erethic typhus : characteristic indications for Phosphoric acid are bland delirium, or silent and 234 TYPHUS. quiet recumbent posture, the patient giving a proper answer for a feAv moments, but shortly afterwards re- lapsing again into his former condition. Having spoken of a typhus stupidus, avc ought to allude to a remedy Avhich is closely allied to Phosphoric acid, and is yet too much neglected in typhus, we mean Acidum muriaticum. There are txvo symptoms Avhich indicate this remedy exclusively, they are the folloAv- ing: the patient constantly settles doAvn in the bed with moaning and groaning during sleep, and this settling down takes place again eA'en after the patient has been raised, with constant muttering in the Avaking state, and inability to collect his senses ; the second characteristic symptom is: the paralytic condition of the tongue, xvith great dryness in the mouth and fauces ; even AA'hen fully conscious, the patient is not able to moA'e his tongue as he would like ; the tongue feels heavy and too long, so that he is unable to raise it. The accompanying symptoms, such as burning heat, obliging the patient to uncover himself, accompanied with anxious uneasiness in the body, the tossing about, and the frequent waking from sleep ; the loss of appe- tite, aversion to nourishment, etc., are not sufficiently definite to indicate any one remedy in particular. The intermission of the pulse every third beat, and the profuse quantity of watery urine, might perhaps be considered as characteristic indications for Muriatic acid. As a general rule, Acidum muriaticum is a great remedy in typhus stupidus. The principal specific in typhus, especially in a avi II marked typhus abdominalis and putridus, is Arsenic. Diseases of the mucous membranes, which have de- veloped themselves out of gastric, bilious, and mucous fevers, constitute the greater part of the curative sphere of Arsenic; diseases with intermittent type likeAvise correspond to Arsenic ; this is another reason Avhy Arsenic is a great remedy in typhus, with avcII- marked exacerbations. The homoeopathic physician will think of Arsenic even in the commencement of typhus, if unimportant symptoms, such as a single vomiting, a diarrhoeic stool, a little pain, etc., should TYPHUS. 235 be accompanied with great debility, obliging the patient to lie down, and with droAvsiness, the sleep being neA'crtheless disturbed by restlessness andanxiety, wil h burning heat. Soon after the seated, characteristic, burning pains in one side of the abdomen make their appearance, with sensation as if a heap of incandescent coal xvere deposited in that region, Avith coldness of the limbs, and parchment-like, dry, hot skin, panting for drink, petechiae, and white miliaria. The patient complains of giddiness, with buzzing in the ears, and hardness of hearing ; the countenance is pale, livid, and distorted in a peculiar manner ; aphthae form in the mouth, with frequent inclination to vomit, occa- sioning a faint feeling every time the inclination occurs; meteorism, Avith burning and excoriating alvine evacuations, consisting of a yellow water, with cadaverous smell, and passing off without the patient being conscious of it. Further observations will have to show whether small doses of Arsenic are as efficient in typhus as larger (the second, third, sixth attenuation). As for ourselves, we have cured our patients with the lower attenuations, repeating the dose less frequently as the improvement progressed more rapidly. It ought to be noticed that many typhus patients do not complain of pain in the bowels until pressure is made upon the part; in this case the pain is very rarely burning, but on the other hand so much more characteristic as a therapeutic indication. Carbo vegetabilis holds almost the same rank with Arsenic in those forms of typhus for which Arsenic is such an admirable specific. We have found Carbo not only indicatetl in the last stage, characterized by decomposition of the fluids, ulceration of the intestinal canal, decubitus gangraenosus, stupor, with rattling, cold sweat over the whole body, hippocratic counte- nance, small, weak pulse ; but also in the second stage, which is, in fact, its principal sphere of activity. In the third stage it has been used with great success by many practitioners. The principal indications for its use are the following: burning stinging in the inmost 236 TYPHUS. parts of the abdomen, Avith great anguish and trouble- some flatulence coming on after every meal, and ac- companied by loose stools. Avith tenesmus, burning, light-coloured, bloody, and having a putrid smell. The appetite is not entirely extinct,'the patient has a great desire for salt food and coffee, complete aA'ersion to meat; the patient is afraid of taking any nourish- ment, on account of the aboA^e-named symptoms, to- gether with burning in the stomach, arising from it. There is nightly agglutination of the eyelids; the patient suffers with hardness of hearing, tingling in the ears : (Carbo is a Aery important remetly for the anguish which is occasioned by violent congestions of the chest and head, and accompanied by burning skin;) bleeding of the nose, Avith stoppage of that organ, which is maintained by a constant formation of scurfs ; eruption around the nose, and the blackish-looking chapped lips ; the patient sleeps with his limbs draAvn up; it is a restless sleep and frequently interrupted by xvaking. On raising the head the patient feels giddy, and is extremely unhappy and oppressed. Carbo is a most important remedy in typhus abdomin- alis during the ulcerative stage. When the aboA'e-mentioned symptoms occur, Rhus. Acidum nitr., Phosphorus, and Lycopodium ought likeAvise to be considered. Rhus and Nitric acid when the pains are not very burning; Acidum nitricum is indicated when certain parts of the abdomen are very sensitive to pressure, Avith dragging, stinging pain in the rectum, evacuations of green mucus, difficult urin- ation, tendency to collapse ; Lycopodium deserves consideration when the urine is burning. An incomparable remedy in the first stage of the disease is Staphysagria, when the following symptoms occur: sordes on the teeth, pale and bleeding gums, with painful swelling of the gums, and rapid decay of the teeth ; vanishing of thoughts and ideas, weakness of memory, dulness of mind, great indifference and ill humour; vertigo, Avith stupifying headache; dimness of the eyes, itching, stinging, and heat in the cant hi ; fulness in the pit of the stomach, with frequent hickup TYPHUS. 237 and vomiting; tension across the hypochondria, op- pressing the breathing ; pressure, xveight, and tension in the abdomen ; cutting pain in the bowels, with nausea ; copious diarrhoeic stools. As a general rule, Staphysagria is the best remedy, if the sexual organs are involved, and if the characteristic pains in the chest, heart, and spinal marroAV, the various gastric troubles, the fetid-smelling sweats, the weariness and bruised feeling in the limbs, the morning and evening febrile erethism occur; all those symptoms point to a deep-seated affection of the nervous system, the com- plete development of which is frequently prevented by Staphysagria. In the second stage of the disease Valeriana is frequently an efficient remedy, when white miliaria and bland delirium have made their appearance. The miliaria occurs most frequently on the chest and in the nape of the neck, it causes a burning and stinging sensation and announces itself a few days previous to its breaking out by stinging pains in the pit of the stomach and a continuous oppression of the chest; this latter symptom is greatly relieved by dry cup- ping at the pit of the stomach. The delirium is ac- companied xvith great nervous erethism and tremor, and consists of illusory notions, such as: the patient is not herself, but some one else, to xvhom she has to give way, on which account she keeps constantly pushing*towards the edge of the bed; or she is in a carriage and has to make room for some other person to come in: or some animals are lying by her side which she fears she will crush by the Aveight of her body, and the like.* The patient complains, more-v over of great pains in the limbs, especially in the feet, which are spasmodically stretched, are extremely sen- sitive to contact, and resume their natural position only gradually as the patient improves. The pains Avhich the patient experiences in the limbs, likewise * The reader will perceive that these symptoms are spoken of as belong- ing to a female patient ; we may infer from this that Hartmann has met such a group of symptoms in his practice in a female patient, and, having cured it witli Valeriana, has inserted it here as a group of general occur- rence.—Hempel. 238 TYPHUS. involve the spinal column, decubitus supervenes very speedily. As a general rule Valeriana may be em- ployed in typhoid feAers which commence with an irritation of the spine, as manifested by violent spasms, asthma, distortions of the countenance, \c. The appetite neA'er disappears entirely, but the thirst is much greater; the febrile heat is continuous, the pulse being accelerated and Aveak, 100 beats a minute ; the sleep is restless, disturbed Avith anxious dreams, during Avhich the patient constantly endea- vours to uncover himself. The abdomen is sensitive to the touch in the ileo-caecal region, it is generally distended ; costiveness, scanty, turbid urine. § 75. In typhus gastricus the following remedies are the most efficient: Ipec, Cham., Puis., Ignat., Nux, Coeculus, Arnica, China, Digitalis. Ipec is in- dicated Avhen the gastric symptoms preA'ail; by slimy, bilious diarrhoeic stools, occasioned by the abuse of pork and pastry (see also Pulsatilla) and appear in company with spasmodic pains. Children and fe- males being particularly predisposed for such affec- tions, Ipec. is especially useful to those classes of persons, and the more so when the following symp- toms occur: the spasms consist in tossing the head to and fro, distorting the features, jactitating the limbs, stretching the body as if in a state of rigor (spinal irritation); starting from sleep as in affright, violent, general heat, especially in the evening hours, accompanied with great nervousness and irritable mood; yellow coating of the tongue Avith constant inclination to A'omit, and vomiting of bilious sub- stances, &c (see gastric and bilious feAers). On a par Avith Ipec. ranks Chamomilla, xvhen con- vulsions and spasmodic symptoms occur, Avith bright- red, dry, cracked tongue, lined with a yelloAvish-white coating, slimy, putrid, and bitter taste, putrid smell from the mouth; inclination to vomit, and bitter A'omiting of food ; pressure at the stomach and dis- tention of the abdomen Avith great sensitiveness to pres- sure, Avith cutting, burning, and pinching pains; diar- rhoeic stools of white or yellowish-green mucus : urine TYPHUS. 239 with yellow flocks ; catarrhal symptoms ; great ner- vous erethism ; vivid fancies both during sleep, which * is full of dreams, and in the waking state during the febrile heat which is accompanied with great thirst. We refer the reader to the chapter on the gastric fevers for a more detailed account of the symptoms indicating the preceding as well as the succeeding remedies. Pulsatilla is a great remedy in typhus gastricus. This remedy is adapted to persons with a mild, yield- ing temperament and a timid disposition with incli- nation to weep. The febrile heat is always mingled with chilliness which comes on as soon as the patient uncovers himself; there is no thirst; the pulse is quick and small; bland delirium, weeping, wringing one's hands, alternating with sopor. Ignatia is adapted to persons xvith fitful temper, changing from mirth to sadness. The fever is almost always accompanied A\'ith sudden flushes of heat, headache, pain in the pit of the stomach, great debili- ty, occasional alternation of redness and paleness of the countenance, dry, chapped lips, white tongue, deep sleep with snoring, accelerated small pulse, and the gastric and bilious symptoms which characterize this remedy. Nux is equal to any of the above-named remedies in this variety of typhus; in many respects it is supe- rior, since the action of Nux extends over almost all the organs and systems of the human organism. Pulsatilla is closely related to Nux, but more so to Phosphoric acid. The difference betAveen Nux and Pulsatilla is more general than special. Puis, is more suitable to females, Nux more to males ; Puis, cor- responds to the mild yielding temper, Nux to a lively, sanguine, choleric temperament and an artful, mali- cious disposition ; Pulsat. is indicated by predominant paleness, Nux by a bright-red complexion, and in general by plethora A\diieh, in many persons, is indi- cated by haemorrhoids. These are the general dif- ferences. The particular indications for Nux are the following: troublesome heat Avhich is frequently 240 TYPHUS. mingled with flushes ; hard, full and frequent pulse; pains and debility in the limbs, tightness and dulness of the head, xertigo, aching pain in the fortdiead* (relieved by laying the head upon the table) ; oppres- sive crampy pains in the stomach and a tensive pres- sure in the pit of the stomach Avith nausea., bitter taste and eructations, xvith yellowish coating of the tongue, complete loss of appetite and vomiting of the ingesta, cutting spasms in the abdomen, constipation, painful emission of urine, Avhich looks reddish and frequently bloody ; all impressions from Avithout are intolerable to the patient, he is deeply affected by them, he moans, groans, he becomes vehement, even unto rage. Coeculus ranks on a par with Nux, Avhen the gas- tric symptoms, such as: loss of appetite, aversion to any kind of food or drink, inclination to A'omit and nausea unto fainting, bitter eructations, painful op- pression in the pit of the stomach, and constrictive spasms in the abdomen in the direction of the in- guinal ring, frequent, small, diarrhoeic feculent evac- uations, are accompanied by heat of the upper part of the body, chills of the loAver limbs, cold feet, burning heat in the whole countenance, burning thirst, sudden attacks of violent anguish, 6cc. This remedy deserves consideration whenever typhus de- velopes itself out of a severe illness, or is brought on by frequent chagrin. In this case it is indicated by frequent attacks of a disagreeable burning heat and redness of the cheeks, by evening exacerbations char- acterized by hot hands and a sensation of dry heat over the whole body, with nightly sleeplessness and delirium; by frequent shiverings in the day-time, xvith great debility, obliging one to lie down; great sensitiveness of feeling, extreme ill humour, depres- sion of the vital energy, tremor of the limbs, paraly- tic immobility of the limbs, hemiplegia, sudden attack of anguish with shortness of breath and palpitation of the heart. Arnica is a valuable remedy not only in typhus gastricus, but also in genuine typhus, if stinging pains TYPHUS. 241 with pressure be felt in the head, especially the fore- head, with frequent bleeding at the nose which does not afford any relief, with continuous general heat, external and internal chilliness, and unquenchable thirst during night. Arnica is likewise an excellent remedy in typhus stupidus, when the patient is entire- ly unconscious of himself, like one, Avhose brain has been violently concussed; the patient does not stir, nor is any delirium present. China may prove useful for the following symp- toms : tearing pains in the head with pressure, espe- cially at night, accompanied with anguish, fear, un- easiness with subsequent sleeplessness, congestion of blood to the head with heat, fulness, vertigo, buzzing in the ears, hardness of hearing, pale, sunken coun- tenance ; dryness of the mouth, yellow coating of the tongue, slimy bitter taste, great desire for cold water; heartburn after eating but little, empty retching, car- dialgia, constrictive flatulent colic deep in the abdo- men, and pressing of the flatulence from within out- ward, with tension and anxiety below the hypochon- dria, and diarrhoeic, slimy stools containing undigested food ; Avhite and turbid urine; oppression of breath- ing, especially in the evening, with uneasiness in the chest and a small, feeble pulse ; general chilliness and rather cool extremities. All these symptoms, which are characteristic indications for China, point to a rather acute as well as slow typhus gastricus, and likewise to a difficult convalescence, arising from a depression of the vital forces by exhausting evacua- tions and secretions. Digitalis likewise corresponds to a typhus gastricus. Even before the physician has thought of the disease, Digitalis is indicated by a constant desire to urinate, with scanty emission of a dark-brown urine, especially at night; the patient complains of dizziness and vertigo when rising. This condition of things, AA'hich is not very alarming of itself, frequently precedes the outbreak of the real typhus for days and weeks. The disease generally sets in with a painful stiffness in the 11 242 TYPHUS. back and limbs Avhich is most intense after dinner. Weight and indolence in the limbs easily supervene, requiring the patient to lie doAvn. The first symptoms generally denote a depression of the vital energies. with slow, sluggish pulse. Characteristic and infal- lible indications for Digitalis, are: a yellowish com- plexion, constant desire to urinate, disturbing sleep, al- ternate chills and heat, burning of the head, face and ears, redness of the cheeks, anguish, excessive dread of the future ; optical illusions; violent Aomiting of bile, with crampy pains in the stomach sometimes relieved by eructations ; painful pressure in the region of the liver, etc. § 78. The remedies which aac shall mention in the fol- lowing paragraphs, are no less efficient in the treatment of typhus than any of the preceding, and may have to be used in any variety and stage of typhus as the symptoms may require. In order to avoid the necessity of constantly recurring to the same remedy in des- cribing the A'arious groups of symptoms for AA'hich it may be required in the A'arious stages and forms of typhus, avc xvill mention at once the xvhole series of the symptoms to which the remedy corresponds in typhus generally. Stramonium is particularly indicated by muscular spasms, spasms of the facial muscles, pharynx, especial- ly when drinking or generally when swallowing, dis- tortion of the eyes, tremor of the limbs, even of the tongue when protruding it. It will be found efficient in that form of typhus xvhich is occasioned by spinal irritation; the fever increases to a great degree of A'iolence with exacerbations at different periods of the day, especially.in the afternoon and at midnight, ac- companied Avith loss of consciousness, trembling,small, rapid, and frequently intermitting pulse. The delirium, if present, is generally of a bland character, a sort of unintelligible muttering; the patient is either in a state of sopor or sleeplessness ; stool and urine are frequently retained. These symptoms denote evidently a typhus stupidus for Avhich Stramonium has been TYPHUS. 243 employed, with success. It may likewise prove use- ful in typhus erethicus. Closely related to Stra- monium and useful in typhus stupidus, is Hyosciamus. This remedy deserves attention when the fever has set in suddenly without any precursory symptoms, or perhaps with a sudden swoon (see Veratrum). In spite of the burning febrile heat of the whole body with evening exacerbations, without thirst, putrid taste in the mouth, red, dry tongue : the pulse is small, slow and weak. The patient tosses from side to side owing to the violent erethism of the nervous system, he has no sleep ; if any sleep should take place, it is frequently disturbed with startings as if by fright, grinding of the teeth, profuse sweats, which disappear again as soon as the patient wakes and cannot, therefore, be considered critical; the skin is dry, parchment-like, the extremities are cold, the whole body feels weak and exhausted, there is great anguish as precedes the eruption of miliaria; the patient is entirely stupid and unconscious, or else there is muttering delirium, absurd talk and flocci- legium. Hyosciamus is likewise suitable for the fol- loAving symptoms: excessive wakefulness, subsultus tendinum, slight convulsive movements of the limbs ; quick, full, and hard pulse, with distention of the veins all over the body, and burning heat; constant delirium with open eyes; desire to escape, Avithout knowing Avhy ; rattling breathing, distortion of the features and eyes ; demeanour as of a maniac ; scanty emission of urine, which needs not to depend upon a spasm of the bladder, but may be occasioned by a diminished secre- tion ; the involuntary emission of stools and urine during an absence of consciousness is no counter-indi- cation of Hyosciamus, inasmuch as that phenomenon may occur in consequence of a paralytic weakness of the sphincter muscles, and of an entire absence of mind in the patient xvith consequent absence of all volition. These two symptoms hold a prominent rank among the physiological effects of Hyosciamus upon the healthy organism. Opium is another valuable remedy in typhus. It is 244 TYPHUS. particularly indicated by the folloAving symptoms: loss of consciousness and sopor ; the patient lies xvith open eyes, and is speechless ; the limbs are rigid ; the pulse is quick, full, and hard; the face is dark red, and puffed; the respiration laboured, snoring and rattling ; all these symptoms afford an image of a true typhus stupidus (apoplecticus), Opium xvill be found cflicient in that condition of the patient. If this condition have lasted too long, and a sloxv. feeble, intermittent pulse set in, and those parts which xvere bloated collapse, Opium xvill not do any good. Nor will any other remedy. Death xvill soon take place. If the patient should be lying AA'ith his eyes closed, without sleeping ; if the hearing and taste of the patient should not have entirely disappeared ; if the patient should still give a sign of life when spoken to; if there should only be the highest degree of sopor, without a complete par- alysis of all the functions and organs: in such a case it might perhaps be possible to reanimate the vital energies and the mental poxvers. This result could only be accomplished by one remedy, which acts by exciting the olfactory nerves, it is Spiritus nitri dulcis, which should be applied to the patient's nose every minute at first, and afterwards less frequently, as the signs of a restored vitality increase. As soon as the patient's consciousness has returned, the Spiritus nitri. dulcis ceases to do good, and Rhus, Nux, Belladonna, Pulsat., Acid, phosphoricum, or some other remedy will have to be employed. Camphor has been employed with great success in typhus by many homoeopathic physicians. By some Camphor has been found useful after Rhus, especially when the following symptoms occurred : violent de- lirium, hot and tight and dull head ; cold, clammy skin, Avith colliquative sweats ; great debility, inclina- tion to diarrhoea. More particular indications for Camphor are the following: the febrile paroxysm sets in Avith a sudden loss of sense, falling doxvn Avithout consciousness, spasmodic stretching of the body, txvitchings of the facial muscles, and shortness of breath. After these symptoms have disappeared, the TYPHUS. 245 patient complains of a constrictive, beating headache, with burning hot forehead, cold hands and feet; the headache increases by every change of position; verti- go sets in, as if the patient would fall over, with loss of consciousness, weak and scarcely perceptible pulse; these symptoms are gradually followed by heat, which is first felt in the face, and then over the whole body, hands and feet remaining cold; loss of thirst; scanty and rare emission of turbid urine, depositing a thick sediment. Cina is said to be very useful in typhus, since it has a powerful stimulating action upon the nerves of the abdomen. Cina corresponds most accurately to a worm fever, with typhoid symptoms ; when such symp- toms occur, Cina is probably of importance only in the commencement, when burning heat of the face, red- ness of the cheeks, increased desire for cold drinks, slight delirium, restlessness, tossing about, prevail, especially in the evening and at night; between the exacerbations the patient shows a sort of indifference to either agreeable or disagreeable things, although he calls for a good deal; he complains of a numb and stupifying pain in the head, with sensation as if the head were screwed in; this pain increases to such a degree that it causes convulsions and contortion of the limbs. Hellebore has been recommended in typhus, which has developed itself out of some other disease ; for instance: out of scarlatina, measles, cholera, gastric and worm fever, etc. Hellebore corresponds more or less to the following symptoms : internal chills in the evening, in bed, with burning heat over the whole body, especially the head, with gloAving cheeks, ab- sence of thirst, sometimes even aA'ersion to drink. Particular indications for Hellebore are : the febrile symptoms which have been mentioned in the preceding paragraph, and Avhich are accompanied by the folloAV- ing symptoms: bloatedness of different parts of the body, xvith heaviness in the same ; sopor, with numer- ous fancies, and tossing to and fro; hypochondriac mood, and dulness of stmse ; the scalp feels bruised, Avith oedema of the Avhole body; dark, turbid urine. 246 TYPHUS. Among the symptoms of Lachesis avc distinguish the folloAving typhoid condition: chilliness every evening, xvith draAving in the back, and in the loAver limbs from below upwards; dry heat at night: loss of appetite and exhaustion. In a tew days the IblloAA'ing symp- toms supervene : vertigo when sitting up in the bed ; the eyelids feel paralyzed, and it is difficult to open them ; bitterness in the mouth; simple pain in the chest and dry cough, tearing in the left thigh and back. After these symptoms have lasted some time, a sopor- ous condition sets in after the patient has passed a very restless night, characterized by a sort of stupified lying on the back, from Avhich the patient only Avakes by shaking him violently, and talking to him xvith a loud voice ; his tongue is x*ery heavy xvhen talking ; sunken countenance, the lower jaw is hanging dox\ n ; the pulse is seventy, soft, unequal; some sweat, Avith cool- ness of the legs and feet; the tongue is red, smooth, dry, and he protrudes it xvith great difficulty. He emits a copious quantity of brown-red urine. Secale has been found efficient by several homoeo- paths in typhus arising from other diseases, as xvell as in that arising from an irritation of the spinal mar- row. The patients gradually lose their appetite, tie- sire to drink continually, especially cold Avater, are in a constant state of fever, Avhich consists principally of dry heat, with hurried pulse ; they are. very rest less, sleepless, debilitated ; they complain of wandering pains in the back and small of the back, gradually i assuming a spasmodic character, and flying from one part to another; those spasms are of a tonic character in the feet and hands, clonic in the facial muscles, AA'ith subsultus, tremulousness, jerks; the spasms in the muscles of the chest occasion asthma. Secale is a ( distinguished remedy in that stage of the fever ; if re- peated every two or three hours the spasmodic pains soon disappear, after xvhich another remedy may be exhibited, unless the delirium and the fever should have subsided under the influence of Secale. Lycopodium, of which mention has been made above, is not only applicable to a few single symptoms in typhus, but to typhus generally. It has been sue TA'PHUS. 247 cessfully employed in those fevers when they were characterized by constipation, Avaking with ill humour, scolding, screaming, and various improper manners. Characteristic indications for Lycopodium are : nervous erethism, without heat of the head or redness of the face, circumscribed redness of the cheeks, great de- bility, sweats which do not relieve, and a red, dry tongue. In order to enable the beginning practitioner of homoeopathy to select Lycopodium with a tolerable degree of certainty, we shall try to define the group of symptoms for which Lycopodium is more particularly adapted. The Lycopodium typhus commences with a concealed chilliness which continues for several days, is worse towards evening, the skin being cold to the touch all over, and the sleep not being particularly disturbed by the coldness ; in a few days the chilliness gives way to a burning heat all over the body, accom- panied with shortness of breathing, slight thirst, ful- ness of countenance, frequent startings from sleep, and vertigo when rising, as if everything turned in a circle. Gradually the sleep becomes more and more restless, disturbed xvith fancies and a number of confused dreams, occasioning a constant tossing about, shriek- ing, and waking ; the patient, even when of a mild temper, becomes irritable and sensitive, vehement; tightness and dulness of the head, difficulty to think, selection of wrong words when talking, and a slight delirium supervene. The skin remains dry, even xvhen the fever increases ; the tongue becomes dry, heavy, is painful as if burnt, Avithout thirst, or but little desire for Avater ; the patient is extremely faint and debili- tated ; frequent ineffectual urgings for stool make their appearance, accompanied with frequent but scanty discharges of burning, dark brown urine, especially at night. These fevers are ahvays accompanied Avith shortness of breath, congestion of blood to the chest, palpitation of the heart. Nat rum muriaticum has likewise been recommended in typhus characterized by xveakness, dryness of the tongue, and great thirst. Characteristic indications 248 TYPHUS. for Natrum mur. are : typhus following upon exhaust- ing diseases ; typhoid symptoms may be prognosticated when the patient is unable to recoAer his strength, complains of bruised feelings in the limbs, depriving him of his night's rest by arresting as it avc re the breathing ; extreme mental and physical debility, con- tinuous febrile heat,XAith eAening exacerbation ; quick, full pulse ; hurried, oppressed • breathing ; constant palpitation of the heart, xvith anguish, headache, as if the head would burst, especially in the forehead, xvith such a violent throbbing in the forehead that the patient sometimes loses his senses and becomes de- lirious ; the complexion is livid, the tongue dry and heavy, so that he is scarcely able to talk ; aversion to food ; a good deal of thirst—which, when quenched, occasions a distention of the abdomen, and a good deal of rumbling and cutting in the bowels, sometimes even an inclination to vomit, and small Avatery stools ; there is a copious secretion of urine, which deposits a brick- dust sediment. § 77. Some physicians have recommended Sulphur in the treatment of typhus. In our opinion Sulphur ought only to be given for the purpose of restoring the susceptibility of the organism to the action of one or the other of the remedies which we have indicated for typhus. In this respect Sulphur acts like Opium and Mercury, and should be employed when the following indications for its use are present: the typhus is a consequence of some acute cutaneous disease ; or the patient has been affected in former times with some chronic cutaneous affection ; it is likewise useful when Pulsat., Merc, and Nux, although they seemed to correspond to the symptoms, had no effect, or xvhen the action of the specific remedies is prevented by tin: abuse of spirits to which the patient was addicted pre- vious to his illness. Sulphur is likeAvi.se indicated AA'hen the patient is of a scrofulous habit and had been complaining of pains in the limbs previous to the in- vasion of typhus ; it may also be ust fully employed when a violently burning miliary eruption frequently makes its appearance in one or the other part of the TYPHUS. 249 body during the course of the disease ; or, finally, in gastric fevers with typhoid symptoms. More particu- lar indications are the following: continuous profuse sweats which afford no relief; the sleep at night is disturbed with fanciful ravings; even when the patient wakes the fancies continue to crowd upon the patient, the head feels dizzy and benumbed, which the patient is unable to account for; he is extremely timid, inclines to start, is out of humour, and easily vexed ; hardness of hearing ; sunken eyes surrounded with blue mar- gins ; pale and wretched complexion; dry and chap- ped lips ; dry, parched, bright-red tongue ; and taste as of blood in the mouth; Sulphur is, moreover, characteristically indicated by the painfulness of the abdomen to the touch, with sensation as if it were sore and raw inside ; there is no diarrhoea, but some- times such a violent urging that the stools frequently pass off involuntarily ; this same statement applies to the urine which is very rarely of the same colour, and generally changes in colour from time to time. Spigelia, Digitalis, and the Muriate of magnesia, afford in many cases essential benefit in treating the ailments which often remain after typhus. We have already spoken of Digitalis. Magnesia muriatica removes the pains as if bruised all over, the great debility and weight of the limbs, the ill humour conse- quent upon that condition of the limbs, especially when occurring in individuals whose nerx'es are weak even in a state of health ; the restless sleep at night xvhich is frequently disturbed by anxious dreams, nightmare; the sensation of oppressive xvcight in the head, xvhich frequenl ly lasts a long xvhile, and is accompanied xvith vertigo and a dull and dreary feeling. Spigelia corresponds more particularly to the feeling of weakness in the reproductive organs, without, how- ever, being an exclusive remedy for that condition. Characteristic indications for Spigelia are: great de- bility after the slightest exercise ; sad and desponding mood, accompanied with a pressing pain in the fore- head from within outAvards, Avhich extends deep into orbits especially when stooping forAvards, and appears 11* 250 TYPHUS. with increased violence cAery other day; the acid taste in the mouth AA'ith painful fissures in the tongue ; the complete aversion to smoking; excessive appetite and great thirst; the painful pressure in the pit of the sto- mach, AA'hich makes every least pressure from Avithout unpleasant, and is accompanied Avith palpitation of the heart and anxious oppression of the chest; the feeling of fulness in the abdomen eA*en after a moderate meal with rumbling in the bowels and papescent stools. § 78. We shall conclude the chapter on typhus and typhoid diseases by a few cursory remarks on certain forms of typhus, Avhich Ave haAe not yet had an op- portunity to treat in our country (Germany), and the probable remedies of which we Avill point out Avith a feAv broad indications. Before proceeding Ave will state, that it is exceed- ingly bad practice to change the remedies every six or tAvelve hours, as some physicians do, xvho get frightened, if they do not see an improvement in that time. Typhus, if it should have fully set in, cannot be cut short by a remedy, and all that the physician can do, is, to cure the patient. It is therefore advisa- ble to repeat the remedy, provided it has been chosen Avith all possible care, until an improvement takes place in the symptoms; if the patient should get worse, this would be positive evidence that the remetly was not homoeopathic to the disease. If the symptoms do not get Avorse, this may be considered an improve- ment in typhus; it xvould be indiscreet to give another remedy under such circumstances with a view of has- tening the cure ; Ave might perhaps destroy the good effects which we had so far obtained by our treatment. A frequent change of remedies is only justifiable in case the symptoms should vary frequently, provided always that the changes in the symptoms are no me- dicinal aggravation. The physician who conducts the treatment has to decide about that. If he should not clearly recollect the physiological effects of the remedy, let him either refresh his memory, or else wait three or four hours before prescribing a new remedy. At the end of that period the disease will have taken such a TYPHUS. 251 turn as will either justify or condemn the selection of the last remedy. Should the frequent changes in the symptoms constitute regular paroxysms, the physician would then have to select among the following reme- dies, the principal of which we shall name first: Ars., Carbo veg., Veratrum, China, Nux, Coeculus. A good deal is said about pneumo-typhus as a par- ticular disease, without considering that the inflam- matory process in the lungs frequently takes place in company with the typhoid, and that the known hy- postasis, which is going on in the lower lobes of the lungs in every typhoid disease, sometimes increases to a real pneumonia, in which case the inflammatory symptoms are more marked than those which proper- ly belong to the typhoid process. The treatment is the same as that of pneumonia typhosa, of which we shall treat hereafter. As regards diet, the patient ought to live on thin gruel, soups made of salep, sago, oat-meal, &c, light and easily digested meat, such as pigeons, capons, chicken, &-c, light vegetables, and even bread and a little butter, if the patient should have any desire for it. The patient may eat fruit, raw and boiled; his drink should be boiled milk, toast-water Avith a little mulberry, raspberry, althea or cherry-juice. The patient may likewise drink buttermilk, xvhich xvill not injure him in the least. There is scarcely a disease, xvhere the desire of the patient for one or the other kind of food ought to be regarded xvith more care, than in typhus, especially if the patient desire acid things. The temperature of the room should be the same at all times, rather cool, and the patient should not have too much coA'ering. The room should be kept perfectly quiet, as every impression, xvhich the patient receives from Avithout, tends to irritate his brain and furnish neAV food to his ravings. It is of the utmost importance, that the patient should be kept clean, and the room should be aired from time to time, Avithout, however, exposing the patient.* * AVe recommend our readers never to allow recovering typhus patients any raw fruit; for a fortnight after the cessation of the fever, the diet should 252 PUTRID FEA'ER. § 79. Typhus putrid us. febris putrida. Fever with de- composition of the animal matter. Typhus putridus sometimes sets in as an epidemic fever ; in Avhich case it becomes a primary disease xvhich is engendered by a putrid contagium ; most frequently, hoAvever, typhus putridus developes itself out of an acute fever, and more particularly out of typhus ; it may likeAvise arise from every other kind of fever, even from an inflammatory, by the patient being kept too hot, or in uncleanliness, vitiated air, etc. In men who are affected xvith some morbid dyscrasia, the scorbutic diathesis, or who have been poisoned with Mercury. The fundamental character of typhus putridus is an excessive depression of the vital forces xvith disposi- tion to putrid decomposition. Without mentioning again the general characteristic symptoms of typhus, which are the same in all the varieties of that disease, aa'c xvill content oursehes Avith simply mentioning those Avhich belong to typhus putridus exclusively; they are: quick, small, soft, easily compressible pulse; calor mordax, the hand, Avhen touching ihe patient, experiences a disagreeable, pungent, burning, prick- ling and stinging sensation, Avhich increases as the contact is prolonged and leaves a similar sensation behind for some time ; internal chilliness occasionally, or shherings creeping OA'er the skin; the breathing is generally calm, no thirst; great anguish, despondency, indifference, insensibilily. Characteristic indications are, likeAvise: putrid, cadax'erous smell of the breath, of the exhalations from the skin, and of other secre- tions ; petechiae ; profuse,oily, clammysweats ; turbid, dark urine, colliquath'e diarrhtea, hemorrhages from every orifice of the body, decubitus, tendency to gan- grene; the blood which is evacuated does not decom- pose itself into cruor and serum like healthy blood, but forms a pappy mixture. be extremely simple, although the patient need not starve ; butchers' meat, stimulating drinks, potatoes, celery, radishes, and the like, should not be used. Some physicians, who are even very clever in other respects, are not sufficiently careful in regulating the diet of their patients.—IIimpel. PUTRID FEVER. 253 § 80. The treatment of these fevers, xvhether pri- mary or consecutive diseases, is very seldom successful. The existing symptoms do not so much point to certain remedies as to a decomposition of the fluids and more particularly the blood. The fever is not a putrid typhus, as long as symptoms of decomposition have not made their appearance. Even if the putrid state should set in as a primary dis- ease, there are precursory symptoms denoting a gastric, bilious, pituitous, or typhoid state, and requiring a treatment such as has been indicated for those conditions. The following remedies are principally indicated for that variety of typhus: Arsenicum, Arnica, Carbo veg. and anim. ; Kreosot, Acidum phosp. and muriat.; China, Ipec, Mercur., Mercur. dulcis, Rhus, Bellad., Nux vom. and moschata, Hyosc, Opium, and some- times perhaps Camphor and Cuprum. Arsenic is probably preferable to every other remedy when the disease has reached its worst stage, when the patient complains of burning heat, great anguish and restlessness, when petechiae, aphthae and profuse colliquative secretions are present. Arnica may be of use when profuse'and frequent hemorrhages take place, and great thirst, headache, yellow countenance and loss of appetite are present. The two varieties of Carbo ought to be tried when the blood is entirely decomposed, when stupor and raling are present, xvith cold sweat of the face and limbs, hippocratic counte- nance, small, scarcely perceptible pulse, great disten- tion of the. veins, and especially, if such a fever occur after the excessive use of China. Kreosot may be ot service when the patient complains of an excessive debility in the limbs, and when a racking, painful cough from the inmost parts of the chest is present, ac- companied with a sensation of warmth xvhich rises in- to the throat; and lastly, when the patient complains of a painful pressure on the top of the head which is aggravated by contact. The two acids correspond particularly to the colliquative stage. China is indicated at the commencement of the disease by hemorrhages, yelloAv skin and countenance, excessive, 254 HOSPITAL FEVER. debility and pain in the limbs. Ipec. and Hyosc, may likeAvise be indicated at the commencement of the disease xvhen the symptoms Avhich have been describ- ed last, are accompanied by spasms. Rhus and Bella- donna are preferable to all other remedies Avhen the nervous system is principally involved in typhus putridus. Opium should be employed xvhen the irri- tability of the organs is entirely gone, provided the other symptoms correspond. Nux is the remedy Avhen the disease sets in A\'ith excessive debility and the gastric and bilious symptoms such as: livid com- plexion, bitter and putrid eructations and taste, vcIIoav coating of the tongue, constipation, are predominant. Nux moschata is more particularly indicated Avhen putrid debilitating diarrhoea and bloody expectoration are present. Mercurius is to be administered when the nervous system is Aery much excited. Avhen there is a tendency to profuse sweats and putrid decomposi- tion, accompanied Avith great painfulness of the region of the liver, the epigastrium, and pit of the stomach. Mercurius dulcis is indicated by similar symptoms, when the process of decomposition has reached its acme. We have no other reason for recommending Camphor and Cuprum except that these txvo remedies have been employed Avith success in Cholera, from which avo have, perhaps Avrongly, inferred that they might likewise prove useful in typhus putridus. § 81. Typhus contagiosus, bellicus. Hosjtital or jail fever. This typhus is characterized by the symptoms of the ordinary typhus or the typhus putridus, and is propa- gated by a contagium. At first it is of an inflammatory character, the typhoid symptoms only setting in after- wards Avith tendency to exanthema, Avhence the fever is also termed petechial fever. The treatment is pretty much the same as that of typhus and typhus putridus. The principal remedies in typhus petechialis are probably Bryonia, Rhus, Ar- senicum. Dietetic rules.—Every contagium being increased by YELLOW FEVER. 255 excessive warmth and becoming so much more poison- ous as the temperature of the sick room is kept above the proper standard—the thermometer in a sick room should never be above 67° Fahrenheit. To have this temperature in the summer season, vessels with cold water should be constantly kept in the room and the room should be frequently sprinkled. The patient should rest upon a mattress, and should be but lightly covered. The patient must be kept clean; the room is to be frequently aired and only one patient should be in a room at a time. The contagium is increased by several patients being confined in the same room. Among the means which have been recommended for the destruction of the contagium, the best is undoubtedly a frequent re- newal of air by means of a current passing through it; the patient has to be guarded against that current, of course. § 82. Typhus pestilentialis. We knoxv nothing of the treatment of this disease, and shall, therefore, content ourselves with stating the characteristic symptoms. The pest is propagated by contact, never by the air. Its principal phenomena are : buboes and anthrax, that is, inflammatory swellings of glands, xvith ten- dency to gangrene which sets in with great rapidity, especially in the axilla and the inguinal region; pe- techiae, ecchymosis, violent feA'er, anguish, excessive vomiting, the brain is greatly involved ; all the secre- tions have a putrid smell and the prostration of the patient is excessive. The following remedies might perhaps be proposed as corresponding more or less to the symptoms: Vera- trum, Arsenic, Acidum hydrocyan., Lauroc, Kreosot, Quinine, Lachesis, etc. § 83. Typhus icterodcs. Yellow fever. This disease arises from some endemic miasm. Its symptoms are : yellow colour of the skin, A'iolent A'o- miting of black substances, black stools, great anguish, 256 LEXTESCEXT TYPHI'S. debility, A'iolent fever. The course of this feA'er is very rapid. The following remedies may perhaps be of use ; Arsenic, Digitalis. China, Nux, Crotalus, Bryonia, Sul- phur, etc. § 84. Typhus lent us. Lcntescent typhus. This kind of typhus is a primary, idiopathic disease, which does not depend upon any local affection, and may be occasioned by A'arious causes. The essential character of the disease is great ner- vous debility and prostration of all the functions. It developes itself slowly, sometimes for months, Avithout any inflammatory symptoms. Sometimes it sets in as a sequel of an acute fever, inflammatory typhus; or it may arise from excessive physical and mental exer- tions, venereal excesses, onanism, great loss of blood, chronic hemorrhages, and blenorrhoea. • The symptoms of such a fever are : small, quick, variable pulse ; changeable urine ; chilliness and coldness more fre- quent than heat; no sweat, or only evanescent sAveat; cerebral symptoms ; spasms; hypochondriac mood, which is greatest in the morning and before breakfast, xvhen the patient feels worst; the fever is less after dinner, and then the patient feels better; these last symptoms distinguish the lentescent typhus from a hectic fexer which depends on local causes. § 85. The treatment of slow typhus does not essen- tially differ from that of ordinary typhus. The follow- ing medicines xvill be found the most efficient: Coco., Camph., Acid, phosp., Phosphorus, Lycop., Ignat., China, Ipec, Arsenic, Verat. alb., Plumb., Mercur., Helleb. niger, Digitalis, Conium, Cuprum, Stannum. If the disease arise from care and chagrin, a small dose of Acidum phosph. is the most certain remedy (according to Rummel it may, in that case, be given alternately with Arsenic) ; if it arise from grief, one or tAvo doses of Ignat. 18 will cure it. Coeculus is an excellent remedy, if the disease be occasioned by frequent vexation and irritation of tem- per ; the symptoms being as follows: frequent evan- LENTESCENT TYPHUS. 257 escent attacks of a disagreeable, burning heat, and redness of the cheeks ; eAening exacerbations charac- terized by hot hands, sensation of dry heat all over the body, sleeplessness at nights; or frequent shiverings in the day-time accompanied with great debility, so that the patient is obliged to lie down ; the patient is xery sensitive and irritable. Repeated doses of Camphor may be administered when the temperature of the skin is very low, and the patient is very weak and not very sensible. Ipecacuanha is undoubtedly one of the most distin- guished remedies in this disease ; it ought to be re- peated frequently. Veratrum, not too high, is an excellent remedy when the febrile paroxysm sets in at times in the evening, at times in the morning, with redness and heat of the face, heat of the hands, intermingled with febrile shiverings and accompanied with great despondency; between the paroxysms the body feels cold, and a cold sweat makes its appearance, at least upon the fore- head, the patient being, moreover, very weak and listless. Ht Ueborus niger is indicated by the following symptoms : constant chilliness of the whole body Avith cold hands, burning heat internally, the head feels dull and stupid ; the patient complains of drowsiness, heavinesss and debility of the feet, stiffness of the knee- joints. These symptoms occur when out of bed; as soon as the patient lies down he feels hot and sweats, without thirst. China, Arsenic, and Digitalis, have been mentioned in dela.il in the chapters on typhus. 258 SIXTH CLASS. INTERMITTENT OR CHRONIC FEVERS. §86. Intermittent fever. Fever and ague.' It is very difficult to establish general rules for the treatment of intermittent fever. The typo of the fever, the peculiarities of the chilly and hot stages, of the sweat and thirst, are not the only indications for the selection of a remedy ; the character of the apyrexia has likewise to be considered and will differ in differ- ent patients. This is one reason Avhy we should only be able at the bed-side of the patient to determine xvhat remedy we shall use in the case. A second reason why the indication of specific remedies for intermittent fevers is difficult, is that they rouse, more readily than any other affection can do, the dyscrasia Avhich may be latent in the system; this then combines Avith the fever and impresses upon it a peculiar character. There are other diseases Avhich either set in Avith or acquire an intermittent type (diseases where no vascular erethism is present, but the intermittent character of the disease is evident); in these diseases the remedy has likeAvise to be chosen at the bod-side of the patient. These and similar difficulties shall not deter us from communi- cating the folloxving remarks relative to the treatment of intermittent fever; theyAvill perhaps aid the begin- ner in homoeopathy in selecting proper remedies for the cases which he may be called upon to treat. § 87. Intermittent fevers might be considered syno- chal feA'ers, inasmuch as great vascular irritation is present in every case of fevev and ague. The differ- ence betAveen those two classes of fevers is simply this, that a synochal fever has only one paroxysm, whereas an intermittent fever consists of a succession of syno- chal paroxysms Avith intermitting type. This state- * See the excellent treatise on the treatment of intermittent fever, by Dr. Hartlaub in Hartlaub and Trink's Annals, Vol. III. (This treatise will be published in one of the next numbers of the Examiner.) See also Boenninghausen's treatise on the treatment of intermittent fever, translated by Charles J. Hempel, M.D. This is a practical essay and alwo- lutely necessary to a physician who wishes to treat intermittent fever with success. INTERMITTENT FEVER. 259 ment only refers to pure intermittent fevers ; if such a fever should possess some of the characters of syno- chus or typhus, it belongs to the class of complicated intermittent fevers, for which it is much easier to dis- cover a specific remedy than for simple fevers of that class. An intermittent fever is recognised and its character determined by the periodicity of the paroxysms and the intermissions, the only two essential and charac- teristic phenomena in intermittent fever. The parox- isms and the intermissions themselves are so various that it is impossible to give a detailed account of the symptoms. In some fevers the paroxysms consist merely of heat; in others of coldness, with or without subsequent sweat; there are fevers with coldness all over the body, the patient nevertheless feeling hot to himself, or he experiences chilliness although the skin is hot to the touch ; there are fevers where one parox- ysm consists of a mere chill or coldness followed by a feeling of health, the other of heat followed by sweat or without sweat; in some fevers the heat comes first and the chilliness afterwards ; in others the chilliness and heat are followed by a long intermission, after which sweat breaks out, which may be considered in the light of a second paroxysm; there are fevers where no sweat is present, others again where sweat constitutes the paroxysm xvithout heat or chilliness, or where the sweat is only present during the heat. There are many more peculiarities, especially as re- spects the accompanying symptoms, headache, bad taste, nausea, vomiting, diarrhoea, absence of thirst or else violent thirst, pains in the bowels and limbs, sleep, delirium, temper, spasms, etc., before, during, or after the chilliness, heat, or sweat, not to speak of a number of other characteristic differences. The characteristic appeara nces of the intermission should not be neglected by the physician, particularly if the paroxysm should not be wtdl marked, in which case the apyrexia will be characterized by symptoms xvhich do not generally exist after a paroxysm. The general symptoms of fever and ague are: chil- 260 INTERMITTENT FEVER. liness, heat, and sAveat, recurring at regular or irregu- lar periods, folloAved by' the appearance of a red, brick-dust sediment in the urine ; during the apyrexia the patient feels more or less comfortable and the pulse isnormal Most frequently the paroxysms recur at regular periods, every tAventy-four hours (quotidia- nae),forty-eight (tertianae), seventy-tAvo (quartans),etc. We know Aery avcII that modern pathologists do not number intermittent fevers among the febrile diseases. Various affections may be distinguished by a regular intermittent type without having a febrile character* Such intermittent diseases originate in the peripheral nerves, not the vascular system, which is affected secondarily on account of the intimate relation existing between those nerves and the blood-vessels ; hence it is that intermittent diseases are now termed gangli- onic, cerebral or spinal intermittent. Nevertheless we have preferred treating this class of diseases as usual, pointing out their characteristic peculiarities as much as was necessary and occupying ourselves principally with their homoeopathic treatment. The duration of an intermittent fever is very un- certain, from one week, to several weeks or even months. In no disease there is a greater disposition to relapses than in intermittent fevers ; in a quotidian a relapse takes place on the seventh day, in a tertian on the fourteenth, in a quartan on the twenty-eighth after the cessation of the last paroxysm. A relapse may be anticipated if a feverish feeling should remain in the system ; if the feverish colour should remain on the cheeks ; if the strength of the patient should not increase with his appetite ; if the last paroxysm should be like the first; if at the time Avhen the paroxysms used to occur, slight chills, a drawing and stretching of the limbs, continual yaAvning, irritated pulse, changeable urine, should make their appearance. Relapses are frequently brought on by moral causes, slight errors in diet, by eating milk, eggs, fish, etc. ; by changes of temperature, walking along the water, continual use of cold drinks, etc. An intermittent fever is not of itself a dangerous INTERMITTENT FEVER. 261 disease, but it may become so by concomitant symp- toms ; a long duration of the fever may occasion a peculiar cachectic state, dropsy, nervous affections, etc. Exciting causes are : low marshy regions, stagnant waters ; atmospheric miasmata occasioning epidemic intermittent fevers; colds and wet skin, lying upon a cold soil or floor; excessive use of cold water, heavy- dishes of flour, acid fruit containing a good deal of water, fish. § 88. It is important to give the remedy immediately after the paroxysm. If the apyrexia should be very short or some of the symptoms of the paroxysm should remain during the apyrexia, the medicine should be administered when the sweat commences to abate or the symptoms which usually appear in the wake of a paroxysm begin to disappear. It is likewise expedient to repeat the homoeopathic specific a few hours before the next paroxysm. The treatment of intermittent fevers is not as easy as it would seem at first sight; every case of inter- mittent fever has to be examined independently of any other case, for this reason, that almost every case differs from the other, even in an epidemic intermittent. In every case of intermittent fever the character of the chills, heat and thirst (not so much the sweat) has to be minutely inquired into ; next to that the concom- itant symptoms and the symptoms of the apyrexia, especially those which remain from the paroxysm. The type scarcely ever determines the selection of the homoeopathic agent, since any type can be controlled by it, provided it is otherwise homoeopathic to the symptoms. Puis., Ipec, Nux, etc. are most suitable to quotidian, and Arsenic to quartan intermittent fevers ; still they will remove fevers with any other type, proA'ided the symptoms correspond. A writer in the Archiv advises in some fevers to give four doses of Ipec. at equal intervals, and a dose of Nux in the next apyrexia. The endemic intermittent feA'ers of marshy regions are most speedily removed by a few doses of China, 262 INTERMITTENT FEVER. higher potencies. If this kind of fever should not yield to China in persons A\-ho have sufficient exercise and otherAA'ise live carefully, the cause is to be found in the psora haA'ing become roused from its latent state ; all such cases require an antipsoric treatment. Some Aery experienced homoeopathic physicians administer a feAV doses of Aconite, higher potencies, a few hours previous to the paroxysm if it be violent. This proceeding is not irrational, as every paroxysm partakes more or less of the character of a synochal or erethic fever and is most readily controlled by Aconite. The principal remedies against intermittent fever are : China, Quinine, Ars., Verat., Arnica, Ant. cr., Nux, Bell, Cocc, Caps., Carbo veg. and anim., Can- thar., Ignat., Lach., Puis., Sabad., Sepia, Dig., Bryo., Dros., Dulc, Natr. mur., Lye., Staphys., Sulph., etc. China corresponds more or less to the folloxving symptoms ; no thirst during the chilly stage, thirst be- tween the chilly and hot stage ; China is not suitable when thirst is present in the hot stage ; if thirst be present during the hot stage of a China-intermittent, the heat ought simply to be a burning or dryness of the lips which require moistening, but no real thirst is experienced by the patient. If the thirst set in after the heat, or during the sweaty stage, China is the remedy. China corresponds, if the lever should com- mence with a secondary symptom, such as : palpitation of the heart, anxiety, frequent sneezing, nausea, great thirst, canine hunger, oppressive pain in the abdomen or head ; or if the veins should become distended Avhen the head feels hot, or when the temperature of the body is slightly raised, or Avhen the patient merely feels hot to himself and not to others, or Avhen the skin feels hot to others. China is moreover indicated by congestion of blood to the head, redness and heat of the face, generally accompanied with chilliness and coldness to the touch of the extremities, or by heat of the face Avhich is perceptible only to the patient, the face feeling cold to the hand, with cold swea.1 on the forehead. Nux, together with Verat., Bryo., Bellad., Coc, INTERMITTENT FEVER. 263 Puis., deserves consideration when the bowels are con- fined, or when gastric or bilious symptoms make their appearance in consequence of gross errors in diet; or when nervous symptoms set in in consequence of the spinal marrow being more or less irritated. Nux has so far proved most useful in quotidian and tertian fevers, which make their appearance in the afternoon, evening or night, consisting of alternate chilliness and heat, xvith great desire for beer ; aching pain in the forehead, vertigo, nausea, bitter taste and eructations, spasms of the stomach, great weakness, all these symptoms setting in even at the commencement of the paroxysm. In intermittent fevers, accompanied with bilious and gastric symptoms, Cham., Ant. cr., and Puis, are on a par with Nux, (see the chapter on bili- ous and gastric fevers). Nux is highly important in some kinds of the so-called apoplectic intermittent fevers, with vertigo, anguish, feverish shiverings, a peculiar kind of delirium, consisting of vivid and some- times frightful Adsions, and occasioning a tightness in the region of the stomach, typhoid and febrile symp- toms being intermingled. Nux will prove serviceable in fevers where the following symptoms set in in the very commencement of the attack : paralytic weak- ness of the limbs, debility in the knees and feet, exces- sive weariness, tremor, sudden failing of strength, swoons, A'ertigo, with vanishing of the senses, giddi- ness and weight of the head as in a state of intoxica- tion, desire to lie doxvn ; troublesome, anxious breath- ing, palpitation of the heart, fear of death, qualmishness, shiverings, followed by anxiety and xvarmth ; warm cheeks, with internal shiverings; the face feels hot, with shiverings over the rest of the body ; heat in the head, Avith coldness of the body ; burning in the eyes, Avithout any inflammation being present; tearing, beat- ing, stinging headache, increased by walking, and by the open air ; loss of appetite, aversion to bread ; bitter ant I sour eructations ; fancies in the night in a state of half sleeping or xvaking ; furious delirium ; burning, itching rash, and a burning itching of the whole body. The exhibition of Belladonna depends, like that of 264 INTERMITTENT FEVER. Nux, more upon the concomitant symptoms than upon the character of the paroxysm itself. Belladonna being a great remedy for diseases xvhich return peri- odically, it must be of great use in curing the regu- larly recurring painful paroxysms of fever and ague, AA'here the chilliness is but slight, the heat is sometimes accompanied Avith chills, sweat and thirst are moderate, and the patient drinks merely for the purpose of re- lieA'ing the dryness of his mouth and fauces. Bella- donna is sometimes suitable in a quotidian intermittent, when the paroxysms are accompanied xvith the 1'oUoav- ing symptoms: violent headache, with vertigo ; hallu- cinations, redness of the eyes, nausea, A'omiting, constipation, chills, or simple chilly creeping over the skin, with thirst Avithout any considerable heat after- wards, moderate increase of the temperature of the skin, sweat. Bellad. deserves consideration in fevers of long standing, or in those xvhich had been suppressed by Quinine and have returned afterwards, with sxvell- ing of the liver and spleen, incipient dropsy, derange- ment of the digestive powers, and violent headache during the paroxysm. Veratrum is useful in fevers consisting simply of external coldness, or mere internal heat, Avith dark urine ; or when a warm sweat is present all over the body, or only on the forehead, which soon becomes cold, and is accompanied with vertigo, nausea, exces- sive pain in the small of the back and back. Cina, tincture, is the best remedy for fevers, com- mencing with vomiting of food, and subsequent canine hunger ; or where the chilliness is accompanied Avith thirst. FeA'ers, where A'omiting of mucus is present during the cold stage, with moderate thirst both in the hot and sweaty stage, mucous stools in the apyrexia, with con- stant nausea and loss of appetite, art; cured by Pulsa- tilla. Antimonium cr. is closely relatetl to Puis:; it is particularly distinguished xvhen the sweat sets in with the heat and disappears speedily, dry heat remaining, with constant thirst and various gastric symptoms, such as : want of appetite, eructations, nausea, aver- INTERMITTENT FEVER. 265 sion to food, vomiting, coated tongue, bitter taste, tight- ness and pressure in the stomach, pain in the chest. Coeculus removes fevers Avith the following symp- toms in the apyrexia: obstinate constipation, spasms of various kinds, especially of the stomach, paralytic weakness of the small of the back. Arsenic is a great remedy in intermittent fevers, Avhen neither the chilliness nor the heat are well marked, or they appear alternately or simultaneously; or when the heat is burning and unpleasant even to the hand, accompanied with anguish, great restlessness, and an unquenchable thirst; or when the chilliness sets in principally in the afternoon or evening, followed by dry heat at night or towards morning, then sweat. Arsenic is the best remedy when at the time of the paroxysms unimportant existing symptoms become much more violent, or when those symptoms set in previous to the paroxysm, or when symptoms appear during the paroxysm which do not seem to belong to it, such as: violent anguish, buzzing in the ears, tearing in the bones and limbs, tremor in the limbs, paralysis, syn- cope, etc. The chilly stage is preceded by ill feeling through the whole body, with stretching of the limbs and drawing in the same ; yawning, debility, inclination to lie. down, headache, vertigo with stupefaction, confused feelings in the head, xvith inability to collect one s senses. BetAveen the chilly and the hot stage, the fol- lowing symptoms make their appearance : debility and sleep ; vertigo, thirst, hickup, anxiety, nausea, vomiting of bile, diminution of the pains. During the apyrexia : hickup, pressure in the forehead and temples, with frightful dreams; bruised feeling in the limbs. Arsenic is moreover suitable in feA'ers Avith the fol- lowing symptoms : inclination to Aomit, or bitter taste during the chills ; no taste, or the taste is not con- stantly bitter and spurious, the bitterness existing only for a short while during or immediately after a meal; excessive vertigo, nausea, tremor, sudden prostration of strength ; frequent drinking, but little at a time : the sweat sets in a little while after the heat, or not at all; intolerable pains and anguish about the heart. 12 266 INTERMITTENT rEVER. Bryonia corresponds to quotidian and tertian fevers, whose paroxysms set in early in the morning, preceded by vertigo, oppression and pressing pain in the fore- head, coldness and chilliness being more prominent than heat i thirst during the chilly and hot stage, dry cough, with stinging in the chest, asthma, nausea, and gagging, pale countenance. Ipecacuanha xvill be found useful xvhen the chilly stage is moderate and short, the heat is very great, and thirst is present only during the cold stage ; the heat is frequently perceived only about the head, in Avhich case the cheeks are red, accompanied with dilatation of the pupils, feeling of mental and bodily prostration, and constrictive tightness of the chest. Opium is useful in soporous intermittent fevers, char- acterized by snoring, convulsive movements of the limbs, constipation, warm sweat. Sabadilla corresponds to fevers of any type xvhich set in at the same hour, xvithout either anticipating or postponing ; the chilly stage is short, folloAved by thirst, then heat, or the fever consists of mere coldness ; during the apyrexia a slight chilliness is constantly present, a troublesome, oppressive distention of the stomach, with want of appetite ; nightly, dry cough, pains in the chest, A'iolent oppression of breathing. Ignatia is suitable to any type, and corresponds to the folloAving symptoms : the coldness yields to external warmth, or some parts are hot. others cold, chilly and shivering, or the heat is merely on the skin, Avithout thirst; thirst during the chilly, but not the hot stage ; or the paroxysm is accompanied by dulness and con- fusion of the head ; pains as if bruised in the right side of the occiput, pressure in the pit of the stomach, great debility, pale countenance ; dry, chapped lips, xvhite tongue, deep sleep, Avith snoring, nettle-rash, appearance of the thirst after the fever. If the continuance of the fever depend upon a roused psora, Carbo veg. xvill prove useful xvhen the following symptoms are present: previous to the paroxysm— throbbing in the temples, tearing in the 1 eet h and bones, stretching of the limbs, cold feet; during the chills— INTERMITTENT FEVER. 267 thirst, blue nails, great debility; during the heat— sweat, absence of thirst, headache, vertigo, red face, obscuration of sight, nausea, pain in the stomach, ab- domen or chest; oppression of the chest, pain in the lower limbs; the headache continues a long while after the fever. Carbo veg. is most suitable to tertian fevers, but it has likewise been employed with advantage in quotidian and quartan fevers, and in fevers which re- appear after having been suppressed by large doses of China. Caps, is related to Carb. v., and may be administered in quotidian and tertian feA'ers, and in fevers recurring after an abuse of China, the following symptoms being present: prevalence of the chilly stage, during which the patient is tormented by great thirst, there is no thirst, or only very little, during the hot stage, heat and sweat appear together. During the chilliness the patient complains of anxiety, restlessness, inability to collect the senses, intolerance of noise, headache, pty- alism, vomiting of mucus, painful swelling of the spleen, pain in the back, tearing in the limbs, and con- traction of the same ; stinging in the head during the hot stage, accompanied with bad taste in the mouth, cutting colic, with ineffectual urging, pain in the chest and back, tearing in the limbs. Natrum mur. is suitable to the same class of fevers as Carbo and Capsicum. They are characterized by pains in the bones, pain in the back, headache, great debility, yelloxv, livid complexion, bitterness in the mouth, ulceration of the corners of the mouth, loss of appetite, pressure in the pit of the stomach, with pain- ful sensitiveness to contact. The chilly stage is more- over characterized by shortness of breath, yawning, drowsiness, thirst; thirst during the heat, with a good deal of violent headache. Rhus is a remedy for feA'ers which arise from the skin having got wet in a shower. The paroxysm it- self is not characterized by any remarkable symptoms; the accompanying symptoms, however, are of import- ance, such as : convulsions, tingling in the ears, hard- 268 INTERMITTENT FEVER. ness of hearing, dry coryza, sleeplessness xvith rest- lessness and tossing about, thirst at night, nettle-ra«h, gastric symptoms. The chilliness is sometimes cha- racterized by pains in the limbs, headache, vertigo, in- clination to Aomit. Chamomilla, Mezereum, Sulphur, Sepia, Tartar emet., etc, are likeAvise suitable to the cure of inter- mittent fex-ers, the latter remedy particularly Avhen sopor is present during the paroxysm. We Avill conclude this chapter with the description of a feAv cerebral symptoms, recurring at regular in- tervals. There is a peculiar kind of headache Avhich is felt in the morning after waking ; upon rising it be- comes centred in the right frontal protuberance, in- creases to a pressing burning, as of an incandescent coal; it extends doAvn to the eye, and about noon it has become so violent that the patient has to lie doA\-n. The pain diminishes after 11 o'clock, and the patient feels entirely xvell again at 1. This headache yields to one or tAvo doses of Carbo veg. A headache on one side of the head, Avhich recurs every three days, with excessive sensitiveness of the scalp in the morning, commencing Avith a feeling of coldness in the limbs, and preceded by sleeplessness and general sxveat, yields to pretty large doses of Quinine, one every three or four hours. Repeated doses of Bellad. 2, 3, will remove a head- ache which seems to be seated in the glabella, and feels like on oppressive Aveight; it is aggravated by meditating and fixing one's attention, the vessels in that region become distended, the place itself becomes red, an inability to collect one's senses, languor of the mind, and complete aversion to life supervene ; these symptoms disappear by keeping perfectly quiet, and in the afternoon the patient feels xvell, and the mind is easy.* Tartaricum emet. is a good remedy in intermittent fevers when the paroxysm is accompanied Avith sopor; * Spigelia is a specific for an aching over the eye, with soreness of the eyeball. I have cured tuch headaches, even when of yean' standing, with a few dose* of the first attenuation.—Hempel. INTERMITTENT FEVER. 269 also Chamomilla, Spongia, and Plumbum. If a psoric miasm should have been roused by the fever, compli- cating the fever, and rendering it very obstinate, the antipsorics have to be employed against it: Tinct. sulp., Lycop., Amm. mur., Calc. earb., Sepia, Calc sulph. (Hep. sulph.), and others. § 89. China cachexia. A China cachexia is an intermittent fever which has been treated Avith large doses of Quinine, without getting well, and has become complicated with the symptoms of a China poisoning. A China cachexia requires the greatest discretion and circumspection on the part of the physician. It is a threefold complication of disease : the original fever which is scarcely yet recognizable, the morbid dis- position originally existing in the organism, and having become roused by the fever, and the poisoning by the drug. The first thing to be done is to remove as much as possible the effects of the China, in order to obtain a distinct image of the original disease. Those effects cannot be expected to disappear entirely, because they are too intimately interwoven with the symptoms of the roused psora. Nevertheless, the remedies hax'e to be chosen with a direct view of eradicating the effects of the China from the system. Among those remedies the true antidotes to China are the first to be used. One of the first remedies against a China cachexia is Belladonna, especially when the following symp- toms prevail: extreme sensitiveness and irritability of the nerves, langour of body and soul, excessive sensi- tiveness to the least noise, and to impressions of any kind received through the senses ; tremulous xveakness in all the limbs, dilatation of the pupils, dim eyes, which are surrounded with blue margins ; bloated, livid countenance, yellow tinge of the xvhites of the eyes: tearing headache, xvhich returns at regular periods, and affects the nerves very deeply ; it is espe- cially felt in the temples, and is reproduced or aggra- vated by the least noise ; great debility and drowsiness, without being able to sleep ; or, if sleep should set in, 270 INTERMITTENT FEVER. it is a restless kind of sleep, disturbed xvith anxious frightful dreams, or by paroxysms of real anguish, or by sudden flushes of heat. The nervous erethism manifests itself particularly by a moaning, anxious and oppressed breathing. An absence of irritability, especially in the muscular fibres of the intestinal canal, as indicated by constipation, is no counter indi- cation for Belladonna. A characteristic indication for Belladonna is the following symptom, xvhen arising from an abuse of China : distention of the abdomen, especially in the region of the transverse colon, xvhich protrudes like a pad, and is very painful A second important antidote to China is Ferrum. It is indicated by congestion of the head, distention of the veins, heaviness of the head, and a beating, ham- mering headache ; livid, jaundiced complexion ; bloat- edness of the face, especially the eyes ; pressure in the abdomen and stomach from the least nourishment; tension of the abdomen under the ribs, and especially in the right hypochondrium, causing asthmatic suffer- ings and anxiety; vomiting of food, xvant of animal heat, paralytic xveakness of the Avhole body, or of parts of the body. All these, and the folloAving remedies, may in almost all cases be preceded by a few doses of Ipec. at inter- vals of txvo or four hours, or by Arnica, except xvhen well marked and characteristic symptoms should re- quire the immediate exhibition of some other antidote. Veratrum album antidotes the coldness of body and the cold sweats produced by China, provided all the other symptoms correspond. Pulsatilla may be given under the following circum- stances : the food tastes bitter, the taste is otherwise natural and correct; the fexer generally comes on in the evening, and is accompanied with the following symptoms : pale countenance, A'ertigo, Avith stupefac- tion, painfulness and heaviness of the head ; painful oppression of the chest, moist cough, vomiting of mucus, diarrhoea, sopor. Arsenic is to be resorted to when the febrile paroxysms are not very violent, when the coldness is less marked than the heat, xvhich is INTERMITTENT FEVER-. 271 burning and of long duration, without much sAveat, and when other painful symptoms Avere either present before the paroxysm and are aggravated by it, or supervene during the paroxysm. Scarcely any remedy is more efficient in removing secondary paroxysms of fever than Arsenic, although other medicines may seem to be indicated by the symptoms. The higher poten- cies of Arsenic are not"as efficient as the lower for such purposes; we have found the tincture of Arsenic the most adapted to our use.* Staphysagria cures fevers which reappear after having been suppressed by Quinine, when the follow- ing symptoms occur: the cold stage comes on in the evening, without any subsequent heat, and accom- panied with scorbutic symptoms. Sulphur is indicated when the Avell-selected remedies do not act, and this want of action manifestly depends upon an excited psora. These fevers generally have an irregular type, are accompanied with great ereth- ism of the circulation, distention of the veins of the hand, slight convulsive jerks in the liaibs, all these symptoms appearing mostly at night. Lachesis has been recommended in China fevers with any type, especially, however, quartan, setting in with twitchings during the chilly stage, and thirst during the heat. Secondary symptoms are : draAving in the back and extremities, loss of appetite, A'omiting, hickup, anxiety and uneasiness, as from apprehension of some accident, violent headache, deep breathing, moaning, etc Calcarea may be given for the same symptoms as Sulphur, especially when occurring in young, plethoric subjects, children and delicate women. § 90. There are other drug-diseases besides those of * This may be true, and yet I recollect a case of fever which had been treated for four months in succession, in the New-York Hospital, with large doses of Calomel, Quinine, blisters, emetics, and the whole host of allopathic deviltry, without the least benefit to the patient, and which I cured with two doses of Arsenic, 18. The symptoms were : violent chills, with bilious vomit- ing and tearing in the limbs ; burning heat of the skin, burning tongue and mouth, unquenchable thirst, sensation as if fire were coursing through the veins and epigastrium, anguish, horrid hammering in the temples, profuse sweats, debility, etc.—Hempel. 272 INTERMITTENT FEVER. China. Such diseases may be caused by the abuse of natural and artificial mineral Avaters, either when used as baths or drinks: by the external as avcII as the in- ternal use of the mercurial preparations; Opium, Valerian, Digitalis, and others. These artificial dis- eases can only be remoA'ed by the antipsorics. In treating diseases AA'hich are complicated by drug symp- toms, the physician ought to commence the treatment by antidoting the most prominent of the latter symp- toms : to accomplish this, now one, now the other medicine Avill have to be used, according as the symp- toms AA'hich require to be antidoted can be manifestly traced to one or the other drug. We shall afterwards recur to the special cases of drug-diseases, and shall then indicate their treatment more in detail. .}