wmi %^XH'iDOc * -St ._ Ltl'l -. ._ it** W ^~ t^- NATIONAL LIB R ART OF MEDICINE Washington,D.C. •1\>-'- "■" Vv^'4 THE HOMOEOPATHIC THEORY AND PRACTICE OF MEDICINE. E. E. MARCY, M.T3., AND F. W. HUNT, M.D. v VOL . II. i:- J: N E W - Y O R K WILLIAM RADDE, 550 PEARL-STREET. Philadelphia: F. E. Boericke, 635 Arch-st.—Boston: Otis Clapp.—St. Lovis: H. C. G. Luyties.—Chicago: C. S. Halsey.—Cincinnati: Smith & Worth- ington.— Cleveland: JonN B. Hall, M.D.—Detroit: E. A. Lodge, M.D.— Pittsburg, Pa,: J. G. Backopen & Son.—Manchester, Eng.: H. Turner & Co., 41 Piccadilly and 15 Market-st.—London, Eng.: H. Turner & Co., 77 Fleet- Btreet. 18 6 5. \S65 Kntcred according to Act of Congress, in the yeai 1864, by WILLIAM RADDE, In the Clerk's Oflice of the District Court of the United States for the Southern District of New-York. he.nby mrwio, Printer and Stereotyper, 39 Centre-street. CONTENTS OF VOLUME II. Page Genus VII.—Inflammatory Diseases of the Kidneys and Urinary Organs, 9 1. Normal Anatomy of the Kidneys, 9 Diagnosis.—Examination of the Urine, ................... 12 Composition of,.............. 16 Solids,...................... 17 Acids, ...................... 20 2. Bright's Disease of the Kidney— Desquamative, Albuminous Ne- phritis, ..................... 21 Chronic Form of Bright's Disease, 27 Second Stage of Bright's Disease 28 Treatment of Desquamative Ne- phritis, ................... 29 3. Chronic Desquamative Nephritis, 44 Dropsy,.................... 46 Complications. — In the Brain, Heart,.................... 49 Liver, <&c,................... 50 Rheumatic and Gouty do....... 50 Uraemia,.................... 52 Microscopic Observations,..... 57 Treatment,................... 59 4. Nephritis Simplex,............ 66 Treatment, ................. 68 Poisons thrown off from the Kid- neys...................... 69 5. Hematuria,................... 69 Treatment, .................. 70 6. Hajmaturia following Scarlet Fe- ver..................... I. 600 7. Disease of the Kidney caused by Surgical or Mechanical Lesions, 71 8. Disease of Capsula Renales. Adi- son's Disease,.............. 72 9. Cystitis, Inflammation of the Bladder, .................. 75 10. Dysuria, .................... 77 11. Irritable Bladder............. 78 12. Suppression of Urine, Ischuria Uenalis,................... 79 Retention of Urine,........... 80 13. ;: resis—Incontinence of Urine, 86 Genus VIII.— Ophthalmia. — Affec- tions of the Eye and its Appendages, 87 A. Acute Ophthalmia,............ 88 1. Affections of the Tunica Con- junctiva. Conjunctivitis,.... 89 Peaq Conjunctivitis from Extension of Strumous Eczema,....... 95 2. Chronic Ophthalmia,......... 99 3. Purulent Ophthalmia,........ 101 4. Gonorrhoeal Ophthalmia, ......102 Infantile Do.................. 103 5. Granular Ophthalmia. Conta- gious Conjunctivitis. Egyp- tian Ophthalmia,........... 103 6. Opacity of the Cornea,......... 113 B. Affections of the Deeper-Seated Structures of the Eye,....... 113 1. Inflammation of the Cornea,... 113 Ulceration of the Cornea,...... 113 Conical Cornea,...............114 2. Iritis........................ 11-4 Treatment,................... 115 3. Choroiditis,................. 118 4. Amaurosis,.................. 120 Treatment,.................. 126 5. Hj'drophthalmia. — Dropsy of the Eye, .................. 129 Treatment,.................. 131 6. Cataract,.................... 131 Treatment...............■..... 133 7. Glaucoma. Staphyloma,...... 134 Treatment,................... 135 8. Hypermetropia,............... 137 Myopia,................. 138,140 9. Asthenopia. ITebetudo Visits. Amblyopia Presbytique,..... 139 Squinting,................... 139 10. Fungus Haematodes and Cancer of the Eye,................ 144 C. Affections of the Appendages of the Eye,.................... 144 1. Hordeolum.—Stye,............ 144 2. Entropium. — Inversion of the Eyelids,................... 145 3. Eetropium. — Eversion of the Eyelids.................... 145 Exophthalmia,............... 146 4. Puncta Lachrymalia, Diseases of, 146 Fistula Lachrymalis........... 146 Stillicidium Lachrymarum...... 147 Spasmodic Contraction of the Eyelids.................... 149 Trichiasis.—Inverted Eye-lashes, 149 Foreign Bodies in the Eye,..... 149 iv CONTENTS. Page Traumatic Injuries of the Eye,. 150 D. Strumous or Scrofulous Ophthal- mia, ...................... 150 Mercurial Ophthalmia,........ 155 Genus IX.—Inflammatory Diseases of the Fibrous and Muscular Sys- tem, ....................... 156 1. Irritable Inflammation,........ 156 Acute Rheumatism,........... 156 Chronic Rheumatism,......... 158 3. Arthritis.—Gout,..............162 Treatment, .................. 166 4. Arthritic Dyspepsia.—Dyspeptic Gout,..................... 168 Treatment, .................. 171 6. Arthropathia—Inflammation of the Joints,................. 174 A. Diseases of the Soft Parts, .... 174 Arthropathic White Swellings, 174 1. Extra-Capsular,.......... 174 2. Intra-Capsular,........... 174 3. Specific or Blennorrhous,.. 174 4. Fungous,.......(........ 174 5. Synovial Arthropathia, ... 175 Hydrarthrus,............ 175 6. Cartilaginous do., ....... 175 7. Superficial Arthropathie of the Bones,............. 175 8. Deep-seated Arthropathie of the Bones,............. 176 Treatment,............. 176 Order IV.— Dysthetica — Cachexia. Abnormal Conditions of the Circu- lation Dependent on Deteriorations of the Blood,................... 177 Blood in Health,............. 177 Dyscrasias of the Plasma of the Blood,.................... 180 Influence of Disease,.......... 181 Proofs that the Blood becomes Deteriorated,............... 183 Septic Influence,. . 183. Vol. I 541 Blood Poisoning,.............. 184 Drug Poisoning,.............. 185 Latent Miasms which Originate Chronic Diseases,........... 186 Psora, Syphilis. Sycosis. Metastasis from the Mucous Mem- brane to the Skin,.......... 186 Sympathetic Relations between "them,.................... ISO Hereditary Dyscrasias......... 187 Allopathic Authorities,........ 188 Genus I.—Anaemia,............... 190 Pagi Cerebral Anaemia. City Cachexia, 191 Anaemia Lymphatica,......... 191 Genus II.— Hremorrhagia.—Haemor- rhages, ...................... 194 1. Traumatic Haemorrhage, ...... 195 Treatment, .................. 196 2. Haemorrhages from Exhaustion,. 197 Treatment,....._.........-.- 198 Genus III.—Purpura,............. 199 1. Purpura Haemorrhagica, ...... 199 2. Purpura Urticans............. 200 3. Purpura Senilis,.............. 200 Genus IV.—Toxaemia.— Blood Poi- soning,...................... 202 1. Cachexia Mercuriale,...'....... 202 2. Toxaemia from Effects of Tobacco, 203 Genus V.-—Phthisis.—Consumption. Emaciation,.................. 205 1. Phthisis Pulmonalis.—Pulmonary Consumption,.............. 205 Early Stage,................. 209 Physical Signs,............... 211 Pathology................... 220 Tubercle, ................... 222 Causes....................... 225 Hygienic Measures,........... 231 Choice of Climate,............ 235 Treatment,.................. 240 Pulmonary Haemorrhage,...... 255 2. Acute Phthisis.-Quick Consump- tion,...................... 256 Granular Phthisis,............ 256 3- Tuberculosis of the Bronchial Glands.................... 257 Genus VI.—Struma.— 1. Scrofula.— King's Evil,................... 259 Causes,...................... 259 Treatment................... H01 2. Arthrocace.—Scrofulous Disease of the Hip-Joint,..........261 3. Scrofulous Disease of the Mesen- teric Glands,.............. 262 Marasmus, 262, 267, Vol. I. 884, 890 Treatment of Scrofulous Diseases, 268 4. Bronchocele, Goitre,........... 273 Thyroid (Maud. Enlargement of. 273 5. Parenchymatous Bronchocele,.. 274 Treatment, .................. 275 6. Cretinism.-Struma Tyrolensium. Cagotism, ................. 278 Genus VII.—Carcinus—Cancer, ... 280 Diseased Cell-Development,.... 280 1. Cancer—Carcinoma,.......... 282 Cephaloma,.................. 283 CONTENTS. V Pagj Scirrhus,.................... 284 Fungus Haematodes,.......... 284 Melanosis, .... 5.............. 284 Ostoid, or Spina Ventoso,...... 284 Cancroid—Epithelial Cancer, .. 284 Treatment of Cancer,.......... 285 Cancer of the Lips, Cheeks, ... 287 And Tongue,................. 289 Buccal Cancer, .............. 289 Mucous Tubercle.............. 289 Lupus,...................... 289 Cancer of the Stomach,....... 293 Cancer of the Uterus,......... 297 2. Fungus Haematodes,........... 298 Genus VIII —Lues.—1. Syphilis,... 300 Chancre,.................... 304 Secondary Effects of the Poison, 308 1. On the Mouth, Alcoholismus,................ 444 Genus HI.—Alusia —Hallucinations, 446 1. Hallucinations. Illusions of the Senses,.................... 446 2. Anaemic Affections of the Brain, 449 Delirium Trem-ens.-Mania a potu, 449 Delirium Ebriosorum.....450, 452 Prophylactics,...............456 3. Alcoholismus Chronicus,....... 457 General Progressive Paralysis,.. 459 Treatment of Alcoholism, ..... 460 4. Dementia,.................... 461 5. Nostalgia, Home-sickness,...... 462 Genus IV.—Fatuity,—Idiocy,...... 464 Treatment of Idiocy, .........467 Order II.—Affecting the Sensation,.. 468 Nerves, Structure of,.......... 468 Physiology,.................. 470 Pathology of the Nervous Sys- tem, ...................... 471 Disease an Exaggeration of the Nervous Function,.......... 473 Genus I.—Neuralgia,.............. 477 Treatment,.................. 485 Complications of Neuralgia,.. . . 494 1. Neuralgia from Local Irritation, 496, 485 2. Dental Neuralgia,............. 497 3. Traumatic Neuralgia,.......... 497 4. Nervous Sick Headache,......498 5. Hemicrania, Megrim,.......... 499 Treatment.................... 500 6. Cephalalgia.—Headache,.......506 1. From Determination to the Head,.................. 506 Page 2. From Predisposition to Apo- plexy................... 507 3. From Catarrh,............ 507 4. Rheumatic Headache,...... 507 5. From Disordered Stomach,. 507 Treatment.........Vol. I. 270 6. From Constipation,....... 508 7. Neuralgia Coeliaca.—Neuralgia of the Abdominal Nerves,...... 509 8. Cardialgia,................... 510 Idiopathic,................. 510 Of Drunkards,........... 512 9. Gastralgia,................... 514 Treatment,................. 515 10. Gastrodynia Neuralgica,....... 519 11. Nervous and Neuralgic Diseases of Women,................. 520 12. Injuries of the Spine,.......... 522 1. Concussion of the Spinal Mar- row.............._...... 522 2. Inflammation of the Spinal Marrow,...............523 Congestion of the Spinal Cord, 524 Lateral Curvature of the Spine, 525 Genus II.— Myotica.— Affecting the Muscles,....................... 526 Muscular Contraction and Con- vulsive Diseases,............ 526 Reflex Action,................ 528 Spasms by Eccentric Irritation,. 529 Disease Reflected <.n DistantParts, 530 1. Tetanus -Trismus.-Locked Jaw, 531 Opisthotonos................. 581 Emprosthotonos,...........*.. 531 Pathology,................... 633 Treatment,................... l>;;4 Woorara and Nux-vomica,...... 536 Strychnine, Tests of,.......... 538 Other Remedies,.............. 539 Tetanus, Chronic.............. 541 2. Hydrophobia.—Rabies,........ 543 3. Angina Pectoris.—Stcrnalgia, . . 552 Acute do., .................. ,r,.j2 Chronic do., ............... 533 Treatment,.................. 557 Palpitation of the Heart, Vol. I. 842 Nervous Pulsations of the Aorta, 557 Ossification of the Aorta,...... 558 4. Strabismus—Squinting, . . ..... g(;Q 5. Chorea.—Saint Vitus' Dance, 5til Sycotic Affections of the Spinal Marrow and Ganglionic System, 567 Epidemic Chorea, Religious Con- CONTENTS. vii Page vulsive Affection of the 19th Century,.................. 567 6. Barbiers,.................... 570 7. Beriberia,........."........... 571 Order III.— Systatica.— Complicat- ed Derangement of the Sensorial Functions,..................... 572 Genus I.—Sympathetic Affections,.. 572 1. Nervousness,................. 574 2. Antipathy.................... 577 Genus II.—Dinus.—Vertigo,....... 578 Genus II.—Sj'spasia.—Convulsions,. 580 1. From Deranged Circulation in the Brain,..................... 580 2. From Direct Violence,........ 580 3. Convulsions of Children........ 582 Treatment of Convulsions,. . . 584 4. Epileptiform do.,............. 586 5. Cramps in the Limbs,........ . 588 6. Hysteria,.....................589 7. Epilepsy.....................593 Idiopathic Epilepsy,.......... 596 Sympathetic Epilepsy ,........ 597 Nervous Affections Resembling Epilepsy,.................. 598 Convulsive Affections Occurring during Sleep............... 600 Theory of Epilepsy,........... 601 Causes of Epilepsy,........... 603 Treatment,................... 605 Genus III.—Asphyxia.—Apnoe, .... 614 1. Asphyxia from Submersion.— Drowning.................. 615 2. From Poisonous Effects of Burn- ing Charcoal, .............. 615 3. From Strangulation. Hanging,. 616 Treatment of Asphyxia,....... 619 Apparent Death.—Swooning.— Syncope.—Suffocation,...... 626 4. Catalepsy.—Catochus.—Trance,. 627 Diagnosis.—Signs of Death,. ... 629 5. Apoplexy,................... 633 Pathology,................... 638 Serous Apoplexy,............. 641 Simple Apoplexy,............ 642 Treatment of Apoplex}',....... 643 6. Coma.—Stupor,............... 650 Narcotism,..............'..... 650 Treatment of Coma,........... 650 Poisoning by Opium........... 651 7. Anaemic Coma.-llydrocephaloid, 654 Effects of Lightning........... 655 8. Paralysis. Palsy,............. 656 Pathology,................... 657 Paraplegia................... 659 Hemiplegia from White Soften- ing of the Brain,............ 659 Treatment of Paralysis,........ 660 Paralysis of the Auditory Nerve, 663 Deafness from,............. 664 Paralysis Metallorum,......... 666 Paralysis from Spinal Affection, 668 With Disease of the Kidneys, 669 Inflammation of the Spinal Cord 669 Mercurial Palsy,...........671 CLASS V.—Diseases of the Re- productive Function. Order I.— Ccnotica.—Affecting the Secretions,..................... 674 1. Amenorrhcaa.—Retention, Sup- pression of the Menses,...... 674 Treatment,.................. 679 2. Dysmenorrhcea, Painful Menstru- ation, ..................... 681 Treatment,.................. 684 3. Menorrhagia, Profuse Menstruation 689 Treatment,................ 691 4. Leucorrhcea.—Fluor Albus, .... 695 Treatment. .................. 699 5. Inflammation and Ulceration of the Os and Cervix Uteri, .... 701 Prolapsus Uteri............... 713 6. Spermatorrhoea. — Involuntary Emissions................. 714 Treatment,.................:. 716 Spinal Disease from Masturbation, 717 7. Galactorrhcea.—Tabes Lactea, .. 718 8. Chlorosis. Green Sickness, .... 719 Treatment,................... 723 Metritis,..................... 729 Order II.—Affecting the Parenchyma. Genus 1.—Cyrtosis. 1. Talipes-Kyllopodia.-Club-Foot, 730 Treatment,.................. 731 CLASS VI.—Diseases of the Ex- cernent Function,............. 733 Order I.—Affecting Internal Surfaces, 733 Absorption in Causing and Curing Disease,................. 7: 3 Genus I.—Hydrops.—Dropjy....... 7^!8 1. Anasarca.—Cellular Dropsy,.... 744 2. Ascites.—Abdominal Dropsy, . . 745 3. Hydrothorax,.............7*7. 761 4. Ovarian Dropsy.............. 748 Treatment of Dropsy,.......749 Vlll CONTENTS. 5. Hydrocele Dropsy of the Testicle, 762 6. Hydrarthrus.-Scrofulous Inflam- mation of the Joints,........ 764 7. Spina Bifida.-Dropsy of the Spine, 765 8. Uraemia.—Retention in the Blood of the Contents of the Urine,. 767 Genus II.—Lithia.—1. Urinary Cal- culi.—Stone in the Bladder....... 770 Varieties of Calculi,........... 771 2. Calculi in the Kidneys,........ 773 Nephralgia Calculosa,......... 775 Chemical Changes in the Urine, 776 Mucus as a Ferment, .. 777, 783, 798 Acid Fermentation,..... .... 781 Products of Fermentation,..... 783 Calculi formed from Urates,___ 785 Effects of Alkalis,............ 789 Treatment of Calculus,.........799 3. Diseases of the Bladder accompa- nying Calculus,............ 802 Genus II —Paruria,............... 807 1. Hernia Humoralis............. 807 2. Fistula in Perineo,............ 808 3. Diabetes,.................... 808 Pathology,................... 808 Treatment,................... 814 4. Diabetes Complicated with Piar- rhaemia or Fatty Substance in the Blood, ................ 815 5. Albuminuria,................. 820 Genus III. -Hydatids.-Parasitic En- tozoa.......................... 822 Hypertrophy of Cellules,.......823 ' Hydatids of the Liver,......... 823 Treatment, .................. 824 Genus IV.— Parostia.— Diseases of Bones,........................ 826 1. Exostosis,................ 827 2. Osteitis,..................... 828 3. Enchondroma,................ 830 4. Osteoid,.................... 830 5. Osteoporosis,................. 830 Osteomalacia,................ 831 Osteo-Sarcoma,.............. 833 6. Rachitis —Softening of the Bones, 833 Genus V.—Adiposis.—Obesity,..... 836 Atrophy,..............:..... 836 Corpulency,...............837 Treatment.................... 838 Genus VI.— Malformations. Physi- cal Deformities,............... 839 1. Cretinism,....................839 2. Tumors,.............*........ 840 Order II.—Diseases Affecting the External Surface,........................ 841 The Skin..................... 841 Cryptogamic Parasites in their Relation to Disease, 843,........ 843 Cutaneous Diseases,....... 845, 860 1. Pityriasis, Dandruff,....... 846, 863 2. Tinea Capitis—Scald Head...... 846 3. Eczema,............• 848, 860, 863 4. Pemphigus,.................. 851 5. Rupia,....................... 851 6. Ecthyma,..................... 851 7. Acne.—Rosy, Drop.,........... 855 Genus II.—Papular Eruptions, Lichen, 856 Parasitic Vegetables on the Skin, 858 Porrigo,..................... 858 Baldness............. 862 861, 859 Psoriasis,.................... 857 Mycelium, Favus,............. 860 Treatment of Parasitic Skin Dis- eases, ..................... 861 Microsporon,................. 863 Genus III.—Vesicular Varieties. 1. Herpes, Tetter.—Dartre,....... 866 Diagnosis,................... 867 Treatment,................... 868 2. Lepra—Leprosy,.............. 870 Lepra Graccorum,............874 Lepra Anaesthetica,........... 874 Treatment,..'................. 878 8. Scabies.—Psora.—Itch,.......879 Treatment..................882 4. Psora Guttata,................ 885 Genus IV.—Malis. Cutaneous Ver- mination,................. 886 1. Malis Filiaria. Guinea Worm,. . 886 Genus V.—Ecphyma.-Cutaneous Ex- crescence,............... OgiT 1. Corns,.................. 007 2. Diseases of the Nails,.......... 891 3. Onychia,................. gya 4. Bunions,................. one 5. Naevus Materni,............. 897 Genus VI.—Trichosis.-Morbid Hair, 898 1. Trichosis Pollicis.—Gray Hair, 898 2. Plica Polonica.—Plailed Hair, .. 899 Albino Skin,.............. qqi Sclerema,................ qn. Verruca.—Warts,............ qqi THE HOMCEOPATHIC THEORY AND PRAOTIOE OF MEDICINE. Genus VH-INFLAMMATORY DISEASES OF THE KIDNEYS AND URINARY ORGANS. , 1. NORMAL ANATOMY OF THE KIDNEYS. While the subject of Renal Diseases is under consideration, it may be interesting to present a brief anatomical and physiological de- scription of the healthy kidney, with the ordinary physical and chemi- cal character of normal urine. By such a course we enable the medi- cal man to compare, with facility, morbid with healthy conditions of the organ. The great advantages of this mode of procedure, in placing concisely before the reader every thing pertaining to these organs,, both normal and abnormal, and the amount of time and labor thus saved in looking up reliable authorities, will be apparent to every one. Among the writers who have distinguished themselves in extending our knowledge respecting the anatomy and physiology of the diseases of the kidneys, we cite the following: Todd and Bowman, Phys., Anat. and Phys. of Man ; George Johnson, On the Diseases of the Kid- ney, &c; Hassall, The Urine in Health and Disease ; Thudicum, A Treatise on the Pathology of the Urine ; Basham, On Dropsy, con- nected with Disease of the Kidneys j Beale, Illustrations of the Constituents of Urine, &c.; Rayer, Traite des Maladies des Reins $ Lehmann, Physiological Chemistryy Becquerel, Semeiotique des Urines, dec. / Frerichs, Die BrigMsche Nierenkrankheit und deren Behandl.; Prout, On the Nature and Treatment of Stomach and Renal Diseases /. Scherer, Annal. der Chemie und Pharmacie; Christison, On Granular Degeneration of the Kidneys/ Bird, Urinainj Deposits, <&c; Bence Jones, An. Chem. in relation to Stomach and Renal Diseases/ Solon, On Albuminuria. 10 DISEASES OF THE 8ANGDINOUS FUNCTION. The researches of these authors have been so extensive, and their observations and illustrations are so minute and accurate with regard to everything pertaining to the kidneys, in their healthy and diseased states, that we shall not hesitate to avail ourselves largely of their valuable experience. The Anatomy and Physiology of the Kidneys.—Location.—The kidneys are located deeply in the lumbar region, on each side of the spine, and " directly beneath the ribs of the lumbar region." Form.—Symmetrical glands, in form much like a French bean, with their convex margins directed outwards, and their concave borders or hilums, towards the spine. Size.—From four to four and a half inches in length, about two inches in breadth, and from one to one-eighth inches in thickness. Weight.—From four and a half to five and a half ounces. Anatomical Relations.—The ascending colon lies in front of the right, and the descending colon in front of the left kidney. A small portion of the duodenum touches the anterior surface of the right kid- ney. The spleen, and the lower part of the stomach, when distended, are directly over the upper portion of the anterior surface of the left kidney,— the former organ being in actual contact with it. The posterior portions of the kidneys are in close proximity to the lumbar and psoas muscles, and in contact with the diaphragm. Renal Capsule.—A strong, fibrous membrane enveloping the kid- neys, attached externally to a bed of adipose tissues, and internally to the gland itself; giving out here and there fibrous attachments to the cortical substance and receiving in return a number of small vessels; connected above with the fibrous layer of the pelvis, and at the hilum with the ureter. Renal Surface.—On the surface of the kidneys are eight to ten im- perfect fissures, indicating the original lobular divisions of the organ during intra-uterine life. Other lobular demarcations are perceptible, arising from a peculiar arrangement of the stellate veins upon the renal surface. These veins enter the cortex vertically from its surface, and during their passage to the hilum are recipients of blood from the venous plexuses of the tubuli uriniferi. Renal Matrix.—A tissue composed of a firm, transparent, fibro-cel- lular net-work, in which the entire substance of the kidney is embedded. The tubes and blood-vessels of the gland traverse the matrix in all directions, and, in a section of the kidney, may be recognized as deep- red oval spots, surrounded and supported by the intervening meshes of the matrix. Todd and Bowman suppose that its only office is to serve as a support for the tubes and capillary vessels. Substance of the Kidney.—Anatomists have divided the kidney into two separate portions, termed cortical and medullary. NOKMAL ANATOMY OF THE KIDNEYS. 11 Cortical portion.—The external and cortical portion is from two to six lines in thickness, of a reddish color, soft consistence, and dotted throughout its structure with a number of minute, deep-red granular spots—the Malphighian corpuscles. It is composed chiefly of the con- voluted uriniferous tubes, and the Malphighian bodies. Tubuli Uriniferi.—These convoluted tubes consist of a delicate basement membrane, attached to the matrix, and lined with epithelial cells, whose office it is to separate from the blood, the urea, uric acid, the sulphates, the phosphates, and the other solid constituents of the urine. These tubes terminate at, and are continuous with the Mal- phighian corpuscles, and are connected below with the straight tubes of the medullary portion, which receive the urine as it is secreted by the Malphighian bodies and the cells of the convoluted tubes. Malphighian Bodies.— Are made up of small round tufts of capillaries from the afferent, and terminating in the efferent vessels, and enclosed by capsules lined at their lower thirds with epithelium. Their function is to separate from the blood the aqueous portion of the urine. Medullary Portion.—The internal medullary portion constitutes the remaining part of the gland, is less soft than the cortical substance, of a deeper red th'an the cortical portions, although Todd and Bowman describe it as paler, and its substance is arranged in the form of cones, named from their discoverer, pyramids of Malphighi. These cones or pyramids are made up of the straight tubes, which are continuations of the convoluted secreting cortical tubes, and appear to be simply channels for conveying the urine from the secreting cells to the pelvis of the kidney. They are lined by a thin squamous epithelium which serves to shield the basement membrane from the irritation of the pass- in <* urine. As the tubes proceed from the apices of the cones to the cortical substance, they throw off numerous anastomosing branches, which become more numerous, and of smaller diameter as they ap- proach the bases of the pyramids. The number of pyramids is usually placed at from ten to fifteen, and their apices float freely in the pelves of the kidneys. No Malphighian bodies have been observed in this portion of the organ. Renal Blood Vessels. The following is Todd and Bowman's de- scription of the vessels of the kidney: " The renal arteries divide into four or five branches, which enter the kidney at the hilum between the vein and the ureter. These vessels are surrounded with a quantity of fat. They pass between the papillae to the bases of the cones, over which they spread. From these arteries smaller branches are given off, which ascend in the cortical substances nearly to the surface, and, in so doing, give off on all sides, a number of small terminal twigs, the afferent vessels of the Malphighian bodies. Arrived within the capsule, 12 DISEASES OF THE SANGUINOUS FUNCTION. the small afferent vessel at once divides into four or five branches, each of which again divides dichotomously. The small capillary vessels form loops, which project towards the opening of the uriniferous tube. The blood is received from these vessels, which lie towards the outside of the tuft, by branches of the efferent vessels which converge towards the more central part of the tuft to form one trunk, which leaves the Malphighian body, and soon breaks up into a plexus of capillary vessels, in the meshes of which the tubes lie. The terminal arterial twigs with their appended tufts, when injected with vermillion, have been compared nut inaptly to a branch of currants." Examination of Urine. — General Principles.—The first urine Voided in the morning or at the period of longest fasting from food and drink, is the truest expression of the kidney secretion, and contains the largest proportion of solids. This the urine of the blood, as distin- guished from that of the food and drink. As an average, in relation to the general habit of body, or with a view to the influence of paroxysmal diseases, &c, Chossat adopted the method, afterwards approved by Lecanu, Becquerel, Lehmann, Thudi- cum, and other authorities, of collecting the whole of the urine during several days and nights consecutively, and mixing in one mass what Lad been voided during twenty-four hours, before* proceeding to the analysis of this average urine. Finally, an average is taken of the variations during several successive periods. Lehmann insists upon the necessity of this method, and advises, whenever it is impracticable, to confine the analysis to the solids of the urine. For practical convenience, Thudicum advises the use of a flat-bodied glass, with a narrow, turned-up neck, and a mouth fitted to the require- ments of the sex, either funnel-shaped or elipsoid. The neck should fit into a gap in the front border and wall of the bed-pan so that the penis shall lie easily in the neck of the urinal, and no urine be lost. ^These urinals should be graduated upon a scale of fluid ounces up to fifty or sixty, or centimetres two thousand, with forty divisions. For the quantitative analysis of healthy urine, see the "Practical Handbook of Medical Chemistry," by John E. Bowman, Am. ed., p. 41; or, " Thudicum's Pathology of the Urine," Chap. 2; or " Becquerel, iSemeiotique des Urines," Chap. X; or "Lehmann's Physiological Chemistry," Am. ed., Vol. 2, p. 149 ; or " Carpenter's Human Physio- logy," Am. ed. of 1858, p. 389. Other physical properties of urine are treated of in the same connection. For estimates of the solids of the urine, based on its specific gravity, &c, see also, Johnson, On Diseases of the Kidneys, p. 43 ; or Golding Bird, On Urinary Deposits, p. 46; or Christison, Table, lib. 7, of Prdc. Med., Lond.: 1840, vol. iv.; or Berzelius, Lehrbuch der Ch.} j3d ed., vol. x., p. 285. NORMAL ANATOMY OF THE KIDNEYS. 13 For a practical approximation to the specific gravity of the whole urine, test, by the urinometer, that which is passed first in the morning and last in the evening, and then strike an average. Lehmann prefers the direct weighing of equal volumes in glass flasks,—thermometric and barometric relations being taken into account. The specific gravity of the glass, and the co-efficients of expansion of the air and water for a vacuum, by means of logarithms or a couple of algebraic equa- tions. See Schmidt's Entwurf einer Untersuchens-Methode thieri- scher Sufte; or Thudicum's work pre-cited, p. 33. The Pycnometer, made to facilitate this operation, contains a thermometer in its stopper. Becquerel measures the density of urine with Baume's areometer. (See p. 13.) Normal Urine.—Physical Characters.—Quantify in Health. This varies chiefly with the proportions of water, but averaging, under ordinary circumstances, about thirty ounces in summer and forty ounces in winter. The lungs and skin normally, the intestinal canal and serous membranes abnormally, may supply the function of the kid- neys in evacuating the water of the urine, but as the secretion of water is merely accessory, not essential to their function, so our chief atten- tion must be paid to the relative proportions of the different solid con- stituents. These may normally vary from 0*20 to 0*80, or from forty to fifty grammes (Becquerel), or 1000 grains (Todd and Bowman), in twenty-four hours, for a man who lives freely; but less for the aged, and for women and children, whose urine is more watery. Specific Gravity.—Making a fair average, it may be placed at 1020. But, in conditions of health, its density varies from 1010 to 1025. Normal urines of 1017 have 28*5 solid parts. {Lehmann.) Aqueous urines, when not accounted for by the quantity of fluids im- bibed, or by the chill and moist state of the atmosphere, are sometimes symptomatic of emotional agitation,—of joy, fright, anxiety, or of ner- vous disorders ; hence they are oftenest remarked in the female. Poly- dypsia, anaemia, diabetes, and hysteria are cited by Becquerel as the states in which the urine is most aqueous. A healthy adult passes from thirty to forty ounces of urine in twenty- four hours — the quantity in summer varying from thirty to thirty-five ounces, and in winter from thirty-five to forty ounces. Of the solid constituents of healthy urine more than one-half is urea. This is derived in part from the metamorphoses of the tissues (probably the gelatinous tissues), and in part from innutritious and unassimilated food. The proportion of urea is increased by the use of animal food and active exercise, and diminished by vegetable and other non-nitro- genous articles. In or out of the body, it is readily converted into Carbonate of Ammonia; as one atom of urea and two atoms of water i 14 DISEASES OF THE SANGUINOUS FUNCTION. form two atoms of Carbonate of Ammonia. The causes which deter- mine this conversion are various. Among them may be cited: In cases of uraemia, it is an interesting question, whether the morbid effects are due to the presence of the unchanged urea in the blood, or to its conversion into Carbonate of Ammonia. A careful proving of these two substances would aid us in deciding the point, and might af- ford valuable hints in treatment. Uric-acid exists ready formed in the blood, and is found in healthy urine in the form of Urate of Ammonia. Johnson supposes that it forms less than —jVu part of healthy human urine. Prout supposes that it is derived from the decomposition of the albuminous tissues ; while Liebig maintains that it results from the decomposition of the nitrogenous tissues. Ammonia is another constituent of healthy urine, and is found in the form of Urate of Ammonia. 1000 parts of urine contain from 2'16 to 2*19 parts of Ammonia. Hippuric acid is another healthy constituent of healthy urine, and forms about -5-sVu part of the entire quantity ex- creted. This acid abounds in carbon, and is usually abundant in con- sumptive and other patients, whose blood is imperfectly decarbonized. The sulphates of healthy urine are chiefly those of Soda and Potash, although Sulphates of Lime, Magnesia, and Ammonia are usually pi'esent in minute quantities. They are supposed to be derived in part From the metamorphoses of the tissues, and in part from the food. Un- oxidized Sulphur is also found in the urine, but its precise combinations are not yet fully understood. According to Ronalds, from two to five grains of Sulphur are excreted daily. Phosphates of Potash, Soda, Lime, Ammonia, and Magnesia, are also found in minute quantities as constituents of healthy urine. They are also derived from the changed tissues and from food. Unoxidized Phos- phorus, in minute quantities, is also present in normal urine. From the analysis of normal urine we observe, that traces of the Chlorides of Sodium, Potassium, Lime, Ammonia, and Magnesia are present, and that they are derived chiefly from the food. Color.—The color of healthy urine has been termed by different writers, amber-colored, straw-colored, sherry-wine-colored, yellow, &c. We know of no term truer or more expressive, than amber-colored. As already observed, in infants, females, aged persons, and in certain anae- mic conditions, the urine is more watery, and consequently paler in color. Red urines generally indicate an excess of acid, a high specific gravity, and the presence of a large proportion of solids. Many causes may contribute to the production of highly-colored urine in health • like an undue elimination of the water through the pores, abstinence from drinks, and the use of highly-nutritious and highly-seasoned food. NORMAL ANATOMY OF THE KIDNEYS. 15 The use of certain drugs and beverages may also give a red tinge to the urine. Red urine is also an accompaniment of many abnormal con- ditions, like fevers, dropsies, and maladies characterized by a rapid decomposition of the tissues and the blood. The acid which gives the red color to urine is the Bi-phosphate, or Acid-phosphate of Lime, and not uric or lactic-acid, as is generally supposed. Deep-yellow urine indicates the presence of bile. Dark urines—brown, blue, or black, are observed during the pro- gress of many malignant diseases, and are due to rapid morbid changes in the tissues and to a decomposition of the blood. Black urine is sometimes voided after long-continued epileptic convulsions, in conse- quence of protracted and spasmodic muscular contraction. Brown, red, or blackish urine is sometimes due to the presence of blood. Under the microscope, the globules appear deformed and irregular, and they finally disappear. Amorphous fragments are then found similar to those observed in albuminous urine. Turbid urine indicates, first, the presence of mucus with diminished density, paler color, and, after standing a few hours, a separation into an upper and clear layer, and a lower and turbid and opaque one, with ammoniacal odor, in consequenca of the decomposition of urea into carbonate of ammonia, which mucus rapidly determines. Second, turbid urine is also caused by the presence of pus. Such urine is less dense than natural, of a greenish color, clears soon after emission, and deposits a thick, whitish, and foetid sediment. Like mucus, it hastens the conversion of urea into carbonate of ammonia. Under the micros- cope, pus-cells are observed in the upper or transparent stratum, at first very numerous, but, after ten or twelve hours, (as in case of blood- globules), they disappear, and a kind of granules are found in their stead. Sediments.—The sediment of acid urines is composed of uric-acid crystals, acid urates of soda, ammonia or lime. The sediment of alka- line urines consists of carbonate and oxalate of lime, and ammoniaco- magnesium phosphates. Sediments of pus, mucus, and blood-globules are not unfrequently found. The composition of urinary sediments is so various, arising from the decomposition of the urine and its waters, that we can only allude to them here, and refer the reader to Becquerel, On the Urine, and to Thudicum's Pathology of the Urine, for more minute information upon the subject. Acid Urine.—Normal urine is generally acid, as may be proved by test-paper. By standing it becomes more acid, and passes through an acid fermentation, resulting in the separation of reddish-yellow rhom- boid-shaped crystals under the microscope. Acid urine is deep-colored and dense, and the acidity is derived from the bi-phosphate, or acid- phosphate of lime, and not, as is commonly supposed, from the uric or 16 DISEASES OF THE SANGUINOUS FUNCTION. lactic acid. Liebig attributes the acidity of the urine to the presence of acid-phosphate of soda. Where great accuracy is not requisite, the '• urine may be tested for acidity with litmus paper. The tests should be applied at different periods of the day, and an average drawn ; since the degrees of acidity are constantly changing from the food and drink consumed, from fasting, exercise, &c. Neutral Urine.—This is only ordinary urine very much diluted, like that which is observed in anaemic subjects. Alkaline Urine.—This is rarely observed. Its sources are blood, pus, and the decomposition of urine or carbonate of ammonia in the bladder—the last being the most frequent. The most frequent deter- mining cause of this alkalinity is the action of the oxygen of the air upon the substances cited. But the urine may be alkaline at the instant of its secretion in the kidney. After standing for a considerable period, acid urine sometimes becomes alkaline, in consequence of the decom- position of urea, and the development of carbonate of ammonia, am- monio-magnesian phosphates, and phosphate of lime. This result may likewise be produced by boiling urine for several hours. Composition of Urine.—When we consider the various circum- stances which are in constant operation to modify the composition of urine, it will not appear surprising that chemists have presented us with such diverse analyses. The urines of the claret-drinking French- man, of the beer and port-drinking Englishman, of the lime-water drinking Yankee, and of the fruit-consuming denizens of tropical climates, must of necessity present great diversities in chemical com- position. Even under any circumstances, the variety of food and drinks, atmospheric changes, habits of exercise, mental emotions, ex- cessive mental or physical exertion, continual modifications are oc- curring in the composition of the urine. It is evident, therefore, that any analysis which may be presented must be regarded as only an ap- proximation to the actual result. We place before Our readers an analysis of Becquerel, quoted from Johnson's "Diseases of the Kidney" p. 48, and another from Berzelius. "This analysis of Becquerel was adopted by Dr. Prout as beino- the most accurate. Dr. Prout took as a standard, thirty-five ounces of sp. gr. 1020, and employing M. Becquerel's data as the basis of his calculations, he obtained the results which are shown in the following table; the proportion of solids and liquids being thirty-three of the former to 967 of the latter." Composition of 1000 Parts of Ueink. Water,.. Urea, ... Uric-acid, 967- 14230 •468 NORMAL ANATOMY OF THE KDDNEYS. 17 Organic matters in- r Lactic acid ? -j separable from each) Coloring matter, (......... 10167 other, ( Extractive matter, ) / Chlorides Salts .. / Phosphates . ' Sulphates f Ammonia -> Lime i Soda \................ 8-135 Potash . Magnesia J 1000-000 Berzelius gives us the following tabk as the b Composition of 1000 Parts of Urine. Water,.......................................... 933. Urea,.......................................... 30-10 Uric-acid,.................................. \- Sulphate of Potassae,............................. 3-71 Sulphate of Soda,................................ 3-16 Phosphate of Soda, .............................. 294 Chloride of Sodium,.............................. 4-45 Phosphate of Ammonia,.......................... 1-65 Muriate of Ammonia,............................. 1-50 Free Lactic-acid, Lactate of Ammonia, Phosphates of Lime and Magnesia, > Animal matter insoluble in Alcohol, J Fluoride of Calcium,...........a trace. Silica,.......................a trace. Mucus of the bladder,............................ 0-32 1000000 Solids of Normal Urine.— Urea. Chemical composition : C2 H4 N2 02 = 60., sp. gr. 1-35. Of the solid constituents of healthy urine, urea forms from 7\*** part. It forms flat quadrilateral prisms, with aspect and taste like Nitre. It belongs to the class of organic bases, and forms crystalizable compounds with several of the acids; is soluble in five parts of cold or two parts, of boiling alcohol—in its own weight of cold water, and in every proportion of boiling water; is in- soluble in ether; is permanent in the air; fuses at 250° F., and at a higher temperature yields by spontaneous decomposition, ammonia, cyanate of ammonia, and dry solid cyanuric-acid. According to John- son, 270 grains, or more than half an ounce of urea is excreted by a healthy man in twenty-four hours. It readily results from the trans- formations of various azotized matters, and, when not removed by the kidneys, it accumulates in the blood, and appears in the saliva, the bile, the gastric secretions, in nearly all the humors, and is so abun- dant in the sweat as to form, after spontaneous evaporation, a blueish- white crust, especially upon the face. The quantity of urea is in« Vol. II.—2. 18 DISEASES OF THE'SAXGONOUS function. creased by all causes which determine rapid metamorphoses of the tissues. Its prolonged retention in the blood gives rise to what is termed uraemic poisoning, to which we shall refer hereafter. For excellent methods of ascertaining the absolute quantity of urea in urines, we refer the reader to Thudicum's work on the " Pathology of the Urine," pp. 52, 67, and 69—" Methods of Liebig, Bunsen, and Davy." When the quantity of excreted urea continues above or below the natural standard for any considerable period, disease may be in- ferred. Among the causes which determine its diminution in the urinary secretion are insufficient food, impaired digestion, chronic maladies, anaemic conditions and diseases of the convoluted tubes of the cortex of the kidneys. The principal causes which form the excretion of an excess of urea, are the assimilation of large quantities of nutritious food, the use of stimulants, febrile disorders, and general activity of the circulatory and digestive functions. Uric-acid.—Chemical composition: Cx0 H4 06 N4 = C10 H2 04 N4 + 2H0. Pure uric-acid, according to Brande, is a " soft, white, crys- talline powder; it is insipid and inodorous; it reddens moistened lit- mus paper. It is almost insoluble in cold water (requiring, according to Bensch, from 11,000 to 15,000 parts), but soluble in between 1,800 and 1,900 parts of boiling water; it is insoluble in alcohol and in ether." When it is decomposed by heat it yields carbonate of ammo- nia, hydrocyanic acid, empyreumatic oil, cyanuric acid, urea, and car- bon. It forms -468 in 1000 parts of normal urine, according to Becquerel. The average amount discharged by a healthy man in twenty-four hours is stated by Becquerel to be from 0*49 to 0*56 grammes, The proportions, however, may vary much in different in- dividuals without any impairment of the health—such variations de- pending upon the quantity and quality of food and drink consumed, habits of life, &c. Uric acid in combination with one or more bases—ammonia, soda, or lime—is one of the most common sediments of the urine. Uric- acid, being insoluble in the blood, can only exist in this fluid in the form of a urate—chiefly urate of soda—and is separated by the kid- neys, passes to the pelvis of the kidneys, to the bladder, and thence out of the body as a urate of soda. But, during the passage of the latter through the urinary organs, portions of it are often decomposed and uric acid set free by the free phosphoric and lactic acids of the urine. This decomposition may occur in the kidney, in the bladder or after the emission. In order to ascertain whether the urine holds in solution a urate we add to it either nitric, acetic, or muriatic acid. If uric acid is speedily precipitated, we infer the presence of a large quantity of the urate • NORMAL anatomy of the kidneys. 19 but, if a long time elapses before a deposit is apparent, it indicates the presence of only a small quantity of the salt. In all cases of albumi- nuria either nitric or muriatic acid should be employed, as nitric acid precipitates albumen. The following is Dr. Golding Bird's diagnosis of uric acid depo- sits : " When heated in the urine, the uric acid deposit does not dis- solve, the crystals merely become more opaque. They generally be- come more distinct, from the solution of the urate of ammonia, which is frequently mixed with them, and sometimes completely conceals them from view. Hence the best mode of discovering this deposit is to warm the urine, when turbid from excess of urate of ammonia, in a watch-glass : the acid becomes visible at the bottom of the glass as soon as the urate dissolves." Creatine.—General Appearance. In its crystallized form it is a colorless, transparent, and glossy substance. Chemical Composition.—Cg H9 N3 04 + 2 Aq. Specific Gravity.—l-35 to 1"34. Quantity in Normal Urine, and whence derived.—An excremen- titious substance, derived from the muscles ; excreted from the blood by the kidneys, and passing thence into the bladder and out of the body; a constant constituent of the urine, but present in very small quantities. Quantity Passed in Health in Twenty-four Hours.—Thudicum places the average quantity passed in twenty-four hours at 0*305 grammes. How Increased or Diminished.—The quantity is increased by muscular action, febrile conditions, and whatever produces rapid meta- morphoses of the muscular tissues. The causes which tend to dimin- ish it are muscular inactivity, anaemic conditions, feeble action of the circulatory and respiratory systems. Mode of Detection.—First evaporate the urine to a dry extract, then, with a solution of ammonia, dissolve out the creatine, and finally evaporate the solution of ammonia, leaving the creatine in a crystalline state. Under the microscope these crystals present themselves in various forms, but may be readily distinguished by accustomed ob- servers. (See Hassall on Urinary Diseases.) Creatinine.—General Appearance. Creatinine crystallizes in ir- regular groups of very transparent and light-colored crystals. They may be distinguished from those of creatine by their lack of lustre. Creatinine is usually present in the urine in a free state. Much of it is supposed to be derived from the conversion of creatine into creati- nine during its passage through the urinary organs, and after the urine has been evacuated. Chemical Composition.—Formula: C8 H7 N3 02. It is more 20 DISEASES OF THE SANGUINOUS FUNCTION. soluble in water than creatine—one part dissolving in 11'5 parts ot water at 60° F. Its chemical character is almost identical with that of ammonia. 9 Specific Gravity.—-The specific gravity of the crystals is about equal to 1*35. Proportion in Normal Urine.—Always greater than that of crea- tine, from whence it is derived. Quantity Passed in Twenty four Hours.—-The average quantity passed in twenty-four hours in health, varies, according to the experi- ments of Thudicum, from 5*61 to 9*66. From whence Derived.—An excrementitious substance, derived in part from metamorphosed muscular tissue, and in part from the con- version of creatine into creatinine after the urine has been separated from the blood by the kidneys. Causes which Increase or Diminish It.—Like creatine, it is in- creased by those causes which effect a rapid disintegration of the mus- cular tissues, and diminished by those conditions which retard those muscular transformations. Mode of Detection.—Same as for that of creatine. Hippuric Acid.—General Appearance. In its crystalline state it is in the form of " delicate silky needles or rhombic prisms;" taste bitter; sparingly soluble in cold, but more readily in boiling water, and still more soluble in alcohol. Supposed by Liebig to be a con- stant constituent of normal urine, in about the same proportion as uric acid; but the observations of Duchek do not confirm this opinion. Chemical Composition.—Formula: N. C. 18. H8. 05 x Aq. It is readily decomposed by nitric acid, and converted into benzoic acid. It enters into combination with several alkaline and earthy bases to form the hippurates. Quantity in Normal Urine.—Much diversity of opinion prevails upon this point. According to Liebig, uric acid and hippuric acid are present in healthy urine, in about equal proportions ; while Hoesle and Duchek deny that the latter is a normal ingredient of this se- cretion. Quantity Passed in Twenty-four Hours.—The quantity secreted depends much upon the habits of the individual and the kind and quantity of food consumed. But the average amount may be placed at from 040 to 0*50 in twenty-four hours. From whence Derived.—It is derived principally from the non- nitrogenous elements of the food {Liebig). Bird supposes that it may owe its origin to an undue retention of carbon in the blood, from defec- tive action of the lungs and liver. How Increased or Diminished.—Increased by rest and by the uso of fruits, like pears, plums, cherries, apples, &c, and diminished by ao- NORMAL ANATOMY OF THE KIDNEYS. 21 tive exercise in cold air and rigid abstinence from stimulants, coffee, and meats. Mode of Detection.—Turbid urine indicates the presence of con- siderable hippuric acid, while clear urine usually contains but a small quantity. For other methods of detecting it see " Thudicum on the Pathology of the Urine," p. 143. Coloring Matter of Urine.—Thudicum gives the name of uraema- tine to this substance, from the supposition that it is " derived from the pigment of the blood or haematine." In a dry state it is of a deep red color, and it is this substance which communicates to urines their various tints. Scherer supposes that it is derived from the decompo- sition of blood corpuscles. It is composed chiefly of carbon. But little is known at present of its exact character—its derivation, chemi- •cal reactions, &c; but it is doubtless an effete and excrementitious substance. Fixed Salts of the Urine.—Sulphates. Of the fixed salts of the urine the sulphates of potassa and soda are the most abundant. The average quantities of each in 1000 parts of urine are as follows, according to Berzelius : sulphate of potassa, 3*71; sulphate of soda, 3*16. A small quantity of pure sulphur is also present in most healthy urines. They are derived in part from the metamorphoses of the tissues. Phosphates.—Berzelius gives us the following proportions of these salts as pertaining to normal urine-: phosphate of soda, 2-94, and phosphate of ammonia, 1*65, in 1000 parts of urine. Traces of phos- phates of lime and magnesia are also always present in normal urine. Free phosphorus is said to be a constant constituent of healthy urine. Derived chiefly from disintegrated muscular, brain, and nervous tissues, and from food and drinks. Increased by mental activity and cerebral irritation. Chlorides.—These occur in normal urines in the form of chloride of sodium and potassium—the proportion of the former to 1000 parts of water being 4*45, and of the latter a trace. Minute quantities of the following substances are likewise found in all normal urines : silica, free lactic acid, fluoride of calcium, hydro- chlorate of ammonia, acetate of ammonia, albumine, gelatine, and ben- zoic acid. 2. BRIGHT'S DISEASE OF THE KIDNEY. Synonyms.—Albuminuria.—Acute desquamative nephritis. (Johnson.)—Renal cachexia. (Wood).—Albuminous nephritis.— Granular degeneration of the kidneys.— Fatly degeneration of the kidneys.— Wrcemia. In 1837 the attention of the medical public was first seriously directed to this malady by Dr. Bright, of London. Although a few previous 22 diseases of the sanguineous function. writers had vaguely alluded to the disease, and thrown out some hints with regard to its probable nature, yet to Dr. Bright belongs the credit of having first presented to the profession a systematic and moderately accurate description of the symptomatic and pathological phenomena of the disease. We adhere to the term " Bright's disease" to designate the malady, because not one of the other names applied to it conveys a just impression of its actual nature. The prime cause, the ultimate essence of the malady is not located in the kidneys, but in the blood itself, in the form of retained effete matter from diseases, from the pre- sence of noxious drugs, from checked perspiration, &c. So long as these poisons remain in the blood, its normal condition is disturbed, and the entire organism suffers. Nature, always kindly in her instincts, always on the qui vive to sustain the integrity of the delicate organi- zation over which she has been placed in charge by the Great Archi- tect, strives to eliminate all disturbing agents through one or more of the natural emunctories of the body; and she always selects the most appropriate channels to throw off each deleterious substance. As examples we cite the following: When the poison of variola has infected the blood, the skin is selected as the eliminator, and the energies of the system are concentrated to throw out upon this part, suppurating pustules loaded with the escap- ing poison of small-pox. The copious discharges from the pocks usually suffice to relieve the blood of its morbid constituent, and thus enable the system to return to a normal state. But in some instances the pustules fail to perform their full duties as eliminators, the kidneys are called into requisition as auxiliaries, and, as a consequence, renal inflammation is sometimes the result. In the case of scarlatina poison, the most important eliminators are the skin and the mucous membrane of the throat and intestinal canal. When the poison is intense, and the natural recuperative forces are feeble, these parts fail to perform their offices efficiently, and an extra amount of labor devolves upon the kidneys. During the passage of this poison through the tubuli uriniferi, an inflammatory congestion is produced, which prevents the Malphighian corpuscles and the epithelial cells of the tubes from separating from the blood normal urine, and permits the passage of albumen, fibrin, and other abnormal constituents. In measles, erysipelas, and other cutaneous disorders similar con- ditions not unfrequently obtain. So likewise in many other conditions of the system; in scrofula, psora, constitutional syphilis, the presence in the blood of poisonous substances, like mercury, phosphorus, turpen- tine, copaiba, and other drugs, retained perspiration from the action of cold, &c, the kidneys may become inflamed in their efforts to eliminate these noxious influences. During this process of elimination, if the BRIGHT'S DISEASE OF THE KIDNEY. 23 poison is directed towards the skin, eruptions and cutaneous inflam- mations of various kinds may result; if it is attracted to the bowels a diarrhoea will occur; if to the liver, hepatic inflammation will ensue ; if it passes out of the blood through the kidneys, we shall have the usual phenomena of acute desquamative nephritis, with a rapid production and detachment of the epithelial cells of the convoluted tubes, inflam- mation of the Malphighian bodies, exudation of serum, fibrin, &c. When renal inflammation results from any of the causes cited, it can only be regarded as an effect of the action of the passing irritant. To this effect medical men at present direct their chief attention, almost regardless of the more deep-seated and vital derangements which originate the complaint. In a therapeutical point of view the dis- tinction we have described is important in guiding the medical man to a more comprehensive and efficient mode of treatment. Bright's disease may originate from other causes than those enume- rated. In our own practice we have on several occasions met with both acute ahd chronic forms of the malady, which were clearly trace- able to irritable bladder, and other chronic affections of this organ. In several of these instances incontinence of urine (especially noctur- nal) had existed for years previously to the renal attacks. It is highly probable that long-continued sympathetic irritation of the kidneys from urethral strictures, cystic calculi, and other causes of similar character, may eventually give rise to the complaint under certain circumstances. In a monograph recently published in Paris, entitled " La Fievre Jaune de La Nouvelle-Orleans," by our friend A. J. F. Cartier, M. D., it is stated that albumen is often found in the urines of yellow-fever patients, during the second and third stages of the malady. Dr. Cartier has personally verified this statement in several instances. Does not this fact go far to prove that the immediate cause of yellow fever is a blood-poison, introduced from without, the tendency of which is to pro- duce a rapid decomposition of the blood, with consequent functional derangement of nearly all the organs, and "finally exudation of serum into the stomach, black vomit, general prostration and death, unless the poison be eliminated during the first stage of the malady, through the pores, the kidneys, and other emunctories? A confirmation of this view consists in the fact, that when the cutaneous, renal and hepatic se- cretions are kept in uniform and steady action from the outset of the disease, recovery invariably results. Albuminous urine has often been detected in cases of cholera as- phyxia, and in ship, hospital and other typhoid fevers. In these examples, as in the cutaneous maladies enumerated, the blood is con- taminated with specific morbid poisons, and during the reaction of the vital force to eliminate them, the kidneys become inflamed. One of the most common and characteristic phenomena connected 24 DISEASES OF THE SANGUINOUS FUNCTION. with Bright's disease consists in the presence of albumen in the urine; and from this circumstance it has received, from Martin Solon, the ap- pellation of albuminuria. A symptom no less common, consists in the retention of urea in the blood; from which fact other writers have em- ployed the word urcemia to designate the malady. Others still regard the complaint as dependent not only upon a depraved condition of the blood, but of the entire organism; and, in accordance with this view, Professor Wood, of Philadelphia, has presented us with the term renal cachexia, to express the disease as a unit. Another constant phenome- non connected with the disorder is a more or less rapid production and detachment of the epithelial cells of the tubuli uriniferi ' in con- sequence of which Dr. Johnson has named it desquamative nephritis. From the uniform presence of albumen in the urine Rayer employs the term albuminous nephritis. One form of the disease superinduces granular formations in the kidneys, from which the designation granular degeneration of the kidneys is derived by Dr. Christison. Another variety appears to be connected with waxy deposits, and these cir- cumstances have given rise to the terms fatty and waxy degeneration of the kidneys. When we reflect that the kidneys are effected only secondarily, and that all of the conditions we have cited are only isolated symptoms of quite different primary and deep-seated causes, we shall perceive that not one of the terms which have hitherto been employed to express the malady as a unit is strictly appropriate. For this reason, and until a more just and comprehensive appellation shall be devised, we shall still adhere to the original designation of Brighfs disease. A majority of authors have made a general division of the malady into the acute and chronic forms. This general arrangement we shall adopt in the present article, although we agree with Valleix " that it is impossible to say, precisely, what are the symptoms which corres- pond particularly to the three forms admitted by Bright, or to the three degrees of Christison, or to the five varieties of Martin Solon or rather all of the symptoms of the malady corresponding indifferently to these forms, to these degrees, to these varieties." A single division has a real importance in pathology, like that which has been estab- lished by M. Rayer. This author has described an acute and a chronic albuminous nephritis. The first corresponds to the two first of the six anatomical forms admitted by M. Rayer, and the second to the four last.—Guide du Me diem Practicien, par F. S. P. Valleix, p. 100. Acute Form.—Acute desquamative nephritis is the appellation given to this affection by Dr. George Johnson of London. The con- voluted tubules which compose the cortical portion of the kidneys are primarily and chiefly involved in this form of the disease, although the Malphighian corpuscles and the entire gland ultimately become con- BRIGHT'S DISEASE OF THE KIDNEY. 25 gested and somewhat enlarged. The most notable results of this in- flammatory congestion are: albuminous urine, retention of urea in the blood, and dropsical effusions. Symptoms of the Disease.—Rigors or chilliness, followed by febrile reaction; hot and dry skin, rapid and full pulse, thirst, dryness of the mouth aud throat; pain in the region of the kidneys, often extending to-the groins, thighs, penis, and testicles, and tenderness of the kidneys on pressure; irritation at the neck of the bladder, and sometimes at the extremity of the urethra, giving rise to frequent desire to urinate, especially during the night; scanty, red, or smoky urine; loss of appe- tite, nausea, and sometimes vomiting, with other symptoms of gastric disturbance \ dull or acute pains in the head and limbs; restlessness and lassitude. These phenomena are speedily succeeded by puffiness of the eye-lids and face, oedematous swellings of the body and limbs, and dropsical effusions into the serous cavities, more or less extensive. The pleura is exceedingly prone to become involved in the morbid action and to throw into its cavity undue quantities of serum, in con- sequence of which we often observe distressing paroxysms of rapid and difficult respiration, and palpitation of the heart from the slightest exertion. In all forms of the complaint these paroxysms are quite apt to recur at regular periods—usually every evening and night, and to continue for several hours with distressing severity. Urine.—Much diminished in quantity and sometimes almost entirely suppressed, usually' red, from admixture with blood, or cloudy and turbid, of a specific gravity from 1,016 to 1,025. If the urine be placed in a watch-glass and slowly heated by a spirit lamp to the boiling point, an albuminous precipitate will be discovered; or, if a few drops of nitric-acid be carefully added to a small quantity of urine, the albuminous cloud appears and is soon precipitated. When both of these tests develop the precipitate, we may safely count on the presence of albumen in the urine. Under the miscroscope, the urinary sediment reveals coagulated fibrin, " epithelial casts," epithelial cells, blood globules, and fibrinous casts from the inflamed urinary tubes. After the disease has con- tinued for two or three weeks, Dr. Johnson has sometimes observed oil-globules in the epithelial cells and on the surface of the epithelial casts. These appearances do not appear to be connected with fatty degeneration of the kidneys, and is deemed amenable to remedial measures, provided the oil-globules are in small quantities compared with the epithelial casts. Johnson asserts that this condition is far more common in adults than in children. Not unfrequently uric-acid crystals are observed in these urinary sediments, but they do not occur with sufficient uniformity to be regarded as peculiar to the disease. 26 DISEASES OF THE SANGUINOUS FUNCTION. The above symptoms, if promptly met with suitable remedies, may terminate in complete resolution and a restoration of the organs to a normal condition, or they may partially subside into a sub-acute inflam matory condition, which may eventuate in one of the chronic forms of the malady; or, if the acute symptoms continue to progress unchecked until a certain amount of urea has accumulated' in the blood, chronic poisoning will ensue, and drowsiness, headache, general failure of mental and physical power, stupor, and convulsions will terminate life. Morbid Anatomy.----If a section of the kidney be made, it will be found somewhat enlarged, heavier than natural, soft, congested and bloody. The cortical portion is infiltrated with a dark, turbid fluid, and the blood-vessels are distended with a still darker fl-uid. Other dark spots from ecchymoses are observed in the tissue of the gland. {Rokitansky.) The cortical substance is usually thickened to the amount of half an inch. {Rayer) The pyramids are also involved and their blood-vessels are distended with dark blood. The natural dark- red color of the healthy organ is changed to a still deeper hue, and is dotted throughout its substance with the congested and dark Mal- phighian bodies. The convoluted tubuli are distended with detached epithelial cells, and are abnormally opaque. The fascia propria and the mucous membrane of the calices and pelvis are thickened, and their vessels injected with a brownish-red blood. Causes.—By far the most frequent direct cause of the affection con- sists in the passage through the Malphighian corpuscles and the secret- ing tubes of the cortex, of effete and excrementitious matters derived from the blood. In the present state of knoAvledge it is impossible to determine the number of diseases which are caused or are connected with deterioration or contamination of the blood, and which give rise secondarily to renal affections during the efforts of the recuperative forces to eliminate them through the urinary organs. It is highly probable, however, that many more maladies than have hitherto been enumerated may safely be added to the list. Retained effete matters from checked perspiration, whether arising from exposure to cold or from other causes, is a common cause of acute nephritis. A less frequent, but by no means an uncommon cause of the disease may be found in the elimination from the blood of poisonous drugs' which have been administered by old-school physicians. Nearly Til the resinous diuretics, like Copaibae, Turpentine, and Cubebs, as well as most other diuretics, like Nitrate and Hydriodate of Potassa? Digi- talis, Apocynum-cannabinum, Petroleum, Cantharides, and the like ate capable of producing so much irritation in their passage through' the secretory tubes of the kidneys, even in small quantities, as to produce albuminous urine. A similar effect has been observed from the elimim bright's disease of the kidney. 27 tion of Mercury, Arsenic, and other mineral substances from the blood. The abuse of alcoholic liquors, particularly those which are adulte- rated, is mentioned as a cause of the disorder. Long-continued inflammation of the neck of the bladder, from stricture, enlarged prostate, calculi, &c, occasionally tend to develop albuminous nephritis from sympathetic irritation. Several cases of this description have fallen under our own observation. Mechanical injuries over the renal region may superinduce this variety of nephritis in scrofulous, syphilitic, gouty, and other subjects predisposed to the complaint. Prognosis.—In forming an opinion respecting the probable result of acute albuminous nephritis, it is necessary to regard the actual con- dition of the patient and the nature of the exciting cause. When it occurs in healthy persons, and is dependent on exposure to cold, or humidity, or abuse of spirituous liquors, diuretics or other drugs, or the elimination of effete matters during the later, periods of mild diseases, we may generally count on a favorable issue, provided suitable remedial measures have been promptly adopted. But when it appears as a sequence to malignant scarlatina, erysi- pelas, typhus, yellow fever, or cholera-asphyxia, and the system of the patient is much contaminated and reduced from previous disease, the prognosis must always be regarded as doubtful, and often positively unfavorable. A scrofulous, psoric or gouty diathesis, constitutional syphilis, and cancerous, mercurial and arsenical cachexias are always unfavorable concomitants in this affection. Chronic Forms of Bright's Disease.—Many attempts have been made to group together certain phenomena, and to classify them as characteristic indicators of the various forms of Bright's disease. Pathology, chemistry, and microscopy have all been called into re^ quisition as aids in determining this classification, but the subject is still involved in much doubt and confusion. Many eminent continental physicians, like Frerichs and Reinhardt, regard the different forms of the disease as successive stages of one primary inflammatory con- gestion ; the first link in the chain being inflammatory congestion, the second inflammatory exudation, and the third absorption. English and American writers for the most part recognize the existence of these stages, but deny that they have any necessary connection with each other. They assert that each of these forms is often met with as an in- dependent malady, and without any previously existing acute disease either in the kidneys or elsewhere. This argument, however, loses its force when we reflect that acute desquamative nephritis sometimes * 28 DISEASES of the sanguksous function. runs its course with symptoms so mild as scarcely to attract attention. Thus a Cold, with slight febrile symptoms, high-colored urine, and tenderness and pain in the lumbar region may occur repeatedly with- out exciting a suspicion of kidney disorder; and yet these very symp- toms may be dependent on inflammatory congestion of the kidneys. It is so common a circumstance for patients to be troubled with what is vulgarly termed " crick in the back" during the existence of severe colds, that nearly all pains in this region are included under this general appellation, and are passed by unheeded. In this manner the first stage of Bright's disease often remains undiagnosed, and the more chronic stage of exudation gradually and insidiously establishes itself. How few there are who cannot recall one or more attacks of cold, with febrile reaction, scanty and red urine, nausea, and pain in the loins; and yet one of these unheeded attacks may constitute the first stage of this formidable disorder. In several instances we have. met with chronic albuminuria in in- dividuals who were confident that they had never suffered from any af- fection of the kidneys; but who, after minute examination and careful reflection, have been able to call to mind previous attacks similar in character to acute desquamative nephritis. Adopting the views of Frerichs and Reinhardt, we proceed to describe— The Second Stage of Bright's Disease.—Upon the supposition that all forms of chronic Bright's disease have been preceded by one or more inflammations of the cortical substance of the kidneys, we sub- mit the following additional remarks: It is a well-established fact that many serious chronic maladies are but sequences, more or less remote, of previous acute inflammations. Thus many cases of uterine displacements, fibrinous depositions upon the utero-genital structure, hypertrophies of mouth and neck of the uterus, and chronic ovarian disorders are distinctly traceable to pre- vious inflammatory conditions of these tissues. These inflammations, either from negligence on the parts of patients, or insufficient medical treatment, are only partially subdued, and are allowed to subside into sub-acute or chronic states, and thus to remain as nuclei for the action of any future morbid exciting causes. One of the most common results of all acute inflammations is an exudation into, or upon the affected tissue, with a consequent thickening or hypertrophy. This may super- induce morbid irritations; or it may continue to exist for months or years almost unnoticed, when perhaps, some additional exciting cause will develop a new and more serious train of symptoms. A pneumonia may run through its course and leave the patient well with the exception of one or more points of hepatization. A future ex- citing cause, perhaps years afterwards, may develop in the affected parts softening and consumption. The first inflammation sows the bright's disease of the kidney. 29 seeds, and a later exciting cause germinates them into a fatal chronic degeneration. So in the nephritic disorder, a primary inflammation, but partially Bubdued, leaves the renal tissue thickened and obstructed by an exuded foreign substance; and the organ is placed in a condition to become readily affected by any future noxious influence that may be brought to bear upon it. This renal infiltration may be gradually and imper- ceptibly absorbed, or it may remain stationary for a long period with- out producing any serious inconvenience, or a second acute inflam- mation may be re-established, or the future elimination of some dele- terious substance from the blood through the oppressed gland may de- velop one of the chronic forms of renal degeneration. The kind of de- generation will be determined by the nature of the exciting cause, and the constitutional and acquired peculiarities of each case—some con- stitutions favoring the development of granulations, some fatty de- generations, others waxy or scrofulous degenerations, &c. Treatment of Acute Desquamative Nephritis, or the First Stage of Brighfs Disease. Aconite.—Symptoms. Chilliness, followed by general heat, rapid and full pulse, thirst, dry skin and tongue, nausea, vomiting, loss of appetite, general restlessness ; pains in the head, back, and limbs; pains in the loins ; sensitiveness in the renal region ; numbness in the small of the back, extending as far as the lower limbs ; restless and sleepless during the night; scanty, bright-red, hot urine without sedi- ment ; urine very scanty and turbid; retention of urine, with pressure in the bladder, or stitches in the region of the kidneys ; enuresis, some- times accompanied with profuse sweat, with diarrhoea and colic ; face red or pale, and puffy. Gastric and Abdominal Phenomena.—Pressure in the stomach and hypochondria, accompanied with paroxysms of shortness of breath, and even asthmatic symptoms ; nausea and inclination to vomit—espe- cially in the pit of the stomach ; vomiting, with nausea, thirst, general heat, profuse sweat, and enuresis ; inflammation of the bowels ; perito- nitis ; the abdomen swollen and distended as in dropsy; ascites; diar- rhoea, with enuresis and colic. Pneumonic and Pleuritic Phenomena.—Shortness of breath, es- pecially when sleeping, after midnight, or when rising from the recum- bent posture ; paroxysms of suffocation, with anxiety, and aggravation of all the sufferings in the evening ; asthmatic complaints ; pneumonia and pleuritis in their first stages, with active febrile symptoms. Cardiac Phenomena.—Palpitation of the heart, with great anguish and difficult respiration; carditis ; palpitation of the heart, with op- pressive aching in the cardiac region. Cerebral Phenomena.—Fullness and pressure in the head; head- 30 DISEASES OF THE SANGUINOUS FUNCTION. aches—stinging, beating, or lancinating, or contractive, with dullness of the intellect, and, finally, convulsions or coma. All of the symptoms are worse in the evening ; pains particularly intolerable at night, and disappear for the most part when sitting; many of the symptoms appear in the evening, or early in the morning; ailments arising from colds. Pathology.—Kidneys gorged with blood ; congestion of the kid- neys ; face puffy and bloated ; abdomen distended ; effusion of yellow serum into the abdominal cavity. Clinical Remarks.—At the commencement of this malady Aconite is often a useful remedy. Its influence upon the nervous and circula- tory systems, which are always more or less seriously involved, should induce us to examine it among our first remedies. Nor is it alone use- ful against the febrile reaction of the first days of the disorder; but it possesses strong homoeopathic relations with pneumonic, pleuritic, car- diac, gastro-intestinal, cerebral, and rheumatic complications. It does not, indeed, deserve a place as a direct specific in any form of the disease; but, as a modifier and controller of many troublesome acces- sory symptoms of a febrile character, it will be held in high estimation. Among the symptoms which pertain to this form of the malady is a persistent dryness of the skin. There are but few remedies more ho- moeopathic to this condition than Aconite. Ammonium-carbonicum.—Symptoms. Chilliness, followed by fe- verish symptoms, which are especially troublesome in the evening and during the night; with nausea, pressure at the stomach and chest, eructations, thirst, restlessness, and sleeplessness ; dull, bruised, or shooting pains in the region of the kidneys; pains in the loins, in- creased by walking; violent throbbing pain in the small of the back and loins, when at rest; drawing pain from the small of the back to the thighs ; dull pain, extending from the loins and hips to the abdo- men ; face red and bloated, or pale and bloated ; drowsiness in the daytime ; weary, disturbed, and unrefreshing sleep ; mind dull and con- fused ; extreme lassitude and sense of fatigue ; spasmodic twitchin«-s in the arms, hands, and legs. Gastric Phenomena.—Nausea, pressure at the stomach and chest, eructations, thirst; pressure at the pit of the stomach, nausea and oppression after eating; weakness of digestion. Thoracic Phenomena.—Dyspnoea and palpitation of the heart after eve^v exertion ; difficult breathing at night; painful oppression of the chest; pressure at the chest, with nausea, thirst, and feverish symptoms. Cerebral and Nervous Phenomena.—Involuntary twitchings of the muscles of the arms, hands, and other parts of the body; impaired bright's disease of the kidney. 31 memory; dullness of intellect; convulsions (from injection into the veins). Urine.—Very red, turbid, and foetid ; frequent urging to urinate, with scanty emission, especially at night; cloudy reddish urine mixed with blood ; involuntary emissions of urine at night; urine mostly cloudy, whey-like, very ammoniacal and musty; discharge of urine leaving chalky spots ; symptoms worse in the evening and in the open air. Pathology.—The morbid changes which this substance produces in the kidneys have not as yet been investigated. Seybert asserts that it operates specifically upon the capsules of the kidneys. From the renal pains, and the marked changes of the urine, which have been observed during its exhibition, it may be inferred that it also acts spe- cifically upon the kidneys themselves. Under its use the body becomes much emaciated, and the muscles soft and flabby. Clinical Remarks.—This remedy is indicated after the febrile symptoms have somewhat subsided, and symptoms of uraemic blood- poisoning obtain. Among the symptoms which particularly point to Ammonia are the following : pale and bloated face ; extreme lassitude; mind dull and stupid ; dull pains in the loins ; frequent and scanty urination ; urine red and turbid, or light and cloudy; gastric disor- ders ; dyspnoea, oppression of the chest, and palpitation of the heart after exertion ; involuntary twitchings of the muscles ; convulsions; coma. Apis-mellifica.—Symptoms. (Edematous swellings of the face and extremities ; paleness of the face ; face red and swollen ; febrile symptoms, with headache, pain in the loins, gastric derangement, hurried and difficult respiration; pain and soreness in the region of the kidneys on pressure or on stooping; constant dull pains in both kidneys, with a very small secretion of red urine; short, rapid, and anxious breathing at night; difficult and anxious respiration ; repeated micturition every few minutes ; frequent and painful urging to urinate, with scanty discharges of urine mixed with blood ; burning in the urethra before and after micturition ; frequent and copious discharges of urine. Pathology.—From its marked effect upon the quantity and quality of the urinary secretion, and the renal pains to which it gives rise, we infer that it operates specifically upon the kidneys, and produces mor- bid alterations in them analogous to those of inflammation and conges- tion. At present we are not in possession of any pathological facts with reference to its action upon the kidneys, and must therefore con- tent ourselves with inferences derived from pathogenetic and therapeu- tical observations. Clinical Remarks.—We have employed this medicine with benefit 32 DISEASES OF THE SANGUINOUS FUNCTION. in all forms of Bright's kidney. In the acute variety we regard the fol- lowing phenomena as especially indicative of Apis : moderate febrile symptoms, with pains in the head, back, limbs ; thirst; restlessness ; nausea; short, rapid, difficult, and anxious respiration; cedematous swellings of the face and extremities ; ascites ; oedema pulm,onalis; hydrocephalus ; frequent urination, with small, red, and turbid dis- charges. Against albuminuria following scarlatina it is one of our most im- portant and frequently-indicated remedies. Drs. Madden, Munger, and Barker have reported a number of cases of post-scarlatinal dropsies, with albuminous urine, cured with the third dilution. We have been informed by Dr. B. F. Joslin, Sr., that he has cured two cases of acute albuminous nephritis with Apis : one in a man thirty-five years of age, which supervened during convalescence from a typhoid fever; and the other in. a girl of six or seven years of age, which probably originated from a cold. The treatment in both in- stances was commenced with pellets saturated with the tincture, fol- lowed by the sixth, then the twelfth, and, finally, thirtieth dilution. The best effects followed the use of the last-named attenuation. Apocynum-cannabinum.—Symptoms. Slight fever, with thirst, dry mouth and tongue, headache, nausea, dull pains in the region of the kidneys and in the legs, flatulent distention of the bowels, diarrhoea, restlessness, scanty urine, rapid and oppressed respiration. Pathology.—All admit the specific action of this drug upon the kidneys, but we are not in possession of any facts which enable us to determine the kind of morbid alteration which it produces. But, from the few pathogenetic symptoms which have been published, we' infer that it gives rise to an inflammatory congestion of the secreting tubules of the cortex. Clinical Remarks.—At an early period of the malady, before the epithelial linings of the tubuli uriniferi have become extensively in- jured and detached from the basement membranes, this medicine may be prescribed with advantage. Its specific impression under such cir- cumstances, both upon the blood and upon the renal tubules, may be of such a character as to arrest the further progress of the disease in some instances. By some its influence is supposed to be purely me- chanical—stimulating the tubules to an augmented secretion, and thus relieving the system of any existing excess of serum ; but it is by no means improbable that future provers may experience dynamic effects having important homoeopathic relations to the more interior and vital phenomena of Bright's disease. Several physicians have alluded to its efficiency in removing dropsi- cal effusions consequent upon acute and chronic albuminuria^ and in bright's disease of the kidney. 33 some instances where the renal attack is slight, and the epithelium is not much impaired, it will accomplish all that is claimed for it by these gentlemen. Arsenicum-album.—Symptoms. Chilliness, followed by dry heat of skin, thirst, headache, backache, great restlessness, violent pains oppression and burning in the stomach, nausea; short, rapid, and diffi- cult respiration ; oedema of the face and ankles ; languor; weakness; pain and trembling of the limbs ; anxiety; confusion of ideas; vertigo; yellow, red, or livid countenance ; general feeling of malaise', conges- tion of the kidneys; frequent desire to urinate ; scanty, red, dense, albuminous, and bloody urine ; general anasarca. Gastro-Intestinal Phenomena.—Nausea, retching, vomiting; severe pains in the stomach and pit of the stomach—burning, or pressing, or spasmodic, or gnawing, or tearing, worse after eating and on pressure; distention of the stomach; abdomen distended: spasmodic, or cut- ting, or burning pains in the abdomen, with heat, thirst, and loose- ness of the bowels ; flatulent distention of the abdomen ; ascites ; diar- rhoea, with frequent and painful micturition. Pulmonary and Cardiac Phenomena.—Suffocative oppression and arrest of breathing at night, or in the evening in bed; anxious and oppressive shortness of breath on walking, or on making any exertion; shortness of breath and short hacking cough, increased by exercise and worse at night; palpitation of the heart, particularly at night; pulsations irregular, with anguish and oppression of the chest; dropsy of the chest, with its usual concomitant symptoms. Cerebral and Nervous Phenomena.—Fits of anguish, with great weakness and tremulousness of the body; involuntary spasmodic twitch- ings of various parts of the body; trembling of the limbs ; general loss of strength ; tetanic spasms ; epileptic convulsions ; coma. Urine.—Congestion of the kidneys; urine scanty, high-colored, dense, albuminous, depositing blood-disks and casts of uriniferous tubes of the kidneys, and death from tetanic spasms {Jackson, of Edin- burgh). Frequent painful and difficult micturition ; urinary secretion diminished; suppression of urine {Christison). Urine scanty, acid, and high-colored; renal colic extending towards the bladder, and then vesical tenesmus; urine sometimes increased and sometimes dimin- ished ; frequent urging to urinate, compelling him to rise during the night; involuntary micturition, even at night during sleep ; diminished discharge of red urine, with burning; urine turbid, dark brown, and depositing a slimy sediment. Pathology.—Kidneys enlarged and congested; kidneys look li1 tallow ; thick, turbid, purulent urine in the pelvis of the kidneys ■ experiments on cats Dr. Quaglio found in the bladder greenish y urine containing a large amount of albume% fiat-globules,, and Vol. II.—3 ^•i DISEASES OF THE SANGUINOUS FUNCTION. of the epithelium of the urinary tubes; reaction neutral-urea, uric acid and chloride of soda notably less ; kidneys double the natural size, greatly congested, especially the cortical portion which was brown-red, hard, and augmented in diameter; the cut surface exuded a red and viscid liquor. The Malphighian bodies were streaked with red and congested; the glandules filled with blood; the tubes of Bellini filled with fibrinous clots, dotted with sanguineous globules. Other samples of urine contained cylinders of fibrine, fat-globules, and albumen; diminution of urates, renal capsule slightly adherent, cortical substance yellow and friable, fibrinous exudations and fat-globules issuing from the openings of the canaliculi, their epithelium altered and filled with fat. In another case, the kidneys were enlarged, slightly hardened, but with a smooth and glossy surface ; many tubes of the Malphighian pyramids filled with fibrin. In another case, the urine in the bladder was clear and yellow, containing fat-globules; crystals of uric acid and oxalates and the debris of epithelium of Bellini's tubes. In the kid- neys, whose capsules were easily detached, there was the same fatty degeneration of the epithelium ; other tubes were deprived of their epithelium; the greater part of the canaliculi were enlarged in such a manner as to form granulations upon the surface of the kidneys." {Ex- periments of Dr. Quaglio, on cats, with Arsenite of Potassee, see North Am. Horn,. Jour., No. XXVIL, p. 660.) Clinical Remarks.—Arsenicum appears to correspond in a remark- able manner to several stages of Bright's disease. Its pathogenetic and pathological phenomena probably bear a closer resemblance to the symptoms and morbid appearances of Bright's kidney, than those of any other medicine. In its action upon the convoluted tubes of the cortex, it actually gives rise to inflammatory congestion, a detachment of epithelium, depositions of fatty and oily matter in the epithelial cells of the convoluted tubes of the cortex, it actually gives rise to inflam- matory congestion, a detachment of epithelium, depositions of fatty and oily matter in the epithelial cells of the convoluted tubes, and to so much derangement of function as to lead to a retention in the blood of urea, uric-acid, and other proper salts of urine, and to the escape of albumen from the blood, through the Malphighian bodies into the urinary tubes and bladder There is likewise an equally remarkable analogy between many of the secondary and constitutional symptoms of Bright's disease and those of Arsenicum. Both superinduce general anasarca, ascites, hy- drothorax. Both produce inflammation of the pericardium, and of the structures of the heart, with their accompanying disturbances. Both cause general emaciation, pallor of the skin, and a gradual diminution of vital force. Both induce inflammation of the meninges of the brain effusions of serum into the ventricles, spasms, convulsions, coma. bright's disease of the kidney. 35 In view of this intimate homoeopathic relation between this drug and acute Bright's kidney, we have prescribed it in several instances, after the employment of Aconite, and usually with marked success. We have used the third, sixth, twelfth, and thirtieth dilutions, and have wit- nessed prompt and unequivocally good results from all of them. And when we remember how extensively the minute capillary apparatus of the renal structures are implicated in the acute form of the malady, and how essential it is that the atoms of the remedy should bear directly upon these infinitesimally small vessels, Ave shall not wonder that minute atoms penetrate farther, and operate more beneficially than crude atoms of the same medicine. Asparagus-officinalis.—Symptoms.—Moderate febrile, reaction, with a sense of fatigue and somnolence, especially at about three o'clock, p. m. ; general increase of heat with slightly accelerated pulse; rapid and irregular pulsations of the heart especially on exercising; slight pains in the kidneys during the afternoon; pains in the kidneys just under the false ribs ; frequent and painful micturition ; urine scanty, brown and without sediment; frequent desire to urinate ; haematuria; urine limpid and exhaling an odor sui-generis / yawning and somno- lency; symptoms worse from motion. Pathology.—We are not aware that any observations have ever been reported touching the morbid alterations of the kidneys induced by this medicine. From the pathogenesis, it may be inferred that its. action upon the convoluted tubes is only slight and transient. Clinical Remarks.—This remedy may sometimes be indicated, after the more acute symptoms have been subdued by Aconite, Mercurius,^ Kali, Arsenicum, and other potent remedies. When the urine is still scanty, and slightly dark, and the patient is restless and hot in the af- ternoon and evening, with lassitude, somnolence, and slight pains in the renal region on moving about, a few doses of the third dilution will be likely to prove beneficial. Cannabis-indica.—In the cerebral complications which so often ac- company this malady, whether in the form of occular illusions, wander- ing or partial delirium, mental obtuseness, or exhilaration, spasmodic twitchings, or actual convulsions, this is one of our most important re- medies. I have recently witnessed a most excellent cure of an ap- parently almost hopeless case of uraemic convulsions (post scarlatinal) with this remedy. Under the persistent use of the remedy at the first dilution, for four days, the convulsions gradually ceased, the urine be- came abundant and natural in color—having lost all the traces of al- bumen, blood-globules, and other abnormal appearances. We regard Cannabis-indica as the most valuable of all other me- dicines in the convulsions consequent on this disease. CopaivjE-balsami'm.—Symptoms.—Chilliness in the forenoon, fol- 36 DISEASES OF THE SANGUINOUS FUNCTION. lowed by febrile symptoms in the afternoon; dull and sometimes spas- modic pains in the lumbar region; gastric derangement; nausea, vomit- ing, bitter taste, burning pain in the stomach, colic, diarrhoea; difficult respiration and palpitation of the heart on making any exertion; diur- nal somnolence; vertigo; dull pain in the head; spasmodic attacks in various parts of the body; pale and sickly appearance ; frequent desire to urinate; urine scanty and passed drop by drop ; retention of urine ; burning pain on urinating; foaming urine; balsamic or violet odor to the urine; general languor and uneasiness; involuntary trembling, and moving the extremities, head and trunk. Pathology.—Albumen has occasionally been detected in the urines of patients who have been under the influence of Balsam-copaivae for a considerable period. And, simultaneously with this appearance of albumen, there has usually been a diminution of the proper salts of the urine. From these circumstances it is reasonable to suppose that the medicine operates specifically upon the epithelial cells of the tubuli ■uriniferi, and, perhaps, the Malphighian bodies, producing in them a kind of inflammatory congestion. . Clinical Remarks.—It would seem to be homoeopathic to those cases of post-scarlatinal dropsies occurring after an imperfect develop- ment, or an abrupt repulsion of the rash. Its well-known action upon the skin in developing an eruption similar in appearance to that of scarlatina, affords an additional circumstance in its favor as a remedy in these cases. Cannabis-satiya.—Symptoms.—Chills, fever, violent thirst; drink- ing causes tremor, shaking, coldness of the hands, knees, and feet, and distortion of the face ; diurnal somnolence ; disturbed nocturnal sleep; dull, lancinating pains—slow and intermitting—in the left side of the back, under the last rib ; pulling pain in the renal region, extending to the inguinal glands, with sensation of malaise at the pit of the stomach ; obtuseness of mind; impaired memory; confusion of ideas ; pain and congested feeling in the head ; great weariness and weakness; nausea, vomiting; pains and spasmodic pressure in the stomach ; tetanic spasms of the upper limb and trunk; frequent desire to urinate, with tenesmus, sometimes accompanied with burning pains; urine red and turbid; urine .filamentous, as if mixed with pus ; painful and scanty discharge of bloody urine. Pathology.—Pus in the left kidney, not far below the pelvis. Clinical Remarks.—Cannabis will often be found useful in cases which have been preceded by irritation of the neck of the bladder ir- ritable bladder, strictures, &c. It is highly probable that the secreting tubes of the kidneys occasionally become inflamed and congested in consequence of long-continued and severe irritation in the bladder • and bright's disease of the kidney. 37 it is in such cases that Cannabis, Cantharides, Apis, and the like, will be likely to cover the totality of the symptoms. Our experience with this class of remedies, in the malady under con- sideration, is in favor of the third dilution and upwards. Cantharis-vesicatorum.—Symptoms.—Chilliness, followed by fever, with headache, pains in the back and limbs, thirst, dryness of the mouth, anxiety, frequent pulse, scanty and red urine ; face red, animated, hot, and burning; face and neck swollen, and eyes prominent; face pale or yellowish, thin and sickly ; lips peeled, tongue denuded of epithelium, soft palate, of a deep-brown color; lips, tongue, and pharynx covered with vesicles; ptyalism; delirium; loss of consciousness; great forget- fulness; dozing, semi-stupid mood, indifference to surrounding objects; headache, vertigo, sensation of weight in the head, sensation of numb- ness and pressure in the head; tearing, lancinating, and burning pains in different parts of the head; dull, pressive, lancinating, or burning pains in the kidneys, sometimes extending to the abdomen and thighs, and accompanied with urethra and hypogastrium; inflammation of the kidneys ; nephritis and haematuria; general dropsy; anasarca; anasarca and ascites; attacks of convulsions ; frequent convulsive movements; intense headache and chills, convulsions and coma ; convulsive move- ments, cold sweat, agony, and death; frightful convulsions and death at the end of two days, (the post-mortem revealed deep ulcerations of the stomach, intestines, kidneys and bladder); gastric derangement, nausea, vomiting, pains of a burning, contractive, pressing, or lancinat- ing character in the stomach ; flatulent distention of the stomach and bowels; acute, burning pains in the umbilical region; colic, followed by diarrhoea; violent diarrhoea, with persistent burning pain at the anus; laborious respiration; accelerated and difficult respiration; spasmodic cough ; palpitation of the heart; frequent desire to urinate, with vesical pain ; strangury ; urine bloody and passing off drop by drop ; urine scanty and dark ; urine very red and covered with a black pellicle; urine bloody, small in quantity, and vesical tenesmus; sup- pression of urine ; retention of urine, with great desire to urinate ; re- tention of urine in cholera; haematuria; general weakness; heat and sense of excoriation in all the cavities of the body. Pathology.—Redness of the medullary substance of the kidneys; redness of the pelvis of the kidneys and of the ureters; ulceration of the kidneys; suppuration of the kidneys; kidneys red and inflamed; vivid redness of the medullary substance. Clinical Remarks.—Like Cannabis, this remedy is especially ap- propriate in nephritic affections which have been preceded, or which are accompanied by cystic or urethral inflammation. We have already observed, that Bright's disease is not unfrequently preceded and ac- companied by strictures of the urethra, irritable bladder, and irritation 38 diseases of the sanguinous function. of the neck of the bladder; and that these maladies occasionally operate as exciting causes of the former affection. As a general rule, Aconite may precede this medicine with advantage to subdue the more acute symptoms; after which Cantharis may-often be consulted with benefit. By referring to the above pathogenesis, it will be observed that it pos- sesses many phenomena pertaining to each form of albuminuria. Renal pains, scanty and high-colored urine, frequent micturition, and general excitement of the vascular and nervous systems, indicate its applica- bility in acute nephritis; while paleness and puffiness of the face, anasarca, dropsical effusions, dozing, semi-stupid mood, short and diffi- cult respiration, palpitation of the heart, gastro-intestinal derangements, great debility and lassitude, spasmodic twitchings, convulsions, and coma point to it as a remedy in many groups pertaining to the chronic forms of the disease. We were formerly in the habit of employing the first or second dilu- tion in water in these cases, but an enlarged experience has demon- strated the superiority of the more attenuated preparations of the drug. Digitalis-purpurea.—Symptoms.—Febrile symptoms slight; fever- ish shiverings, alternating with transient flushes of heat, accelerated pulse, and moderate tendency to perspiration; anasarca; general dropsy; general paleness of the skin; pale face; swelling of the cheeks and lips; general weakness; swelling of the feet in the day- time, going off at night. Renal Phenomena.—Bruised pain in the region of the kidneys when stooping or moving about; tearing pains and sharp stitches in the small of the back during motion. Gastro-intestinal Phenomena: white coat upon the tongue; ptyalism; nausea; vomiting; burning, or lancinating, or pressing, or spasmodic pains in the stomach; great sense of weakness in tho stomach; contractive, or pressing, or cutting, or pinching, or cramp- like pains in the abdomen; light-colored diarrhosic stools; ascites. Cardiac Phenomena: pulse frequent, (primary effect), and abnor- mally slow and weak, (second effect); organic affection of the heart (principally of the left side) especially hypertrophy, with or without enlargement of the left ventricle ; dropsy of the pericardium • ascites and anasarca, with organic affections of the heart, after scarlet fever. Asthmatic respiration and palpitation of the heart, especially when walking. Cerebral Phenomena: dullness of the head; difficulty in concentrat- ing the mind; vertigo and trembling; pressing, burning, or lancinating pains in the vertex and forehead; drowsiness; lethargy; uneasy unre- freshing sleep; sleep disturbed by frequent desire to urinate; general dullness of mind and inertia; spasms; violent convulsions: convulsive bright's disease of the kidney. QO motions and involuntary twitchings of the cheeks, and of the fingers and thumbs. Urine: continual desire to urinate, only a little at a time, of a dark brown color, and hot and burning on passing; frequent desire to urinate during the night; excessive emission of urine day and night with great exhaustion; enuresis succeeded by retention of urine; sleep disturbed from frequent desire to urinate. Clinical Remarks.—Supposed to act best upon blondes with soft and lax muscles, or upon scrofulous subjects, or upon persons of phlegmatic or sanguine temperaments. This medicine operates speci- fically not only upon the kidneys, but also upon the circulation, redu- cing the frequency and force of the pulse, and thus diminishing undue febrile action. It is, therefore, often appropriate at the outset of acute Bright's disease, either alone, or in alternation with Aconite. Rilliet and Barthez commend it highly in Bright's disease of children. These gentlemen report two cures of the chronic variety, in boys of eight and nine years of age. {Maladies des Infans, vol. 2, p. 51.) " They both took Digitalis for several days consecutively, with evident action both on the pulse and urine. The pulse considerably diminished in frequency, the urine became at the same time more copious, the anasarca disappeared, and the urine lost all traces of albumen." These gentlemen advise the persistent use of the vapor bath in con- junction with the internal use of Digitalis. Our knowledge respecting its pathogenesis and pathology is as yet quite limited and imperfect, yet its action upon the urinary glands is so prompt and specific as to render it worthy of attention in all cases of Bright's kidney. Kali-nitricum.— Symptoms: Violent chilliness, with trembling of the whole body; coldness in the afternoon or evening, with pain in the vertex; shuddering in the evening, followed by heat and sweat, with- out thirst; heat and sweat over the whole body; chilliness, heat and sweat in alternation; inflammatory conditions, with full, hard, and quick pulse.—Drowsiness ; dull, heavy, pressing pains in the head; pulse re- duced to sixty per minute ; gastric and intestinal disturbances ; foetid breath ; thirst, without appetite; eructations, nausea, heartburn, vomit- ing ; pain and pressure of the stomach; spasms of the stomach ; burn- ing, heaviness, fullness, faintness at the stomach; distention, fullness, and cutting or drawing pains in the abdomen; diarrhoea; difficult and oppressed breathing on ascending a stairs; violent palpitation of the heart, in the night, when lying on the back, or on the right side, or when moving about quickly; pain in the small of the back, in any posi- tion, continuing the whole day and night, or in the morning on waking, or in the evening, or during the night—of a bruised, or pressing, or crampy, or burning character; spasmodic, painless jerkings of the fingers, hands, and other parts of the body; sudden swelling of the 40 DISEASES OF THE SANGUINOUS FUNCTION. body, neck, and thighs; convulsions ; symptoms worse at night in bed; diminished secretion of urine; frequent desire to urinate, which con- tinues through the night; increase of urine, with reddish deposits, or with a mucous sediment; frequent emission of a pale, turbid urine; urine of a specific gravity of 1030 to 1040; salts of the urine greatly increased. Pathology.—During its rapid passage through the tubuli uriniferi, it must of necessity stimulate them more or less, and eventually super- induce an inflammation, and probably an exudation into the renal tissue. Clinical Remarks.—Our attention was first called to this medicine as a remedy in Bright's kidney, by Dr. Warner, of Buffalo. This gentleman, and his partner, have been in the habit of employing it in suitable cases, for many years, and with highly satisfactory results. If we mistake not, these gentlemen have cured several well-marked cases of granulated kidney with the medium attenuation of this drug. We record our experience of its decided utility in both the acute and chronic forms of the malady, when there are: distressing paroxysms of difficult and rapid respiration, occurring during the evening and night, and diminishing towards morning, considerable gastric derange- ment, spasmodic pains at the pit of the stomach, short, hacking cough during the night, persistent, dull, bruised pains in the renal region. In such groups, we have often observed prompt and decided improvement from the use of the thirtieth attenuation. Kali-hydriodicum.—Symptoms: Chilliness, with drowsiness, com- mencing at the lower part of the back, and extending upwards and through the body; chilliness, with dryness of the mouth and thirst, in the evening; flushes of heat, with dullness of the head and malaise in the body; heat, followed by sweat in the afternoon; frequent attacks of dullness and heaviness of the head; general feeling of malaise: oedema of the eye-lids; face pale and swollen; dyspnoea; dry, hacking cough, with oppressed breathing; pleuritis ; burning pain in the pit of the stomach; restless and confused sleep ; bruised pains in the small of the back, particularly troublesome at night; violent pain in the small of the back constantly; darting pains in the small of the back when sitting; nightly urination; blood-red urine ; painful urging to urinate • discharge of mucus from the urethra. Pathology.—From the fact that this drug, when taken internally, is rapidly eliminated through the kidneys, it may be inferred that it is capable of producing more or less irritation and congestion of the tubuli uriniferi. We know that it causes enlargement of the sub- maxillary glands, and infiltration of the surrounding cellular tissue and it is not at all improbable that similar effects are produced upon the kidneys. bright's disease of the kidney. 41 Clinical Remarks.—We have found this remedy most frequently in- dicated towards the termination of the acute stage of the malady, after the inflammatory congestion of the renal tubes had in a great measure subsided, leaving the parts more or less thickened and infiltrated with lymph or fibrinous matters. If the case has been preceded or accom- panied by rheumatism or gout, the indications for its employment will, for the most part, be still stronger. When the renal affection is de- pendent upon a scrofulous diathesis, or upon the presence in the system of Mercury, or of syphilitic contamination, this medicine is a remedy of much value. Like Carbonate of Ammonia, it possesses the property of preventing coagulation of blood, albumen, fibrin, and milk, and of re- dissolving them when coagulated. Mercurius-sublimatus-corrosivus.—Symptoms. Febrile symp- toms not strongly pronounced; irregular febrile reaction; feeling of heat and anxiety, which prevents sleep at night; frequent, small, quick, feeble, tremulous pulse ; slow, nervous, febrile conditions, with profuse sweats and great debility; chilliness and colic pains on motion ; swell- ing and redness of the face ; coated tongue, fetid breath, ptyalism; nausea, vomiting, violent, tearing, or burning, or pressing, or gnawing, or darting pains in the stomach ; diarrhoeic stools ; pains in the head, back, and limbs ; shortness of breath, oppression of the chest, rapid and difficult breathing, excessive dyspnoea, palpitation of the heart; headache, drowsiness, and anxiety; general condition of anasarca, ana- sarca of the face and limbs, face red and swollen; periodical convul- sive movements of the facial muscles, arms, and feet, constant trembling and spasms of the limbs, convulsions, general insensibility; scanty red urine, which is passed with difficulty; suppression of urine ; urine red, scanty, and albuminous ; increased secretion of light'and albuminous urine. Pathology.—Kidneys enlarged and congested ; cortical portion of the kidneys much thickened and of a deep-red color. Clinical Remarks.—Twenty years ago Martin Solon advised the employment of Mercury, both internally and externally, as a remedy in Bright's disease. Since the publication of Solon's work on Albu- minate, there has been a great diversity of opinion with regard to the value of mercurial preparations, some opposing their use on the ground that they are capable of exciting inflammation of the kidneys de novo, and of giving rise to albuminous urine, thus rendering them injurious in cases where the organ is already suffering from inflammation; while others, like Wood,* commend them in all forms of the disease, except fatty degenerations and scrofulous or cachectic complications. Guided by an unerring therapeutical law the homoeopathist is not *"Prac. Med.," Vol. II, p. 584. 42 diseases of the sanguinous function. subjected to the conflicting opinions and practices of the empirical schools. The very reasons which cause doubt and confusion in the minds of our opponents, viz., the direct local action of Mercury upon the renal glands, the production of albuminous urine, and other phe- nomena of Bright's disease, determine the homoeopathist in his selection of it as the remedy. In the doses employed by the allopathist, it is not surprising that a drug having such decided homoeopathic relations with this malady, should be productive of harm rather than benefit. As large and crude doses of Belladonna or Opium would do injury in acute cerebral inflammations, so must large and crude doses of Mercury aggravate seriously acute renal affections. But in the attenuated doses of homoeopathy, the results are most happy—the delicate impressions produced not unfrequently arresting the progress of this grave dis- order. In addition to the specific influence which several of the mer- curial preparations exert upon the kidneys, we may take into account their attenuating effects upon the blood and their power of promoting absorption of plastic exudations into the parenchyma of the organ. We have found it most frequently applicable in that form of the com- plaint, termed large white kidneys, (stage of inflammatory exudation), and prescribed in attenuations ranging from the third to the twelfth. Mercurius-iodatus.—Symptoms.—Shuddering succeeded by slight febrile reaction—hot and dry skin, dull pains in the head and back, restlessness, dryness of the mouth, thirst, morbid excitability of the nervous system, fetid breath, putrid or coppery taste, general anasar- cous condition of the entire body, glandular enlargements about the neck, paroxysms of rapid and difficult respiration, and pleuritic pains in the chest, bilious or dysenteric discharges from the bowels, scanty, red and hot urine; urine scanty and loaded with solid constituents, dull pain in the region of the kidneys. Pathology.—In the absence of any definite facts with regard to the morbid alterations produced by this substance in the kidneys, we can only infer that changes are induced similar to those referable to the action of Mercurius-sublimatus-corrosivus. Both Iodine and Mercury administered separately, operate specifically upon the entire glandular system, superinducing inflammation, congestion and plastic exudations, and there is no reason to suppose that when in a state, of chemical union, these peculiar properties are destroyed. Clinical Remarks.—Unfortunately there has not yet appeared a respectable proving of this valuable medicine. Even the few patho- genetic phenomena which we have recorded have been derived from observations during its administration in other maladies. But ab usu in morbis, we infer that it is one of our most valuable remedies in several forms of the disease under consideration. Especially in those forms which appear to be connected with scrofula, and constitutional bright's disease of the kidney. 43 syphilis, it must always hold a high rank as a remedy. When the af- fection is complicated with hypertrophies, or hepatic disorders, it is also strongly indicated.—The lower attenuations of this medicine have proved most efficient in our practi.ce. Mercurius-solubilis.—Sympto?ns.—Nightly febrile paroxysms; in the evening and night, chilliness, followed by heat of skin, restlessness, frequent emissions of urine, and involuntary jerking, twitching, and tossing of the head and limbs, during sleep ; chilliness and heat alter- nating, especially in the face, back, chest and arms ; febrile symptoms, with profuse perspiration; chilliness, followed by heat, and violent thirst; febrile paroxysms, cnaracterized by a predominance of chilly sensations, sweats, and general feeling of malaise, drowsiness in the day-time and sleeplessness at night; general weakness, languor, and lassitude; puffiness of the face; dropsicaV swellings of the feet and legs; ascites; fetid breath; tongue coated with a white fur and some- what swollen; nausea, increased by eating; bitter vomiting; great sensitiveness and painfulness at the pit of the stomach, particularly to the touch; shortness of breath and dyspnoea, especially on ascending a stairs or in walking; stitching or burning pains in the chest; bruised, or cramp-like, or stitching pain in the small of the back ; visible twitch- ings of the fingers and hands; frequent desire to urinate, with scanty discharge; frequent desire to urinate during the night; scanty, fiery- red urine; urine dark-red or brown; urine turbid, even Avhile leaving the urethra, and depositing a sediment; floculent discharges at the end of urination; symptoms worse during the night. Pathology.—We are not aware that any examples are recorded il- lustrative of the morbid changes superinduced in the kidneys by this mercurial preparation; but from its pathogenetic and therapeutical action upon the system, it would seem to resemble the other prepara- tions of Mercury in producing renal disorders. Clinical Remarks.—It has been found most useful in cases of Bright's kidney, which have been accompanied with secondary sy- philis, diarrhoea, and dysentery. Terebinthina.—Symptoms.—Rigors, succeeded by feverish heat throughout the whole body, pulse hard and frequent, headache, red face, pain in the back, thirst, and sensation of dryness of the mucous mem- brane; dropsy; anasarca; ascites; general languor and loss of strength; drowsiness; confusion of ideas, relieved by copious and rapid micturi- tion ; dyspnoea; difficult and laborious respiration, as if from congestion of the lungs; aching pain in the left kidney; pressure in the kidneys when sitting, going off during motion; sensation of heaviness and pain in the region of the kidneys; pain and feeling of increased warmth in the kidneys ; fleeting drawing in the right kidney, and thence proceed- ing to the right hip; violent burning, drawing pains in the region of 44 DISEASES OF THE SANGUINOUS FUNCTION. the kidneys; urine scanty, red, and sometimes bloody; scanty and red, or clear and profuse urine; complete suppression of urine; the urine deposits a thick, muddy, light-yellow sediment, like wine, and has the smell of violets; the urine deposits a slimy sediment twelve hours after micturition ; haematuria; profuse menstruation ; albuminous urine. Pathology.—Inflammation and congestion of the cortical portion of the kidneys; kidneys somewhat enlarged, softened, and of a dark- red color, (on animals). Clinical Remarks.—Professor Henderson has cured several cases of both acute and chronic albuminuria with this medicine. Several medical gentlemen of our acquaintance are in the habit of using it as their principal remedy in the acute form of the disease, and commend it in* the highest terms. We have found the second dilution of this remedy of eminent service in many cases of both acute and chronic albuminuria. It will be ob- served that we have designated the second dilution. A large experience in this malady, with almost every strength of the medicine, has con- vinced us, that the best results can be obtained from this dilution. We regard Terebinthina as one of the very best remedies in Bright's disease. 3. CHRONIC DESQUAMATIVE NEPHRITIS. (Johnson) Second Stage of Bright's Disease. Inflammatory Exudation. (Frerichs.) Large White Kidney. This form of the disease not unfrequently exists for many months without attracting any special attention, and without any apparent renal symptoms. We have known cases to advance within a few days of a fatal termination with no abnormal phenomena except slight pallor of the skin, lassitude, and the occasional occurrence of dyspeptic symp- toms. In allusion to the insidious manner in which it sometimes becomes fully established, Dr. Johnson remarks as follows :* "A reference to case No. 13, will show that a patient may go to bed apparently in good health, and without having experienced any symptoms which had led him to suspect that his kidneys were unsound. In the night he is seized with symptoms of suppression of urine, and of severe abdominal inflammation. After an illness of a few hours he dies, and his kidneys ire found to be so far disorganized by a disease, evidently of a chronic nature, that the wonder is, not that they ceased to act when they did, but that tliey had continued to discharge their functions so long. "Again, in case No. 14, there was precisely the same disorganization of the kidneys as in the instance just alluded to. The patient was ♦"Diseases of the Kidney," pages 170 and 171. bright's disease of the kidney. 45 seized, after a slight indisposition, with palsy of one side, followed by complete insensibility, which soon ended in death. There was no ap- pearance in the brain which would explain the symptoms, but the kid- neys were in precisely the same state of chronic disease as those in the case just alluded to. The bladder was empty; no urine had been passed for several hours before death; and the patient's friends had often noticed that his urine was scanty, but he had appeared to be in tolerable health, and his medical attendant was not consulted before the last fatal attack." These slight ailments may continue for an indefinite period—usually from two to eight months, when shortness of breath is observed after ascending a stairs, or other exertion, either accompanied or soon suc- ceeded by the following symptoms : pale and waxen appearance of the skin; considerable emaciation; ©edematous condition of the face, limbs and often of the entire body ; usually some tenderness in the region of the kidneys on pressure, though this symptom is sometimes {always according to Becquerel) absent; dull aching pains in th% lumbar re- gion are occasionally, but by no means generally, present; frequent desire to pass water, especially during the night; gastric, intestinal, cardiac, and pulmonary disorders are quite prone to obtain; rapid and difficult respiration on making the slightest exertion, and often very distressing paroxysmal attacks occurring every evening and night, lasting from ten to fifteen hours, and rendering it impossible to retain a recumbent position for an instant during a paroxysm; de- bility ; nausea; occasional vomiting; urine variable in quantity, color, and chemical and microscopical characters (See below) ; drowsiness ; obtuseness of the mental faculties ; convulsions; coma and death. During the course of the disorder, a great variety of symptoms, not strictly pertaining to the malady, are often observed. Among these we 'have noticed, burning heat in the head, particularly on the vertex, relieved by copious applications of Bay-rum, Cologne, &c.; a peculiar white appearance upon the tongue, mostly on the sides and under part, looking as if it had been par-boiled,—sometimes accompanied with burning, smarting, and soreness of the furred part, appearing and dis- appearing, and generally accompanied with an amelioration of the other symptoms during its continuance, and for a short period after its dis- appearance; putrid, sickening odor of the breath; pulse sometimes frequent, weak and irregular (in cardiac complications), and at other times normal in frequency and volume; spasmodic twitchings of the muscles of different parts of the body, usually worse at night; severe paroxysms of pain at the pit of the stomach, apparently of a spasmodic character. Johnson alludes to the frequent occurrence of nose-bleed- ing and monorrhagia, and believes them to be in some way connected with the renal affection. 46 diseases of the sanguinous function. Becquerel asserts that the disease has usually the following three modes of commencement: a. Chills, fever, vomiting, lumbar pains, pulmonary congestion,.cough, rales, dyspnoea. I. Fever and infiltration, which shows itself in all parts of the body at once. This mode of attack he considers most frequent. c. The disease advances stealthily, and would remain unknown even though mortal, without an examination of the urine. Alterations of the Urine.—In quantity it is variable—usually more abundant than in health, but sometimes less. In color it is mostly light, or colorless, varying from a smoky water-color to a dirty brown hue. It very rarely contains blood-globules, but when it does the urine assumes the color of dirty broth. Its density is less than that of the acute form, although greater than that of normal urine. The specific gravity varies from 1005 to 1015. It has an acid reaction, and the usual tests precipitate albumen. By the microscope we may detect epithelial cells, amorphous granu- lar fragments, granular epithelial cylinders (the fall of the epithelial sheaths of the tubuli), termed by Dr. Johnson "granular casts," and in a very few instances, blood-globules. These blood-globules, according to Johnson, become more unfrequent the farther the disease advances from the acute stage, until in the third stage (small contracted kidneys) they are never to be found. Robin asserts that epithelial cylinders are occasionally found in normal urine, so that these appearances alone would not determine the existence of Bright's Kidney. Becquerel supposes that the quantity of albumen in these urines varies from toss LU i u u u> Prominent Concomitant, or Secondary Phenomena. Dropsy.— As soon as the normal epithelium of the convoluted tubes has become so far degenerated and disintegrated as to be incapable of separating from the blood urea, uric-acid, and the other normal solids of the urine, they accumulate in undue quantities in the blood, and nature strives to eliminate them through other channels—the skin, the serous-mem- branes, the intestines, the lungs, the liver, and all other available out- lets. During these vicarious processes of elimination, the capillaries of the tissues acted on, become obstructed, and their circulation im- peded in such a manner as to permit exudations of serum through their walls, and thus dropsical effusions in various parts of the body. At the same time the congested Malphighian bodies allow the escape of undue quantities of serum, thus causing disalbumination of the blood from the normal standard of 70 or Tulhr to 10 and even -nfVo". It is evident then that two morbid conditions constitute the most direct causes of dropsical effusions,—by retention of excrementitious urinary constituents and disalbuminution of the blood. Further on we shall bright's disease of the kidney. 47 again allude to this subject. Dropsy is not invariably present in this form of the disease, especially when the renal secretion is abundant, or when there are frequent and copious discharges from the bowels, by which the poisonous blood accumulations may be evacuated. In other instances the constitution appears to possess the power to resist for a long time the deleterious action of the retained urinary constituents, without the supervention of dropsy or other troublesome symptoms. But in general, nature asserts her rights, and opens every available channel in order to expel the noxious matters from the vital fluid, even at the risk of irritating, and of producing serous effusions from these new and unused tissues of elimination. The water appears to accumu- late in one or another place without apparent cause. Perhaps it is earlier and oftener observed in the face than elsewhere; and in pa- tients of active habits we generally find infiltration of the limbs and ascites. Effusion into the cavity of the chest is an early and rather frequent result of this disease ; but we very rarely meet with ventricu- lar dropsy. The composition of the infiltrated water is the same as that of the serum of the blood diluted with much water. Of one thousand parts, the solid constituents constitute only from ten to fifteen parts, instead of eighty to one thousand, as in the serum, and forty to fifty to one thousand, as in affections of the heart. In health, the proportion of albumen in the blood is from seventy or eighty to one thousand parts. In acute desquamative nephritis, the proportion is reduced below to-utt, at which point infiltration must occur. In the chronic forms this disalbuminution must be still greater, to give rise to dropsy. These dropsical accumulations sometimes become so extensive as to cause very serious inconvenience, and not unfrequently danger to life. Pleural, ventricular and peritoneal effusions are the most dangerous. Infiltrations of the extremities and of the scrotum often become very extensive and troublesome ; but they may be readily and safely relieved by delicate scarifications. We have often adopted this mode of tempo- rary alleviation, and always with success and safety. Respiratory Apparatus.—Among the vicarious channels for the elimination of the excrementitious renal accumulations in the blood are the pulmonary structures. In the act of elimination the capillaries of the pleura, the pericardium and of the cellular structure of the lungs often become engorged, and effusions more or less extensive occur. Some of the first symptoms, therefore, which arrest the attention of both patient and physician, are shortness of breath, increased to a painful extent from the slightest exertion, and a sense of oppression throughout the entire thoracic region. In the first instance there is only pulmonary oedema with effusion into the air-cells of the lungs ; but 48 DISEASES OF THE SANGUINOUS FUNCTION. in more advanced stages of the disorder, large and dangerous accumu- lations occur in the thoracic cavity. In robust and plethoric indi- viduals, pneumonias and bronchial affections are likely to be superin- duced. In scrofulous subjects hemoptysis and tubercular consumption are not unfrequently developed. We have already alluded to the periodical recurrence of evening arid nightly paroxysms of dyspnoea. This symptom has been observed in both the second and third stages of the malady. It usually commences in the afternoon and evening, and continues with such severity as to prevent the patient from taking a moment's rest in the recumbent pos- ture, until some time in the morning, when there is generally a remission for a few hours. During the existence of this stage, if the patient takes cold, or is subjected to the influence of a cold and humid atmosphere, pleurisy or pericarditis may occur; although these attacks are far more common in the stage of absorption. Albumen has often been detected in the urines of children suffering from membranous croup. The rationale of this phenomena has not yet been fully explained. Digestive Apparatus.—Another channel for the elimination of the retained urinary excrements, is the gastro-intestinal mucous mem- brane. The influence exerted upon the stomach is two-fold; first in the form of irritation of the gastric mucous membrane, and consequent symptoms of- indigestion, like nausea, occasional vomit- ing, eructations, acidity, flatulent distention, heart-burn, oppression, gastric sensitiveness, &c, and secondly upon the nervous apparatus of the stomach, producing a train of severe neuralgic symptoms. The stomach sometimes becomes so seriously involved that the mucous membrane becomes thickened, softened, and in rare instances, ulcerated to a considerable extent. Severe paroxysms of neuralgic pains—usu- ally at the pit of the stomach, are not an unfrequent attendant upon the malady. We have known cases run through the entire second and third stages to a fatal issue, with scarcely a pain or other unpleasant symptom, except those which have been referred to the stomach__some- times by both patient and physician. The action of the urea, ammonia, &c, upon the intestinal mucous membrane produces flatulency, sensitiveness of the bowels, and diarrhoea • and post-mortem examinations now and then reveal redness, ulcerations and softening of portions of this structure. Bernard detected ammonia in large quantities in the stomachs and intestines of dogs whose kidneys had been extirpated. This ammonia is supposed to arise from the conversion of urea, either in the blood- vessels or in the digestive canal, from contact with the secretions it here meets with. •BRIGHT'S DISEASE OF- THE KIDNEY. 49 Brain and Nervous System.—Drowsiness, convulsions, and coma usually terminate the life of the patient. These symptoms approach gradually and increase in intensity for a period varying from a few hours to several days, when convulsions or complete coma extinguish life. fl In two instances we have noticed the frequent occurrence of involun- tary spasmodic twitchings in various parts of the body. These attacks are somewhat painful, mostly confined to special parts, but sometimes affecting several portions of the system at once. As a general rule, cerebral lesions are not found in these cases, not- withstanding the very grave character of this complication. The direct cause of these cerebral phenomena is ursemic, or according to Frerichs, ammoniacal contact with the cerebral tissues, or serous effusion into the ventricles. The immediate, effect of uraemic or ammoniacal poisoning upon the cerebral and nervous tissues, is to impair their vitality and to depress their ordinary manifestations. This is evident from the insidious ap- proach and progress of the symptoms; general indifference to sur- rounding objects ; somnolence ; slowness of speech; the patient is with difficulty roused to a full appreciation of what is transpiring around him, and seems to fall asleep in the midst of a conversation, with his eyes open; deep and slow respiration ; temporary confusion of ideas ; sluggish performance of all the functions. Cardiac Complications.—At an early period, Dr. Bright observed that an intimate connection existed between granular kidney and heart- disease. He supposed that the cardiac affections were for the most part due either to the stimulant action of the poisoned blood upon the heart itself, or upon the capillary circulation, affecting it in such a manner " as to render greater action necessary to force the blood through the distant subdivisions of the vascular system." Johnson," Rees, and other eminent English writers adopt the latter explanation. Hypertrophy and dilatation are the most common organic changes of the heart super-induced, or connected with chronic desquamative nephritis. And from the circumstance that valvular lesions are quite uncommon in these cases, it has been inferred that the abnormal blood constituents in their continual passage through the heart have stimu- lated its muscular structure into hypertrophy or dilatation. When the renal malady exists in gouty or rheumatic subjects, we shall sometimes find valvular lesions, fibrous depositions, and other serious organic changes which had been produced by these maladies before the existence of the kidney-disorder. Such instances render cases still more complicated and dangerous, both from the local and remote symptoms to which they give rise. It is highly probable that the kidneys and the heart often become affected simultaneously, and Vol. II.- 1. 50 DISEASES OF THE SANGUINOUS FUNCTION. from the same cause, in individuals suffering from gout. The action of the excessive quantity of uric acid, the urates, &c, in their constant passage through the heart, producing organic changes in this organ, and during their elimination through the kidneys, congestion of the tubuli uriniferi. In examples of this kind, both organs are affected 'with equal promptness and severity, and they should both receive prompt and efficient attention from the physician. Hepatic and Spleenic Complications.—These organs sometimes become involved during the existence of renal disease. For reasons similar to those which obtain in the production of pulmonary, gastric, cerebral and cardiac affections, the liver, and in all probability, the spleen take on morbid actions of various kinds, according to the con- stitutional, or acquired peculiarities of patients. Examinations of the alvine discharges during the progress of albuminuria, always indicate more or less disorder of the hepatic secretion. And if the same at- tention were to be given to the minute changes caused by the retained urinary excrements upon the liver and its secretion as has been be- stowed upon the kidneys and the urine, we have no doubt that much additional light would be thrown upon the intimate nature of the malady; and that many morbid conditions which are at present in- explicable could be satisfactorily explained. In the act of circulation the blood-poison is constantly brought into contact with almost all parts of the organism, and operates simultaneously upon those organs and tissues with which it has affinities—as for example, the kidneys, the skin, the liver, the lungs, the digestive apparatus, the serous membranes, &c. The results of these impressions are derangements of function or organic lesions, according to the amount of retained foreign matters in the blood, the nature and importance of the tissues involved, and the constitutional peculiarities of patients. And as a disordered function of one organ is often compensated for by extra and vicarious labors of other organs, a mutual morbid reaction is established between various tissues of the body for the general good. Each structure strives to ex- pel the noxious invader, each shares the general danger, and each re- ceives more or less injury. Johnson asserts that the liver is affected in a large proportion of cases of chronic nephritis, and assigns as a reason the frequent common origin of the two diseases, viz., high living and intemperance in the use of alcoholic liquors. This gentleman re- gards cirrhosis as the most common hepatic complication in these cases, although he has occasionally met with contraction and induration of the liver, with its usual concomitant ascites. Rheumatic and Gouty Complications.—The frequent occurrence of chronic nephritis in gouty subjects has been noticed by many writers. Upon the supposition that the renal affection was always associated with, and dependent upon a gouty diathesis, Dr. Todd gave to the third BRIGHT'S DISEASE OF THE KIDNEY. 51 stage of the malady the designation of Gouty Kidney. This hypothe- sis of Dr. Todd is doubtless erroneous ; but it is nevertheless true that the same abnormal blood constituents which produce the phenomena of gout, are also capable, under favorable circumstances, of developing desquamative renal disease. But as this is only one of many cases possessing similar powers, the designation of Dr. Todd is manifestly inappropriate. The renal affection is by far the most common in those cases of gout which appear to be associated with chronic eruptive dis- ease, especially porrigo and eczema. The skin and the kidneys are the two chief eliminators of the morbid blood-constituents, in both gout and rheumatism ; and it is for this reason that we so often find cuta- neous and renal complications in old cases of this description. The passage of the urates, uric acid, &c, through the cutaneous capillaries obstructs and retards their action, rendering them incapable of throw- ing oft' the effete matters presented to them, and thus causing the ac- cumulating matters to force their way out of the blood, in the form of vesicular or pustular eruptions. In passing through the kidneys the same substances often cause chronic nephritis. When brought in contact with the smaller joints they give rise to gout. Less frequently the renal affection has been associated with chronic rheumatism, and for the same reasons as those just adduced with reference to gout. Uterine Complications.—Of eleven cases of chronic albuminuria in females which have come under my observation, all but one had sup- pression of the menses during the continuance of the disease: This exceptional one had frequent and exhausting attacks of menorrhagia, which contributed much to hasten a fatal result. Johnson, while al- luding to the general absence of the menses in these cases, has observed menorrhagia in so many instances as to deem the circumstance worthy of special mention. Not unfrequently a sudden check to menstruation is the first link in the morbid chain of symptoms, wdiich lead to al- buminuria; and it is not impossible that a vicarious menstruation through the kidneys may in some instances develop in them the malady in question. Rayer suggests that the constant drain from the blood of its hfematosin, induces such a condition of anaemia as to arrest men struation from pure lack of vitality necessary to sustain this function. Altkrations of the Blood.—In estimating the composition of the blood in albuminuria, regard must be had, firstly, to the primary causes of the blood-contamination, and, secondly to their effects upon the kidneys, and the further alterations of the blood from renal obstruction. If the original blood-poison be one of a transient nature and easy of elimination, the issue will probably be favorable; but if the primary cause is of a chronic character, persistent, deep-seated, readily reproduced, and diffi- cult of removal, our opinion respecting the final result must be unfavorable. In the first category may be included retained perspiration, scarlatinal, *L DISEASES OF THE SANGUINOUS FUNCTION. erysipelatous, typhoid, choleraic, alcoholic, and other similar agencies; while in the latter class Ave may place chronic gout and rheumatism, certain chronic cutaneous affections, constitutional syphilis, scrofula, incurable hepatic, cardiac, and pulmonary disorders, deleterious drugs, &c. Healthy blood may be said to consist of three separate elements, viz: 1, the red globules, suspended in their colorless liquor; 2, fibrine; 3, serum, composed of albumen dissolved in alkaline water. Besides these principal elements it contains phosphates of magnesia, ammonia, and lime, lactates of soda and magnesia, and common salt. The analy- sis of Dumas of 1000 parts of healthy blood gives 790 of water, 127 of globules, 3 of fibrine, and 80 of solid constituents of the serum, of which 8 are inorganic. Any material alteration of these normal con- stituents induces more or less derangement of the general health ; and the presence of either of these elements in the urine is a sure indication of serious renal lesion. So any addition to the blood of substances foreign to it, must of necessity give rise to more or less disturbance, according to the nature of the contaminating agent. The most pro- minent alterations of the blood in chronic Bright's disease are, defi- ciency of albumen in the serum, which is usually of low density, great diminution of the red globules, and the retention of certain urinary ex- crements—urea, uric acid, and the several retained salts of the urine. Andral and Gavarret made five analyses of the blood in many different cases of the disease, and with the following average result: of 1000 parts of blood, they found a considerable increase of Avater (837-1 in place of 790; nearly the natural quantity of fibrine (2'7 in place of 3); a marked diminution of the red globules (91-8 in place of 127); a not- able diminution of the solid matters of the serum, and especially of albumen (684 in place of 80). Until a recent date it has been supposed that most of the secondary morbid phenomena incident to this affection, were due to the presence of urea in the blood, and to the action of this substance upon the various tissues of the organism. From this hypothesis the malady has received the designation of urcemia. But the experiments of Frerichs have placed this matter in a new light. This gentleman denies that the blood-poisoning is due to urea, but attributes it to carbonate of ammonia, which has been formed from this substance within the blood vessels. He infers this from the following circumstances : ammoniaca l odor of the breath; chemical indications of ammonia in the breath • traces of ammonia in the alvine discharges, and in several secretion \ of the body—the perspiration, bile, and certain mucous and serous se cretions; and an abnormal quantity in the blood, (of which it i natural constituent, and serving to retain it in a fluid state). As an additional confirmation of this view Frericks adduces the fa BRIGHTS DISEASE OF T.'.E KIDNEY. 53 that large quantities of urea are sometimes detected in the blood of patients who remain free from all cerebral, and other symptoms, Avhich are supposed to be peculiar to uraemic poisoning. Injections of urea into the blood-vessels of dogs have also been made Avithout producing its supposed characteristic effects upon the organism; while similar in- jections of carbonate of ammonia have speedily induced convulsions. Another circumstance confirmatory of this opinion of Frerichs, may be found in the fact that the pathogenesis of carbonate of ammonia cor- responds very closely with the phenomena of Bright's Disease. The following symptoms from " Jahr's" Symptomen-"codex,'' page 67, de- monstrate this: "dropsical swellings; the head feels muddled, dull, stupefied; great difficulty of breathing, especially in ascending a few steps, or on making the least exertion ; frequent palpitation of the heart; severe dyspeptic symptoms ; great emaciation of the whole body; comatose conditions; convulsions." Both urea and carbonate of ammonia are normal constituents of healthy blood, the latter in all probability being converted from the former by the action of the albu- men of the serum Avithin the blood-vessels, and so long as the proper proportions are maintained, no disturbances or derangements of function occur; but when urea in excess pervaoes the blood, it is rapidly con- verted into carbonate of ammonia, the blood becomes poisoned, and the secondary effects of chronic nephritis due to the action of carbonate of ammonia, manifest themselves. When Ave remember Avith what facility urea may be converted into carbonate of ammonia by contact with fermentescible substances like albumen, mucus, and certain al- kalies, and that several of these substances are always present in the blood of patients suffering from albuminuria, the hypothesis of Frerichs will not appear unreasonable. So long as the normal composition of the blood remains unchanged, only the necessary quantity of ammonia to retain it in a fluid state, is con\*erted from the circulating urea; but Avhen this condition becomes changed, and neAV elements are added to the blood, other affinities occur, new chemical action takes place, in- ordinate quantities of ammonia are formed, and ammoniacal poisoning results. Schetlein and Renling object to this hypothesis, because that am- monia (CO2 Az H3) is expired during the course of many diseases, typhoid fevers, yellow fever, cholera-asphyxia, malignant erysipelas, small-pox, scarlet-fever, and similar maladies, and also in the death agonv. In these instances the ammoniacal breath is caused by an actual loss of vitality and consequent decomposition of the blood, by which the ammonia which holds it in solution, is set free and allowed to escape through the lungs. In chronic nephritis quite a different condition obtains, since there is no actual decomposition of the blood, and no diminution of the normal amount of ammonia; but a constant 54 DISEASES OF THE SAXGUINOUS FUNCTION. excess of this substance derived from the retention and conversion of urea. Nature strives to eliminate this superfluous agent through the lungs, the intestinal canal, the skin, and perhaps other channels. It is doubtless true that urea also exerts a deleterious influence upon the system when existing in excess in the blood; but its toxical properties are much less important than those of ammonia. Other retained urinary substances are likewise capable of poisoning the blood. Gallois has repeatedly demonstrated this fact with regard to an excess of uric acid in the blood. This agent poisons in a less dose Avhen injected into the blood than when taken by the stomach. It causes acceleration of breathing, trembling of the limbs, jerking of the muscles, subsultus, convulsions, tetanus and death. Pathological Condition of the Kidneys.— The following is an excellent general description of the condition of the kidneys in this form of the disorder. " The kidney is still much larger and heavier than is natural, and smooth on its surface; but the sanguine congestion is diminished, or gone; Avhile the inflammatory exudation into and among the proper tissues of the glands is great and manifest. This exudation, by its presence and its pressure Avithin and around the tubules, empties the capillary vessels of their blood, and keeps them empty. The cortical portion of the kidney, still unduly broad, loses its red color, becomes pale or yellowish, and contrasts more strongly with the red lines of the pyramidal bodies. Gradually the matters exuded suffer further change, and sometimes undergo a fatty degeneration. The tubules lose their uniform cylindrical shape, and bulge a little here and there; their epithelial cells enlarge, become opaque, contain granular matter, and perhaps oil-globules ; finally, they crumble down, and are partly washed aAvay with the aqueous portion of the urine which proceeds from the Malphighian bodies."* The kid- neys are generally enlarged, slightly deformed, and a little augmented jn consistence. Granulations on red or grayish ground of the size of millet-seeds, accumulated or isolated, and appearing whiter than the rest of the tissues—more abundant at the tAvo extremities, and towards the outside of both kidneys.. The cortex thickens at the expense of the tubular substance. Authors have differed so much respecting the classifications of the various forms of the disease, that some confusion exists in their svmp- tomatic and pathological description. Thus, Dr. Bright recognizes three forms or varieties: Martin Solon admits five degrees or varieties: M. Rayer makes a general division of the malady into acute and chronic albuminous nephritic, and then subdivides these into six other forms—two pertaining to the acute, and four to the chronic stao-e of * "Watson's Practice of Phys.," p. 1028. bright's disease of the kidney. 00 the disorder: Christison admits only three degrees of the disease, the tAvo first characterized by similar anatomical conditions of the kidneys, Adz., a deposit in the cortical substance of a grayish yellow matter, slightly granulated in the first degree, and decidedly so in the second degree, the granular substance resembling cheese, and involving chiefly the cortical substance. He usually found more sanguineous congestion in the first, than in the second degree. In the third or last degree, the morbid deposit gradually invades the remaining tissue of the kidneys, impairing to a greater or less extent their normal structure and functions. By this it will be perceived that Christison recognizes only one kind of morbid change for all of his three degrees, the differences consisting in the extent rather than the kind of morbid action. Bright denies the existence of any morbid deposit in the first form : but as- serts that the cortical substance is transformed into a granular tissue in the second form. In this second form he always found the kidneys still larger than natural, and that he could render the granulations more distinct by maceration. The third, fourth, and fifth forms of Mr. Rayer, and the second and third degrees of Martin Solon, cor- respond with sufficient accuracy for practical purposes, to the second stages of the English writers. In all instances, the volume and weight of the kidneys are above the normal standard, the red and marbled spots peculiar to the acute form, have diminished or entirely disap- peared, granular deposits are found in the cortical substance, and some- times in the tubular cones, more or less thickening of the mucous membrane of the pelves and calices of the kidneys, the external sur- face of the kidneys is ordinarily of a pale yelloAV color, but is noAV and then dotted Avith milk-Avhite spots, and glossy, or, in a very feAv cases, with a feAV brown or slate-colored spots. One of the most direct and important effects of the disease upon the renal glands, is the partial or total destruction of the epithelial lining of the convoluted tubes. During the earlier periods of the affection, the cells are not ordinarily detached in very large quantities, and as these are Avashed off rapidly by the watery portion of the urine from the Malphighian bodies, the renal function is only moderately disturbed. But after the desquama- tive process has continued for a considerable period, a greater or less accumulation of epithelial cells takes place in the tubes, and they be- come so much choked up and obstructed as to prevent their reformation. In the mean time they become disintegrated, the tubes are distended, pressure is made against the remaining epithelial linings of the tubes and the Malphighian bodies, thus adding an additional cause of irritation to the renal structures. "A microscopic examination shoAvs that some of the tubes become so completely filled by their epithelial contents, that a further formation of cells within them is impossible for Avant of room, so that the re- 55 DISEASES OF THE SANGUINOUS FUNCTION. production of epithelium appears to be entirely arrested."* After this process of desquamation and disintegration have continued for some time, "the basement membrane of the tube is thus left quite denuded, or Avith only a feAv broken particles of epithelium scattered over its sur- face."! Dr. Johnson describes another process by which the tubes become destroyed without any actual desquamation of epithelium. This process is denominated disintegration of the epithelial cells. In the process of desquamation the cells are throAvn off from the basement membrane into the convoluted tubes, entire, and are either washed out of the tubes by the watery part of the urine, or accumulate within them to their injury. "Disintegration may occur, however, either in the cells which have accumulated in the tubes after being shed in an entire form by a process of desquamation," or in those still attached to the tubes. "With reference to the two processes, already alluded to," remarks Dr. Johnson, "by Avhich the epithelium becomes disintegrated, I have observed that only the true desquamative process leaves the tubes quite denuded, and that the disintegration of the epithelium, unaccom- panied by desquamation, destroys the tubes Avithout a previous denuding process."......Apparently the most common "result of the destruction of the epithelium, is the gradual Avasting of the tube."......"The materials Avhich are occasionally found in the degeneration of the tubes are, first an unorganized fibrinous or albuminous material; second, oil; and third, serum."^: Johnson supposes that this fibrinous or albuminous material is secreted by the basement membrane after the destruction of its epithelial cells." After the convoluted tubes have become denuded by the destruction of their epithelium, they occasionally become dilated into transparent cysts, containing serum, and sometimes thick and discolored liquids. In other and rare instances, some of the denuded tubes become lined with transparent nucleated cells, which are supposed by Johnson, to serve as a substitute for the normal epithelium, and Avhose office is "to secrete a serous or watery liquid." Respecting the condition of the blood-vessels, they become distended with blood of a vitiated quality, their linings become irritated and thickened, and their entire structures become so enfeebled as to impair, or suspend their normal functions. In allusion to this subject Johnson remarks: §"the ap- pearances which I have observed in the blood-vessels are such as in- dicate an impediment to the circulation through the inter-tubular capil- laries, and a consequent increase of pressure upon the vessels Avhich in the order of the circulation, lie behind these. The Malphio-hian * •' Diseases of the Kidney," by Geo. Johnson, p. 212. f Loc. cit. % Johnson § Diseases of Kidneys, p. 228. BRIGHT'S DISEASE OF THE KIDNEY. 57 capillaries and the arteries have their coats remarkably thickened, while the walls of the inter-tubular capillaries and of the emulgent vein present no appearance of hypertrophy or thickening." "We consider the nature of Bright's disease* to consist in an in- flammatory process, which proceeds' from a stage of hyperaemia to one of stasis, and then gives rise to a product, which is not only remarkable by its peculiar character, but which, in well-marked cases, by its ex- cessive accumulation, causes a singular alteration in the appearance and structure of the kidney. It commonly runs, as we have already stated, a chronic course, Avith. occasional exacerbations, but it is some- times acute." The following are among the pathological degenerations obser\red with the microscope by Kolliker in Bright's disease, f " The membrana propria is frequently thickened to O'OOl, or even 0*002 of a line, when it often presents, on the inner aspect, very delicate, closely approxi- mated, transverse striae. The epithelial cells, particularly in the cortical substance, frequently contain oil-drops in considerable quantity, so as often to present a deceptive resemblance to the cell of a fatty liver, and at the same time they are usually enlarged to a diameter of 0-02 of a line. Together writh the oil, pigment granules (of the coloring matter of urine?) occur in them (also in the straight canals), whereas the concretions of uric acid and calcareous salts, which are so frequently met with in the canals of the tubes in the vertebrata, have not as yet been demonstrated with certainty in the cells themselves. Colloid- like, bright yellow masses are very frequent in the epithelial cells, which then most usually increase in size, dilate into slender cysts as much as 0*05—0*072 of a line long, and finally, by bursting, empty themselves of the colloid substance, whence the latter is found free in the uriniferous' ducts, and also in the urine."...... "The Malphighian bodies may also expand into cysts, in Avhich, to- gether Avith a clear fluid, the atrophied glomerulus is often visible on the Avail." "The tubuli uriniferi contain fibrine, in cylindrical masses, corres- ponding to the cavities of the tubules, and also the above-mentioned colloid-like substance ; concretions in the ducts of Bellini, consisting, in the adult, chiefly of carbonate and phosphate of lime: in new-born infants, of uric-acid salts, which give the pyramids a brilliant golden- yellow color, and, if not exclusively, still only occur in children avIio have already respired (betAveen the third and twentieth day after birth)." Diagnosis and Prognosis.—The principal phenomena which pertain to chronic albuminuria are the folloAving: urine pale and Avatery, some- • Itukitanski's Path. Anat, Vol. I. p. 155. f Diseases of the Kidneys, p. 228. 58 DISEASES OF THE SANGUINOUS FUNCTION. times slightly turbid, or smoky—usually augmented in quantity—of a diminished specific gravity—of an insipid odor resembling beef- broth—persistently frothy on agitation—albuminous—deficient in urea and the normal salts, and containing "granular casts," scattered portions of disintegrated epithelium, and a feAV entire epithelial cells; oedema of the feet and ankles, afterwards extending to the legs and thighs, and often general infiltration of the cellular tissue, and effusions into the serous cavities; unusual paleness of the skin, in consequence of the poverty of red-globules in the blood; excess of urea, carbonate of am- monia, and urinary salts, and a diminution of albumen and red-globules in the blood; and in a majority of cases dyspeptic symptoms, dryness of the skin, and habitual dyspnoea, especially on making any exertion. From acute albuminuria it may be distinguished by the lighter color of the urine, its greater quantity, its lower specific graArity, the pre- sence of granular casts, and scattered bits of disintegrated epithelium, absence of blood-globules, less renal irritation and pain, less febrile disturbance, and the less rapid progress of the malady. From hepatic, cardiac, and other forms of dropsy, as well as from other maladies haAdng similar symptoms, it may be recognized by the presence of albumen, and disintegrated epithelium in the urine. The prospects of recovery will depend upon the duration and extent of the renal affection, the secondary complications to which it has given rise, and the curability or removal of the acting cause. If the con- voluted tubes have entirely lost their epithelial lining, and other formations have taken their place, like cysts or morbid deposits; or if the tubuli often having been denuded of epithelium, have shrunken and become nearly obliterated, a cure must not be expected. This con- dition Avill be indicated by the gradual diminution in the urine, of epithelium, the continued absence of urea and the normal urinary salts, the persistent diminution in the density and lightness of color of the urine, paleness of the skin, great emaciation, dropsical infiltrations and effusions, and other secondary ailments. A sudden diminution of the urinary secretion, especially in advanced stages of the disease indicates immediate danger. The most common and dangerous of these se- condary affections are inflammations of the serous membranes of the thorax, abdomen, and brain, or effusions into their cavities. Of these the cerebral complication is the most alarming, and the one which most frequently terminates life. Next in importance to this are effusions into the pleural and peri-cardial cavities, from Avhence proceed the distressing paroxysms of dyspnoea and palpitation of the heart Avhich so often afflict the subjects of this malady. When one or more of these serious complications are present, and the abnormal conditions of the urine above alluded to obtain, the prognosis will be unfavorable But Avhen the exciting cause, is susceptible of ready removal like bright's disease of the kidney. 59 abuse of alcoholic liquors, and exposure to a cold and humid atmosphere, and the renal desquamation has not been of long-standing or extensive, a reasonable expectation of cure may be entertained. Valleix in his " Guide du Medecin Practicien" p. 154, presents us with the following diagnostic table. Chronic Bright's Disease. Urine pale, smoky, and having an insipid odor. Its density is diminished; and it has lost most of its salts and urea. Albumen in considerable quantity, and always present. (Edema almost always commences in the lower limbs ; and ascites comes after- wards. Other slight symptoms of Bright's dis- ease. Acute or Chronic Bright's Disease. No fever (chronic form) or slight fever (acute form.) Dropsy. Never Suppuration-. Pain in the kidneys wanting or slight. No painful retraction of the testicles, nor pains in the grandes levres, &c. Albuminous Urine of Bright's Disease. No purulent globules. Urates and phosphates in less quantity than natural. Other symptoms of Bright's disease. No pellicle (cremor) on the surface. Other Chronic Affections which produce Dropsies. Urine of a normal color, and preserv- ing a urinous odor. Density normal; salts and urea normal. Albumen in small quantity ; and only appearing transiently. In diseases of the liver, ascites precedes oedema. Characteristic symptoms of diseases of the heart, liver, &c. Simple Acute or Chronic Nephritis, with Albuminous Urines. Always pretty well marked fever. No dropsy. Often terminates in suppuration. Pain in the kidneys more or less severe. Painfitl retraction of the testicles, and pain in the grandes levres, &c. Urine rendered Albuminous by the Pressure of Pus. Purulent globules, distinguishable by the microscope. Salts often more abundant than in the normal state. Symptoms of inflammation of the urinary passage. Pellicle (cremor) on the surface, after a few hours repose. Treatment.—Aconitum-napellus.—Sympto?ns: face pale, sunken and bluish ; stupid expression of countenance ; skin of a deep yelloAV, or white color; heat and dryness of the skin ; coldness of the extremities ; sleepless and restless at night; sudden sinking of strength; paroxysms of suffocation with anxiety, and aggravation of the difficulty in the evening; respiration short, imperfect, irregular? with feeble pulsations of the heart; shortness of breath, especially when sleeping, after mid- 60 diseases of the sangulnous function. night, or when rising from the recumbent posture; pressure in the stomach and hypochondria accompanied with paroxysms of shortness of breath, and even asthmatic symptoms; pleuritic, pneumonic, and cardiac complications; nausea, vomiting, thirst, general heat, profuse sweats, and enuresis; peritonitis; ascites; pains in the loins; sensi- tiveness in the, region of the kidneys; numbness in the small of the back, extending as far as the loAver limbs; drowsiness; he sleeps while sitting in his chair with his head bent forward ; dyspnoea, convulsions, paralytic Aveakness and death; general convulsions ; convulsive move- ments of separate parts, the cheeks, extremities, &c.; stupor with con- vulsive motions of the facial muscles, and the eyes closed; loss of con- sciousness during the convulsions; copious discharge of urine, which deposits a red sediment after standing; retention of urine; enuresis, sometimes accompanied with profuse SAveat, diarrhoea, and colic. Pathology.—See page 29 of this volume. Clinical Remarks.—When the renal affections become complicated with disease of the serous membranes, like pleuritis, peritonitis, and arachnitis, Aconite will prove an important remedy. So likeAvise, in hepatic, pneumonic, enteritic, and other inflammatory complications, it must always be regarded as one of our most valuable medicines. In such cases it must be looked upon in the light of an auxiliary rather than as a direct local specific. The symptoms are usually Avorse in the evening and early in the morning. Ammonium-carbonicum.—Symptoms: face pale and bloated; pale- ness of the face with physical and moral weakness ; muscles soft and flabby; impaired memory; mind dull and confused; drowsiness in the day time; uneasy, disturbed and unrefreshing sleep at night; extreme lassitude and sense of fatigue ; Aveakness of digestion; pressure at the stomach, nausea, and oppression after eating; dyspnoea and palpitation of the heart after every exertion; difficult breathing at night; painful oppression of the chest; pain in the small of the back, increased by motion or walking; bruised or shooting pains in the region of the kid- neys ; violent throbbing pain in the small of the back and in the loins when at rest; drawing pain from the small of the back, extendino- to the abdomen and hips ; spasmodic tAvitchings of the arms ; convulsions * fre- quent urging to urinate especially at night; involuntary emissions of urine at night; urine turbid, whey-like, and very ammoniacal and musty smelling; discharge of urine leaving chalk-like spots; cloudy, reddish urine mixed with blood; symptoms worse in the evening and in the open air. Pathology.—Lining membrane of the kidneys inflamed and thick- ened; kidneys enlarged, soft, of a light-yellow color, and the convoluted tubes obstructed with detached epithelial cells (in animals). Clinical Remarks.—This medicine has proved very beneficial in bright's disease of the kidney. 61 albuminous nephritis folloAving scarlatina, typhoid fe\ers, malignant erysipelas and small-pox. In such cases we have observed unequivocal benefit from the employment of the lower attenuations. A reference to the pathogenesis above given will enable the physician to determine its homoeopathic relations with special groups of morbid symptoms. Apis-mkllifica.— Symptoms: paleness of the face; cedematous swellings of the face, and extremities; nausea, eructations, heart-burn, rapid breathing at night; difficult and anxious respiration after exer- cise ; hurried and difficult respiration with fever and headache ; pain and soreness in the region of the kidneys on pressure or on stooping; con- stant dull pains in both kidneys, with very small secretion of red urine; frequent and copious discharge of urine; repeated micturition eA'ery few minutes ; burning in the urethra before and after micturition; fre- quent and painful urging to urinate, Avith scanty discharges of urine mixed Avith blood. Pathology.—(See Apis, p. 31, this Volume.) Clinical Remarks.—This is undoubtedly one of our most valuable remedies in both the first and second forms of Bright's disease. If ad- ministered in doses sufficiently attenuated, it Avill often afford marked relief, and sometimes effect permanent cures. It is to be regretted that more careful experiments have not been made with reference to its special action upon the kidneys, and the morbid alterations it produces upon the secreting tubes and other portions of the renal tissue, as well as in the urine. This defect in proving, applies to most other drugs as Avell as to this one. Apo<'vnum-cannabinum.— As a palliative in removing the dropsical accumulations consequent on this form of renal disease, this medicine is held in high estimation by many physicians of our school. Several medical men of this city are in the habit of prescribing "Hunt's de- coction," and, as they assure us, Avith much success. (See Apocynum- cannabinum, p. 82, this Volume.) Arsenioum-album.— Symptoms: face pale and sunken; or lead- colored, or bluish, or yelloAV, livid and disfigured; face swollen from anasarca; face bloated, puffed, and red, or pale. Emaciation. General anasarca. Dropsy of the chest with the usual concomitants, suffocative oppression, and arrest of breathing, in the evening, or at night in bed; anxious and oppressive shortness of breath on Avalking, or on making any exertion; palpitation of the heart, particularly at night. Abdominal dropsy Avith the usual concomitants, indigestion, oppressive respiration, &c. Nausea, vomiting, eructations, distention and burning of the stomach after eating, sensation of faintness at the stomach, tremulous- ness of the body. Pain in the kidneys, extending towards the bladder, and then vesical tenesmus. Sense of fullness and congestion in the renal region. Turbid urine which deposits a sediment and looks like 62 diseases of the sanguinous function. clay. Urine alternately increased and diminished. Thick, cloudy, pus-like urine. Frequent urging to urinate, especially during^ the night. Involuntary micturition, even at night during sleep. Urine colorless, turbid, albuminous, and depositing a slimy sediment. ^ Fre- quent, painful, and difficult micturition. Urinary secretion diminished or suppressed. Spasms. Convulsions. Coma. Symptoms Avorse in the evening, at night, and after eating. Pathology.— A reference to the pathology of Arsenicum will de- monstrate from a pathological point of vieAv, its strong homoeopathic relations to this form of renal disease. Both the morbid alterations of the glands and of the constituents of urine, bear a most striking analogy of the present malady. Clinical Remarks.—We have already alluded to the remarkable homocopathicity of this medicine to acute Bright's disease. It Avill be found equally appropriate in the chronic varieties of the affection. Indeed, when the renal disease is accompanied Avith dropsical effu- sions, or serious gastro-intestinal disorder, we regard Arsenicum and Apis as our tAvo most reliable remedies, for they correspond not only to the local and immediate symptoms of the renal disorder, but to the more serious and secondary constitutional phenomena. These maladies act best at the medium and higher attenuations. Asparagus-officinalis.— Symptoms.—DroAvsiness, lassitude, and dullness of intellect. Rapid and irregular pulsations of the heart, worse on exercise. Oppression of breathing, aggravated by exercise. Slight pains in the kidneys, felt mostly during the afternoon. Emission of a small quantity of pale, yellow urine, which soon becomes turbid and filled Avith a whitish dust, which settles after a few hours, leavino* the urine clear: after the vessel has been emptied and rinsed, a fatty substance was observed to adhere to its Avails. Urine abundant, limpid, and exhaling an odor sui generis. Frequent and painful micturition. Pathology.—See page 35, this Volume. Clinical Remarks.—This drug possesses but few symptoms which correspond to this form of the affection. In the few instances where it has apparently afforded some relief, it has been employed in from the third to the twelfth dilutions. Astacus-fluviatilis.—Symptoms: face and eye-lids puffed, great prostration of strength, and slight delirium. Drowsiness and tendency to stupor—internal coldness, great sensitiveness to the open air. Trem- bling in the right renal region. Sudden tearing pain in the right renal region, when sitting down. Emission of a large quantity of pale yellow, and acid urine. Urine containing much albumen. Urine of a deep-yellow color and leaving a deposit. Clinical Remarks.—We have prescribed it with benefit in one case of chronic albuminuria, which appeared to be connected with gout and BRIGHT £ DISEASE OF THE KIDNEY. 63 chronic eczema. A persistent use of the sixth dilution of this remedy for a period of four weeks, tAvice daily, appeared to ameliorate all of the symptoms. Digitalis-purpurea.— SympAoms: paleness of the face; general paleness of the skin. Anasarca. Emaciation of the body. Puffiness of the cheeks and lips. Dull, heavy pain in the head; difficulty of concentrating the mind; pressing or burning pains in the vertex or fore- head ; vertigo and trembling; drowsiness or lethargy; uneasy, unre- freshing sleep ; sleep disturbed on account of frequent desire to urinate. Great weakness. White fur upon the tongue; nausea, vomiting; pt}Talism; burning, or lancinating, or pressing, or spasmodic pains in the stomach; sense of great Aveakness in the stomach. Contractive, or pressing, or cramp-like pains in the abdomen; ascites; diarrhoeic stools. Pain in the region of the kidneys as if bruised, vriien stooping or mov- ing about. Frequent desire to urinate during the night; excessive emission of small quantities of Avatery urine; frequent and copious emission of watery urine. General dropsy Avith hypertrophy of the heart, and other organic affections of the heart. Dropsy of the chest. Ascites. Ascites and anasarca with organic affections of the heart. Rapid and difficult respiration on exercising. Asthmatic respiration on Avalking. Pulse frequent, or slow and Aveak. Involuntary twitch- ings of the fingers, thumbs, and other muscles of the body. Spasms Convulsions. Pathology.—See Digitalis, p. 38, this Volume. Clinical Remarks.—It is supposed to be especially useful when there is a tendency to waxy or fatty degeneration of the kidney. When the renal disease is associated with an organic affection of the heart, it is often an indispensible remedy. It is supposed to operate favorably in patients of scrofulous dyscrasias, or in those who have been enfeebled by injudicious allopathic medication. Kali-hydriodicum.—Symptoms: face pale and swollen; oedema of the eye-lids. General feelings of malaise. Frequent attacks of dull- ness and heaviness of the head. Restless, confused sleep. Burning pains in the pit of the stomach. Dry hacking cfcugh, with rapid and oppressive breathing. Pleuritis. Bruised pain in the small of the back, particularly troublesome at night. Darting pains in the small of the back when sitting. Painful urging to urinate. Nightly urina- tion. Frequent and copious emission of pale and Avatery urine. Dis- charge of mucus from the urethra. Diminution of the red globules of the blood. Emaciation. Pathology.—See page 40, this Volume. Clinical Remarks.—Especially appropriate in renal disorder con- sequent upon chronic rheumatism, or gout, or which appears to be con- nected with constitutional syphilis, mercurial cachexia, or scrofula. It 04 DISEASES OF THE SANGUINOUS FUNCTION. is more frequently indicated in the stage of inflammatory exudation, than in the acute stage. Its action upon the exudated matter is such as to promote its absorption, and upon the obstructed tubuli, to restore their impaired function. Kali-nitricum.—Symptoms: drowsiness; heaviness, pressure, and dull pains in the head. Gastric and intestinal derangements; foetid breath. Sudden swelling of the body, neck, and thighs. Oppressed breathing on ascending a stairs ; violent palpitation of the heart, and dyspnoea in the night, when lying on the back, or on the right side, or when moving about quickly. Pain in the small of the back in any po- sition—constant, or in the morning on Avaking, or in the evening, or during the night, of a bruised, or pressing, or cramp-like, or burning character. Spasmodic, painless jerkings of the fingers and hands. Pulse below the natural standard. Frequent emission of a pale, turbid urine; increased urine with reddish deposits, or Avith a mucous sedi- ment; urine of a specific gravity varying from 1030 to 1040. Clinical Remarks.—This is certainly a valuable remedy against the distressing paroxysms of oppression of the chest, and difficulty of breathing, which so often afflict patients suffering under granulated kidney. But it does more than afford relief to the dyspnoea, and other symptoms arising from dropsical accumulations ; as several physicians have observed that patients have occasionally been permanently bene- fitted after the use of the remedy. Its best effects ay ill be derived from the medium and higher attenuations. Merctrius-iodatus.— Symptoms: face pale, wTaxen, and chlorotic in appearance. General anasarca. Paleness of the skin; dryness of the skin. Irritation and ulceration of the mucous membrane of the air-passages. Foetid breath; putrid or coppery taste. Paroxysms of rapid and difficult breathing, and pleuritic pains in the chest. Nausea; vomiting; eructations; bilious diarrhoea; dysenteric discharges from the bowels. Scrofulous degenerations of the glandular system. Morbid excitability of the nervous system. Dull pains in the renal region. Urine either increased or diminished in quantity, and of high density. Pathology.—See page 41, this Volume. Clinical Remarks.—OAving to the paucity of pathogenetic observa- tions, physicians have been obliged to employ this medicine more or less empirically. In my own practice, I have regarded its pathogene- sis as similar to that of the other mercurial preparations, and have pre- scribed it in accordance Avith this general resemblance. This mode is neither scientific nor accurate, but the good results I have observed from the remedy have induced me to persist in its use. That it exer- cises a special control over this condition of inflammatory exudation modifying favorably both the morbid state of the kidneys themselves and of the blood, and thus ameliorating, and in some instances curing bright's disease of the kidney. 60 the totality of the symptoms, Ave entertain no doubt. Indeed, we be- lieve it to be equal, and, in some cases, superior in value to Arsenicum, Apis, or corrosive Mercury; and it is highly probable that future ex- perimenters will confirm this opinion pathogenetically, pathologically and therapeutically. Mercurius-sublimatus-corrosivus.—Symptoms: pale, Avaxen color of the skin of the entire body ; paleness of the face ; bluish paleness of the face ; puffiness of the face ; SAvelling of the head and face ; anasarca of the face and limbs. Deranged digestion: nausea; vomiting, and burning pains in the stomach ; foetid breath. Shortness of breath ; ex- cessive dyspnoea; palpitation of the heart. Disposition to stupor; transitory soporous conditions; headache. Spasms in all the limbs. Urine increased in quantity, light, and albuminous; urine scanty, red, and albuminous ; suppression of urine. Pathology.—Kidneys enlarged, soft, and somewhat congested. Clinical Remarks.—The marked specific action of this medicine upon the kidneys, its power in promoting absorption of cxudated mat- ters into the renal tissues, and its influence as a modifier of the morbid action peculiar to this stage of Bright's disease, render it a highly ap- propriate remedy. For the reasons adduced when alluding to this drug, we advise the employment of the medium attenuations. Mercurius-solubilis. — Symptoms: general paleness of the face and of the skin; white, clay-colored face. Puffiness of the face. Drop- sical swellings of the feet and legs. DroAvsiness during the day, and sleeplessness at night. General weakness, languor, and lassitude. Tongue covered with a white fur, and somewhat SAvollen. Foetid smell from the mouth; nausea increased by eating; bitter vomiting; great pain at the pit of the stomach, Avorse wrhen pressed upon. Ascites; shortness of breath, and dyspnoea, especially on ascending a stairs, or on Avalking. Bruised, or stitching pain in the small of the back. Spasmodic tAvitchings of the fingers and hands. Frequent desire to urinate, with scanty discharges; frequent urination during the night; urine turbid even while leaving the urethra, and depositing a sediment; flocculent discharges at the end of urination. Symptoms Avorse during the night. Pathology.—The morbid renal alterations induced by this mercurial, are probably similar to those of Mercurius-sublimatus-corrosivus—en- largement, softening, and slight congestion. Clinical Remarks.—Chiefly applicable in syphilitic, hepatic and diarrhoeic or dysenteric complications; but quite secondary in im- portance to the tAvo preparations last described. Mercurius-vivus. — Symptoms: face le*ad-colored and bloated. Ptyalism, exhaustion, delirium, convulsions and death. Bad digestion; putrid breath; nausea; vomiting; white, apthous-like fur upon the Vol. IL—5. 66 DISEASES OF THE SAXGUINOUS FUNCTION. tongue, extending to its under side. Debility, languor, pains in the limbs, emaciation. Dull pains in the small of the back on Avalking, or lifting any thing. Pathology.—Probably like Mercurius-corrosivus, it is capable of giving rise to enlargement, softening, and congestion of the kidneys; but there are not a sufficient number of facts at the present time to en- able us to determine its precise pathological relations Avith these glands. Clinical Remarks.—This medicine has been found useful in chronic albuminuria of children, complicated with marasmus and bowel affec- tions, or with constitutional syphilis. In a few eases of this kind it has appeared to ameliorate the morbid group with more promptness and certainty than the other forms of mercury. If the little patients are emaciated, weak, languid, Avithout appetite, and troubled Avith bilious or dysenteric discharges, it Avill be certain to afford relief. Terebinthina.—Symptoms: face pale and sunken. Anasarca ; as- cites; general dropsy. Stupefaction, and deep sleep; confused and languid on waking; relieved by copious and rapid micturition. In- creased menstruation. Dyspnoea; difficulty of breathing, with a sense of congestion of the lungs. Sensation of heaviness and pain in the kidneys ; pain and sensation of increased warmth in the loins ; pressure in the kidneys when sitting, and going off during motion; aching pains in the left kidney; drawing or burning pains in one or both kidneys, extending to the hips. Urine clear, watery, and profuse ; enuresis ; urine of a wine color, of the odor of violets, and depositing a thick, muddy, light-yellow sediment; urine depositing a slimy sediment tAvelve hours after micturition. General languor and loss of strength. Pathology.—See page 43, this Volume. Clinical Remarks.—Several distinguished homoeopathic physicians have commended this medicine highly in both the first and second stages of Bright's kidney. We have found it most serviceable in those cases which appear to have been associated with chronic irritations at the neck of the bladder, strictures, and irritable bladder. 4. NEPHRITIS SIMPLEX.—INFLAMMATION OF THE KIDNEYS. Diagnosis.—Inflammation of the kidneys commences with the or- dinary febrile symptoms, |ike slight chills, hot and dry skin* thirst: frequent and hard pulse, either accompanied from the first, or speedily succeeded by deep-seated, aching pain in the region of the kidneys which soon becomes acute and pulsative; urine scanty and hiis, Arsen., Calc, Cannabis, Conium, Kali-iod., lycop., Mer., Staphys. Purulent Ophthalmia, or Blennorrheea jEgyptiaea, as Avell as the ophthalmia neonatorum are of sycotic origin. The first appears parti- cularly after re-vaccination among the soldiery. Dr. Wolf proposes Thuja as the remedy, though he has tried it in but feAV cases. He suc- ceeded in some with Aconite and Apis. The same treatment Avill also cure chronic ophthalmo-blenorrhoea. The greatest danger is produced by the localization of the sycotic poison in the brain, where it causes all the symptoms of the most acute inflammation; and yet after death no sign of inflammation is found. Such cases are of rare occurrence, though they originate in the suppression of a fresh blennorrheea, or of a catarrh in children after vaccination, Or in scarlet fever. In such cases Apis, Belladonna and Stramonium fail; Thuja promises to be the effectual remedy. In doubtful cases Aconite or Apis may be tried; and if the fever still progresses, one dose of Thuja 300°. Sclerotitis.—Though the sclerotica may be specially inflamed it is not commonly much diseased, except in connection with inflammation of other tunics or structures, which are more delicate and more essen- tial to the safety of the sight; therefore, in the complicated inflam- mations which involve the sclerotica more serious disease generally is going on in other structures. Thus injection of the vessels of the sclerotica takes place whenever the cornea or iris are seriously affected, or when the entire globe is attacked, or an abscess forms Avithin it; its structures may become thinned from disease of the choroid; but in all these circumstances the alterations in other parts precede those in the sclerotica, and are the important objects of our attention. The sclero- tica in all of these cases calls for no special care, but the treatment necessary for the whole case depends rather on the nature and decree of the. disease of the associated structures. 6. OPACITY OF THE CORNEA. Diagnosis.—Opacities or specks upon the cornea vary much in size and appearance. Various appellations have been given to these dif- ferent opacities, as : nebula, leucoma, albugo, &c, depending upon the nature of the cause, and the particular tissue affected. The opacity r»ay consist of slight misty or opaque spots, diffused over a part or even the whole of the cornea, of a light color, such as are caused by a per- verted secretion of the inner lamina, and termed nebula ; or of small and circumscribed spots, of a pearl color, and entirely opaque caused by a kind of false membrane under the conjunctiva, and termed leu- INFLAMMATION OF THE CORNEA. 113 coma; or of cicatrices resulting from the healing of ulcers and wounds of the cornea, and termed albugo. When the disease consists of a simple diffused nebulous opacity, we can distinguish through it the pupil and iris, and the rays of light pass to the retina so as to give rise to imperfect vision; but the other kinds of opacity do not permit the passage of luminous rays, and, conse- quently, when situated in front of the pupil, destroy or seriously impair vision. The two first varieties are caused by purulent ophthalmia and granu- lated lids, and are results most to be dreaded, especially in constitu- tions tainted with scrofula, syphilis, psora, or mercury. Treatment.—The best local stimulus is a collyrium, composed of one grain of Sulphate of Zinc to four ounces of Avater. A few drops of this may be put into the affected eye, from two to four times in tAven- ty-four hours, until the opacity begins to disappear, when we should omit it as long as the amendment continues. The internal remedies most to be relied on are: Calcarea-carb., Iodine, Mercurius, Sulphur, Sepia, Arnica, Hepar-sulphuris, Acid- nitricum, Aurum-muriaticum. Attenuations and repetitions the same as in chronic ophthalmia. ■ II. AFFECTIONS OF THE DEEPER-SEATED STRUCTURES OF THE EYE. 1. inflammation of the cornea. Diagnosis.—Inflammation of the cornea may exist as an independent affection, or it may occur during the progress of iritis, and other acute derangements of the internal textures of the eye. Soon after the in- flammation sets in, a number of the serous vessels are observed to carry red blood; the cornea loses its brilliancy; the eyes become sensitive to light; a profuse secretion of tears is induced from exposure to cold, air, light, dust, and smoke; tension and pains are experienced in the eye; yellow spots, composed of pus, are observed betAveen the lamellae of the cornea, by looking obliquely through the eye; these abscesses, if the disease continues, eventually burst internally, and discharge their contents into the anterior chamber, or externally, and form those trouble- some ulcers of the cornea, which so often endanger sight. When these ulcers are small and confined to the anterior portion of the cornea, they may often be cured Avithout material injury te the eye; but when the ulceration pervades the whole lamellated structure of the cornea, it is not uncommon for the aqueous humor to escape through the opening, and even the iris itself to protrude. Ulceration of the Cornea.—Case by Dr. Alex. Walker. {Month. Horn. Review. Vol. 5, p. 268.) A lady, after three miscarriages, &c, Vou II.—8. Ill diseases of the sangutnous function. and extensiA^e hcemorrhage, found, tAvo months after, the left eye be- coming weak and dim; lachrymation ensued; finally ulcers appeared on the cornea; these Avere accompanied by excessive suffering, loss of rest and appetite ; considerable fever. In the course of a few months the eye seemed slightly improAdng; but metastasis took place to the right eye. The diseased condition persisted for sixteen years, during Avhich eighteen different physicians and oculists in succession en- deavored to cure it Avithout success. Stimulants had been prescribed in full variety. The patient was found sitting with her back to the window; the blinds all down, room darkened; photophobia.excessively distressing. Seven ulcers were visible on the cornea; lachrymation so extensive as to saturate four or five handkerchiefs in a day ; inflam- mation higher at night, pain and suffering preventing sleep till four or five next morning; sclerotica and conjunctiva fiery red; meibomian glands much ulcerated ; outer ring of the iris dusky red ; violent pains in the supra-orbital and temporal regions, increasing toward evening; great nervous debility; depression of mind; flatulence; constipation, indigestion. The patient inherited a rheumatic diathesis. The latter fact influenced the prescription. Stimulants discontinued. Bryonia Avas given tAvice a day, and a dose of Aconite at bei-time. Weak collyrium of Bryonia to the eye. This was continued for five days, and then omitted for two. At the end of the first week the inflammation of the cornea, iris, sclerotica and conjunctiva was much reduced. After the third night some refreshing sleep, and improved digestion, less flatulence Cold Avater was used in the morning and after dinner, cold bath in the morning; diet simple, plain but nourishing; suppers forbidden. In the course of the treatment under Avhich she recovered full health in a few Aveeks, she took Sulphur, Calcarea-carb., Mer.-sol., and, occasionally, Aconite. The remedies were generally employed in the sixth and third potencies. Some patients are powerfully affected by the high potencies, others Avho are insensible to the high are satisfactorily cured by the low. Conical Cornea.—Mr. Bowman's operation for relief of this affec- tion consists in "puncturing the cornea near its lower margin, draAvino- out the iris by means of a short blunt hook, and securing it outside of the corneal wound by a fine ligature." '■ 2. IRITIS. Diagnosis.—This peculiar affection of the eye is by no means easy of detection, on account of the situation of the iris, and the small num- ber of external symptoms which characterize the complaint. Inflam- mation of this texture is, however, more productive of constitutional or febrile symptoms than affections of the external tunics. This may in IRITIS. 115 part be owing to the loose attachments of the conjunctiva to the eye, and the more ample scope for effusions into the subjacent cellular tissue. Iritis commences with a dull, pressing, heavy, and deep-seated pain in the orbit; contracted pupil; change in the natural color of the iris to a dark, greenish, or reddish color; a moderate rose-colored blush of the conjunctiva; diminished power of vision, and considerable sensibili- ty to light. As the disease advances, the pains become acute, and extend from the eye into the temples and to the top of the head; the contraction is more strongly pronounced ; sparks and luminous flashes pass through and before the eyes ; the nervous system is excited; the pulse accele- rated ; the skin hot and dry; the intestinal and urinary secretions are partially suppressed, and there are other indications of constitutional disturbance. After these severe symptoms have continued some time, the iris pre- sents an irregular, angular, and thickened appearance, and is covered with specks of yellow lymph. Small abscesses noAV form on the iris, which ultimately burst into the anterior chamber, which is afterwards usually absorbed. If extensive adhesions have formed betAveen the iris and the capsule of the lens, or if the more deep-seated parts have be- come involved in the disease, an almost total loss of sight is the com- mon result. In some instances the inflammation extends from the iris to the re- tina, the choroides, the cornea, and finally involves the whole internal structure of the eye, when the malady will present symptoms character- istic of the inflammation of these different structures. In cases of this description, the symptoms are of the most violent character, the pains are exceedingly acute and painfully throbbing; there is a very rapid contraction of the pupil, the sight is speedily extinguished, the consti- tutional signs are very urgent, and the patient is always in imminent danger of rapid loss of vision. Causes.—The most common cause of iritis is the abuse of Mercury. Syphilis has been often assigned as a cause of it, but we belieA-e, with- out just reason. It has often been observed during the treatment of syphilis by Mercury; but, we think, never in syphilitic diseases where Mercury has not been employed. Other causes are: mechanical in- juries, rheumatism, gout, excessive use of the eyes over minute objects. Treatment.—The most appropriate remedies are : Hepar-sulph., Acid-nitr., Muriate of Gold, Cocculus, Calcarea-carb., Nux-vomica, Belladonna, Conium, Lycopodium, Staphysagria, Arnica, Aconite. Ilepar-sulph-uris, Nitric-acid, and Aurum-muriaticum are cura- tive in iritis arising from abuse of Mercury, with aching, throbbing and tearing pains in the orbit, sometimes extending to the top of the 116 diseases of the sanguinods function. head; pains in the bones about the eyes; fiery sparks before the eyes; intolerance of light; contracted pupil; partial or entire loss of vision; dark or greenish color of the iris: spots of yellow lymph, or ulcers on the iris; febrile disturbance. Cocculus, Nux-vomica, and Belladonna are indicated in arthritic and rheumatic iritis, accompanied Avith deep-seated, lancinating, tearing, or contractive pains in the ball, and extending to the top of the head; involuntary, spasmodic moArements of the globe; irregular contraction of the pupil; discolored and puckered iris; photophobia; pains ag- gravated on moving the eyes, or stooping; luminous specks or dark ob- jects float before the retina; greatly impaired vision; effusion of blood and matter into the anterior chamber of the eye ; indications of gastric derangement, and of general constitutional disturbance. Calcarea-carbonica, Conium, lycopodium, and Slaphysagria are appropriate in iritic inflammations connected Avith a scrofulous diathesis. These remedies cover: greenish or yellowish color of the iris; pupil much contracted and distorted; ulcers which have opened internally or externally; outward distention of the iris ; adhesions of the iris to the capsule of the lens ; moderate participation of all the structures of "the eye in the morbid action; photophobia; vision destroyed or much impaired; difficulty in distinguishing the iris from effused lymph and pus into the anterior chamber of the eye; great general irritability; aching, throbbing, lancinating, or pressing pains in the eye; rapid and irritable pulse ; restlessness ; hot skin; loss of appetite ; mental and physical prostration. Arnica is necessary when the disease can be traced to a wound, or to any mechanical injury of the eye. It may also be properly employed in cases which proceed from sudden exposure of the eyes to an intense and glaring light. Aconite will often be required, either in alternation with one of the other remedies, to control undue febrile excitement, and to remove the violent, congestion, Avhich now and then occurs in iritis. Mercurius-corrosivus.—Case by Dr. Henderson, of Edinburgh.— A gentleman in May, 1852, had inflammation of one eye, declared rheu- matic by an eminent oculist in Glasgow. Bleeding, Calomel, and Opium rapidly improved the eye, but the mouth and tongue became sore and inflamed, which confined him to the house for a month, part of the time in bed. He afterwards relapsed several times Avithin the month, though the attacks were not severe. During the winter he was well, but in March, 1854, he had a new and severe attack. The sclerotica around the cornea was closely and densely injected with vessels and so deeply colored as to present the appearance of ecchy- mosis ; aching pain in the eyeball; the iris dull color; pupil regular IRITIS. 117 though somewhat dilated. The disease had lasted four days Avhen the second homoeopathic dilution of corrosive sublimate wTas prescribed one drop every four hours. Each dose therefore consisted of only the ten- thousandth part of a grain of the medicine. In four days the eye was nearly well, and on the fifth day of the treatment the patient was in perfect health. He had taken five doses per day of the medicine. In a feAV weeks he had a slight relapse, which was cured by the same re- medy without confining him to the house. No mercurial disease ac- companied this mercurial treatment. Clematis.—Rheumatic iritis ; sensation of pressure upon the eyes, Avith photophobia and lachrymation, particularly in the open air; lids forcibly contracted in the morning, with sensation of heat. Administration.—The remedies may be employed at the first, second and third attenuations, depending upon the age and susceptibility of the patient, and the violence of the inflammation. The dose should be repeated in acute cases every tAvo hours, until we are certain of a medi- cinal impression upon the diseased texture. In less urgent cases, a re- petition will suffice once or tAvice in twenty-four hours. Belladonna, and its alkaloid Atropine, are among the most poAverful re- medial agents in acute iritis. Mercurius, which is also truly homoeo- pathic to this disease, agrees very Avell in alternation with Belladonna. It also acts well internally Avhile Belladonna is applied externally. Grgefe advises in the slighter cases of acute iritis the application of a solution of Atropine (four grains to one ounce of water), six, eight, or ten times a day, and in severe cases as often as twenty times in the tAventy-four hours. When synechia posterior with broad and extensible adhesions exists, the tendency to the recurrence of iritis is so great, that the patient and doctor are both ready to adopt the seA^erest measures—even extirpating the eyeball, to get rid of the ever-recurring torment, and to prevent the sound eye from participating sympathetically Avith the diseased one. In such cases Graefe performs iridectomy by excising a small portion of the iris. This treatment he has found efficacious in apparently the most desperate cases, Avhere the anterior chamber was almost effaced, the iris discolored and bulging very much forwards, and the globe of the eye softer than natural and perfectly atrophied. He has repeated the operation on the same eye sometimes as often as six times, and with great advantage. The iris regains its healthy appearance, the anterior chamber refills with aqueous humor, and the Avhole globe becomes firm. The sight too is restored more or less perfectly. The rationale of the cure in these cases is not very clearly made out. Von Gncfe says: "The increased poAver of vision was in no way dependent on re-absorption of the pupillary exudations, but was 118 DISEASES OF THE SANGUINOUS FUNCTION. entirely to be ascribed to an improvement of the choroidal compli- cations" Mode of performing the Operation of Iridectomy.—The lance- shaped knife is introduced into the sclerotic, at the distance of half a line from its junction Avith the cornea, and pushed fonvards into the anterior chamber. Through this Avound the forceps is introduced, the iris seized and dragged out, and a portion, amounting to a fifth or even a third of the whole, cut aAvay. The remains of the prolapsed iris are left in the wound.* 3. CHOROIDITIS. The commencement of organic disease of the choroid, though unat- tended by marked symptoms of inflammation, is still a serious matter, as inflammation often breaks out suddenly. The existence then of the network or gauze, or appearance of large spots in the field of vision, unaccompanied by pain or uneasiness, or any other evidence of increased action in the vessels of the conjunctiva or sclerotica should meet Avith prompt attention. The organ should have perfect rest and be kept from exposure to bright light. Counter-irritation in the vicinity has been found par- tially successful; stimulating drinks are to be avoided; food should be regulated to that extent that the patient's condition may direct. The patient's general health must be corrected. Bleeding has formerly been considered indispensable ; but in many other cases those Avho have tried it, found the bleeding to aggravate the disease; in young, delicate females, Mr. Tyrrell (Encyclopedia of Surgery, p. 90) saAV "the continuance of the depletory treatment most injurious in augmenting the morbid action and hastening the disorgan- izing process." Unfortunately, as relief frequently follows the local abstraction of blood, the patient on every fresh attack or relapse is de- sirous of resorting to the same treatment again ; still finding the relief of short duration; the same course is resumed Avith temporary benefit, but the poAvers of the patient are successively reduced, and the local disease makes progress in disorganization; each relapse promotes fur- ther inflammation, and the anti-phlogistic treatment lessens the poAvers of the system to resist the progressive amaurosis; and, eventually, vision is completely destroyed, and the general health is at the same time materially injured. Mr. Tyrrell says: "I have seen several dis- tressing cases of permanent amaurosis resulting from such treatment, and I have also knoAvn many instances in Avhich the disease has been * Memoirs on certain forms of Iritis, Choroiditis, and Glaucoma. Sydenham Society. 1859. CHOROIDITIS. 119 arrested and vision preserved by raising and maintaining the general poAvers" and pursuing a proper medical treatment. Treatment.—Ipecacuanha.—In one case the following symptoms Avere presented: A lady, aged 47, had excessively painful shootings in the eyeballs, could not gaze on any object without copious Aoav of tears; blue and red halo around the flame of a candle ; pupils neither dilated nor contracted, and moved freely; vessels of the palpebral conjunctiva slightly injected without pain; conjunctiva and cornea uninjured; con- stipation ; no known cause for the inflammation. At the end of six weeks Dr. Tamhayn, in remembering the resemblance of the symptoms to those produced by the dust of Ipecacuanha on a pill-maker employed in a druggist's shop, prescribed that article. Jan. 15th, 1858. Ipecac. tAvelfth dilution, tAVO globules in 200 gram- mes of Avater; a table spoonful three times a day for six days. Jan. 22d, the suffering Avas less, gazed.on objects with less difficulty; the halo around the candle less visible; bowels improved. Ipecac, sixth dilution, two globules. Jan. 29th, improving. The patient can read and work in the daytime. Continued improvement, though some occasional shoot- ings in the eyes, more in the left eye or that first affected. Diarrhceic evacuation about every morning. Ipec. tAvelfth dilution, two globules. Dr. Heniel, of Paris, gives a case in which there Avere lancinations excessively painful in the optic globes, copious Aoav of tears on looking steadily at any object. Blue and red aureoles surround the flame of the candle ; pupil mobile ; no external inflammation, slight injection of the palpebral conjunctiva. Such symptoms had been caused in a drug- gist, pounding Ipecac, and it Avas prescribed Ipec. 12°, a two globules in water, three times a day for six days. The first week after there Avas improvement; constipation removed. A week later, could see to read and sew in daylight. {LArt Medical) Ammoniac.—"A glittering appearance before the eyes as of molten metal." {Dr. Kleinert.) In this case, inflammation of the deeper- seated parts, the choroidea, &c, is present, Avith which amaurosis often commences. Traces of the change must be perceptible in the provers by the aid^of the ophthalmoscope. Muriatic-acid.—Perpendicular hemiopia; thus partial paralysis of the optic nerve, perhaps exudation—extravasation of blood on the choroidea. Alumina causes vision of yelloAV, perhaps perceptible on the cor- pus vitrei and the aqueous humor,—a purely icteric symptom which may appear on other parts of the body. Mercury.__Amaurosis consequent on chronic choroiditis, is often if not ahvays pathologically identical Avith mental imbecility conse- quent on chronic meningitis. In the first case the delicate structure of the retina, vesicular neurine which is expanded on the optic nerve, 120 DISEASES OF THE SANGUINOUS FUNCTION. has been pressed upon by its vascular serous membrane, and the choroid and membrani Jacobi are thickened by a morbid deposit. In the second the vesicular neurine of the hemispherical ganglion is pressed upon by the thickened pia-mater and arachnoid. The success of treatment in inflammations of the eye should encourage us to make efforts equally persevering in the treatment of chronic meningitis. Mr. Tyrrell cured most obstinate cases of amaurosis by perseArering in the use of minute doses of the gray mercurial powder every night or every second night for tAvelve months, taking care in all this time that it should never af- fect the mouth. He even said that he had often seen the cure ar- rested, and sometimes entirely defeated by salivation, in cases in which it occurred through the impatience of the invalid, who Avas too anxious to be speedily cured. By long persistence he said he had " restored many a poor fellow to sight whose case had been considered hopeless.'' 4. AMAUROSIS. Impaired vision coming on suddenly or gradually, and the loss of sight more or less complete; it may be permanent from its first ac- cession, or transient, varying in degree, and returning only at inter- vals, sometimes in the day only or in the night only. It sometimes conies on after great exertion of the eyes with minute or very bright objects, or when the digestive powers are greatly disordered. In some cases the loss of sight is confined to apart of the field of vision; or ob- jects appear crooked, distorted, mutilated, changed in size, or inverted; flashes of light; shining stars, globes of light, or muscae volitantes, are common Avhen the retina is inflamed; when the vital energies of the organ are exhausted, as in dyspeptics or debilitated persons; motes, black specks, muscse volitantes and thick mists of clouds are seen; double vision is caused by disease within the cranium. At a later stage the vision is obscured by clouds, or a net-work of gray, black, or Avhite silvery, luminous red, luminous in the dark. In some cases pain is felt in the eyes, in others there is only a desire for stronger light, in others there is dryness of the eyes and nostrils; the constitution generally presents some peculiarities indicating hereditary disease or functional derangement of important organs; there is a staring un- meaning look in the eyes; an unsteady, uncertain gait; the motions of the eyes- or eyelids may be impeded or palsied; the eyes unusually prominent; the sclerotica bluish, or ash-colored, and, in some, covered Avith small varicose veins; the eyeball is firmer to the touch or softer than natural. After vision is extinct, the pupil is more or less expand- ed and motionless, though when only one eye is amaurotic, the pupil of that eye follows the motions of the sound-one. Sometimes both eyes AMAUROSIS. 121 are amaurotic, and yet the motions of the iris continue under the nervous influence of subsidiary nerves, particularly of the branches of the third and fifth pair. The iris may contract irregularly, may pro- trude towards the cornea or be pressed inwards. Diagnosis.—Distinguished from cataract by the dimness, or loss of sight, being either sudden or partial, presenting the appearance of fly-spots, or motes covering parts of an object. In cataract, the diffi- culty of sight increases very slowly, and is compared to a diffused mist, thin cloud, or gauze, intervening between the eye and the object. Amaurosis, if in its first stages a cloud or mist be visible, goes on in- creasing till sight is extinct; but complete deprivation of sight never occurs in cataract. In cataract the opacity generally commences-in the centre of the lens, and the misty appearance is most noticed Avhen looking directly fonvard, vision being most distinct Avhen he looks sideways; this seldom occurs in amaurosis. In amaurosis the patient desires strong light; in cataract strong light contracts the pupil and renders vision less perfect, as the rays have to pass through the central opaque part of the lens. Amaurosis is usually connected in its origin wi^ headache, vertigo, and disease of the digestive organs. Cataract has seldom any such association. In amaurosis the pupil is either jet- black in health, or a pale greenish color visible when examined in a particular light. {Copland. Vol. I., p. 65.) In amaurosis with glau- coma the opacity is always greenish, in incipient cataract it is ahvays grayish. In the former the opac^ seems at a considerable distance behind the pupil; in lenticular cataract it appears close behind the pupil. In posterior capsular cataract the opacity is streaked, in glau- comatous amaurosis it is always uniform. In the former the opacity seen through a double convex lens appears slightly rough; the glau- comatous opacity is smooth and polished. In the former the eyeball is of the natural degree of firmness; in glaucomatous amaurosis it is firmer than natural. Glaucoma progresses sloAvly, occupying several years ; in cataract the sight rapidly declines. In incipient cataract the contractions of the pupil are as extensive and rapid as in health; in amaurosis it is dilated and fixed, or its motions are limited and slow. In cataract the movements, eyeballs and eyelids are perfect; in amau- rosis they are imperfect and difficult, there is a want of direction to the eyes, and sometimes a slight degree of strabismus. (Mackenzie, on Diseases of the Eye) Symptoms. —The partial or total loss of sight which particularly characterizes this disease, is principally dependent upon a diseased condition of the optic nerve and retina, although other structures oc- casionally participate in the disease. Amaurosis occurs at all ages, and in both sexes, but is most common at the period of the cessation of the menses in females, and at the age of forty or fifty years in males. 122 DISEASES OF THE SANGUTNOUS FUNCTION. The chief circumstances which predispose to it, are : a plethoric and sanguine temperament; hereditary pre-disposition; tendency to san- guineous congestions to the head and eyes ; and an impaired constitu- tion from the abuse of drugs, stimulating drinks, and venereal excesses. Physicians of the old school are much divided respecting the nature and treatment of amaurosis; some suppose it to be a debility requiring tonics and stimulants, while others describe it as an inflammatory af- fection, demanding an antiphlogistic course of treatment. In vieAV of these discordant opinions, and the empirical modes of treatment based upon them, it is not surprising that so few amaurotic patients are cured by allopathic treatment. Amaurosis may be imperfect or perfect. In the former there is a partial, and in the latter a total loss of sight. In the first, the patient sees as through a gauze, or but half of the object, or double, or only when the eye is in a particular position, with respect to the object; while in the last, the patient cannot distinguish day from night. The signs of the approach of the disease are: pain in the forehead and temples, diminishing with the advance of the amaurosis, and ceas- ing Avhen it has become complete; vertigo; Aveakness and cloudiness of vision, apparent Avhen looking at distant or at minute objects ; sparks and moats, or muscse Arolitantes, float before the eyes, annoying the patient, and impairing the sight; in reading or Avriting, a stronger light than usual is demanded; a slight diminution in the brilliancy of the pupil. After these precursory symptoms, the loss of vision gradually becomes more complete, until after months or years there remains a condition of settled and more or less perfect amaurosis. In other instances, the disease advances with rapidity, and terminates in partial or total blind- ness in a few days. But it is not an uncommon occurrence for com- plete amaurosis to follow instantaneously, leaving the victim in blind- ness so profound that he cannot distinguish light from darkness. When either of these three conditions obtains, there are usually but few sio-ns which indicate the presence of so serious an affection; the principal symptoms being only a dilated and immovable pupil, a loss of contrac- tile poAver in the iris, and occasionally slight strabismus. But even these signs are not uniformly present; for cases of complete amaurosis are reported, in which the pupil remained natural, or became preter- naturally contracted, and mobile on exposure to light, and in Avhich the iris and all other visible parts of the organ Avere in a normal condition. The color of the pupil in this disease is ordinarily jet-black, with per- haps, a very slight diminution of its natural brilliancy, but it sometimes presents a red, greenish, or white and cloudy appearance. Cases of this last description are often mistaken for incipient cataract and Avhen the loss of sight is but partial, it is not easy to distinguish between the AMAUROSIS. 123 two maladies ; but the folloAving characteristics will afford us material assistance in deciding the matter. In cataract, the dense Avhite ap- pearance is situated immediately behind the pupil, while in amaurosis the cloud is more deep-seated. In the former the flame of a candle ap- pears to be surrounded by a thin, white, diffused mist or cloud, " which increases with the distance of the light," while in the latter, "a halo or iris appears to encircle 'or emanate from the mist, the flame seeming to be split Avhen at a distance." {Stephenson.) The shape of the pupil is usually round, but someAvhat more dilated than in the normal state, thus allowing a large number of luminous rays to enter the eye. In a feAV cases it loses its circular form, and becomes angular. Amaurosis is attributed by most writers to a paralytic condition of the optic nerve, retina, or to some disease of the thalami nervorum; but does not the peculiar immovable condition of the pupil and iris, Avhen their natural stimulus, the light, strikes them, indicate a loss of sensi- bility and contractility in these structures ? And does not the partial loss of voluntary power over the globe, Avhich occurs during the pro- gress of the disease, indicate a loss of tone in the whole organ ? We have mentioned, as one of the precursory symptoms of amaurosis, floats and muscse volitantes before the eyes. In the imperfect form of the disease, these appearances vary much in their character, and are a source of great annoyance to the patient. Sometimes a single black speck obstructs the sight; sometimes there is an appearance as if a dark gauze or net-Avork were before the eyes; sometimes as if flies, small objects of different forms, sparks, fireballs, and 'various colored lights, Avere moving in various directions. The objects are more trouble- some in a strong light than in dark situations, being in the former of a black or sombre color, and in the latter presenting themselves in the appearance of sudden flashes of light or fire. We are occasionally presented with the disease in an intermittent form, and, in rare instances, as a temporary attendant of some particular morbid condition of the system, like pregnancy, disordered menstruation, hysteria, Avorms, and the irritation of indigestible food. In addition to the symptoms already described, Ave sometimes observe in young and plethoric amaurotics, strongly pronounced determination of blood to the head and eyes, a constant stupefying headache, more or less redness and congestion of the eyeballs, sensitiveness of the eyes to light, a full and hard pulse, a sense of fullness, tension, and pain in the affected eye. It is a point Avorthy of note, that black eyes are far more subject to amaurosis than blue or gray eyes. Beer supposes that Avhere one blue or gray eye becomes amaurotic, at least twenty-five or thirty black ones 124 DISEASES OF THE SANGUINOUS FUNCTION. suffer. No satisfactory explanation has ever been suggested for this comparative exemption of blue or gray eyes. Characteristics.—Distinguished from cataract by the dimness or loss of sight being either sudden or partial, resembling a fly, spots or motes covering parts of an object. In cataract the difficulty of sight increases very slowly and is compared to a diffused mist, thin cloud or gauze inter- vening betAveen the eye and the object. Prognosis.—When the cause of the disease is evident, and Avhich can be removed, the patient young, constitution good, and the attendant disease curable, partial or entire recovery may be hoped for. When it has been suddenly induced, the pupil being only slightly dilated and still moveable, of the natural form and the eyeball not altered in structure, the prognosis is more favorable than when the pupil is fixed in a state of either expansion or contraction, or when the eyeball is either soft or preternaturally hard, or Avhen the back part of the eye presents a greenish opacity. If the attack has been sudden, the A'ision perverted, power over the muscles of the eyelids lost, there may be disease Avithin the brain. If the symptoms have been gradually de- veloped in succession, there may be a tumor, cyst, or exostosis Avithin the cranium; and in all such cases the prognosis must be unfavorable; and also in all cases in which the cause has been long in operation, the loss of sight has been very gradual, the constitution is much im- paired, and the cause cannot be speedily removed. Amaurosis depending on morbid growths within the orbit or cranium, may be considered incurable; but when it depends upon a slight effu- sion upon the brain, or the pressure of a tumor upon the jugular vein of the neck, we may often effect a cure by causing the effused fluid to be absorbed or removed by an operation, or the extraction of the of- fending tumor. We once cured a case of several months duration by removing from the neck a tumor of the size of an orange, and thus re- newing the free course of blood from the head. The sight returned almost immediately after the operation. The loss of sight which some- times accompanies pregnancy and intermittent diseases, often subsides spontaneously after parturition, or the cure of the disease, on which the blindness depended. A faArorable prognosis may commonly be entertained in those recent cases which depend on congestion of the optic nerve, retina, or thalami nervorum opticorum, arising from general plethora., suppressed menstruation or haemorrhoids. The effects also of mechanical injuries, lacerations, contusions and Woavs upon the eye, may frequently be cured. Causes. — First. — Predisposing. — Hereditary disposition; dark eyes; insolation; forced mental or physical exertion; excesses of pas- sion; pregnancy and the puerpural state; habitual stooping ; indigestion * abuse of stimulants; suppressed discharges; menstrual derangements* AMAUROSIS. 125 gout, rheumatism or scrofula; retrocession of eruptions; habitual con- stipation; chronic diarrhaea; typhoid fevers; use of snuff; long con- tinued grief; nursing too long continued; leucorrhcea; masturbation; excessive exercise of the sight on minute objects or in bright glaring light; strumous ophthalmia. Second.—Exciting Causes.—Over-exertion of the sight; very bright light, Avorking Avith minute objects by lamp or gas light at late hours; strong shocks of electricity, as lightning; long continued over-excite- ment of the eye; or mechanical injuries producing contusion or con- cussion of the retina ; strong poisons as stramonium, belladonna, poison- ous fungi, and fish-poison; epileptic or other convulsions; apoplexies or paralysis ; injuries of the fifth pair of nerves; gastric or intestinal irritation, from worms or other causes; hypochondriasis ; accumulations of bile; frights; neuralgia, with or without carious teeth; drying up of old ulcers ; cessation of the menses ; typhoid fever or scarlatina; metas- tasis of gout or rheumatism; syphilis and abuse of mercury. The causes of amaurosis may operate upon the brain itself, upon the optic nerve, or the retina. They may be divided into constitutional, and local causes. In the first class we include : repeated and protracted determinations of blood to the head and eyes, by unusual physical or mental exertion: pregnancy; suppression of natural or habitual dis- charges ; violent vomiting; excessive indulgence in venery; masturba- tion ; unbridled anger, grief, and other passions ; abuse of stimulants ; large doses of opium, lead, belladonna, hyoscyamus, stramonium ; abuse of bitter medicines, as quassia, cinchona, chamomilla, chicory, &c.; exer- cise in a hot sun; general debility; derangement of the digestive organs; the depressing emotions; the pressure of tumors upon the vessels of the neck in such a manner as to prevent the return of blood from the brain. We include in the second class of causes, morbid growths Avithin the orbit: mechanical injuries of the eye; sudden transitions from darkness to a brilliant light; lightning; frequent use of optical instruments, like the telescope and microscope ; exostoses wdthin the cranium; sanguine- ous effusion upon the brain; injuries of the head. Pathology.—First.—Amaurosis is perhaps always dependent on some physical change in the structure of the eye, though this is not ahvays perceptible on dissection. Functional amaurosis, says Beer, proceeds from direct depression of the vital sensibility of the eye ; or from inordinate excitement, and consequent exhaustion of this property. Mackenzie thinks that in all these cases there is a certain degree of organic derangement, even Avhen dissection does not reveal it. In nearly all cases there is sensible organic derangement. Second. — Congestive or inflammatory state of the retina or parts adjoining:—Varicose states of vessels ; unusual injection of the 126 DISEASES OF THE SANGUTNOUS FUNCTION. minute arteries of the adjoining coats and of the retina; complete re- tinitis ; exudations of lymph under the choroid ; inflammation of the external surface of the sclerotic ; injection of the choroid and adhesion of the retina to it; thickening, morbid density of the retina; change of color and ossification or Avasting of the retina. Third.—The optic nerve may be compressed or otherwise affected by structural changes in parts contiguous to it. {Copland, Vol. I., p. 59.) Fourth.—Disease of the Brain or its membranes may cause amau- rosis by impeding the functions of the optic nerves, although the structure of these nerves be uninjured. The most common of these are : organic lesions of the pineal and pituitary glands, sanguinous and serous effusions, tumors, abscesses, softening of the brain. Treatment.—A complete removal of all suspected causes is the first step. When the general symptoms denote debility; Avhen there is languid circulation, muscce volitantes, or dark spectra, an alterant, though supporting treatment is required; light, nutritious, invigorating diet, change of air, moderate exercise, vegetable and mineral tonics, with the usual means of improving the secretions constitute the usual measures for restoring the nervous energies of the debilitated organ. When the disease is obviously connected Avith inflammatory action it is of that character which is not always benefitted by depletion. Per- haps the most common form of amaurosis is that consequent on chronic choroiditis, Avhich is believed to be pathologically identical with that which exists in the brain in mental imbecility, consequent on chronic meningitis. In the former case, says Mr. Solly {On the Brain, ip. 357), " The delicate structure of the retina, the vesicular neurine which ex- pands on the optic nerve, has been pressed upon by its vesicular and serous membrane, the choroid and membrani Jacobi, thickened by morbid deposits." In imbecility from chronic meningitis the vesicular neurine of the hemispherical ganglion is pressed upon by the thickened pia mater and arachnoid. This view of the pathology in many cases of amaurosis has led Mr. Tyrrell, of London, to a successful course of treatment. By persevering in the use of extremely small doses of Mercury every night or every second night for twelve months, Mr Tyrrell has succeeded in curing most obstinate cases of amaurosis. By employing such minute doses that no drug symptoms are produced Mercury will often restore the sight in amaurosis, even Avhen the per- ception of light is destroyed; it is not entirely hopeless if the globe re- tains its natural consistency; neither abnormally hard, or soft and shrunken; when the disease is of very long continuance, then the re- tina and vitreous humor become sometimes implicated in the morbid action and partial atrophy ensues. Tyrrell says: "The safety of the treatment and its efficacy depend greatly on the support of the general powers; for while this is properly AMAUROSIS. 127 sustained, the remedy can- not produce any general injurious effect though its operation on the local disease may proceed most beneficially." If the general poAvers are not maintained "the effects of mercurial action on the system are extremely distressing and injurious, and it can rarely be continued long'enough to remedy the amaurosis." Case by Mr. Tyrrell.—"A man, aged thirty-eight, had been amau- rotic for seven years. He had lost the perception of light; the globes possessed their natural firmness and elasticity; the pupils were clear, but irregular, from many points of adhesion between the pupillary margin of the iris and the anterior capsule of the lens ; the irides Avere discolored and dull, and he had the vacant aspect of a blind person. Mercurial treatment Avas tried Avith good diet; but the mouth became tender and sclerotitis occurred. But the treatment was continued, and Belladonna Avas applied night and morning to each eyebrow. He soon became sensible to light, and gradually acquired the poAver of discern- ing objects ; and the adhesions between the irides and capsules of the lens began to give way; the pupils to assume their natural figures; by degrees the vision improved, inflammation subsided; the pupils became regular and the irides brilliant. The Mercury was continued for above sixteen weeks, Avhen the amaurosis was completely subdued, and vision perfect." In this case it is evident that Mercury in an attenuated form would have cured the amaurosis and left the patient in a better con- dition for permanent health. In brain affections Ave should be guided by similar principles. Treatment.—The specifics for the different forms of amaurosis are: Belladonna, Nux-vomica, China, Phosphorus, Ruta-gra/neolens, Stramonium, Sulphur, Euphrasia, Arnica, Cannabis, Hyos- cyavius, Stramonium, Opium, Secale. Belladonna.—External Indications. — Pupil dilated and immov- able ; strabismus; pupil black and round or angular; partial or total loss of vision; listless expression. Physical Sensations. — Power of vision diminished or extinct; sensation of weight and pressure in the eyeball; throbbing or stupefying headache; objects appear double, or wrong side up, or half concealed, or blurred, or surrounded by a fog or mist; dark, fiery and red bodies float before the eyes ; bright flashes before the eyes ; the candle seems surrounded by a halo of different colors; but in which the red pre- dominates. Mental and Moral Symptoms. — Mood generally irritable, but high spirits alternating with despondency. Remarks.—This remedy is called for in amaurotics of full and plethoric habits, and where the malady has been caused by inflam- mation, congestion of the optic nerve, retina, or some part of the brain. 128 DISEASES OF THE SANGUINOUS FUNCTION. Nux-vomica.—External Indications. — Pupils contracted, some- times dilated; spasmodic motions of the eyeball; 'photophobia. Physical Sensations.—Intermittent obscuration of vision; black or gray moats before the eyes; stupefying headache ; Aveakness of sight, worse in the light of day; luminous vibrations on the' side of the eye; vertigo. Mental and Moral Symptoms. — Disposition melancholic and hypochondriacal. Remarks.—Nux is applicable in amaurotic complaints arising from excess of study and abuse of stimulants and opium. It is also indicated for temporary loss of sight, which sometimes accompanies intermittent diseases. China.—Externed Indications.—Pupils dilated and insensible, or slightly contracted; a Avhite cloud deep within the eye; photophobia. Physical Sensations.—Indistinct and confused vision; muscae voli- tantes ; sudden obscurations of sight; only the outlines of objects can be discerned; general debility; irritability; morbid sensitiveness of the whole system. Mental and Moral Symptoms.—Disposition cheerful and languid. Remarks.—China will apply when the disease is of a purely atonic character, and has originated from excessive loss of blood or pus, or from protracted chronic or acute diseases. Phosphorus.—External Indications.—Pupils and eyes natural. Physical Sensations.—Sudden attacks of blindness during the day; distant objects appear to be enveloped in smoke or mist; black spots before the eyes; diminished vision; he sees as through a net-Avork or gauze; sparks before the eyes in the dark; tremulous vision; luminous vibrations before the eyes; the flame of a candle seems to be surrounded by a green halo. Mental and Moral Symptoms.—Spirits gloomy, dejected, and with- out any cheerful reaction. Remarks. — In amaurosis consequent on masturbation, loss of animal fluids, and in impoverished old people, Phosphorus is an ex- cellent remedy. Ruta-graveolens.—External Indications.—Pupils contracted; in voluntary movements of the balls of the eyes ; spasms of the lids. Physical Sensations.—Sense of weight and pressure in the eye- balls ; weakness of the eyes; inclination to read or write by a very strong light; muscae volitantes; red halo surrounding the flame of a candle; cloudy vision; weariness of the eyes. Mental and Moral Symptoms.—Indifferent, irresolute and peevish. Remarks.—Amaurotic complaints arising from abuse of the eyes with optical instruments, in reading fine print, or working at small ob- HYDROPHTHALMIA, OR DROPSY OF THE EYE. 129 jects, and also from contusions, and other mechanical injuries, will re- quire the use of Ruta. Stramonium,—External Indications.—Pupils dilated and immov- able ; eyes staring, and somnolent or glistening. Physical Sensations.—Sense of weight and tension in the eyes; ob- scuration of sight; objects appear small or double ; black colors appear gray; sparks and specks float before the eyes; objects seem surrounded with a red or light border; cloudy vision ; vertigo; headache. Mental and Moral Symptoms.—Disposition irritable and touchy; hysterical and cataleptic. Remarks.—Stramonium is suitable in paralytic affections of the optic nen'e and retina; connected with deranged menstruation, hysteria, epilepsy and catalepsy. In incipient amaurosis, and frequent and sudden and short attacks of blindness, we may refer to Sulphur, Euphrasia, Arnica, Canna- bis, Hyoscyamus, Conium, Aurum, Digitalis. Administration.—We are in the habit of employing from the first to the sixth attenuations. Repetitions should not be made more than once or tAATice in the twenty-four hours. As soon as an impression i3 apparent, we should await the result before administering again. 5. HYDROPHTHALMIA, OR DROPSY OF THE EYE. ' Diagnosis.—This disorder proceeds from the formation of a preter- natural quantity of the aqueous or the vitreous humors, while the ab- sorbent vessels convey into the circulation only their customary amount of these secretions; or the humors may be formed as usual, but owing to some defect or loss of power of the absorbents, the natural quantity is not taken up and carried into the circulation. But it is highly proba- ble, in most cases, that the disease is dependent on a morbid condition of both the secerning and absorbent Aressels, and the normal equilibrium between secretion and absorption becomes thereby destroyed. This idea receives confirmation from the fact, that most dropsies of the eye can be traced to previous inflammation of the internal textures of the organ. The unnatural accumulation may be confined to the aqueous humor in the anterior chamber, or to the vitreous humor in the posterior chamber, or both humors may be affected at the same time. When the aqueous humor is alone involved, the disease may be recognized by the folloAving marks: dimensions of the cornea larger than natural; increased size of the anterior chamber of the eye; turbid appearance of the aqueous humor; partial or total loss of motion of the iris; pupil natural and immovable ; iris less brilliant than natural; sense of weight and tension in the eyeball; weakness of sight; perversion of vision, VOL. II.—9. 130 diseases of the sanguinous function. either in the form of presbyopia or myopia: general loss of voluntary motion over the ball; partial or total loss of vision. When there is a preternatural accumulation of the vitreous humor, the enlargement of the globe is more deep-seated; the ball assumes a conical shape; the cornea is unusually prominent; the pupil is con- tracted; there is a diminution of vision; myopia; deep-seated pains ; tension and heaviness; impaired motion of the ball; and eventually, total blindness. When the disease consists of an unnatural accumulation of both humors, we shall have a combination of symptoms including nearly all described under the aqueous and vitreous varieties of dropsy. After the vitreous humor has been for some time affected, its character is changed, and it acquires a soft and usually a watery appearance. In many cases, the eye attains a size so enormous as to protrude far from the orbit, and it is thus rendered quite impossible to close the lids over it. In this condition the patient has a frightful appearance, and the organ itself, from its exposure, is constantly irritated and in- flamed. Causes.—The immediate cause of dropsies of the eye is an undue action in the arteries which secrete the humors, and a diminished action of the absorbent vessels; or, sometimes an inordinate aqueous or vitreous secretion, with a normal action of the absorbents. Hydrophthalmia is generally supposed to depend upon some con- stitutional cause, like general dropsy, hydrocephalus, chlorosis, or se- condary syphilis; but, as a general rule, it may be traced by some pre- vious inflammation of the internal structures of the eye. In infants and young children, it is often exceedingly difficult to discover the real cause, especially when the external indications are obscure, and, on this account, the earlier history of the case can rarely be ascertained; but in adults, we shall often be able to discover previous sub-acute in- flammation in the internal structures. Prognosis.—The allopathists deem this disease, when fully formed, incurable. They find that no shedding of blood, no punishment of stomach, boAvels, salivary glands, skin, or other inoffensive parts of the body, can cure or palliate it. That the prognosis is unfavorable Ave do not deny; but we believe the disease may often be cured in its early stages. We have treated but two cases homceopathically; and but one Avith a favorable result. This was of six months standing, confined to the aqueous humor, and with but moderate distention of the cornea; the other case involved both humors, had continued more than a year, and had arrived at the condition termed "ox eye," when the treatment Avas commenced. In this instance paracentesis became necessary, and the patient ultimately lost his eye. So long as the disease is confined to its incipient stage, and even CATARACT. 131 after the unnatural accumulation has commenced, provided no serious disorganization has taken place in the important tissues of the eye, Ave may predict a favorable result; but if organic lesions have occurred, and the accumulation in the anterior or posterior chamber is consider- able, with total loss of sight, our prognosis must be unfavorable. Treatment.—If the dropsy depends upon a constitutional fault, our remedies must be addressed to the remote difficulties. So long as these continue, mere local means will be inadequate to accomplish our object; but constitutional and local remedies may be used in alternation with probable advantage. If the eye be much distended, and medicines do not act with sufficient promptness and energy, the operation of para- centesis may be made to evacuate the superabundant humors, after which the remedies will generally prove sufficiently powerful. We believe the following to be the best at present known: Bella- donna, China, Pidsatilla, Mercurius, Hyoscyamus, Stramonium. Conium; Nux-vomica, Arsenicum, Plumbum, Aconite, Sepia, Sulphur. It is doubtful whether either of these exercises a positively specific in- fluence upon the secretory and absorbent vessels affected in hydroph- thalmia, but they are capable of acting upon the generally morbid con- dition upon which the local disorder depends; they thus aid in arresting its progress, and occasionally in effecting cures. Administration.—In the same manner as advised in amaurosis. 6. cataract. ' Diagnosis.—Strictly speaking, this disease belongs to the province of surgery rather than that of medicine ; but as homoeopathy promises results somewhat important in a medicinal point of view, we take the liberty of presenting a few words respecting the malady in this place. By the terra cataract is understood, an opacity of the crystalline lens, or its capsule, which causes an obscuration, or a total loss ot vision. Authors recognize and describe several varieties, both of the lenticular and capsular cataract, and among the most common are:— First.—The^m or hard cataract, peculiar to old people, and re- cognized by its amber color, small size, and by its density and hard- ness. Vision is never totally destroyed in these cases, and the struc- tures of the eye retain their natural contractility. Second.—The fluid or milky cataract, caused by a change of the lens into a Avhite and semi-fluid mass, of so large a size as to nearly obliterate the posterior chamber, impair the motions of the pupil, and prevent the admission of rays of light. Third.—The soft or caseous cataract, which presents an appear- ance someAvhat similar to the last variety, with the lens much enlarged. 132 DISEASES OF THE SANGUINOUS FUNCTION. of a cheesy consistence, and of a light gray or sea-green color, oblite- ration of the posterior chamber, impaired motion of the pupil and ins, and either partial or total blindness. The lens in this variety, always presents an appearance of more firmness and consistence than in the milky cataract, aud the dark irregular spots or lines which sometimes traverse it, remain the same in all positions of the head, while those which are now and then observed in all the milky variety, change their location with every motion of the eyes. Fourth.— Capsular cataract, consisting of an opacity of the capsule of the crystalline lens. The opacity commences at the margin of the pupil, in the form of " distinct, white, shining points, specks or streaks; its color, therefore, is always very light, and never altogether uniform, eAren when the disease is completely formed." {Beer) When this kind of cataract occurs in children at or soon after birth, it is called con- genital cataract. The capsular cataract does not generally continue for a long period before the lens becomes invol ved also in the opacity. When the dis- ease has been preceded by a good deal of inflammatory action, Ave may find cohesions of the anterior capsule of the lens with the urea; or of the whole of the capsule with the lens; or all the three species of ad- hesion may exist together." {Beer, p. 318.) Cataract is sometimes complicated with amaurosis. This complica- tion is not always easy of detection, on account of the symptoms of these diseases bearing so close a resemblance. When the lens or its capsule are alone affected, the opacity is immediately behind the pupil, the iris and pupil possess some degree of mobility, and there is some little appreciation of light; but Avhen amaurosis is conjoined with cata- ract, we have the same appearance of the lens or capsule, but a dilated and immovable pupil, an insensible and immovable state of the iris, and an absolute loss of vision. The first intimation we have of a forming cataract, is defective vision when attempting to read fine print, or to look at minute objects. As the disease advances, all objects appear indistinct; a mist is con- stantly before the affected eye; a strong light is required to read or write; a small speck now commences just behind the centre of the pupil, and continues to extend until the opacity entirely obstructs th« passage of rays of light to the eye; when the opacity is complete, i\, black ring is seen around the edge of the pupil and the sight continues to diminish until blindness is complete. Causes.—Frequent and long-continued use of the eyes in reading fine print, writing, or looking at minute objects by a strong light; con- gestion of blood to the eyes, from exercise in the hot sun, in furnaces, and other places where hot and bright fires are kept; exposure of the eyes, irritating fumes and vapors, like sulphurous acid, chlorine and CATARACT. 133 other gases, and the vapors of sulphuric ether, nitric, sulphuric and muriatic acids, hereditary predisposition, mechanical injuries, wounds of the capsule or lens. Prognosis.—When the cataract is confined to the lens, or to its capsule, and no complications exist from unnatural adhesions, from amaurotic symptoms, or from serious constitutional disturbance, a favorable issue may be expected. On the other hand, a dilated pupil an immovable iris, a profound blindness, which has been disproportion- ate to the gradually forming opacity, unnatural adhesions of the capsule, and an irritable and vitiated constitution, will render our prognosis unfavorable. Treatment.—Before resorting to the operation of couching, or ex- traction, as is so often done by the old school surgeons, we should al- Avays give our medicines a fair trial. It is quite true that we have but few remedies which simulate this affection in their pathogenesis, yet the successful results which have been observed from the use of medicines in a few cases, render it incumbent on us to avail ourselves of them on all proper occasions. After a thorough trial with medicines, like Silicea, Graphites, Kali- hyd., Merc.-hyd., Calc-carb.-ac, if there is no prospect of amendment, the patient should be turned over to the surgeon for the necessary operation. ' In a few cases of incipient cataract, much benefit has followed the local employment of sulphuric ether vapor to the eye, and should our internal remedies prove fruitless, there can be no objection to a trial of this substance. As internal remedies we suggest: Silicea, Graphites, Iodine, Merc.- hyd., Conium, Pulsatilla, Magnesia-carb., Sulphur, Cannabis, Phosphorus, Digitalis, Spigelia, Euphrasia. Conium and Cannabis may be employed Avhere the cataract has arisen from a wound or other injury to the eye. Magnesia-carbonica, Pulsatilla, Digitalis, and Phosphorus, have proved curative in capsulo-lenticular cataract, either with or Avithout abnormal adhesions, also in opacity of the lens or capsule alone. These remedies are useful when the disease has been accompanied Avith ophthalmia. Sulphur is appropriate in those cases Avhich seem to be connected ayith a scrofulous or psoric diathesis. It has also been found curative i 1 cataract complicated with amaurosis. Euphrasia, or Spigelia may sometimes be alternated with Sulphur with benefit. Administration.—The same as in amaurosis. A case is given by Dr. J. Mouremans,* of a lady, aged 77 years, * L'Homceopathe Beige. 134 DISEASES OF THE SANGDINOUS FUNCTION. who had been blind four years. She is small, emaciated, of salloAV complexion, mother of three children. Vision had become impaired gradually several years ago after inflammation of the eye. She then sav/ snoAv-flakes and spider-webs in the atmosphere. In 1856, April 29th, she could hardly distinguish light from darkness; pupils dilated and mobility of the iris partially impaired, crystalline lens obscured, of whitish color, and uniformly shaded; no pain; inability for four years to continue her occupation. Euphrasia 30th, May 16th, improvement, continue Euphrasia, higher potency, three globules at once. Aug. 4th. Begins to distinguish objects but they look distorted. Cannabis 30, continued till Dec. 1. Condition not changed. Sulph. 200, three globules given at once. March 2d. The crystalline lens appeared less clouded. Could distinguish persons though as in a mist. Causticum 200. April 30th. Still saw black spots before the eyes; but vision im- proving, Silicea 30. At the end of May, the patient overjoyed at her condition, can readily distinguish all objects; could recognize the letters in a book; that she could deA'ote herself again to her former oc- cupation. Sees a halo around the light of a candle. Phosphorus 30. Two months later, she came to render thanks for the benefits she had received. Her vision Avas so far improved that she could thread a needle, could seAV and could read with ease. Three years afterwards the sight continued good. 7. GLAUCOMA. Mr. Hancock says he does not regard the disease merely as a choroiditis, or irido-choroiditis, with infusion into the vitreous and aqueous humors, as this vieAv seems to regard results rather than causes. He believes "that glaucoma, whether acute or chronic, is es- sentially a disease of the blood and the blood-vessels, and that the ef- fusion or infusion, as it may be described, is the result of this condition, which if not arrested, sooner or later destroys sight." He does not rely on any operation for the cure of glaucoma, relying mainly upon constitutional remedies. "In acute glaucoma," says Mr. Hanson, "the eyeball is constricted and marked by a circular depression at the point corresponding to the ciliary muscle, whilst the vessels around this part are gorged to a great degree. The eyeball is elongated in its antero-posterior diameter, and the cornea lessened in all its diameters, and rendered more conical than natural; Avhilst, when the patient turns his eyeball sideways, irregular bulging of the sclerotica (Staphyloma), is exposed to the view. In one or two cases, also, in which I performed iridectomy, the pupil was dilated to excess, and the iris so tense and rigid that it resembled a cat-gut, and could with difficulty be drawn through the Avound." The GLAUCOMA. Lokj pathology is not clear. This author thinks he can " readily under- stand that the lateral expansion of the eyeball being, in a great degree, prevented by the constriction of the ciliary muscle, the force of the compressed fluid acts more powerfully in the antero-posterior direction; hence the puckering and cupping of the retina, the irregular bulging of the choroid, the alteration in the shape of the cornea, and elongation of the eyeball." A more careful examination of the pathological appearances led this observer " to suspect that the ophthalmoscopic and pathological ap- pearance of the blood-vessels Avere greatly enhanced by, if not in some instances entirely due to,the obstruction of the circulation caused by the undue and excessive constriction exerted upon them by the spas- modic or extreme contraction of the ciliary muscle, analogous to the spasm so often observed in the muscular fibres of the urethra, as Avell as in the sphincter muscle in certain affections of those parts. "This supposition was strenghtened by the character of pain so often described by patients as ushering in the attack of acute glaucoma; in one case, a lady Avho had been exposed to a very strong light at a party, felt upon her return home, as though she had received a violent bloAV upon her eye." {lancet, Feb., 1860.) Pathology.—In glaucoma the pupil is dilated, of a sea-green, bottle- green, or dirty-green color; the cornea is someAvhat flattened anteriorly, and nearly as sensitive as in the natural state; the iris is rather con- vex anteriorly; the globe of the eye is harder than usual; the sight is diminished from slight amblyopia to complete blindness; the ophthal- moscope, shows the papilla of the optic nerve, as it enters the globe and spreads out into the retina, to be concave, in place of convex, as it is normally; it likewise demonstrates pulsation of the arteria centralis retiinw Von Graefe attributes all these symptoms to increase of the intra-ocular pressure. He divides glaucoma into acute and chronic. Acute glaucoma, is considered to consist in a choroiditis (or irido- choroiditis) with diffuse imbibition of the vitreous body and aqueous hu- mor, and in Avhich increase of the intra-ocular pressure, compression of the retina, and the well-knoAvn series of secondary symptoms, are produced by the increased volume of the vitreous humor. Treatment of Glaucoma.—This disease, previously regarded as in- curable, has been treated Avith partial success by Von Graefe by the operation of iridectomy. J. W. Hulke, assistant surgeon to the London Ophthalmic Hospital, &c, has reported two cases thus treated. It is claimed that " the hardness of the eyeball, the peculiar progressive contraction of the field of vision, the paralyzed dilated pupil, the in tense throbbing pain, the excavation of the optic nerve entrance, and pulsation of the retinal vessels," are consequences of "excessive tension 136 DISEASES OF THE SANGUINOUS FUNCTION. of the eyeball, produced by a superabundance of fluid Avithin it, which is probably exuded from the choroidal vessels and distends the vitreous humor." "The eye being an organized living tissue, having a locular or cellular arrangement, the distention of its loculi with dense fluid, as serum, Avould give the Avhole tissue an unnatural turgidity, and stiffness. The fluidity of the organ, which occurs later in the disease, depends upon the breaking up of its dissepiments, when it shares the atrophy Avhich finally involves all the ocular structures." Von Graefe long ago demonstrated a flattening of the cornea in this disease, "by comparing the size of the image which the flame of a candle forms upon the glau- comatous cornea with that Avhich it forms upon the healthy cornea of the other eye;" it is "immediately apparent that the glaucomatous cornea furnishes the larger image, proving that its outline has a larger (flatter) curve. "The excavation of the optic nerve entrance" is explained in the Jacksonian prize essay on "Diseases of the Retina," Dec. 1860. {Archiv fur Ophthalmologic") It is there shoAvnthat "theoptic nerve entrance constitutes the Aveakest, the most yielding point in the fundus, where the first visible effects of excessive pressure Avould naturally be ex- pected." {Medical Times and Gazette, Sept. 1, 1860, london lancet, Feb. 1861, p. 144.) Surgical Treatment.—Von Graefe first attempted to treat it by paracentesis of the eye, and he accordingly performed this operation repeatedly in a large number of cases; but of these only two were per- manently cured, though there was temporary amelioration in most. He next attempted to produce "permanent diminution of the intra- ocular pressure" by iridectomy; but the general result was not very satisfactory; it seemed only to cause rather a refilling of the atrophied or softened eye. The result, however, of the same operation "in ulce- rations and infiltrations of the cornea" gave hopes of further advantages in the other cases. Cases, in which this operation was performed.—First:—In the premonitory stage of glaucoma. In this it was successful, even when this stage had lasted a long time. Second:—Early stage of acute inflammatory glaucoma. "Vision was perfectly restored in all cases in which the operation was per- formed before the termination of two Aveeks from the occurrence of the inflammation." Some of these cases were perfectly desperate, for every trace of the qualitative perception of light had been already ex- tinguished." Third:—Later period of acute glaucoma. Here improvement Avas obtained, though less apparent; the improvement was considerable even after the inflammation had lasted many Aveeks, ^ptronided the field of vision was not contracted, nor the optic papilla excavated." HYPERNETROPIA. 107 In the opposite condition the operation not adArised by excrutiating spasmodic pain, Avhich lasted seA'eral hours." He had tried Graefe's method by iridectomy and found it objection- able, from First:—"The disfigurement resulting from the removal of a portion of the iris, the formation of a coloboma iridis." Second:—The removal of one-fifth of the iris. "All agree that the smaller the quantity of iris removed the better. By excision of a portion of the iris, the edge of the lens, with its suspensory ligament passing in front of the vitreous humor to the ciliary process, is exposed to vieAV. To remedy this incom^enience, Mr. BoAvman makes an incision above, believing that the cover thus given to the upper lid to the margin of the lens which has been ex- posed by the removal of the iris contributes to the perfection of vision. Third:—"The loss of the power of adapting the eye to near ob- jects, which it in some degree retains in chronic glaucoma." Operation proposed by Hanson. — "Introduce a Beer's cataract knife at the outer edge of the cornea where it joins the sclerotica. The point of the knife is pushed obliquely backwards and downwards until the fibres of the sclerotica are divided obliquely for rather more than one-eighth of an inch. By this incision the ciliary muscle is divided} whilst the accumulated fluid flows by the side of the knife." 8. HYPERMETROPIA. Defective Power of Accomodation of the Eye. This disease was first described by Von Graefe in his u Archiv fur Ophthalmologic, II. 1,179. It has since been thoroughly investigated by Donders. We abridge their views, as presented by another author."* By hypermetropia is meant that peculiar condition of the eye in which the refractive power of the eye is too low, or the optic axis (the antero-posterior axis) too short; wre may, however, have both these causes co-existing. We may also diagnose the hypermetropic eye by its peculiar shape; it appears flatter and smaller than the normal eye, it does not fill out the aperture of the lids, there is a greater or less space (like a little pouch) between the eyeball and the canthus, more particularly the outer canthus. The normal eye unites parallel rays upon the retina Avith little or no effort of accommodation, but it also possesses the power of accom- modating itself without difficulty or annoyance for divergent rays, coming from objects six to eight inches from the eye, for a short time it can * Mr. J. S. AY tils, Medical Times and Gazette. 138 DISEASES OF THE SANGUINOUS FUNCTION. even unite rays upon the retina Avhich come from three to four inches distance. The focal point of the dioptric system lies in the normal eye exactly upon the retina. In the myopic eye, the state of refraction is too great, or the optic axis too long, so that Avhen the eye is in a state of rest, the focus of the dioptric system lies in front of the retina, and parallel rays (emanating from objects at an infinite distance) are brought to a focus before the retina, and only more or less divergent rays are united upon the latter. "Now in hypermetropia we have just the reverse of this. The re- fractive power of the eye is so low, or its optic axis so short, that Avhen the eye is in a state of rest, parallel rays are not united upon the re- tina, but behind it, and only convergent rays are focussed upon the latter. Treatment.—When the eye does not possess sufficient refracting poAver to converge the parallel rays of light to a focus on the retina, the only successful mode of treatment consists in selecting and adapt- ing to the Avants of the individual convex glasses which by giving the rays of light a sufficiently convergent direction may neutralize the hypermetropia. The mode of suiting the eye with glasses of the proper. convexity is best described by Mr. Wells, according to the theory of Donders. "The presence of hypermetropia is thus tested. If a person can see distant objects through a convex-glass, he is hypermetropic. The best object is Jaeger's test-type. The strongest glass with which the patient can read at a distance of twenty^ inches gives us the degree of hyper- metropia before the action of atropine. If this glass be convex 24, his hypermetropia equals uV. The power of accommodation is then to be paralysed by a strong solution of atropine (4 grains to one ounce of water): after this has acted for from two to three hours, the degree of hypermetropia is to be again tested. In young persons with a good range of accommodation, the difference in the convex glass required before and after atropine is often very considerable. In the normal eye the far-point begins to recede from the eye about the age of fifty- five or sixty, the eye becomes hypermetropic, at eighty the hypermetro- pia may, according to Donders, equal -■&. li Range of Accommodation,"—We change the hypermetropic eye into a normal one by means of the suitable convex glass, and then find the nearest point at which No. 1 of Jaeger can be read Avith this glass. If the near-point lies at seven inches, A = i. " It has already been pointed out that presbyopia may co-exist with hypermetropia. "Spectacles."—A person suffering from hypermetropia must be gra- dually accustomed to wear those glasses which neutralized his hvner- metropia after the accommodation was paralyzed by atropine. At first ASTHENOPIA. 139 weaker glasses will be required, but the strength should be gradually increased until he has arrived at the glass which really neutralizes his hypermetropia. These spectacles should be Avorn both for far and near objects, should indeed, be always Avorn when the eyes are used. If the hypermetropia is great, or if a presbyopia co-exists, two pairs of spec- tacles will be required, a strong pair for reading, &c, a Aveaker for distance. "Hypermetropia is a very frequent cause of asthenopia and also of convergent strabismus. The asthenopia is produced by the overstrain- ing of the accommodation apparatus in reading, writing, &c, Avithout the proper spectacles. We have seen that the hypermetropic eye has already to exert its power of accommodation more or less for distant objects, in viewing Avhich the normal eye hardly uses its accommodation at all. How much greater must this exertion be when the hyper- metropic eye looks for any length of time at near objects, the rays from which are strongly divergent. The eye cannot keep up this great strain of its poAvers of accommodation for any length of time, and hence symptoms of asthenopia soon arise. Hypermetropia often causes convergent strabismus. As the poAver of accommodation increases Avhen the convergence of the optic axes is augmented, a person suffering from hypermetropia often squints in- voluntarily, in order to see more distinctly. This squint becomes per- manent, if the hypermetropia is not treated, and a strabismus opera- tion will then be required. 9. ASTHENOPIA —HEBETUD0 VISUS. AMBLYOPIA PRESBYTIQUE. The eye presents a perfectly normal appearance; its movements are restricted; convergence of the axes of vision takes place Avithout diffi- culty; the perception of objects is generally as perfect as ever; and yet in spite of all this, reading, Avriting, or any other employment re- quiring near objects to be vieAved, induces fatigue; objects become con- fused and indistinct, and a sense of tension is felt above the eyes. Such a height does this reach that temporary relinquishment of the employ- ment is rendered necessary. After resting a few moments vision be- comes again distinct, but the same symptoms develop themselves a^ain sooner than before. The amount of labor that can be performed is directly proportional to the amount of rest that has been taken. So long as the eyes are not employed on near objects vision appears normal, and no disagreeable sensation is experienced. No sooner, hoAvever, does the patient, regardless of what he has experienced, at- tempt to continue his previous occupation, than the symptoms become more and more pronounced; the pain in the forehead groAvs more in- tense ; the eyes become red, the tears Aoav freely, yet the eyes them- 140 DISEASES OF THE SANGUINOUS FUNCTION. selves are rarely painful. As this condition becomes more aggravated, the patient is obliged to close his eyes and pass his hand over his fore- head. Has too persistent an effort been made, all Avork on near objects must be given up for a considerable period. Pathology.—This is little understood. Mackenzie thought the seat of the disease must be sought in the organs by the operation of Avhich the eye adapts itself to different distances. Dr. Derby,* regards "an abnormal structure of the eye as lying at the root of the whole matter." He says: The results of modern investigation show:—That the agent in the act of accommodation is the crystalline lens, which varies its convexity, without changing its position. That Avhere objects are so distant from the eye that the rays coming from them may practically be regarded as parallel, such rays are brought to a focus on the retina without any accommodative effort; and that the nearer the object approaches the eye, the greater will be the strain on the accommodation. And Avhile the far-point, or limit of distinct vision of a normal eye, may thus be said to lie in infinity, (rays coming from an infinite dis- tance being parallel) the near point of such eye—i. e. the nearest point for which it can accommodate progressively recedes with advan- cing age, constituting presbyopia Avhen it has increased its distance from the eyes so much so as to cause inconvenience. Thus in an ideal eye the farthest point of vision should lie in in- finity, that is, the eye, when adapted for its farthest point, should possess the power of bringing parallel rays to a union on the retina without ac- commodate effort. Relatively few eyes, however, correspond to this ideal. Parallel rays, entering some eyes adapted for their farthest point, are brought to a union before the retina, so that only divergent rays, proceeding from objects relatively near can form perfect images on its surface. And parallel rays entering other eyes whose accommodative poAver is similarly relaxed, find their place of union behind the retina, to form perfect pictures on which the rays should enter the eye converging. Both of these conditions depend on a defect in the structure of the eye. The first constitutes myopia. The second is called by Donders Hypermetropia (which see page 137.) Presbyopia may exist in con- nection with either. In the first case the far-point lies this side of, in the second beyond infinity. The first requires a concave, the second a convex glass to give power of distinct vision at a distance. In 1858 Donders announced the general association of asthenopia Avith hyper- metropia and this abnormal structure of the eye. In I860, he said of the last hundred cases he had examined of asthenopia, hypermetropia existed in every one. * Medical and Surgical Journal. ASTHENOPIA. 141 According to Donders "the amount of accommodation Ave can brin«- i . . . ° to bear on an object at any distance, depends, in a great measure, on the angle at which it is necessary to converge the axes of vision in order to regard the object; the rule being that the two go, to a great extent, hand in hand, and that the greater the convergence the more accommodation we can bring into play. We distinguish between ab- solute and relative accommodation; absolute being the Avhole amount of accommodation that exists under the most favorable circumstances, the near-point being taken at the greatest possible convergence of the visual axes, and the far-point at their nearest approach to parallelism; Avhile relative accommodation is the amount that can be made use of at any fixed convergence of the axes of vision. Now it is found by ex- periment and observation that where normal eyes need, for a given con- vergence, half their relative accommodation, hypermetropic eyes are obliged to use § or even more,Avhich greatly fatigues them; and the cause of the asthenopic symptoms is thus simply a want of proportion be- tween the convergence of the axes of vision and the amount of re- lative accommodation that is obliged to be brought into play. Treatment.—It was formerly the practice to prohibit the use of positive glasses for the concentration of the A'ision on distant objects and only those very weak were used for near ones. The relief they afforded was therefore but trifling. Now the nature of the disease be- ing understood, we only regard the effect desired, viz., the relief of the accommodation from its unnatural strain, and the restoring of the proper harmony betAveen it and the convergence of the axes of vision. The treatment, therefore, consists in giving the patient glasses that corres- pond with the degree of abnormal condition and structure of his eyes. "The strongest convex lens Avith which he can see distinctly at a distance reduces his eye to one which needs no glass for either near or remote objects." In some patients who possess only a limited power of accommodation, a stronger lens will be needed for work on near ob- jects; "and a simple mathematical process enables us to compute the glass with which he shall be able to work in a given distance, and in so doing bring into play not more than one-third of the whole amount of his accommodation." In ascertaining the "strongest glass with which the hypermetrop can see in the distance," Donders employs a solution of atropia, suf- ficiently strong to paralyze the accommodation, dropping this into the eye before the trial is made. The patient who first thought himself suited Avith a glass of tAventy-four inches for distant objects; "after the employment of atropia, found one of six inches to be the glass re' quired." 142 DISEASES OF THE SANGUINOUS FUNCTION. 10. FUNGUS ILEMATODES, AND CANCER OF THE EYE. Diagnosis.—Fungus Hcematodes had always been confounded Avith scirrhus or cancer until Burns, Hey, and Abernethy pointed out the characteristics of the two diseases, both in respect to their formation and development, as well as their pathology. They possess several qualities in common, like malignancy, inevitable tendency to the de- struction of the affected parts, the power of contaminating the Avhole system, and giving rise ultimately to fatal constitutional symptoms; but in other respects they are entirely dissimilar. Fungus hcematodes is not usually attended with the severe stinging and lancinating pains of cancer; its texture is spongy and elastic, and is soft and apparently fluctuating under the touch, while scirrhus is hard and stony. When fully formed the fungous tumor is of the con- sistence of brain, is of a dark and livid hue, and bleeds on the slightest touch, while the substance of the cancer is hard, fibrous, and cartilagi- nous; at its commencement and during its development, the fungus is knotty and unequal, and thus affords a sign which distinguishes it from cancerous and other tumors. Fungus is more prone to occur in young subjects, while cancer is for the most part confined to persons past the middle age. Fungus of the eye commences in the posterior chamber, Avhile cancer of the eye attacks primarily the conjunctiva or lachrymal gland. The progress of fungus is more rapid and destructive than that of cancer. The first symptom observed in fungus haematodes is defective vision, and, on looking into the eye, a small shining spot is perceived at the bottom of it. This nucleus of the disease commences in the retina and optic nerve, is traversed by branches of the central artery of the retina, ab- sorbing it in its course, until it arrives near the iris, when it presents a dark amber or greenish hue, and is apt to be mistaken for cataract. As the enlargement increases, the ball of the eye becomes promi- nent, irregular, and knotty, the cornea ulcerates, and the disease dis- plays itself externally in the form of a soft, medullary, and purple fungus, bleeding at the least touch. The pupil becomes dilated and immovable in the early part of the disease, and also someAvhat changed in color, which becomes a strongly-pronounced amber or broAvn when the SAvelling arrives at the iris. The sclerotica soon -acquires a dark blue color, is crossed by dilated veins, and is sometimes attacked by the malady as well as the cornea. After the fungus has shown it- self externally, the absorbent glands of the jaw and neck become af- fected with a medullary degeneration; the countenance assumes a sallow and cadaverous appearance; general debility and nervous irrita- tion occur; loss of appetite, impaired digestion; nausea; irritable CANCER OF THE EYE. 143 stomach ; restlessness, and the usual symptoms of hectic fever terminate the patient's existence. Cancer of the eye, as we have before remarked, generally attacks persons advanced in life. This disease, unlike fungus haematodes, commences in the conjunctiva, caruncula lachrymalis, or lachrymal gland, in the form of a hard Avarty excrescence, Avhich continues for an indefinite period, sometimes attended with twinging and lancinating pains, at other times free from all uneasy feelings, until finally its in- terior structure becomes altered in texture, an ichorous matter forms Avithin the swelling, which gradually makes its way to the surface, and thus develops the first stage of ulceration. When arrived at this point, vision is destroyed, an irregular fungous mass shoots up from the ulce- rated point, highly vascular, of a red, brown, or livid color, and easily excited to haemorrhage. As the mass increases, the tissues of the eye become distended ; the ulceration and sloughing advance ; severe lanci- nating pains dart through the globe; the appetite is impaired; the patient loses flesh, strength, and courage; sleep is disturbed; the countenance assumes an anxious, distressed, and sallow appearance; hectic fever sets in, and the sufferer speedily yields to the result. Hitherto the diseases under consideration have usually been deemed incurable by internal remedies, and on this account surgeons have ad- vised the early extirpation of all suspected tumors, hoping in this way to eradicate the affection while it is local, and before the mass of blood becomes contaminated. But it must be admitted, even when the opera- tion has been resorted to early, and under the most faArorabie circum- stances, that a lamentable want of success has for the most part, followed all surgical measures. Stealthy and insidious at their com- mencement they gradually glide along, depositing in all surrounding textures their destructive and fatal poison, until disorganization begins, Avhen the livid, foul, and destructive phenomena appear in their hideous- ness, rapidly communicating their influence through the whole organ- ism, and baffling all efforts of the physician and surgeon. But though experience has so little of promise, we can not admit that there are no remedies in the whole range of the materia medica capable of counteracting this morbid influence. We may yet find some medicine sufficiently specific to cure these diseases during their form- in « stao-e. We believe, indeed, that homoeopathy will, ere long, ac- complish all that we require in this matter. Only a limited number of Avell-authenticated homoeopathic cures of true medullary fungus, or of cancer, have been reported; but the results in these few cases should inspire us with some confidence of success, especially during the early period of the maladies. Causes.—The immediate cause of medullary fungus and of cancer is involved in doubt. Some have suggested the operation of animalculoe, 144 DISEASES OF THE SANGU1N0US FUNCTION. others of a subtle poison, others of a kind of unhealthy inflammation caused by some constitutional defect. Sir Astley Cooper supposed the morbid degefieration ahvaystobe "preceded by a disposition in the constitution to its production." There is unquestionably a specific morbid action in the tumor itself, but Avhether this is owing to some poison Avhich acts specifically upon the particular part alone, or to some constitutional vice, Ave are unde- cided. That there are drugs capable of neutralizing this morbid influ- ence, whether it be constitutional or local, we entertain no doubt. The exciting causes are: Woavs, contusions, obstructions of blood from pressure, and mechanical injuries generally, although the disease often originates without any apparent or traceable cause. Prognosis.—In our present state of knoAvledge, the prognosis must be generally unfavorable ; but not many years will elapse before this state of things will change, and we shall be able to meet these terrible diseases with sure and efficient remedies. Treatment.—The homoeopathic treatment of these affections must be directed by the general principles of treatment of malignant diseases. See Fungus Haematodes and Cancer.—Index. Belladonna has cured malignant disease of the eye, attended with violent pains in the eyeball; a red shining point in the posterior chamber; pupils dilated and immovable ; loss of vision; unusual hard- ness of the substance of the eye ; iris of a dark color, and covered with injected blood-vessels. Malignant affections of the eye have also been cured by Conium, Carbo-vegetabilis, Arsenicum, Mercurius, Acid-nitr., Calcarea* carbonica, and Iodine. Administration.—The same as in amaurosis. III. AFFECTIONS OF THE APPENDAGES OF THE EYE. 1. HORDEOLUM. STYE. Diagnosis.—This is a small boil-like swelling in the edge of the eye- lid, resembling in size and general appearance a barley-corn. It generally commences in the follicles of Meibomius, near the angle of the eye; it soon assumes a dark-red or purple color, and becomes pain- ful from the violence of the accompanying inflammation. The inflam- mation sometimes confines itself to the cellular membrane, and advances very slowly to the suppurative stage, thus causing not only highly troublesome local pains, but a considerable degree of febrile disturbance. In these cases, gangrene and sloughing of the cellular membrane is liable to occur, and either protract the cure, or leaA7e the part in a condition liable to take on a renewed morbid action from the smallest exciting affections of the appendages of the eye. 145 cause. In other instances, suppuration occurs speedily, the abscess bursts and discharges itself freely, and a prompt cure results. Causes.—Use of highly spiced, fat, and stimulating food: disordered stomach and bowels; abuse of the eyes in reading, writing, or seAving by gas-light: scrofulous, psoric, and other impurities of the blood. Treatment.—The appropriate remedies are: Sulphur, Pulsatilla, Staphysagria, Sepia, lycopodium. We usually employ the third at- tenuation, and administer a dose twice daily until the swelling and in- flammation disappear. 2. ENTROPIUM.—INVERSION OF THE EYELIDS. Diagnosis.—This affection consists of an unnatural turning inwards of the whole or a portion of the tarsus and eyelashes, in such a manner as to keep up a constant irritation of the globe, and thus generate a troublesome chronic ophthalmia. If the disease is alloAved to continue for any length of time, the cornea loses its brilliancy, its vessels become injected and ulcers form; there is continued lachrymation; partial or entire loss of vision; great pain and annoyance from the presence of the offending eyelashes. Causes.—Cicatrices arising from previous ulceration of the tarsi chronic ophthalmia; relaxation and paralysis of the lids; ulceration of the ciliary glands. ; \ 3. ECTROPIUM.-EVERSION OF THE EYELIDS. Diagnosis.—Eversion of the lids may be caused by a swelling and relaxation of the lining membrane of the eyelid, which presses the edge of the lid forward until it becomes everted, or by a contraction of the skin of the lid, in consequence of the healing of wounds, ulcers, carbuncles, burns, boils, &c. The consequences of eversion are, con- stant exposure of the globe to external irritating causes: chronic in- flammation of the eye: frequent discharge of tears: dryness of the ball; photophobia; nebulous spots and ulcers of the cornea. Causes.—The principal causes of eversion, in consequence of swell- ing of the lining membrane of the lid, are, protracted chronic ophthal- mia of a scrofulous nature: relaxation from intemperance or old age; a diseased state of the follicles of Meibomius; morbid growths in the part. Other causes of eversion are,, cicatrices on the skin arising from incisions, burns, ulcers, small-pox pustules, and carbuncles. Treatment.—The medicines Avhich haAre been commended in these affections are, Hepar-sulphur., Mercurius-sol., Calcarea-carb., Digi- talis., Borax. Should these remedies disappoint our expectations, a portion of the Vol. II.—10. 146 DISEASES OF THE SANGUINOUS FUNCTION. lid should be excised, in such a manner and in such a situation that the healing cicatrix Avill restore the displaced tarsi and cilia to their normal position. The operation is simple, unattended Avith danger, and quite efficient. If opacity or ulceration of the cornea has already com- menced Avhen we are first called to the case, it will be advisable to have recourse to the operation Avithout delay, and correct all local or constitutional faults afterwards with suitable medicines. The attenuations and repetitions of doses the same as in amaurosis. Exophthalmia. — Protrusion of the Eye. — Secale-cornutum.— Prof. Willebrand published his successes with Secale in relieving the partial paralysis of the ciliary muscle, which renders it difficult or impossible to read or sew for any length of time, or to accommodate the visual foci to small objects at short distances. He says the sphere of action of Secale is found in the vaso-motoric- nerves. The cases in which he has found it most beneficial are: 1. En- larged spleen from ague, after failure of Quinine. 2. Glalactorrhcea.— 3. Indurations, tumefactions and catarrhal affections of the uterus. 4. In blepharitis and pustular conjunctiva of children, preventing re- lapses. 4. fistula lachrymalis. Under this head authors generally include, obstruction of the puncta lachrymalis and of the lachrymal canals, inflammation and suppuration of the lining membrane of the lachrymal sac, and inflammation, thicken- ing and obstruction of the ductus ad nasum. In the most simple form of the complaint, there will be merely an obstruction of the puncta, arising from disease of the Meibomian glands, or of the eyelids, and a consequent interruption to the passage of tears to the lach^mal sac. The manifest symptoms in this instance will be, a continual watering of the eye and overflow of tears upon the cheek, weakness of vision, and an undue dryness of the nostril of the affected side. Another form of the complaint commences in the lachrymal sac, manifesting itself in the form of a small, hard, and circumscribed swell- ing, apparently within the sac. This swelling is quite tender to the touch, and gradually increases in size until suppuration occurs, when the parts over and around the tumor acquire -a red and shinino- appear- ance, not unlike erysipelas. During the early period of the inflamma- tion, the puncta are closed, and tears are forced over the cheek. The inflammation also extends down the nasal canal, causing a degree of tenderness, dryness, and obstruction in the duct and nostril. If the suppurative process continues unchecked, the sac, after becoming much distended, bursts, and gives gradual exit to the enclosed pus; thus re- FISTULA lachrymalis. 147 ducing the swelling and developing a fistula of the lachrymal sac. During the suppurative process, the inflammatory action frequently ex- tends to the external textures of the eye, and if the patient be scrofu- lous or highly irritable, some constitutional disturbance may be present If the disease is permitted to increase, or if injudicious surgical interference has seriously injured the affected tissues, we may expect adhesive inflammation between the walls of the membrane q£,the nasal duct, and permanent obstruction to the passage of tears to the nostril, and also a closure of the lachrymal canals. When this state of thingf happens, the tears run over the cheek as fast as formed; and we are presented with the disease termed stillieidlum lachrymarum. Still another form of the malady consists in a primary inflammation and thickening of the membrane of the ductus ad nasum, Avhich gives rise to a partial or total obstruction to the passage of the tears, and their consequent accumulation in the lachrymal sac. This undue lach- rymal accumulation induces distention of the part, and after a time, in- flammation of its lining membrane, and other consequences Avhich Ave have before enumerated. This form of fistula is dependent upon some disease of the nostril, like syphilitic, scrofulous, mercurial, and can- cerous ulcerations, or inflammation of the nasal membrane from other causes. When the malady is fully developed, it is difficult to decide in Avhich particular structure the inflammation originated: but our diagnosis will always be facilitated by carefully considering the causes of the affec- tion, and the previous inflammations. In whatever part it commence?} the inflammation is certain to extend, sooner or later, to the contiguous structures. Causes.—Scarpa advanced the idea, that all forms of fistula lach- rymalis were attributable to a disease of the minute glands of Meibo- mius, or as inflammation of the lining membrane of the eyelid. This idea has been partially refuted by several eminent oculists, but there is, notAvithstanding, much truth in the theory. According to our oavti observations, those forms of fistula which have originated in the puncta, or lachrymal sac, have been preceded by an inflammation of the Mei- bomian glands, or of the conjunctiva of the eyelids: but where the disease has originated in the ductus ad nasum, it may generally be traced to previous inflammation, ulceration, or injury to the mucous membrane of the nostril. The remote causes which predispose to the affection are: a scrofu- lous, syphilitic or mercurial taint; general debility and tendency to membranous inflammations: caries of the nasal bones; fractures and other injuries in the region of the lachrymal sac and nasal duct; Chronic ophthalmia; pressure of tumors against the lachrymal sac and the puncta. 148 DISEASES OF THE SANGUINOUS FUNCTION. . Prognosis.—Previous to suppuration of the sac, and if there is only a partial obstruction in the lachrymal canals, Ave may anticipate a prompt cure by internal remedies. But if the puncta and nasal duct be en- tirely closed, and the suppurative stage in the sac is far advanced, our prognosis must be unfavorable or reserved. Much, however, must al- ways depend upon the condition of the system, and the causes and complications which influence each particular case. Treatment.—Various methods have been proposed by surgeons for the cure of fistula lachrymalis, but they have proved for the most part unsatisfactory. The different surgical means Avhich have been most commended are, the introduction of a tube or style into the nasal duct; the injection of the sac and nasal canal through the puncta, by means of Anel's syringe, and the introduction of quicksilver. That cures have now and then followed each of these methods, Ave do not deny: but the numerous instances of permanent aggravation of the malady by their employment, render it probable that there .has been altogether more injury than benefit from their introduction into surgical practice. The mode of treatment formerly in vogue of inserting canulae and styles into the puncta lachrymalia has been, according to Dr. Williams, entirely superseded by the method proposed by Mr. Bowman of London. This plan consists in the enlargement of the punctae, to admit of the use of a common-sized surgical probe (p. 67.) But this opinion is not generally accepted. Mr. Haynes Walton* says : " The process of Mr. Bowman I find tedious, and so disagreeable, that but few persons will submit to it sufficiently long. My practice in general, therefore is to dilate for a short time only, using in the first instance the smaller probe, and afterwards the larger one, and then to introduce a style. "When there is really that degree of change in this conduit Avhich imperatively calls - for instrumental treatment, the Avearing of a style is less irksome, the more beneficial and the quicker plan. In some in- stances where my patient's time was short, I have introduced the style at once." (p. 346.) The style recommended is of pure silver and should be kept of dif- ferent diameters, because it may be advisable to commence with a small one. The figure given by Mr. Walton shows a silver wire about the thir teenth of an inch thick and two inches and a quarter long, having its upper end flattened and bent to a rounded right angle. The flat bent portion is to prevent the instrument from slipping out of sight and lies outside the lower lid. Cathcterism of the Lachrymal Passages.—La Forest showed how to re-establish the natural lachrymal passages without any external in- cision. To perform it with success the course and relations of the meati of the nose and their boundaries, must be correctly understood. The * On the Surgical Diseases of the Eye FISTULA LACHRYMALIS. 14S instrument employed is either a solid or hollow sound, the extremity of which is shaped to resemble somewhat an ordinary button-hook, the curvature of the blade not being so abrupt. The extremity of this sound is carried into the nostril in such a manner that, by a movement of rotation given to the instrument, it will pass beneath the inferior turbinated bone of the nasal fossae. This being accomplished, the point should be directed in the inferior orifice of the duct, which is ef- fected by giving to the instrument a slight movement backward and forward, then Avith half a turn, by which the handle is carried inward and dowmvard, it passes through the nasal duct and enters the lachry- mal sac. The hollow instruments of Gensoul are preferable for this operation, as through them, if necessary, fluids may be injected. Such being the difficulties met Avith by the latest writers among the most distinguished of ophthalmic surgeons, we may regard the duty of homoeopathists as the more urgently pressed upon them of testing most fully the powers of their own remedies. It therefore becomes us to 0 inArestigate all of the causes and accompanying symptoms of each par- ticular case, that we may better select remedies, and thus combat with a prospect of success the remote as well as the immediate symptoms. The following medicines haA-*e been found curative in the various forms and stages of the complaint: Calcarea-carb., Acid-nitr., Hcpai - sulph., Silicea, Aurum, Petroleum, Belladonna, Iodine, Digitalis, Lachesis, Lycopodium, Kali-carbonicum,, Natrum-carbonicum. The lower attenuations are ahvays to be preferred, and the dose re- peated every twelve or tAventy-four hours until the disordered tissues are suitably impressed. * Spasmodic Contraction of the Eyelids.—Ilyoscyamus.—Accord- in<* to Wepfer it is capable of producing spasmodic constriction of the eyelids; hence Hecker succeeded in curing a case of this kind by accidentally adding some Ilyoscyamus to a mixture he made up at random. Trichiasis.—Treatment.—To eradicate an inverted eye-lash, or bundle of them, plunge the point of a needle or fine knife, dipped in caustic potash allowed to deliquesce, into the dorsal margin, along the course of the hair or hairs, to the depth of an eighth of an inch. On the second or third clay, remove the lashes so treated Avith the for- ceps * they are all pulled out without any difficulty, and are blackened at the roots. The bulbs of ciliae are completely destroyed, never to be produced. No inflammation of any moment folloAvs the operation, unless the whole toav of ciliae be removed at a time* When a particle of dust or of any insoluble substance gets into the eve it may be removed by washing; but if soluble the water will tend •Dr. Williams, Braithw. Retros. 205, part XLHI. 150 DISEASES OF THE SANGUINOUS FUNCTION. to diffuse it. Putting the eye into a A'essel of Avater and holding it there will often remove the cause of irritation and give relief. If the offensive object be caustic, a strong acid or salt, sweet-oil will mitigate the irritation. But if Spanish flies or dead insects be the cause of the dif- ficulty the oil will do injury. For sharp dusty minerals, paint, or small sharp particles, the Avhite of eggs will often be sufficient; for lime, ashes, dye-stuffs or tobacco, cream or sour milk is the best remedy. We generally succeed in removing the cause of irritation, Avhatever it be, by taking hold of the eye-lashes and raising the lid in such a way as to expose its Avhole under surface to sight. The offending sub- stance is then likely to be brought into sight, and can easily be re- moved by brushing it off with a corner of a light handkerchief, or a piece of soft blotting paper, rolled into a small soft brush. If Avet Avith saliva it may be pushed far enough back into the eye to fulfil the desired object. A particle of iron flying into the eye from a blacksmith's anvil ad- heres closely where it lights. It may be removed by thrusting a bent hair beyond it under the lid and then draAving it forward; if visible it can be removed by the roll of paper, or corner of a linen cloth. Avoid rubbing the eye, soothe it Avith milk-warm Avater; and if the particle is not visible, try to sleep; the substance Avill generally come out of itself. If the eye be red and inflamed give Aconite. In scrofu- lous persons Aconite needs to be folloAved by Sulphur or Calcarea, (Hering, p. 122.) Acetum,—Particle of quicklime in the eye. Bathe the eye Avith diluted vinegar and wash it out. % Traumatic Injuries of the Eye.—Injuries of the crystalline lens from blows, general opacity is observed to follow in a few Aveeks from the reception of the bloAv, and in cases of such injury the prognosis given should be guarded. In one instance, says Dr. Williams, the ap- pearance of cloudiness was delayed for eight years—Avhen cataract made its appearance and required an operation for its removal." The medical treatment of injuries of the eye is simple and Avill be governed by the principles laid down under Ophthalmia and Injuries, p. 689.) IV. STRUMOUS OR SCROFULOUS OPHTHALMIA. This disease is characterized by extreme sensitiveness of the af- fected organs to light. Even the slightest ray causes intense pain and the little patient makes every effort to avoid exposure. During the inflammation an eruption usually makes its appearance on the cheeks, in the vicinity of the eyes, and which often extends to the very organs themselves, thus giving rise to troublesome and dangerous STRUMOUS OR SCROFULOUS OPHTHALMIA. 151 ulcers. These ulcers not unfrequently extend until the structure of the eye becomes so far impaired, that total blindness ensues. Diagnosis.—Scrofulous ophthalmia presents several symptoms Avhich are quite characteristic, and by the aid of which Ave may always form a ready and accurate diagnosis. The disease occurs in subjects of a scrofulous habit, and, in addition to the local symptoms, is accompanied Avith the general symptoms peculiar to scrofula, of which we will speak elsewhere. (See Scrofula, Index.) Indeed, these general marks will often aid materially in forming our opinion, particularly in slight cases. The light and clear complexion, blonde hair, blue eyes, tendency to glandular SAvellings of the neck, the tumid upper lip, eruptions during childhood behind the ears and upon the head, sensitiveness to cold, dis- position to cough after colds, frequent pains and discharges from the ears, indicate the strumous dyscrasia, which often determine and de- velop inflammations of the scrofulous kind. The peculiar symptoms which distinguish scrofulous inflammation of eves, are, the almost absolute intolerance to light; the violent spas- modic closure of the lids on the slightest exposure of the eyes to it, and the strumous eruptions which generally make their appearance in the neighborhood of the eyes. The light is commonly so painful, and the dread of exposure to it is so great, that it is exceedingly difficult to make a thorough examination in children, and as a general rule it is better to trust the voluntary efforts of the patient, in a moderate light, rather than to resort to much violence in attempting to force open the eyes. Usually, by obtaining the confidence of the patient we can per- suade such a display of the globes as will sufficiently satisfy us in re- gard to the case. The vessels of the conjunctiva are generally much injected; there is a considerable discharge of purulent matter; the balls are stiff and painful; the lids SAVollen; vision impaired by the in- flammation, or by ulcers on the cornea; one or more ulcers form on the conjunctiva coArering the cornea; and, if the symptoms continue to in- crease, the sight is finally destroyed. The disease varies much in its progress; is sometimes attended with but little redness of the conjunctiva, but slight pains in the globes, and but a moderate secretion of pus; at other times, during the formation of an ulcer, all these symptoms increase in intensity, until the case nearly resembles one of acute purulent ophthalmia. It is of far more common occurrence in children than in adults. Causes.—The constitutional cause, as we have seen, is a strumous dvscrasia. The local, or exciting causes are atmospheric vicissitudes; undue exposure to cold, light, dust, smoke, and irritating vapors; neg- lect of cleanliness. Puoc.nosis.—Severe purulent ophthalmia under the most favorable circumstances, for the application of remedies is highly dangerous. The 152 DISEASES OF THE SANOUINOUS FUNCTION. chief peril against which Ave haA'e to guard, is ulceration of the cornea. Before this has taken place, and especially if the cornea appears bright, we may entertain hopes of a favorable termination of the case ; but if these opaque specks form while the inflammation retains its intensity, Ave must be prepared for a partial or total loss of vision. Of the diffe- rent kinds of ophthalmia, the gonorrhceal is unquestionably the mosl rapid in its progress, and dangerous in its character. Here, nothing but the most consummate judgment and coolness, with constant atten- tion can avert serious consequences. The other varieties of the malady are not quite so rapid and destructive, but they demand the most skillful and energetic efforts to Avard off injurious results. As a general rule," if Ave are called during early stages of the com- plaint, and exhibit the appropriate specifics judiciously and boldly, little difficulty will be experienced in inducing a speedy and happy issue to either of the Ararieties; unfortunately, hoAvever, the physician is rarely called until the disease is so far advanced that ulceration can not be prevented. It is evident, then, that the prognosis will depend upon the intensity of the disease, the complication Avhich has occurred, the time it has existed, the constitution of the patient, and the remote and exciting causes. Treatment.— The only local application which can be advanta- geously used during the acute stage of purulent ophthalmia, is pure Avater, either cold or tepid. This may be employed as a lotion to the parts, during the course of the acute symptoms, as the judgment of the adviser shall dictate. When the chronic stage has set in, recourse may occasionally be had to stimulating collyria, like the Vinum-opii, solu- tions of Sulph.-zinc, Nitr.-argenti, Sulph.-cuprum, Acetat.-plumbi, and Aconite ; but in regard to these applications, the same rules apply Avith full force here, that we have presented under the head of simple acute ophthalmia, Avhen alluding to the use of collyria. The following remedies cover all of the symptoms which obtain in the different varieties of purulent ophthalmia: Arsenicum, Belladonna, Sulphur, Rhus-toxicodendron, Calcarea-carbonica, Aconite, Mer- curius-sol., Graphites, Phosphorus, Spigelia, Digitalis, Acid-nitr., Hepar-sulphur, Causticum. Arsenicum will proA'e curative in purulent ophthalmia, with much vascular congestion of the conjunctiva; swelling of the lids ; nightly agglutination; photophobia; pressure and burning pains in the eye- balls, aggravated by moving the eyes; nebulous spots, and ulcers on the cornea. Belladona is an admirable remedy in scrofulous inflammation of the eyes, with very great intolerance to light; a constant inclination to remain in the dark, or to plunge the eyes into a pilloAv or some other soft article; purulent discharge ; great swelling of the lids <, spasmodic STRMMOUS OR SCROFULOUS OPHTHALMIA. 153 closure of the lids on exposure to light; chemosis ; tearing, throbbing, smarting, or stitching pains in the eyes ; roaring in the ears; hot dry skin; thirst; nightly agglutination; throbbing of the carotid and tem- poral arteries; pains in the temples and head; ulcers on the cornea; dimness of vision. We have cured seAreral cases of purulent ophthalmia of infants, characterized by great intolerance to light, intense inflam- mation, throbbing of the carotid and temporal arteries, flushed cheeks, hot skin, and other indications of inordinate vascular excitement, with Belladonna, succeeded by Mercurius. We deem Belladonna one of our most valuable medicines in nearly all of the acute inflammations of the eye. The effects arising from the application of a small quan- tity of the extract to the eyebroAvs or temples are sufficient to demon- strate its marked specific action upon the structures of the eye. We have found it eminently serviceable in ophthalmia neonatorum, and in acute ophthalmia. Sulphur is an inAraluable remedy in seATeral kinds of purulent oph- thalmia. It is adapted to the chronic forms, with atonic distention of the conjunctiATal A'essels; swollen and oedematous condition of the lids, with purulent discharge ; suppurating ulcers on the cornea; sensation of itching, burning, and heat, in the eyes and lids; troublesome ag- glutination in the morning; diminished power of motion of the upper lids ; pustules of the cornea ; sensitiveness to the light of the sun; swollen upper lip ; eruptions behind the ears, and on the scalp and face ; pressure and burning pain in the eyes ; impaired vision. Sulphur is one of those-remedies Avhich will be required more or less frequently in all varieties of ophthalmias, not only to combat those lo- cal svinptoms Avhich especially correspond with it, but to correct mor- bid conditions of a more generaPand latent character, Sulphur may occasionally be used with decided advantage in alternation with re- medies Avhich appear to cover all of the manifest symptoms, but which do not produce prompt impressions when given singly. Rhus-tox, is useful in rheumatic, scrofulous, and catharral oph- thalmia, with much inflammation and SAvelling of the lid; redness of the balls of the eyes; profuse secretion of mucus or pus from the eyes and lids; oedematous swelling of the lids and the parts surround- in"- the eyes; morning agglutination, with increased redness of the eyes: pain on turning the balls; lachrymation; photophobia. Rhus-toxicodendron,—This is one of the most important remedies in catharral, erysipelatous, scrofulous, and exanthematic ophthalmia. Many allopathic physicians commend the tincture of 'Rhus in scro- fulous ophthalmia. We can bear Avitness to the value of this medicine in scrofulous ophthalmia, and in chronic ophthalmia which is kept up by a discrasia of erysipelatous character. Calcarcd-carboniea has been successfully employed in every variety / 154 DISEASES OF THE SANGUINOUS FUNCTION. of purulent conjunctival inflammation. Its chief indications are: in- flammation, redness, and purulent secretion from the eyeballs ; SAvell- ing and redness of the eyelids ; nightly, and sometimes daily aggluti- nation of the lids; great intolerance to light; nebulous specks and ulcers on the cornea; inclination to keep the eyes in darkness; scrofu- lous eruptions upon the face and scalp; glandular swellings of the neck; SAvelling of the upper lips and nostrils; pustules on the cornea; pressing or aching pains in the eyes; corrosive inflammation in the edges of the lids, acrid lachrymation, general appearance indicative of the scrofulous dyscrasia. Dr. Dudgeon expresses the opinion that Calcarea " is one of our most important ophthalmic remedies and is surpassed by none in its applicability to the generality of cases of scrofulous inflammation, whether of the eye itself, or its lids; and is indispensable where there is marked scrofulous diathesis indicated by swelling of the glands," &c. Aconite may often precede other remedies in every variety of puru- lent ophthalmia, when the inflammation runs high, and gives rise to febrile symptoms. Intense redness and SAvelling of the affected parts; acute pains ; accelerated circulation; violent photophobia; headache ; hot and dry skin; thirst; flushed cheeks; throbbing of the arteries about the neck, head and face ; loss of appetite, " and perverted A'ision, point to the employment of Aconite." In some instances it may be alternated Avith Belladonna to advantage. Mercurius-sol. has proved successful in our hands in gonorrheal, scrofulous, and infantile ophthalmia; the remedy having been pre- ceded by Aconite. The symptoms were : violent inflammation and redness of the eyes ; great intolerance to light; profuse acrid or puru- lent secretion from the balls and lids; heat in-the eyes; cuttino- and burning pains in the parts; ulcers on , the cornea; cornea dim and misty ; sight impaired ; frequent agglutination of the lid ; gummy and scurfy matter on the edges of the lids. Graphites is one of the best remedies in scrofulous ophthalmia, with excessive intolerance to light; chronic congestion of the con- junctiva ; purulent secretion from the balls and lids ; frequent aggluti- nation of the lids; ulcers on the cornea; porrigo in the face ; eyelids much inflamed, red, and painful; inability to open the eyes before a strong light; constant desire to keep the eyes covered; symptoms worse by day-light than by candle-light; general appearance indica- tive of a scrofulous diathesis. Phosphorus is sometimes useful in obstinate and protracted cases Ox atonic ophthalmia, which have resisted the ordinary remedies There is generally inflammation and moderate redness of the eyes * considerable secretion of viscid mucus; sensitiveness of the eyes to light; heat, burning and itching of the eyes ; lachrymation durino- the STRAMOUS OR SCROFULOUS OPHTHALMIA. 155 day ; frequent and sudden attacks of blindness during the day ; floats before the eyes; Aveakness and indistinctness of vision. Spigelia.—Purulent inflammation, principally affecting the eyelids, with sharp pains in the lids ; pressure and pains in the eyeballs, during motion ; distention and paralysis of the upper lids; painful ulceration of the edges of the lids ; dimness of the cornea; general loss of poAver over the eyes. Rummel speaks highly of Spigelia in rheumatic and gouty inflammations attacking the cornea. Digitalis.—Conjunctival ophthalmias arising from colds, with acute inflammation, redness, sharp stitches, photophobia, secretion of puru- lent matter, and obstruction and dryness of the nose. Nitric-acid and Ilepar-sulph. are the best specifics for the re- moval of mercurial ophthalmia, folloAving the abuse of this drug in syphilis and other diseases. The symptoms are: inflammation, swell- ing and redness of the conjunctiva and lids; secretion of viscid mucus or pus; burning and smarting sensation in the eyes; photophobia, dark and unhealthy ulcers on the cornea; paralysis of the upper eyelids; tears easily excited; nightly agglutination; muscae volitantes and sparks before the eyes ; difficulty and pain in moving the eyes; pains in the bones and soft parts of the forehead and face. Chininum-sulph. has been employed with success at the first tritu- ration in several cases of strumous and chronic ophthalmias. When the malady assumes an intermittent character it will generally prove promptly curative. Euphrasia AYas given by Lobethal with much success in cases of rheumatic, strumous, and catarrhal ophthalmia, where there was "con siderable mucous secretion in the inflamed organ; as also in blennor- rhoeas of the eyes, in all of which cases Ave employ Euphrasia at once, internally and externally; in the former case, one drop of the pure tincture; in the latter as a collyrium, from two to five drops in four ounces of water." Lycopodium is well adapted to scrofulous or catarrhal ophthalmia, and in -obstinate cases of ophthalmia neonatorum. Hahnemann men- tions nocturnal agglutination and lachrymation by day, " as prominent indications for the use of Lycopodium? We have employed Aurum with excellent effects in several cases of ophthalmia of mercurial and syphilitic origin. Some authors re- commend it highly in scrofulous ophthalmia. Other remedies are, Causticum, Sepia, Silicea, Staphysayria, China, and Chamomilla. Administration—In acute cases, Ave prefer the first, second, and third attenuations, and in the chronic stage the first attenuation. The remedy should be repeated in the more violent forms of the complain^ every half hour, until Ave are satisfied Avith the impression produced; ■too DISEASES OF THE SANGUINOUS FUNCTION. but in chronic inflammations, a repetition once in twelve or tAventy-four hours will suffice. During the treatment we should never neglect the external use of pure water, or milk and Avater, either cold or tepid. Genus IX.—INFLAMMATORY DISEASES OF THE FIBROUS AND MUSCULAR SYSTEM. 1. IRRITABLE INFLAMMATIONS. In these diseases the blood-vessels are much less affected than the nerves. The patient may feel agonizing pain when no local disease is discoverable. A lady had an irritable inflammation in the foot. Various remedies were tried without effect. She went to the sea-coast and used a steam bath, after which the pain quickly subsided. The eyes are very subject to this form of disease. But it is more common in the breasts of young females; the lightest touch pierces to the shoulder, and down the arm to the fingers. It is usually connected with amenorrhcea and may be cured by perfect restoration of the menstrual function. It sometimes attacks the testicles Avhich become exquisitely tender without any visible enlargement. Sir A. Cooper says he had to remove the testicle in three cases. One of these Avas in a gentleman from South Carolina. After the surgeons of London had exhausted their skill on him, the torturing part Avas removed, and the patient went home quite well. When this disease is seated in the bladder the pain often resembles that from stone, and blood is discharged Avith the urine. The difference is, that the irritable bladder is most painful when distended, and that which contains the stone is most painful when emptied. On dissection the irritable bladder has been found red and resembling velvet. P. 78. This disease sometimes attacks the rectum. The best remedies are: the high attenuations of Cantharis, Apis, Cannabis-sat., lod., Prenanthus. These medicines will always palliate, and often cure the most severe cases of this kind. 2. ACUTE RHEUMATISM. Diagnosis.—Acute rheumatism usually commences after an abrupt suppression of perspiration, in consequence of exposure to wet, cold or a highly variable temperature. It first manifests itself in the form of slight chills, lassitude, and general uneasiness, Avhich are soon suc- ceeded by SAvelling, redness, pain, and augmented heat in the part af- fected. The pains vary much in character, being sometimes achino- and gnawing, at others lancinating and darting, or dull and throbbing ACUTE RHEUMATISM. 157 or numb, pungent, and prickling, and aggravated by movement, by ex- posure to drafts of cold air, and by the pressure or touch of the hand. In the first instance, rheumatism seizes upon the fibrous textures, but as the inflammatory action becomes developed, other tissues become in- Arolved, the capillaries of the neighboring parts become distended Avith red blood, and the usual phenomena'are present. The larger joints are more subject to rheumatic inflammation than other parts of the body, although it is not uncommon for the inflammation to commence in the head, neck, chest, arms, or legs, and gradually extend into the neighboring joints. The more common accompanying symptoms of acute rheumatism, are: bitter taste in the mouth, coated tongue, rapid and full pulse, moderately hot skin, thirst, scanty, high-colored and sedimentitious urine; intense pain on moving the affected part; anxious and distressed expression of countenance, and occasional perspiration. Rheumatic inflammations are liable to shift from joint to joint, and sometimes to fix upon important internal organs, like the brain and its membranes, the pulmonary structures, and the heart and its appendages. So long as the malady confines itself to the joints, or to the external parts of the body it is unattended Avith danger to life; but when metas- tases occur to important internal organs, the disease becomes in an eminent degree perilous. Rheumatism consists in a specific inflammation of a constitutional dyscrasic or psoric character, but which varies in its manifestations according to the anatomical structure in which it happens to locate it- self.- Thus it may be called:— First.—Muscular Rheumatism, in which the specific inflammation is chiefly seated in the muscular structures; Second.—Articular Rheumatism, in Avhich the inflammation is chiefly confined to the synovial membranes of the joints or to the liga- ments in their immediate vicinity; Third.—Rheumatic Neuralgia; the force of the disease being chiefly spent upon the nerves and their fine investing membranes. Rheumatism in either of the above forms may be either acute, sub- acute, or chronic. First.—Acute Muscular Rheumatism. The pain from sudden movement of the part is extremely great. Second.—Acute Articular Rheumatism is one of the most painful and trying of all febrile diseases, and movement of the joints produces ntense suffering. Third.—In Sub-acute Rheumatism there is little febrile action, little redness or tumefaction of the parts; the pain is less intense and agonizing, although the movement of the affected part in certain direc- tions may excite severe pains which may be either lancinating or spas- modic. 158 DISEASES OF THE SANGUINOUS FUNCTION. Causes. — Acute rheumatism occurs for the most part in young, healthy, and robust subjects, and can be generally traced to undue ex- posure to cold, or to a Avet and variable atmosphere. There is, hoAv- ever, in most persons, who are habitually subject to rheumatism, a con- stitutional dyscrasia, often hereditary. Of the theory of the mode of transmission nothing clearly true has been written. It is argued by Sir Henry Holland,* that the series of actions or changes peculiar to those diseases Avhich occur but once during life, and are sufficient to preArent their recurrence, have their seat in the blood and are carried on everywhere by the circulation; authors who accept this view of the subject have supposed that the "rheumatic, or uric acid diathesis, im- pressed its peculiar characteristics upon the blood, and that this fluid being contaminated, it became the channel through which the morbific cause must affect the health and Avell-being of posterity." {Dr. Ludlam.) There is in some persons a rheumatic condition of the system which is little noticed till it rises to the height of acute disease. It originates in the free use of animal food and fermented liquors. If neglected it often results in violent and destructive inflammation of the organs. The point of attack Avill be that which is congenitally the weakest or Avhich has become so by long-continued excitement; if the subject of attack be one who has long struggled with difficulties the brain is involved. A number of diseases may be termed rheumatic, as arising from a rheumatic condition of the system; we may therefore have rheumatic bronchitis, rheumatic diarrhoea; rheumatic inflammation following in- juries or surgical operations. Chronic rheumatism differs from the acute form in many respects; as for example, absence of febrile symptoms; the fixed character of the pains; no perceptible swelling or redness in the affected parts; the pains sometimes aggravated, and at other times ameliorated'by Avalking, and other exercises ; great sensibility of the diseased tissues to changes of temperature, to humidity, and to cold; dryness and inactivity of the skin; rigidity in the parts, most apparent Avhen attempting to move, or walk, after having been quiet for a considerable period; sedimentitious urine; weakness, trembling, or numbness of the parts. Treatment.—We enumerate, as the principal remedies:__Rhus Bryonia, Aconite, Colchicum., Belladonna, Pulsatilla, Dulcamara Mercurius, Nux-vomica, Phosphorus, Calcarea-carbonica Vera- trum, Hepar-sulphur, Arnica, Colocynth, Lycopodium, Sulphur. Rhus-toxicodendron.-^The integuments about the joints swollen and red; pulse frequent and hard; urine dark, or red, and turbid. Physical Sensations.—Drawing and tearing, or tensive stin be separated from the globules by filtering, though human blood Gannot be filtered. White Globules. — These are small colorless finely granulated corpuscles, soluble in water, and strong refractors of light. Some are round and include two or three granules; these are true lymphatic globules, arising at least in part from lymph mixed with blood. The other white globules are also generally round, though sometimes oblong, or irregular, with edges slightly serrated. They are the product of the coagulation of the fibrin. (Mandl.) State of the Blood in the Vessels.—Many authors have believed that the blood possessed some mysterious powers of vitality. Ac- cording to the observations of Kolk, Treviranus, and others, the globules of blood possess a rotatory motion during life,, independently of the motion arising from the impulse of the heart;; and this motion continues till coagulution takes place. Schulz of Berlin has shown that the blood globules have a power " by which they move on by themselves, surrounded by envelops of coloring matter, and keeping at a distance from each other." Copland imputes this force to the influence exerted by the ganglial nerves on the interior of the ves- sels on which they are distributed. (See Vol. I. p. 843.) To this force of mutual repulsion we attribute the- fluidity of the blood; but there is another force by which the blood globules are attracted by the tissues Avhen brought in contact with them in passing through the minutest vessels. This latter force, first examined by Schultz, "may be com- pared to a vortex, whence globules constantly pass from the arterial or terminal capillaries, and are lost in the different tissues. So that although the vital endowment of the blood is manifested by its fluidity Voi. II.—12. 178 DISEASES OF THE SANGUINOUS FUNCTION. in the vessels, it assumes an opposite manifestation in the capillaries, where this fluid is brought Avithinthe sphere of the vitality of the dif- ferent structures ; each one attracting from it those constituents of which itself is formed, and Avhich are always present in healthy blood.'' " Thus Ave see organization commencing in the chyle, advancing further in the blood, and reaching its acme in the vital attraction of the constituents of the tissues frdn the blood circulating in the capillaries which supply them. At this part of the circle, where the arterial capillaries, with the fluid circulating through them, become, as it Avere, confounded Avith the tissues in which they are distributed, there ap-i pears to be not only a constant attraction of particles by the tissues from the blood, but also an equal extrication of other particles from them into the blood received by the radicles of the veins." (Schultz.) Coagulation of the Blood. — In the process of coagulation the red globules of the blood are principally concerned; "it being chiefly the result of the loss of the vital motion which these globules possess in the vessels, and of the attraction existing betAveen the coloring en- velops and central bodies. As the vital attraction which keeps the red substance fixed around the whitish corpuscles, ceases soon after the removal of the blood from the veins, these bodies can then obey the force which tends to unite them, and they then form a net-Avork, in Avhose meshes the liberated red particles are entangled, and thus produce the phenomena of coagulation. If the coagulum be exposed to a stream of Avater, the colored matter is washed away, while the ag- gregates formed by the colorless corpuscles remain in the form of filaments in Avhich may be recognized an analogous structure to mus- cular fibre, and constitute the fibrine of the blood. The phenomenon of the coagulation of the blood, is due to the eva- poration of its ammonia, on exposure to the air. The blood is retained in a liquid state in the blood-vessels by the pressure of ammonia; and just in proportion to the loss or diminution of this substance, will it retain or lose its fluidity. This may be readily demonstrated by draining blood from the arm into an exhausted receiver. Thus excluded from the oxyo-en of the air, it remains fluid; but if we expose it and collect the products of evaporation, it coagulates, and ammonia is found as one of the products of evaporation. This coagulated blood may be again redissolved, by incorporating ammonia with it at the proper temperature. A knowledge of this fact may prove useful in many maladies which are accompanied with more or less decomposition of the blood as diphtheria, typhus, malignant scarlatina, yelloAV fever, &c. Plasma.—Constituents of Plasma.—Water, fibrin, albumen color- less corpuscles, votatile matter, fatty compounds, and salts. Plasma passes through all the capillary vessels, permeating all or- ALTERATIONS OF BLOOD IN DISEASE. 179 gans and tissues ; and at various points the glands or deporatinn- or- gans, remove from it the substances that if retained would injure its qualities. Many fluid substances, received by the stomach, enter the plasma and mingle Avith the fluid of the blood. These substances pos- sess medicinal poAver of some kind, and they effect one organ or an- other, according to their specific properties. 1. The poisons taken into the stomach produce symptoms Avdiich manifest themselves in some one organ or more, but they do not cause the production of contagious matter in the blood. 2. Poisons inhaled from the atmosphere by the lungs often produce contagious matters in the blood. Thus showing that the tAvo parts of the blood have distinct pathological relations. Experiments show that large quantities of some substances can be throAvn into the blood Avith- out great injury, if not in some cases, with benefit. In 1831 and 1832 the effort Avas made to replenish the exhausted blood-vessels of patients sinking from cholera by injecting saline substances into the veins. In one case five gallons of saline liquid was injected into a vein in the course of four days : nine and a half pounds throAvn in the space of 18 minutes (May 29), and a few hours afterAvards 10 pounds more with 4 ounces of albumen. In a feAV hours 10 pounds, Avith 10 grains of sulphate of quinine ; 10 pounds more of the solution the same day. June 2, six and a half pounds Avith six drops of solution of Morphia. June 19th, the patient Avas reported as Avell, and left the hospital. Such facts, Avith the varying aspects of the people Ave meet with every day, sIioav that the blood is constantly changing in its composi- tion ; and no tAvo efforts at chemical analysis present similar results. That the blood may be maintained in its highest; state of perfection, and fitter for the supply of all the materials requisite for maintaining the system in health, and those materials only, it is necessary that the functions of sanguification, nutrition, depuration, secretion, and absorption should be kept in the most healthful condition. As they by their combined action convey into the general circulation the sub- stances necessary for the supply of the Avaste of the body, or carry out of it those materials which are unfit for its purposes ; so, also they niav derange health by throAving into the blood poisonous matters taken up from the different absorbing surfaces, or by retaining Avithin the blood these worthless or deleterious substances which the Avelfare of the body requires should be rejected and throAvn off. Changes in the Qualify of the Blood.—The chemical constituents of the blood vary in different states of disease. The relative proportion of Albumen is increased in cases of active dropsy, and in most of the exanthemata, especially before the eruption appears. In many in- flammatory diseases the quantity is twice as great as in health, and the blood feels viscid to the touch. (Gendrin, Bright, Blackall, cfcc.) The 180 DISEASES OF THE SANGUINOUS FUNCTION. watery portion of the blood varies from the influence of depletion, many fevers, and other chronic diseases. The coloring matter in the blood is changed in some febrile and malignant diseases, and after the * operation of some virulent poisons, or morbid secretions.—The fibrine varies according to the extent to which blood-letting may have been pre- viously carried, and the degree of vital energy present, or the febrile or inflammatory action prevailing. It varies in its quality in the last stages of some chronic diseases, in the cold stage of congestive fevers, and after exposure to extreme cold, forming fibrinous concretions on the lining coats of the blood vessels. In pestilential cholera, asphyxia and hydrophobia the blood of the arteries has been found resembling venous blood. The electrical state of the blood is also changed by disease; and its temperature has been observed to vary from 86 D to 104°, according to the degree of nervous power in connection with vascular action.—(See Vol. I. p. 175.) The buffy coat seen on the surface of blood drawn from patients suffering from inflammation is only conspicuous in inflammations of the serous membranes, the lungs, and other viscera; it is less strongly marked in children, in pregnant or puerpural females who have been often bled, in rheumatic subjects, and when drawn from a large-sized vein. The buff is also seen in some cases of anaemia and chlorosis; the blood in these diseases having lost its globules and retained its fibrin. In general anaemia there is a deficiency of blood globules ; in health they exist in proportion 119 to 1000 parts of blood; whereas in anaemic patients they may be reduced to 65 parts in 1000. When anaemia arises spontaneously, says Andral, and also in pregnancy, and diseases produced by lead, the globules alone are deficient; but where this condition is produced by repeated blood-letting the blood comes to be deficient also in fibrine and albumen. In plethora the blood globules are increased from 119 parts in a thousand in health to 141 parts, the fibrine remaining in only the normal quantity. (See Andral " On the Blood in Disease? 1844.) But other changes in the intimate nature of the blood, which chemis- try has no power to detect, occur in the course of various diseases In many recorded instances the blood has been proved to have poison- ous qualities; and terrible effects have resulted from its contact witr the skin, cellular membrane, or wounded parts of persons- previously ir health. Even the fcetor from the blood of diseased persons has often caused malignant and fatal diseases. Distemperature or Dyscrasias of the Plasma of the Blood.—There are many varieties of changes of health, moods, tempers, feelings, de- pendent on the qualities of the blood: They may be caused by bad diet as well as other causes, and may be cured by attention to proper diet, good air and the proper regulation of the various functions; the ALTERATIONS OF BLOOD IN DISEASE. 181 plasma having been changed in character, is restored by proper management, food or medicines, which restore to a healthy state the skin, kidneys, bowels. While the unhealthy state of the blood con- tinues, the simplest wounds fester and ulcerate; there are eruptions, pustules or boils on the skin, slight external injury provokes chronic and ulcerative forms of inflammation with or without fever, appearing as scrofula or scurvy. In sailors at sea dieted on salt provisions, who walk about the ship in a hot climate with the feet exposed, every mosquito bite ulcerates and the wound increases in size daily, resisting all local treatment till the diet is changed. Under proper food, and cooler air the wounds heal spontaneously. In some hospitals, bad diet, and air cause fractures to remain long without uniting, on removing to better air recovery takes place. After formidable surgical operations, if the blood is in good condition, free from any constitutional taint, there is early and safe recovery. In unhealthy subjects trifling wounds degenerate into chronic ulcerations. In.the latter case it is asked, (says Addison, Braithwaite's Retrosp., No. 41,) which constituent of the blood is diseased ? Is it the plasma, or the portion from which the elements of repair are taken? Mr. Hunter says: " A person may have a sore upon the leg Avhich is granu- lating freely, when all at once the granulations shall lose their life and fade away. New granulations may afterwards spring up and these shall undergo the same process, and so they will continue to go on, if some alterations in the nature of the parts be not produced in the plasma of the blood. The nature of the granulations will be deter- mined by differences in the quality of the plasma." It is thus shown that forms of inflammation, suppuration and ulcera- tion are produced and kept up Jpy distemperature or unhealthiness of the .blood, more particularly of its plasma. And that a depurative operation is often performed in the plasma by forms of local inflam- mation may be argued from the eruption of small-pox. In scarlet fever it is supposed from the properties of the particles of the exfoliating epidermis that the contagious matter from the blood is discharged by the vesicular action. In gout, that the offending matter is discharged from the blood by the local inflammation is also concluded from the morbid material deposited in the parts inflamed. Further evidences of the truth of this view are found in the great Avork of Roki- tansky on Pathological Anatomy, and in the Lectures of M. Paget. In ordinary inflammation the speedy separation of the plasma, or sinking of the corpuscles which occasions buffed blood indicates a change in the relative qualities of the two parts of the blood. We have accordingly the yelloAvish, greenish, purplish hues, and the floccu- lated appearance like curdled soap in the plasma of buffed blood before its coagulation, in different cases of inflammation. 1^2 DISEASES OF THE SANOU1NOUS FUNCTION. The microscope reveals differences between the blood constituents when taken from the sphere of the inflammation or exterior to it. (Addison, on Inflammation.) In the act of sloughing or separation of dead matter from the ad junct texture blood-vessels are severed by the process, and they are separated without bleeding. In abscesses and ulcerations from thorns or other foreign bodies impacted in the flesh, great changes may occur Avithout bleeding. (Brit. 2Ied. Journ,, April, 1859.) In all cases of repair where exudations and new groAvth appear, the blood-vessels undergo the change from fibrous to corpuscular. Their component elements retrograde. This change is exemplified in granula- tions, the vessels of which bleed on the slightest touch, and Ave believe that in places of inflammation from disordered qualities of the plasma, the coats of the blood-vessels undergo the same changes. Noav as the plasma is the part of the blood that plays a conspicuous part in these changes, so it is not difficult to comprehend how it may be relieAred of hurtful materials by inflammation. "That sores give rise to very different kinds of pus," says Hunter, "is very evident to the naked e}-e; and that the different parts of which the blood is composed, Avill come away in different proportions, Ave can make no doubt; and Ave find that Avhatever is in solution in the blood comes away more in one kind of pus than another." It may then be presumed that inflammation exercises a therapeutical action in dis- ordered conditions of the blood. Zimmermann and Simon regard the fibrin as an exuvial matter or ex- cretion of the corpuscles. Is there any incongruity in finding it to be an essential material, used in the maintenance and repair of the com- mon blood-distributing tissue? » How does matter piass from the corpuscles into the Plasma f — Addison says it can be shown by experiment that molecular and tailed forms of some material substance may be seen issuing out of them and passing into the plasma, Avithout much alteration of their form or color and to any one who witnesses the experiment there can be no difficulty in concluding that the corpuscles, in their natural state, discharge matter into the plasma. He therefore concludes :—That the corpuscles of blood are sustained in their vital and chemical qualities by the plasma and the air; and also that their excretions are passed partly into the plasma and partly into the air; and these properties of the corpuscles being established, there are some broad and acknowledged facts respecting venous blood which claim our attention." (Brit. Med, Jour., 1859, p. 352.) Causes of Changes in the State of the Blood.—Fust.—Causes which vitiate the fluids from which the Blood is formed.—Unhealthy food deranges the digestive function and poisons the circulating fluids. J alterations of blood in disease. 183 The long-continued use of salt provisions, when too exclusively used, produces scurvy. Diseased rye causes chronic arteritis and gangrene of the extremities, diseased or putrid flesh has often induced malignant diseases; and the blood after death has been found fluid, dissolved, or blackish. The habitual use of any article possessing medicinal- powers has an influence on health. Acids, alkalis, turpentine, and all the chemical salts change the character and composition of the blood. The dried stale fish, used so extensively in some of the extreme parts of Northern Europe, produce diseases of that order which always arise from an im- pure state of the blood; and eating freely of fresh animal food, by increasing the fibrine and richness of the blood also predisposes to dis- ease but of another order. Excesses in eating and drinking cause a large amount of disease in civilized life. An imperfect performance of the functions by which morbid sub- stances are expelled from the blood is one of the principal causes of disease. Perfect health requires a full performance of all the functions of depuration, including respiration, perspiration, and secretion by all the organs whose office is to eliminate effete or injurious substances from the blood. Proofs that the Blood itself becomes poisonous in some diseases.— The blood in some diseases undergoes vital changes by Avhich a poison capable of reproducing itself is originated. Dr. Home communicated measles by means of blood taken from persons affected Avith that disease. Duhamel gives the case of a butcher, who, having put in his mouth the knife with which an over-driven ox had been slaughtereJ, had his tongue and throat SAVollen a few hours afterAvards, and an eruption of black pustules over his body. He died in four days. Another person having Avounded himself in the hand with a bone of the same ox, avus seized Avith inflammation of the arm, followed by mortification and death. Two females experienced gangrenous inflammation from a feAV drops of the same animal having fallen upon the hand of the one, and on the cheek of the other. By numerous experiments it has been proved that inoculation Avith the blood of diseased animals, or simple contact with it, may produce the malignant pustule in men. Dupuy and Leuret introduced blood taken from a horse affected Avith malignant carbuncle into the cellular tissue and veins of a sound horse and thus communicated to him the same disease. The serious effects Avhich folloAv wounds received in the dissection of bodies recently dead, as Avell as in those in which putrefaction has commenced, are quite common. " The septic influence of certain animal secretions and poisons on the tissues to Avhich they are applied and on the frame generally; are among the most important phenomena of disease." See Vol. 1. p. 511. 184 DISEASES of the sanguinous function. Louis de Castro says the blood of two plague patients infected the air of their apartment with a foetid odor; Zacutus reports the history of three persons who were struck dead by the odor exhaled from the blood drawn from the vein of a person infected Avith the plague. Muralt states that a cadaverous foetor emanates from the blood of persons af- fected with this malady; and Baglivi mentions that a nearly similar phenomenon was observed in the blood of patients in the advanced stages of a very fatal epidemic fever. Haller refers to a case of fever, in which he predicted from this symptom alone a fatal result. In- stances have been published by Zurinus, Alprunner, and Vater, in which physicians were dangerously infected by the foetor of the blood ab- stracted from the veins of persons in malignant diseases. Many have suffered in slighter degree from the same cause in more common dis- eases. Pringle says, an individual who had inhaled the blood of a dy- senteric patient which had stood for some time, was attacked by the same disease. Morton has given the case of a woman in malignant fever whose blood was so offensive, when taken from the arm, that the surgeon and assistants fainted from breathing "the odor. The blood of cattle affected with " the spleen''' is so poisonous that if the blood of such an animal only falls upon the hand it may cause dangerous disease; and the skinning or tanning the skins may have a similar effect. Their flesh, though salted and smoked, is a poison, and always produces death or lingering, incurable disease. Symptoms of Spleen in Cattle.—The animal looks sad and dull; it stumbles and trembles, particularly after drinking; the skin is hot, breath short; and while the symptoms progress, inflammatory tumors are formed. The Treatment of Cattle in this disease is hitherto confined to throwing cold water on them. Hering says, if this does not save them, they must die. The use of cold water is depended on to preserve other animals from the infection; those which die are buried in a deep pit without being touched Avith the hands. Every thing that has been in contact with the diseased animal is to be burned, buried, or purified with chloride of lime-water. When this disease is communicated to man the infected person be- gins to feel "melancholy, weak, and chilly; red spots, black in the centre, show themselves on different parts of the body; these soon be- come bluish tumors, and, eventually, inflammatory gangrenous ulcers. The treatment is not satisfactory. Bleeding is dangerous; warm and moist poultices also do harm. It is thought best to rely on quiet, strict diet, drinking plentifully of cold Avater, and frequently throwing it over the patient, drying him quickly afterwards. Internally give Arsenicum not too frequently." (Hering) In 1770, Fontana instituted a series of experiments on the effects of ALTERATIONS OF THE BLOOD IN DISEASE. 185 the poison of the viper on animals. He procured 3000 vipers and em- ployed 4000 animals which were bitten by the vipers in his presence, or otherwise subjected to the operation of the poison. From his six- thousand, experiments, he deduced the following results: In many instances, on injecting the poison into the jugular vein of rabbits, employing seven seconds in the operation, the animals cried out the moment the venom entered the vessel, were seized with violent con- vulsions and died in two minutes or less. The blood in all the large 'vessels and also in the heart and auricles was black and coagulated. The action of the venom and its effect on the blood are almost instantaneous. The color of the blood is suddenly changed, and becomes from bright red immediately black; this effect is succeeded by the sudden coagulation in the heart, auricles, liver and large venous trunks. Thus "the circulation is totally stopped and the animal dies." The poison of a serpent applied to a naked nerve diffuses its influence with instantaneous rapidity. Dr. Mead says, the bite of a rattlesnake killed a dog in a quarter of a minute. Such is the close connection between the sanguiferous and nervous system that pain and irritation will effect a change, even in the appearance of the blood. Many drugs have shown, when regularly taken for a certain period, the power to produce degeneration of the blood, altering its composi- tion and appearance, thus producing dyscrasias or cachexias, each pre- senting its own peculiarities. Thus, Mr. Sharp, in a late Avork (London, 1861), gives the effects of Titanium in causing and curing "Blood Dis- ease." He found it to operate upon: First.—The Stomach, bringing on nausea, loss of appetite, and feeling of discomfort. Second.—The Brain and Nerves: giddiness, imperfect vision, the peculiarity being that half an object only could be seen at once; desire to keep the eyelids closed. Third.—The Blood:—a perceptible derangement of the whole system, which could not, without danger, have been carried further." He also " found Titanium a most valuable remedy for certain cases of degeneration of the blood, for Avhich no good remedy Avas knoAvn before." LATENT MIASMS OR BLOOD-DYSCRASIAS WHICH ORIGINATE OR PERPETUATE OBSTINATE CHRONIC DISEASES.—PSORA—SYPHI- LIS.—SYCOSIS. Hahnemann says (Organon, §. 204, p. 183): " If we except all chronic maladies which depend upon a mode of living habitually unhealthy, as well as those innumerable factitious diseases, (V. §. 74), Avhich arise from the senseless, protracted, the assaulting and ruinous treatment, even of slight diseases, by allopathic physicians, then all the remainder, without exception, are occasioned by the development of these three 186 DISEASES OF THE SANGUINOUS FUNCTION. t chronic miasms, viz. internal syphilis, internal sycosis, but especially, and in an infinitely greater proportion, internal psora. Each of these is in possession of the entire organism, and has penetrated it in all its parts, before the respective primary representative and local symptom makes its appearance, Avhich prevents the bursting forth of its corres- ponding miasm in another form, and is manifested'in psora by a pecu- liar eruption, in syphilis by chancre and bubo, and sycosis in condylo- mata. Either of these chronic miasms being deprived of its local symptoms will, sooner or later under the influence of natural causes, become deA'eloped, burst forth, and multiply the incredible multitude of chronic diseases which for ages has afflicted the human race." We perceive that the observation made by Hahnemann led him to believe that some one of these latent miasms or poisons constituted the basis of all chronic diseases ; that these miasms might remain latent whether derived from inheritance or from infection; that there avos no limit to the duration of their action; nor could revulsives ever by turn- ing the vital force into new channels effect a real cure. This mode of proceeding might give the disease a neAV outward form, but it Avould only render the system more feeble and less able to react. Hahnemann says: " The more I examine the ordinary cures, the more I am convin- ced that they are not direct transformations of disease converted into health, but revolutionary disturbances of the order of things by medi- cines, Avhich, without being actually appropriate, possessed sufficient poAver to give matters another (morbid) shape : these are Avhat are called cures. "The hysterical ailments of yonder lady were successfully removed by me." "No! they Avere only changed into a metrorrhagia." After some time I am greeted by a shout of triumph. "Excuse me! I have also succeeded in putting a stop to the uterine hoemorrhage." But do you not see, on the other hand the skin has become sallow, the Avhite of the eye has acquired a yellow hue, the evacuations from the bowels have become grayish white and the urine orange-colored. "And thus, the so-called cures go on like the shifting scenes of one and the same tragedy." The frequent metastases of disease from the mucous membrane to the skin and its sudden recession to the internal surface have lonu n.—13- 194 DISEASES OF THE SANGUINEUS FUNCTION. more deeply-seated causes of disease, and strike at the hidden sources of hereditary evils and transmitted maladies. Though old school men aim at the same thing, they defeat them- selves by excessive medication, and thus produce aggravations instead of satisfactory cures. On this point Hahnemann says: " When the patient afflicted Avith itch, after taking Sulphur, complains that the cutaneous eruption groAvs Avorse, the physician who is ignorant of the cause, consoles himself by saying that the itch comes out entirely before it can be cured; in reality the exanthema is caused by tlj,e Sulphur, .and assumes an appearance similar to aggravated itch. Leroy says, viola-tricolor commences its action by rendering the cutaneous eruption of the face worse, though it subsequently effected a cure. The dose was too large, though the remedy Avas homoeopathic. Lyssons says (Med. Transac, Vol. II., London, 1772) : the skin-dis- eases which yield Avith the greatest certainty to elm-bark, are those which it first aggravates. If he had given smaller doses he would not have caused the aggravations. In chronic (psoric) diseases the aggravation produced by homoeo- pathic remedies (antipsorics) occurs from time to time for several days; after remedies whose action continues long Ave may see during the first six, eight or ten days some apparent aggravations of the original malady. "When these days are past, the curative effect of the remedy continues for some days longer." We are often called upon to prescribe for the results of disease, as Avell as for disease actually existing; even here, hoAvever, Ave arc go\rerned by all perceptible symptoms now existing, Avhether they evidence present diseased action or show Avhere diseased action has been progressing at a former time. We find these results of former diseass in all protracted cases, in all chronic diseases. It has been already shoAvn that remarkable diminution or exhaustion of nervous energy generally renders the blood dark-colored, prevents its fibrinous particles from adhering into a coagulum when removed from the veins, causes a disposition of the coloring matter to separate from the central corpuscles, and occasions a diminution of its saline in- gredients. It has been also seen that various articles received throuo-h any channel into the blood change its chemical and physical character. We may then be able to correct diseased states of the blood by intro- ducing medicinal agents through the same channels. Page 178. First.—Treatment of cases, in Avhich buffy or inflammatory blood is present.—Gelseminum, Aconite, Stibium, Ipecac, Bry., &c. ^Second.—Blood witJi loose Coagulum, &c.—This state arises from weak, nervous influence and vascular action, and is usually treated with tonics, or stimulants, chalybeates, mineral acids, and metallic salts. When the blood is of a dark color, Ammonia, Arsenicum HEMORRHAGES. 11? J Carbo-veg., China, are to be considered. In diseases, in which the blood is thin and dissolved as in scurvy, also in malignant and adynamic diseases, vegetable acids, as the citric acid, or vinegar, are the chief remedies. Vinegar Avas used by the Carthaginians and Romans in ail their campaigns ; and it has a tendency to prevent the attenuation of the blood caused by excessive fatigue. The poAver of citric acid is now Avell knoAvn in preventing scurvy. (See Copland, Vol. I. p. 1>4S.; Genus II.—H.EMORRIIAGIA.—H2EMORRI1 AGES. Bichat made the first real advances into the field of pathology Avhich is noAV so extensive ; and to him Ave OAve the first rational generalization of facts in the study of haemorrhages. He shoAved that there are general features Avhich are common to all spontaneous floAvings of blood, and classifies them according to the organs in Avhich they occur. We proceed to notice the most important forms of haemorrhage. 1. TRAUMATIC HEMORRHAGE. Treatment of Hemorrhage from Wounds.—A Avound, Avell closed and dressed, generally ceases to bleed. When there is danger of bleed- ing a compress may be applied over 'it and retained by a bandage. Cold water, immediately applied, "will stop bleeding from small vessels. When the bleeding vessel is larger, as some about the throat, thigh or arms, the whole limb or side of the neck may be compressed by pla- cing a finger on the trunk of the bleeding vessel. If it be an arterv the fact is knoAvn by the blood being of a light vermillion red color, floAving out in jets at intervals as the pulse beats. In this case the danger is greater, and the best surgical measures are imperiously required. Temporary safety may be procured by binding a bandage tight around the limb betAveen the wound and the heart so as to compress the bleed- ing arterv, the location of Avhich is knoAvn by its beating. If the bleeding does not at once cease, find the exact site of the artery, feeling for the pulsation Avith the finger, place directly on the spot a piece of cork and press it doAvn upon the artery till the bleeding is effectually stopped. A bandage applied around the limb, so as to compress the cork firmly on the artery, will restrain the flow of blood till better means can be obtained. Give only cold drinks, keep the limb elevated; place no unnecessary dressings over the Avound; keep it cool Avith cold Avater. If fainting occurs it is beneficial, as it permits coagulation of the blood. If the faintness comes on after great loss of blood, the patient becomes blue 196 DISEASES OF THE SANGUINOUS FUNCTION in the face, has twitching of the limbs, there is danger. Give China. If he does not revive sufficiently give good Avine. (Hering) When the loss of blood is likely to become serious, the tying of the bleeding artery is the only reliance. This even Avhen the vessel is small requires some skill and knoAvledge of general surgical principles. These have been greatly improved Avithin the present century. It Avas a maxim of Hunter to " take care of the vasa vasorum," and of Scarpa, Crampton and Travers, that Ave should "never cut the arterial tissue." Physic and Cooper improved the practice by using a ligature possessing the property dissolubility. Cooper first used it in 1814. And A. Cooper in 1817 tied the femoral artery of a man aged 80, and healed the Avound by the first intention; which proved the great superiority of this method over that of Scarpa. It has been proposed to combine all the advantages of former me- thods. The rule of avoiding the cutting of the true vasa-vasorum is good; these minute vessels should not be strangulated with the liga- ture. To avoid this, and yet secure the vessels, Cooper directs the ligature to be made of buckskin, very soft, and a little broader than the thickness of the skin; and it should not be to tightly draAvn. The wound Avill generally heal by the first intention; and, if it should not, there will be no suppuration and the wound will soon close; and a capsule Avill surround the ligature if the capillaries are not too much injured ; or the ligature will be surrounded by lymph, and will soon be dissolved. After using the animal ligatures several years no second- ary haemorrhage has resulted; the ligature never slipped, other appli- cations Avere never necessary; and the wound nearly ahvays healed by the first intention. As traumatic haemorrhages arise for1 the most part, from strictly local injuries, the treatment cannot be regarded as with the scope of any general therapeutic law. The local appliances of the surgeon will therefore be regarded in these cases. But AAdien the general system becomes involved, and diseased action becomes developed, then our law of cure comes in play, and the appropriate homoeopathic medi- cines must be prescribed. Styptic for Local Application.—The following formulae has been published by M. Hannon: (Bulletin Gen. de Therap) Benzoic acid, 1 part: Sulphate of Alumina and potash, 3 parts ; ergotine of bonjean, 3 parts ; water, 25 parts. Mix. The Avhole is to be boiled for half an hour in a porcelain capsule, constantly stirring, and replacing the evaporated water by hot water. Evaporated with the constant agitation to the consistence of an ex- tract, it presents a chocolate-brown color, strongly astringent taste, and an odor of ergotine. This, says M. Hannon, is the most ener- HEMORRHAGES FROM EXHALATION. 197 getic styptic at present known, whether applied externally or admin- istered internally. Creosote.—When this is not at hand, take the black glutinous drops Avhich hang in old chimneys Avhere wood is burned. A portion as large as a pea may be dissolved in a table spoonful of brandy, then diffused in a glass of Avater, and dropped into the wound. Leech Bites ought never to be inflicted on suffering children; but many people will use them, and some will neglect the patient long enough aftenvards to permit him to bleed to death. To stop leech bites from bleeding it is sufficient to hold the finger for a considerable time on the wound, and apply over it a good plaster of some adhesive plaster or sticking wax, such as that used by gardeners or shoe- makers. (Hering) Punctured Wounds made with blunt and rough instruments do not heal Avell from the bottom unless they are thoroughly cleansed; and they often require to suppurate, for Avhich they need poulticing or some slightly stimulating embrocation. Some of those mentioned under ulcers will answer. If the external aperture is small it may close up before the interior part is well. If the closing can not be otherwise prevented insert into it a tent made of a smooth piece of the bark of Ul/nus-fulva, or slippery elm. It is inserted without pain; and it expands gradually, thus enlarging the aperture. Causes of Spontaneous Haemorrhages. Dr. Joslin, in an article on the Meteorology of Haemorrhage, in 1843, shoAved, that in many cases of bleeding from the lungs and uterus the barometer was generally fall- ing on the days of attack in a greater proportion of instances than could with any degree of probability be attributed to accident: thus out of 54 cases, it Avas falling in 35, at the time of the attack, rising in 18, and stationary in one only. Treatment.—For active haemorrhages, Ave should examine Aconite, Gelseminum, Millefolium, Ipecac, Veratrum-viride, Digitalis, Arnica, China. For passive, and venous haemorrhages, the more commonly indicated • medicines are, Hamamelis, Collinsonia, Secale, Sabina, Ferrum-hyd, Calendula, Ammonium-carb. For haemorrhages occurring during the progress of maladies of a typhoid or malignant character, Ave must refer to Arsenicum, Ammo- niacum-carb., Carbo-veg., China, Muriatic-acid, Gallic-acid, Rhus-tox., Secale. 2 HEMORRHAGES FROM EXHALATION. 1. Haemorrhage from exhalation may happen wherever exhalents terminate; and they have their seats in the mucous surfaces, as the nasal passages, bronchia, stomach, intestines, bladder, &c. They also 198 DISEASES OF THE SANGUINOUS FUNCTION. occur in the serous membranes, as Ave sometimes find bloody serosity in the intestinal cavity ; and also in the cellular tissue. Such are those which produce scorbutic spots. Those of the skin are of rare occur- rence. Finally, glands have been observed to exhale blood. Haemorrhages by exhalation in mucous membranes, as elsewhere, are of two species: passive and active. Active, Avhen they are ac- companied with development of the vital forces ; thus they have this character in the nasal passages when Ave notice a titillating sensation, together Avith a slight pain and redness. At other times they are en- tirely passive, as Avhen they occur near the close of some organic af- fection characterised by debility. Symptoms of Excessive Loss of Blood.—The loss of blood mani- fests itself in paleness, coldness of the surface ; dimness of sight is a prominent symptom. Marshall Hall describes a case of a lady dyin* from uterine haemorrhage. The pulse Avas imperceptible and she was "tossing in that restless state which is so fatal a sign in these terrible cases. She asked: 'Am I in any danger? Hoav dark it is! I can't see!' The light of the wjndoAV was shining full upon the bed. The pupil was completely dilated and motionless before the light." When women recover from this state, or have lost much blood, they will probably have distressing headache with throbbing of the head; noise in the ears, colorless complexion; quick Aveak pulse, all of which symptoms are greatly increased by exertion. For such symptoms some formerly tried bloodletting; if they found relief for a few hours it Avas always folloAved by renewal of the nausea, throbbing headache worse than before. Indeed, the condition is one of anaemia; it is the acute state of what is otherwise called chlorosis ; that pale-faced amenorrhoea Avhich occurs either in puberty or after life, and is cured by a similar treatment. Ipecac.—Many old authors succeeded in curing haemorrhages with Ipecac, while others, as Murray, Scott, and Geoffroy saAv haemorrhage caused by it. If F. Hoffmann praises the efficacy of Alillefoil in various cases of haemorrhage; if G. E.-Stahl, Buchwald and Lceseke have found this plant useful in excessive hemorrhoidal flux; if Quarin and the Editors of the Bre.sla.uer Sammlungen speak of the cure it has ef- fected in haemoptysis ; and finally, if Thomasius, (according to Ilaller) has used it successfully in uterine haemorrhage; these cures are evidently OAving to the poAver possessed by the plant of excitino- in- testinal haemorrhage and haematuria, as observed by G. Hoffmann and more especially of producing epistaxis, as confirmed by Boecker. / Haemorrhage from the Lungs. See Vol. I. p. 797; Haemorrhage from the Stomach. Vol. I. pp. 413, 866. Haemorrhage from the Teeth. Vol. I. p. 237. PURPURA HEMORRHAGICA. 199 Haemorrhage from the Kidneys. Vol. I. pp. 785, 600. Vol. II. p. 70. Haemorrhage from the Rectum. Vol. I. p. 392. Haemorrhage from the Nose. Vol. I. p. 430. GENUS III.—PURPURA. This name is applied to an efflorescence consisting of small, distinct, purple specks and patches, attended by general debility, but Avith little appearance of fever. The efflorescence depends upon an extravasation of blood from the fine vessels under the cuticle. The only form of it that deserves our attention is : 1. PURPURA HEMORRHAGICA. Diagnosis.—The disease is characterized by the appearance on the skin of petechia, or-purple spots of large size interspersed with vibices and ecchymoses, resembling the marks made by the stroke of a whip, or by violent bruises. They appear first on the legs, afterwards on the thighs, arms and trunk of the body; the hands are seldom marked with them and the face remains free. On their first appearance the spots are of a bright red color, but they soon become purple or livid; and when about to disappear they change to a broAvn or yelloAvish hue; the cuticle over them appears smooth and shining, but is not sensibly elevated, except in a feAV rare cases in which it has been seen raised into a sort of vesicle containing black blood, especially on the tono-ue, gums, palate, and inside of the cheek. The gentlest pressure on the skin, as that of feeling the pulse, will often leave a purple blotch like that left after a severe bruise. Purpura haemorrhagica occurs in persons who have a constitutional tendency to haemorrhages, from all the surfaces covered by the de- licate epithelium as Avell as from the skin; they are therefore subject to large losses of blood which are often rapidly fatal. Sometimes the haemorrhage occurs every day at a stated hour; at other times there is a sIoav, but almost incessant oozing of blood from the gums, nostrils, throat, inside of the cheeks, tongue or lips; sometimes from the lining membrane of the eyelids, the urethra or external ear; also from the internal cavities of the lungs, stomach, boAvels, uterus, kidneys and bladder. S'/mptoms.—The appearance of the disease is preceded by great lassitude, faintness, pains in the limbs, though in some cases the pa- tient had been in previous good health. The feelings most complained of are extreme debility and depression of spirits ; the pulse is feeble and frequent; and there are heat, flushing of the surface, perspira- tion and other accompaniments of fever. When the disease has con- 200 DISEASES OF THE SANGUINOUS FUNCTION. tinued for some time the patient becomes salloAV and emaciated; the loAver extremities show oedematous SAvelling which afterAvards extends to other parts of the body. The duration of the disease is in some cases limited to a few days, in others it has continued for months, and even years. It occurs at all periods of life, but is more common among women, and in boys before the age of puberty. Causes.—Depressing influences which operate by depressing the vital powers; sedentary occupations; residence in close croAvded situa- tions ; consequences of acute exanthematous diseases, as small-pox, measles, or puerpural confinement; the ancients attributed the haemor- rhages which attend purpura haemorrhagica to morbid enlargement of the spleen. In children it is often originated by insufficient or im- proper food; in nursing women its causes are similar to those Avhich in other persons produce stomatitis materna. (See Vol. I., p. 740.) Treatment.—When it occurs in women and others too much con- fined within-doors or imperfectly nourished by food, the treatment will be commenced by improving the diet and prescribing change of air, exercise, travelling, at least by being carried abroad. When there has been no restriction of diet, no close confinement, and no debilitating disease has preceded, a different course may be suggested Avhich in its details will be regulated by the peculiar circumstances and features of the individual case. 2. Purpura Urticans.— Diagnosis.— This form of purpura com- mences with the appearance of rounded and reddish elevations of the cuticle resembling the Avheals of nettle-rash, but without the itching and tingling of that disease. The tumors gradually dilate, but within one or two days they subside to the level of the surrounding skin; their hue be- comes darker, and finally livid. They are most common on the legs where they appear with petechia?, but they also appear on the arms, thighs and breasts. It usually occurs in summer, and lasts from three to five weeks. It is occasionally preceded by stiffness and Aveight of the limbs, and some oedema accompanies it. 3. Purpura Senilis appears principally along the outside of the forearm in elderly women, in successive dark-purple blotches of an irregular form, and various in size. Each of these continues for seven or ten days, and then the extravasated blood is absorbed. Treatment.—The principal remedies are: China, Hamamelis, Ar- senicum, Sulphur.-acid, Gallic-acid, Ammonium-carb., Secale, Carbo-vcr. Acetate of Copper.—A girl aged seven years and a half, has had on her skin for eight days, dark red spots from the size of a millet-seed to that of a shilling; the spots especially occupied the upper half of the body, the chest, upper arms, face, and mucous membrane of the mouth. Otherwise the health seemed undisturbed. The urine in nor- mal condition. For five days the chloride of iron Avas administered, but PURPURA HEMORRHAGICA. 201 the spots only increased in size. On the forehead, both eyelids, and elboAvs, bluish ecchymoses of the circumference and height of half a walnut arose. From one alveolar process from which the child had herself extracted an incisor tooth two days before, blood constantly floAved ; her cheeks and lips were pale ; her strength gone. Something of the acid order was given Avhich checked the haemorrhage; but after eight days' trial it Avas given up, for fresh spots appeared; and a boil of the size of a moderate apple developed itself on each shin-bone. The acetate of copper Avas given in solution, (a feAv drops per hour,) July 9th, and it at once arrested the progress of the disease. July 13th. A smart itching of the spotted portions set in; this was folloAved by the usual change of the purple hue of the ecchymosis shining through the skin which became green and yelloAV. And by a Aveek more all morbid symptoms had disappeared. (Domrnes.) 2. A child aged seven years, complexion dark blond, showed a great number of dark purple red (but not bleeding) spots of various sizes, which had made their appearance twenty-four hours before, and occu- pied almost exclusiA^ely the upper part of the body, including the tongue. General health not otherwise changed, urine of ordinary color and chemical properties. Arnica was tried, but it failed to do good, and produced visible aggravation. After four days (or Oct. 31st, 184S,) frequent bleedings of the tongue commenced; the strength decreased. Acetate of copper employed after this (in a solution of gum water and cinnamon water) produced in this case also a rapid and perfect cure, preceded by the same itching of the skin and change of color. (Dommes) 3. Dr. Marx, of Cologne, court physician, reported the following: "A man of melancholic temperament, Avho had been taken ill on a jour- ney, consulted Dr. Marx in 1772. He complained of feebleness and want of appetite, had a dry cough, not very severe, and at times expec- torated blood. On various parts of his skin bluish red spots Avere seen, and reddish blue stripes under the tongue. Pulse small and irregular; blood occurred in the urine and stool and also in the saliva. Respira- tion difficult, with cold and hot fits. The above solution of copper vitriol in cinnamon Avater. In three weeks all morbid symptoms had disappeared, and the patient was able to continue his journey. (British Jour. Horn., I860, p. 542.) 4. Case by Dr. Searcy. (Transaction of the Med. Society of Ten- nessee.) A girl aged tAvelve years, after fever for nine days, Avas con- valescing. Was very pale and feeble; fainted on being raised; sur- face unnaturally cool; restlessness; thirst; headache; tongue pale and flabby; pulse scarcely perceptible and extremely frequent; tender- ness of epigastrium ; boAvels constipated ; and constant oozing of blood from the nares and throat for forty-eight hours, causing extreme ex- 202 DISEASES OF THE SANGUINOUS FUNCTION. haustion. On the face a few red and blue patches; also on other parts, as the limbs, inside of the lips and cheeks, from the size of a pin-head to a five-penny piece. She has always been delicate, is nervous-sanguine, bleeds often from the nose in health. Haemorrhagic tendency or scrofula not knoAvn in the family. She took small doses of Saccharum-saturni, every hour for seven hours, at which time the bleeding ceased. Solution of the same injected into the nares. A blister was applied to the back of the neck and to the calf of each leg. The pulse became stronger; still there is thirst, tender epigastrium; tongue pale and flabby. Under the use of elixir-vitrol, lemonade, light food, &c. She recovered. Sulph.-quinine and the mineral acid perhaps insured the favorable result. Under them the purpural patches ceased to appear on the skin and the old ones faded aAvay as strength improved. GENUS IV.—TOXEMIA.-BLOOD-POISON. 1. Toxaemia. Mercuriale.—Persons long exposed to breathing mer- curial vapor suffer depression of the vital poAvers; the process of animal calorification is imperfect; and it is quite common for such persons to be affected with ulcerations of the mouth and fauces, and with "pain- ful or rheumatic affections of the periosteum, joints, limbs and liga- ments, particularly after exposure to cold." Eruptions occur on the surface of the body Avith other phenomena, "to Avhich the term pseudo- syphilis has been applied ; as well as many of those symptoms usually denominated cachectic." The same effects occur from Avhat is called " a mild, but long-continued mercurial course." The poisonous influence of Mercury was exhibited on a grand scale on board the British ship referred to at Vol. I, p. 95. Thirty tons of the liquid metal Avas picked up and confined in bladders placed in barrels stOAved away in boxes in the bread room. The bladders Avere Avet and soon decayed; the heat of the weather caused them to burst; and the greater portion of the metal Avas secured in casks, though a laro-e quantity escaped and found its way into the crevices in the loAver parts of the ship, Avhere being covered Avith bilge-Avater it soon behorus in combination with Lime.—Dr. Churchill in his paper in the Dublin Hospital Gazette, Aug. 18, 1847, states that the "proximate cause, or at all events, an essential condition of the tubercular diathesis is the decrease in the system of the Phosphorus which it contains in an " oxygenizable state:" of the Hypo-phosphite? of Lime and Soda, he says : These articles are soluble and assimilable. They induce " manifest increase of nervous power, sometimes even from the first day of their administration, together with an unusual feeling of comfort and strength. At the same time the nervous symp- toms, if they have any, disappear; also functional derangements, irri- tation of the intestinal mucous surfaces. The appetite increases often in an extraordinary manner. The evacuations become regular and more abundant; the perspirations, if they have existed, cease; sleep becomes calm and profound." He reported in 1858, thirty-five cases, all of whom, he says, were in the second or third stage of phthisis. Of these "nine were completely cured, eleven experienced great amelioration, and fourteen died." The experiments of Dr. Churchill have now been repeated on a large scale in Europe and America, and a great amount of experience has been published. The hypo-phosphite of Lime, when successful at all, is so in minute and attenuated doses ; we give it, not to supply either Phosphorus or Lime to the blood, but as the means of dynamically. correcting functional derangements, and thus enabling the system to select from the food the various basic elements necessary for the blood. Alcohol in Large Doses.—Alcohol in phthisis is often capable of affording transient relief from symptoms which might not long require its use ; it is also useful in small doses in nearly all cases; but it is a perilous remedy Avhen prescribed in large doses for conditions which we know will demand its constant repetition for a long period. Its in- fluence is proved to be curative to a certain extent, but there must be some limit to the size of the dose. It is prescribed by some practi- tioners in this city on the presumption that there is something in consumptive diseases to give the debilitated sufferers perfect immunity from the bad consequences of this poison.—If we had only to look to the lungs and the general tubercular condition Ave might safely give large quantities of alcohol; but the stomach is also the seat of disease in nearly all consumptives. For Aveeks or months before death they suffer from pain and tenderness of the epigastrium, loss of appetite, thirst, frequent vomiting of acid matters. These symptoms often cause 254 DISEASES OF THE SANGUINOUS FUNCTION. more difficulty than the pulmonary disease ; and after death, M. Louis found the stomach softened or partially destroyed in texture in about one-fifth of the fatal cases ; and he supposed this change to be the result of inflammation. It is probable that he was mistaken in his opinion on this point, and that the solution of the coats of the stomach is effected by the action of the gastric fluid which has retained its digestive power after death. But can it be possible that burning, irritating draughts of alcohol even largely diluted, can exert any soothing or invigorating influence upon a patient affected with any of the symptoms just enumerated ? See Vol. I., 668. 861. The influence of Alcohol on the liver must not be overlooked. In all the commonest cases of phthisis in every stage, the liver is in a state of torpor or congestion; the blood which should flow rapidly through it from the stomach finds its course obstructed; the capillaries of the mucous membrane of the latter organ are congested; the appetite, though sufficiently craving, is capricious, morbid. If strong brandy can be taken without sensible and immediate injury, it is because the case is not a bad one. If it be long co itinued it must increase and render incurable the structural disease that already exists. If in large doses it does not intoxicate, it_ can only be that our patient has al- ready reached that deplorable condition in which he finds it " impos- sible to get drunk;" if it does intoxicate, it shows that the patient has already entered upon that downward course of physical and moral de- gradation in which recovery of health is impossible; and if it Avere possible, to the patient whose earthly existence is thus prolonged, life itself would be of little value. In the effort to support the strength of a consumptive patient by stimulants, wo encounter a danger which in acute diseases is not feared. The patient who has passed the crisis of an acute disease sustained by stimulants can bear to have the dose repeated at intends for the pur- pose of keeping up uniform action, since we know that it will not long be needed. In chronic cases, if we attempt to avert the depression which follows the exhilaration of each dose, we may indeed effect it for a time; but the augmented reaction is increased in force each time it is postponed; and it becomes at last so painfully depressing that the patient can not resist the instinct that prompts to the effort to put it off again, though at the expense of rendering recovery hopeless.* So de- cidedly has Alcohol been seen to produce injurious effects in all the febrile forms of the disease, that many authors have decidedly forbidden all stimulating drinks; as Dr. Epps (p. 237.) says, "Wine is poison in this disease and so is ale (in reference to the sick, pale ale) is deep- dyed delusion." Haemorrhage from the lungs is supposed to occur in more than half * Brit, and Foreign Med. Chir. Review. PHTHISIS PULMONALIS. 255 the Avhole number of patients affected with phthisis. When profuse, and the blood of a bright arterial color, we have almost uniformly relied on Hamamelis, alternated with Aconite. Millefolium is often effectual. In a case in which the life of the patient seemed endangered by mental excitement, Ave gave a solution of Tannate of Quinia 3; followed by "almost instantaneous curative effects. See Vol. I., p. 800. Aconite and Arnica are the medicines commonly prescribed, and these are our best remedies when the haemorrhage is active.* Acetate of Lron has given more prompt and marked results than any other remedy—a drop or a two-drop dose every twenty minutes; or less frequently, in proportion to the severity of the attack. This preparation is an uncertain one, and subject to rapid chemical decomposition on exposure to the air, or on being united with water. The Per-chloride is more manageable and perhaps equally effica- cious. All the salts of Iron seem to be similar in their mode of action. Ipecac, is often given with success. Dr. Kidd says Turpentine, five or six drops every six hours, is a most efficient remedy. Mr. Yeldham relies greatly on China. In the form of Tannate of Quinia, as mentioned above it acts almost instantaneously, and is unob- jectionable in a patient saturated with ague poison, and in momentary dread of death. The most absolute rest and silence ; cold applications to the chest; a small piece of ice held in the mouth, are recommended as highly im- portant. Acalipha-indica.—Introduced to the profession in this country by Dr. Tonnieire, of Calcutta, in a letter to Dr. W. E. Payne. While taking it for jaundice it seemed to bring on cough and haemoptysis; it was then used in consumptive cases with haemorrhage; in three cases it promptly checked the bleeding. Dr. W. II. Holcombe says, a negro had pneumonia for which he was treated by cupping and blistering, Aconite and Phosphorus. "He got up and about, but remained weak and spiritless, had no appetite, and was constantly hawking up mouthfuls of fluid red blood. There was little or no pain in the chest, or cough, no night sweats, but some emaciation, and remarkable slowness of pulse." Ipec. 3. and Hamamelis 3. lessened the red blood for a day, but the next it was red as ever. "The crepitant rale was heard over the upper half of both lungs, and there was slight dullness on percussion." For three or four weeks the disease resisted all treatment devised, and was growing worse: " constant and severe pain in the chest, on distressing cough, pulse one hundred to one hundred and twenty, expectoration of liquid blood more profuse ; dullness on per- * Dr. Pope, p. 37. 256 DISEASES OF THE SANGUINOUS FUNCTION. cussion increased, emaciation progressing; the patient gloomy and de- spairing, though very unwilling to die ; pains in the chest; nightly cough and the bloody expectorations were distressing. Gave Acalipha-indica, twenty drops of seventh dilution in a glass of Avater, — a spoonful every two hours. Next morning the bleeding had ceased, pain and cough greatly de- creased. In a day more, pain, cough and expectoration all gone. Ten days later the man felt perfectly well, fine appetite, perfect secretions walked five miles home. 2. ACUTE PHTHISIS.—ACUTE C ONSUxMPT 10 N. GRANULAR PHTHISIS.-PHTHISIS GRANULEUSE. Though ordinary consumption is eminently a chronic disease, lasting several months or more, Ave frequently meet Avith cases which pass ra- pidly through all its different stages, and end fatally. Dr. Flint says, one patient had been in good health Avhen he was attacked by haemor- rhage from the lungs. He passed rapidly into confirmed phthisis, and died in seventeen days from the first attack. But in these cases there is perhaps always a predisposition and often a latent tubercular deposit already existing, as in that same case, in Avhich there had also been a slight haemorrhage several months before, though the subsequent hack- ing cough without expectoration was so slight as to excite no appre- hension. In true acute phthisis there is no known or suspected tubercular de- posit till the acute disease begins; but, after that time, the deposit is remarkably abundant, extensive, and it undergoes the changes of soften- ing and expectoration with great rapidity. More correctly still is this name given to the form of the disease, in which there is an accumulation in great numbers of gray semi-trans- parent granulations, either remaining isolated, or coalescing, and giving rise to a species of infiltration. This is thought to be essentially distinct in its nature from ordinary phthisis. The granular deposit may effect both lungs, and death may ensue before there is time for softening and excavation. Diagnosis.—The tubercular deposit being developed in both lungs so equally, the dullness on percussion is not so distinctive as in chronic phthisis. Auscultation may only furnish such phenomena,, as the vibrat- ing and bubbling sounds, and sub-crepitant rale, belonging to acute bronchitis. There are not the exaggerated resonance, broncophony and fremitus that denote tuberculous solidification. Symptoms.—Chills, followed by some degree of fever; pulse rapid with heat and dryness of the surface; great muscular prostration; BKONCHIAL PHTHISIS. 257 notable increase in the frequency of the respirations, with or without great suffering from dyspnoea; lividity of the prolabia; towards the end of the disease, quiet delirium; subsultus tendinum and sometimes incontinence of urine may occur before death; pain in the chest not severe ; cough more or less violent, dry, or Avith small expectoration, sometimes bloody. The progress is so rapid that emaciation does not occur to the extent it does in chronic phthisis. Acute Phthisis is less strongly marked than chronic phthisis. If the positive symptoms of the latter form of disease are present in an inferior degree, but the case is progressing rapidly, then acute phthisis may be suspected. From the frequency of respirations, dyspnoea, lividity and rapidity of circulation we might infer disease of the heart; but the latter ought to be positively known by conclusive physical signs, and thus distinguished. Acute phthisis is distinguished from pneumonitis by the latter having physical signs which show solidification over the whole lung (in adults) commonly the loAver lobe, and it travels from lobe to lobe. In the former the disease is developed simultaneously in both lungs, the upper portions of the lungs being most affected. Treatment.—Our main reliance must be placed upon the folloAving "remedies in this malady: Aconite, Phosphorus, Stibium, Bryonia, Stannum, Mercurius-hydriodieum; Ammonium-carbonicum, Kali- hydriodicum, Digitalis, Lobelia-infiata. For the most part, we pre- scribe these medicines at the first attenuations. TUBERCULOSIS OF THE BRONCHIAL GLANDS.—BRONCHIAL PHTHISIS. Enlargement of the bronchial glands is a common accompaniment of pulmonary tuberculosis, though the symptoms during life do not always suggest this condition. In the cases in which tuberculosis is limited to these glands they may increase considerably in size; they m.ay go through processes similar to those Avhich they undergo in the lungs, producing cavities communicating Avith the bronchia, or the oesopha- gus, or even the pleural cavity. The glands primarily affected are those situated near the bronchia; thence the disease extends to the glands imbedded in the lungs, in the direction of the bronchial sub- divisions, also to those in the pericardium, the oesophagus, and the large vessels in the anterior mediastinum. It is only Avhen the bronchial glands are the seat of tuberculous de- posit, Avhen at the same time tubercles are not present in the lungs, that the disease gets the appellation of bronchial phthisis. It is a disease peculiar to childhood, and is rare then, for generally cases be- ginning in this form soon run into true pulmonary phthisis. Vol. ii.—17. 258 DISEASES OF THE SANGUINOUS FUNCTION. Prognosis. Recovery takes place in a few cases only: the rest are fatal, generally by progressing into confirmed.phthisis pulmonalis. Diagnosis.—This is difficult, as explorations of the chest are Avith difficulty made in children's cases; it is difficult in them to distinguish this disease from true tubercular consumption. Bronchial Phthisis is common after bronchitis, and its symptoms continue to appear. The cough assumes *a paroxysmal character like that of Avhooping-cough. There may be oedema of the face and swell- ing of the veins of the neck, arising from the pressure of the bronchial glands on the vena cava. Respiration more or less hurried; loss of flesh observable, but with great fluctuations in degree.* Lymphatic glands of the neck frequently enlarged. Physical Signs.—Pressure of enlarged bronchial glands on one of the bronchi may produce feebleness or suppression of the respiratory sound on one side. Dullness in the interscapular region on percussion; broncial respiration remains in its ordinary site, the interscapular space behind, and in the neighborhood of the sterno-clavicular junction in front, and there it may be exaggerated. Mucous rales, and perhaps gurgling sounds in the same vicinity. If phthisis pulmonalis exist it will be re- cognized by the persisting cough, cinneration, night-sweats, &c, cha- racterestic of that disease. In simple acute bronchitis there is generally disparity of resonance between the tAvo sides on percussion; and the bronchial rales are less marked, but more manifest at the summit of the chest; less abundant expectoration; dyspnoea and increased frequency of respiration, greater than in ordinary acute bronchitis, but less marked, less dan- gerous, and the course of the disease longer than acute general capil- lary bronchitis. Acute Bronchitis. Generally not present, except diarrhoea, which may occur in the latter stages, when *he tuberculization affects the intestines. There is no eruption. Accelerated breathing a marked fea- ture, with dyspnoea more distinct and severe than in any case of typhoid. No such preliminary stage. Mental symptoms less marked, appear later. Typhoid Fever. Has characteristic abdominal symp- toms : as tympanitis, iliac tenderness, gurgling, diarrhoea. The Typhoid eruption is positive when well marked ; but is not always present. This only present when it is compli- cated with pneumonitis, which physical signs should detect. Preceded by a preliminary stage; mental characteristic phenomena appear early and are very prominent. Pul- monary symptoms only show'them- selves at a late period, not at the be- ginning. * West on Diseases of Children, p. 283. SCROFULA. 259 In thac very rapid, and generally fatal form of phthisis, described as acute pulmonary tuberculosis, or tubercular pneumonia, the symptoms correspond to Phosphorus. Iodine or Hepar-sulphur. Phospliorus in health produces emaciation, glandular affections, scrofula, hectic fever, night-sweat, falling off of the hair, dry and burning throat, haAvking of mucus, chronic looseness of the bowels, aphonia, cough with rawness and hoarseness, cough with purulent expectoration, also of blood or tenacious mucus, heavy fullness and tightness of the chest, palpitation of the heart, pneumonia, phthisis. Treatment.—Our principal remedies in this disease are, Phospho- rus, Iodine, Kali-hyd., Kali-bichrom., Bryonia, Kali-phosphite, Sanguinaria, Carbo-vcg., Hepar-sulph., Calcarea-carb., Ammonia- carb., Senega, 2Iercurius-hyd., Drosera, Belladonna. We have Avitnessed the best results from the first and second at- tenuations of these medicines. Prussiate of Potash.—We find this remedy strongly recommended for phthisical catarrh and also in pulmonary tuberculosis attended with "excessive cough and expectoration; inordinate action of the heart and hectic fever." (Dr. Dutcher, Med. Reporter, Vol. VIII., p. 408. Lancet, Cincinnati, Feb. 1862. Dr. Smart, Maine Arner. Jour. Med. Sci, No. 13.) Permanganate of Potash.—This is a new remedy not yet well proved. It is the best of all knoAvn disinfectants and is believed to possess the depurative and other useful properties of other preparations of Potassa. GENUS VI. —STRUMA. 1. SCROFULA—KING'S EVIL. This disease was described by the Greeks under the appellation iiolpaOeg from %olpoc, hog, and by the Latins scrophules, (from scro- pha, female swine.) This name had its origin in the well-knoAvn fact, that scrofula Avas a disease peculiar to the above-named animal. The blood of scrofulous subjects has been found to differ materially from that of healthy individuals. In the former, there is a super- abundance of serum and a deficiency of the fibrinous portion, and the solids which are generated from this blood are, in consequence, lax, feeble, and incapable of resisting exposure, fatigue and disease. Scrofula is for the most part hereditary, but the physician is fre- quently presented Avith well-marked cases of the acquired disease. The circumstances Avhich favor the formation of an original scrofulous dyscrasia, are: cold and damp habitations, want of healthy and nutritious food, constant confinement at labor in close and ill-ventilated 260 DISEASES OF THE SANGUINOUS FUNCTION. rooms, and finally, the use of pork in all its forms, as a principal article of food. Respecting this last cause, we submit to a few re- marks : Since the time of Moses, a large portion of mankind ha*Ve looked upon swine as an impure animal and unfit for food. Its im- purity consists of a disorder of a purely scrofulous character Avhich is inherent in this animal and peculiar to it, and is constantly being de- veloped, especially during confinement and subjection to the ordinary modes of feeding. Recent observations show that the new disease called trichinasis originates in the use of flesh of hogs, which, though appearing healthy, have in their flesh the germs of the living flesh-worms or trichina. When pork containing them is taken into the stomach the calcareous capsule which invests the parasite is digested: the flesh- worms are set free ; and in one day or less they begin to multiply in vast numbers. They then irritate the mucous intestinal membrane, pierce the walls of the intestines and ultimately make their way to the muscular fibres Avhich they eat and destroy. On one occasion in Ger- many all persons who ate of the sausages prepared from a single hog, "died the slow death of exhaustion from nervous irritation, fever, and loss of muscular power. No case was benefitted by medical treatment." It is absurd to argue that flesh contaminated with the scrofulous miasm, can not communicate to the healthy body, after digestion, its morbid particles. The poison pervades every atom of the affected flesh, and no washing or digestion can destroy or banish the noxious quality. Scrofula is most common in temperate latitudes, where the changes of temperature are abrupt, and where the atmosphere is much of the time loaded with moisture. The miasm operates upon almost every struc- ture ; glands, skin, ligaments, membranes, muscles, and bones, all succumb to its attacks. Diagnosis.—The signs which are supposed to indicate the scro- fulous habit, are : precocity of intellect; blonde hair; light com- plexion ; blue eyes: soft and delicate cheeks ; lips thick and red * " frequent swelling of the upper lip and nose," edges of the eyelids red and prone to inflammation; scurf and eruptions on the scalp • laro-e head; sensitiveness to cold ; ends of the fingers blunt instead of ta- pering ; muscles soft and flabby ; morbid sexual propensities. These marks are generally supposed to characterize the scrofulous habit but it has occurred to us to witness far more cases of scrofula in individu 1 the very opposite of this description; but Avhether or not this is th result of accident or whether an erroneous impression has nrev '1 A upon the subject we will not noAV attempt to decide. Amono-st th most common and simple manifestations of scrofula may be ra 1 A glandular swellings of the neck. ^ SCROFULA. 261 These enlargements may occur very frequently during childhood, in the form of Avhat are vulgarly termed " kernels," on different parts of the neck. They are excited into activity by taking cold, by currents of air upon the neck, by measles, scarlatina, and whooping cough, and either remain for a long time stationary and inactive, or run on to more violent inflammation and suppuration. These swellings sometimes attain a very large size, involving most of the glands of the neck, and remain in this condition for many years. More frequently, however, OAving to injudicious allopathic treatment, the swellings are dispersed by external applications, the malady is forced to embody itself upon the lungs, and a fatal phthisis pulmonalis is the result. The next form of scrofula to which we shall call attention, is that in Avhich the joints become affected. The most important of these affec- tions are the 2. WHITE SWELLING. (ARTHROCACE,) AND THE HIP-DISEASE. The approach of these maladies is commonly gradual and insidious. Occasional pains are complained of in the diseased joint, after exer- cise ; the motions of the limb gradually become impaired, and vague pains are experienced in the neighboring joints, which induce the be- lief that healthy parts are the seat of the inflammation. As the disease advances, the ligaments, cartilages, and other- structures composing the joint become so much thickened by the inflammatory action, that the limb after a time becomes stiff, and the joint immovable. In some instances the inflammation is arrested at this point, the suppurative process is prevented, and a recovery by Avhat is called anchylosis, takes place. But in the majority of cases the disorder proceeds on to suppuration, the whole structure of the joint beoomes involved in this action, a profuse discharge of matter takes place from the part, constitutional disturbance is manifest in the form of emaciation, de- bility, night-SAveats, and other symptoms of hectic fever, and the patient soon succumbs. Scrofulous affections of the joints are very difficult of detection in their early stages. The pains are so vague and indefinite, as scarcely to attract attention: there is little ornosAvelling or discoloration over the disordered part; and there is no derange- ment of the general health Avhich indicates that the organism is suf- fering under a serious malady. It is for this reason that the disease is allowed to make serious progress before its true nature is suspected. Like its near relative, the consumption, it strikes silently, but deeply and fatally. See p. 176. Another scrofulous disease, common in infancy, is known as 262 DISEASES OF THE SANGUINOUS FUNCTION. 3. STRUMOUS DISEASE OF THE MESENTERIC GLANDS. The characteristic signs of this malady, are : Wasting of the limbs, pale and alternated appearance of the skin, tumefaction and tender- ness of the abdomen, sunken eyes ; irregular state of the boAvels, variable appetite, passage of partially digested food, general irritability. After the disorder is seated, the process of absorption is suspended, so that only a small amount of nutriment arrives at the blood, and the sufferer is soon reduced to that condition which medical men recognize as marasmus. See Vol. I., p. 884, 890. Although the mesenteric glands sometimes suppurate, yet much more frequently the victims to mesenteric disease die from actual star- vation. The only hope of cure in these cases is in a detection of the malady at its onset, and the services of a thoroughly competent physician. In a previous chapter we have already treated of another, and per- haps the most dangerous form of scrofula, under the head of phthisis pulmonalis, or tubercular consumption, to which Ave refer the reader. There are other scrofulous affections of the different parts of the organism, as the brain, the liver, the skin, the spleen, and the spinal marroAv. The Index under proper heads may be consulted Avith refe- rence to this subject. Hahnemann has included scrofula as a form of psora, but evidently on insufficient grounds. Psora is contagious, scrofula non-contagious. The matter of psoric eruption is capable of communicating its simili- tude by inoculation ; that of scrofula is innocuous when inoculated. Psora, in its specific development upon the skin, assumes the appear- ance of a vesicular eruption; scrofula makes its appearance in the form of extensive ulcers, abscesses, &c. The psoric miasm exercises its specific affinity upon the skin; the scrofulous miasm upon the glandular system. Psora is no respecter of persons, but attacks all constitutions, temperaments, and organizations alike ; scrofola is sup- posed to select its subjects from those who are daintily formed, and possess peculiarities of organization ; psora is readily cured by anti- psorics; scrofula always requires much time, and is often absolutely incurable by any course of treatment. Psora can not be artificially acquired, by any particular mode of life, or any particular food : Avith scrofula it is the reA'erse. Finally, the development of the psoric miasm, when it is clear and apparent, is ahvays specific and uniform viz: in the vesicular eruptions of a peculiar appearance upon the sur- face, and the malady is unequivocally contagious; Avhile the develon- ment of the scrofulous miasm is subject to very great variations but for the most part attacking the glands, rather than the skin, and de- cidedly non-contagious. SCROFULA. 263 Causes.—The scrofulous habit is, in most instances, inherited. In its hereditary subjects Ave may notice from birth radical unsoundness of constitution, an irritability, sensitiveness to slight exposures, prone- ness to catarrhal difficulties, and an inability to resist diseases, which is non-apparent in healthy children. The acquired scrofulous habit is generally amongst the poor, Avho are ill-fed, clad, and housed. We have before alluded to the causes which especially induce this variety of the disease; they are also the chief exciting influences of the hereditary dyscrasia. Atmospheric Adcissitudes, abuse of stimulants, venereal excesses, masturbation, intestinal irritation, excessive mental and physical occupation, scarlatina, measles, abuse of mercury, iodine and other drugs Avhich unduly stimulate the glandular system, also ex- cite the latent disorder. Treatment.—It has been observed that scrofulous persons are pe- culiarly sensitive to cold, and that abrupt changes from heat to cold, in a moist region, are especially calculated to call into active operation the latent malady. For this reason it behooves those who are liable to this affection, whether by hereditary or acquired predisposition, to dwell, if possible, in a Avarm and equable climate. When the lungs become affected, this course Avill often be necessary in order to save life. In all scrofulous diseases, too much stress can not well be laid upon the importance of a mild, dry, and uniform temperature. The food of scrofulous subjects should ahvays be of the most nutri- tious character, in order that a due proportion of fibrine may be intro- duced into the blood. Fresh meats, like beef, mutton, venison, fowls, and veal should constitute the principle articles of food; and bread, rice and other farinaceous substances should be made to take the place of watery and succulent vegetables. Porter, ale, and light Avines may also be used moderately with advantage. Much exercise in the open air is also essential. In taking exercise, it is of the utmost importance that the mind should be agreeably occu- pied, for if Ave Avalk or ride as a task, we shall obtain very little benefit. Bathino-, both in fresh and salt water, is also a means of securing a healthy action of the skin, and of imparting tone and vigor to the Avhole system. The clothing should always be adapted to the season, and in tem- perate and cold latitudes we strongly advise the buckskin wrapper to be worn over thin linen, silk, or Canton-flannel under-shirt. We com- mend the use of these garments during the Avinter from personal ex- perience. Vol. I., p. 197. The remedies most deserving of confidence in the treatment of scro- fula, in its various forms, are : Sulphur, Hepar-sulph., 2lercurius, Io- dine, Baryta, Dulcamara, Conium, Belladonna, Lycopodium, Sepiat 264 DISEASES OF THE SANGUINOUS FUNCTION. Calcarea-carb., Rhus-tox., Aurum-muriaticum, China, Ferrum- iodide, 2lercurius, Oleum-jecoris-aselli. Sulphur.—Scrofulous ulcers on different parts of the surface; humid eruptions behind the ears; purulent discharges from the ears ; scrofulous ophthalmia of children, with eruptions about the eyes, and ulcers on the cornea; chronic enlargement of the tonsils ; enlarged ovaria; SAvelling of the axillary glands ; SAvelled nose; frequent nose- bleed ; swelled upper-lip ; swelling of the glands under the lower jaw ; enlargement and suppuration of the inguinal glands ; SAvelling of the posterior cervical glands ; white swelling of the knee; emaciation; chronic inflammation of the eye-lids ; scrofulous ophthalmia, attended with great intolerance of light, and sense of fullness and distention of the lids; pulmonary cough, with sticking pains in the chest, and co- pious purulent expectoration ; inflammation and pain in the knee and hip-joints ; itching pimples upon the scalp, and pain at the roots of the hairs ; stitching pains in the ears and in the parotid glands ; pain- ful swelling of the upper-lip and alee of the nose ; pain in the region of the li\rer after exercise; pain in the abdomen on pressure, and in the inguinal glands ; sensation of weariness and fatigue in all the limbs ; want of vitality, sensitiveness to cold; pains worse during cold weather; despondency, alternating with gaiety; irritable, insolent and dis- contented. Administration.—One grain of the third trituration every twenty- four hours, until the beneficial effects are visible. In the treatment of scrofula, as in all chronic diseases, we generally succeed best with the remedies given in the higher dilutions and re- peated at longer intervals than av6 usually depend on in acute cases. On this point Dr. Lutze says: " In cases of chronic diseases, or diseases which run a long course, have existed for years, and deeply taint the organism, as deafness, blindness, gout, paralysis, old eruptions, open sores and old ulcers, fistulse, herpes, curvatures of the back and bones, caries of the bones, the medicine should never be frequently repeeited, nor should the same medicine be given twice in succession. Each dose should be alloAved sufficient time to develop its full effect, since it is the subse- quent action of the drug that achieves a cure." In such cases the practice of the author now is to dissolve " three to five pellets of the 30th potency in a cupful of fresh water of which I give a swalloio morning and evening for four or five days, etfter which I allow the medicine to act for three or four months, sometimes even for five or six months, or even lonaer if the improvement continues: if it should cease, and three months should have elapsed, I then give another remedy. " The reason why I do not giA-e another remedy under three months SCROFULA. 265 (except in case acute symptoms supervene,) is, because I have noticed that the primary action of the drug is sometimes not developed under tAvo or three months, after Avhich a cure takes place, which could not have been accomplished if I had not Avaited a sufficient length of time to allow the medicine to manifest its full action, or if I had interfered with it by the untimely repetion of the dose. " The curative process should not be vieAved as materially as it very frequently is. The properly-selected remedy starts the cure, the natural curative power finishes iti" Sulphu/:—Case by Dr. Lutze.—"Mr. II. from Holstein. Age 40 years. Almost constant pain in the left side of the chest; frequent yawning, sneezing and eructations.. Occasional pain and swelling in the pit of the stomach, empty eructations Avhen pressing upon this region. Deaf of the left ear from his infancy. Swelling at times of the left cheek, at other times of the mouth, nose and eye. Stiffness in the nape of the neck. DraAving pains in the left thigh. Weakness of the stomach and nerAres. In former years, inflammation of the glands and lungs. He had the itch Avhen young, which had been removed with an oint- ment. I sent him four powders, to be taken in eight weeks. No. 1 containing four pellets of Sulphur 30, which were to be dissolved in a cupful of Avater, aswalloAV to be taken morning and night for four days. After eight Aveeks the folloAving report was sent to me: A few weeks after taking the medicine, all the symptoms grew*Avorse, but in three weeks a general improvement set in. The left ear began to discharge again, which had not been the case for years, and the flatulence and pains in the chest have abated, so that the patie'nt feels much better. I sent four poAvders of Sugar of Milk, for the effect of Sulphur now first began to show itself. The next report being still more favorable, I continued the non-medicinal poAvders. Twelve months after the com- mencement of the treatment, I received the following report: ' The hear- ing of the left ear, Avhich had been deaf these thirty-tAvo years, is re- stored, and I am cured, except a small SAvelling near the left eye and some stiffness of the nape of the neck.' Another non-medicinal dose completed the cure. One dose of Sulphur o0 did all this in the space of four months." After some other cases as strong or stronger in the testimony they give in favor of the principle contended for by Dr. Lutze, he thus con- cludes this section: "These cases shoAv that no second dose of a remedy should be given as lono- as the first dose has not exhausted its action, and in cases where no effect is observed, as in case of deaf and dumb patients, Ave allow a dose to act at least for three to five months; since it is impos- sible to know what is going on in the interior of the organism, and it is so easy to injure the salutary action of a drug by the untimely exhibi- 266 DISEASES OF THE SANGUINOUS FUNCTION. tion of another remedy of which we have had repeated instances in the case of externally perceptible ailments." Iodine.—Hahnemann (Chronic DiseasesVol.il.) says: "Iodine is particularly indicated by the following symptoms: Dizziness in the morning; beatings in the head ; smarting in the eyes ; buzzing in the ears ; hardness of hearing ; coated tongue ; salivation ; taste of soap in the mouth ; sour eructations Avith burning; heartburn after eating heavy food; canine hunger; nausea; shifting of flatulence ; meteorism; con- stipation ; Avetting the bed; delay of the menses ; cough ; old morning cough ; difficulty of breathing ; external SAvelling of the neck ; lassitude of the arms in the morning, in the bed ; numbness of the fingers; dis- tortion of the bones; dryness of^ the skin; night sweat." Teste says, these are only the secondary symptoms of Iodine, and that the primary ones are exceedingly similar to Ipecac. The effect of excessive doses may be seen in a case given by Dr. Gairdner in a Avork on Iodine : A young English lady had bronchocele for which Iodine was prescribed. For a time the action was favorable and the tumor Avas diminished; but a gnawing pain commenced in the stomach; great oppression and anx- iety. The remedy was pressed further. In a Aveek she became ema- ciated ; there were vomiting, pain in the abdomen most severe; thirst distressing ; alarming diarrhoea; excrutiating pain in the stomach; vio- lent cramps and convulsive actions of the muscles, arms, back, and legs; vomiting and purging of feculent, thin, bloody, slimy, or dark green matters, streaked with blood; tongue loaded with thick crust of the same color; countenance pale, contracted Avith peculiar expression, denoting abdominal suffering; pulse small, hard, frequent, scarcely to be numbered; inability to SAvalloAV. She was only relieved by repeated Avarm anodyne embrocations to the pit of the stomach and feet; hot bath. For ten days she had frequent attacks of diarrhoea, with intense abdominal pain; arms and body became almost fleshless; the breasts, Avhich had been large, Avere almost flat; calves of the legs almost dis- appeared; thighs little larger than the Avrists in health. Dr. Gairdner says, he never before saAv such rapid and complete emaciation; and the French nurse exclaimed " de Charnee /" She Avas subject to re- lapses for many months, with frequent, violent spasms of the stomach. Her nervous system was so deranged that she never enjoyed one hour free from the most wretched depression of spirits. A work by M. le Dr. Labourdette, sIioavs the therapeutic advantage of the milk of animals, medicated by digestive assimilation, in passing certain drugs in an infinitesimal form through their bodies. This Avork Avas discussed in the French Academy of Medicine, April 26, 185!', in the course of Avhich M. Trousseau proclaimed the dynamic action of drugs and shoAved that their curative poAver in the smallest doses was not de- pendent on contact of the drug in its crude form Avith the living organ. SCROFULA. 267 ism. Iron, he said, was now known to be only assimilated in infini- tesimal proportions, and Avas chiefly useful in stimulating the assimilative organs to help themselves from the common food; that milk from a cow. or nurse will act by virtue of dynamic properties, imparted by the gene- ral state determined in the animal, irrespective of the quantity of mercury which it contains. M. Chatin gives in the Gazette des Hopi- taux cases of goitre, cured by the administration of vegetables, con- taining Iodine, after Iodine in a crude state had failed. Marasmus.—Iodine.—M. Grange having advised the use of iodized food for goitrous patients. M. Rilliet of Geneva, where goitre is very prevalent, made a trituration of Hydriodate of Potash, to be given in the food in the proportion of one part to a thousand, which was supposed to be perfectly innocent; and thus seasoned the food of those for whom he prescribed. But he soon found unsatisfactory results. * "Tavo ladies, past 60, and a gentleman, past 15, belonging to differ- ent families," Avere attacked by "emaciation, palpitations, accelerated pulse, general trembling, great nervous mobility and diminution of strength." M. Rilliet had forgotten his iodized food, and was perplexed. Was it "incipient heart-disease, latent diabetes, or a chloro-ancemic state, due to causes undetermined?" He had seen similar symptoms folloAv the use of Hydriodate of Potash,"in doses of ^ of a grain daily; made out the nature of the new disease; and cured his three patients in the course of several months. One relapsed by going to the sea- side, came near phthisis, and recovered after a country residence and drinking asses' milk. Another lady near 60, by a short residence on the seaboard, " returning to Geneva, she Avas excessively thin, her pulse at 130, and her nervous system highly excited. She recovered in two months under change of air and drinking asses' milk. These two pa- tients had taken no Iodine, and must have inhaled it in the sea air. M. Rilliet concludes in opposition to the authors who had recommended iodized food: 1. "That the long-continued absorption of small doses of an iodized salt, whether mingled Avith Avater, air, or food, is not free from danger. 2. That the inhabitants of certain localities are more than others ex- posed to iodic toxication." 3. That this special susceptibility depends on the Iodine in the air, Avater, or aliments furnished in these places. 4. That iodic poisoning is more to be dreaded when given in small than in large doses. 5. That these results are more to be feared in persons advanced in life; and Avhen Iodine is taken by persons past the fortieth year, it should be suspended on the first symptoms of saturation. These symptoms are: "Canine appetite, emaciation, palpitations, nervous sus- ceptibility." Dr. Rilliet might have saved himself and his patients some trouble * Gazette Ilebdomadaire. 268 DISEASES OF THE SANGUINOUS FUNCTION. by studying the pathogenesis of Iodine long ago, given by Hahnemann: * " Over-excitement of the whole nervous system ; ebullition of blood and pulsations over the Avhole body, increased by any effort; trembling, tottering gait; great debility; atrophy; extreme emaciation; general oedema. Pulse accelerated, hard and small; consumptive fever; vari- able appetite—either excessive or absent; digestion very feeble; dys- pepsia ; Suffocation ; is blown on going up-stairs, Avith violent palpitations and cramp-like pains about the heart on the least effort." Exercise.—Muscular 2lotion.—This being a disease in which the lymphatics are specially implicated, and these vessels having no central organ of impulse, like the heart, to propel their contents fonvard, the support given to their wTalls by the feeble tissue surrounding them is but small, and some additional aid to propel the fluid is necessary. The lymph itself is imperfect, arising from imperfect nutrition; and all these circumstances conspire to cause stagnation in the lymphatic vessels, and those glandular enlargements characteristic of scrofula. Muscular con- tractions, Avhen not accompanied by nervous exhaustion, propel the lymph forward and tOAvard the general current of the venous circulation. The walls of the lymphatics are supported by the tonicity of the adjacent tissue; and the lymph itself is more perfect, because the functions of the muscular and glandular systems are more perfectly performed. Animal Magnetism.—This disease Avas called centuries ago the "King's Evil," because it Avas believed that the sovereign Avas imbued with a peculiar virtue, by which he could cure it by the laying of his hand on the diseased person. The first king of England Avho Avas sup- posed to have this virtue, was Edward the Confessor.f The power was transmitted to his successors. In the reign of Charles the Second, in the course of fourteen years, no less than 92,107 patients were touched by the king's hand; and according to Dr. Richard Wiseman, Sergeant Surgeon to the king, the most of these Avere cured or benefitted. % The poAver of EdAvard the Confessor to cure scrofulous disease by the "laving on of hands," Avas so fully believed in by the people of England that Shakspeare introduces it as a feature in that monarch's character in the tragedy of Macbeth. (Act IV., Vol. I. p. 334). Mal- colm inquires of the doctor : ----------"Comes the king forth, I pray you1? Doctor. Aye, sir : There are a crew of wretched souls That sir : his cure. Their malady subdues The great essay of art, but at his touch, Such sanctity hath Heaven given his hand, They instantly amend. Malcolm. I thank you, Doctor. * Materia Medica Pura. f Million of Facts. % " Surgical Treatises on Tumors, Ulcers, &c." SCROFULA. 269 MacDuff. What is this disease he means ? Malcolm. "lis called ' The Evil!' A most miraculous work in this good king; Which often, since my here-remain in England, I have "seen him do. How he solicits Heaven Himself best knows ; but strangely visited people, All swollen and ulcerous, pitiful to the eye, The mere despair of surgery he cures ; Hanging a golden stamp about their necks, Put on with holy prayers. And 'tis spoken, To the succeeding royalty, he leaves The healing benediction. With this strange virtue, He hath a heavenly gift of prophecy ; And sundry blessings hang about his throne That speak him full of grace." Rhus-tox.—External indications : Tinea capitis ; soft tubercles ont ie hairy scalp; scrofulous ophthalmia, with photophobia, and an erupt* m about the eyes ; chronic swelling and induration of the parotid glaud, the axillary, and other glands; enlargement of the bones ; herpetic and moist or dry scurfy eruptions in different parts of the body ; SAvell- ing and other signs of inflammation in the hip and knee-joints. Pain in the hip-joint, increased on pressing the trochanter major, and attended with the shortening of the limb, and alternating pains in the knee; pains of Avhite-SAvelling, and scrofulous affections of the ankle-joint; scalp painful to the touch, or from moving the hair back- wards ; inflammation and tenderness of the edges of the eye-lids ; eyes sensitive to light; eye-lids itch and feel swollen ; crusty eruption in the nose, and about the mouth ; repugnance to bread and other food; stitches in the side ; short, or anxious, and painful cough ; oppression of the chest; glandular swellings, painful Avhen touched; stiffness and lameness of the limbs; very sensitive to the open air; pains worst during inaction, or in the cold air. Ill humor; languor; disinclination to all mental or bodily exertion. Administration.—A drop of the third dilution each day, as long as may be seemed necessary. Iodine.—Enlargement of the cervical parotid, thyroid and tonsil glands: scrofulous inflammation of the knee, with swelling, heat, and redness; elongated and enlarged uvula; induration of the os uteri; glandular indurations in different parts of the body; rough and dry skin ; general emaciation ; hectic appearance. Physical Sensations.—Catarrhal affections of the mucous mem- branes depending on scrofula ; swelling and pain in the liver; inflam- mation in the knee, Avith stitches and burning, and increased pain on motion of the joint or from pressure ; contraction of the oesophagus from enlargement and inflammation of the glands and mucous mem- 270 DISEASES OF THE SANGUINOUS FUNCTION. brane, with stitching pains during deglutition; enlarged mesenteric glands; tumid abdomen with pains on pressure; SAvelling and pain in the bronchial glands ; glandular swellings about the neck and axilla, painful, especially on pressure; itching and pimples on the arms and chest; general debility; hectic fever; pains aggravated by exercise, by contact and by warmth. Nervous irritability and increased sensi- tiveness to external impressions. Administration.—Same as Rhus. ^ Baryta-mur.—Chronic induration of the cervical glands ; scrofulous eruptions and ulcerations; tinea capitis; enlargement of the liver, of the testes, and of the mammae ; chronic inflammation of the eyelids. Physical Sensations.—Itching eruptions of the scalp ; general ema- ciation and debility ; scrofulous disease of the throat, aggravated after cold; scrofulous affections of the ears, attended with throbbing and itching, and discharge of purulent matter ; inflammation and suppura- tion of the tonsils; pains in the affected joints and in the long bones; liability to sore throat after every cold ; disease of the mesenteric glands in children; pains, mostly on the left side, when sitting, and re- lieved by exercise in the open air; adapted to old men and young children. Imbecility ; absence of mind ; impaired intellectual powers. Administration.—The second or third attenuation may be given— a dose daily—until the requisite impression is produced. Dulcamara. — External Indications. — Moist and suppurating herpes, forming crusts, or scurvy, branlike eruptions ; SAvellings of the cervical and submaxillary and inguinal glands; swelling of the calf of the leg ; emaciation ; scrofulous inflammation of the eyelids. Physical Sensations.—Pains in the enlarged glands, particularly on motion; great susceptibility to cold; pains in the joints on exposure to cold; pains worse during rest; paralysis of the upper eyelids; phthisis pulmonalis, before the tubercles commence softening ; pulmonary symp- toms brought on by repeated colds; pains in the chest; febrile symp- toms ; lassitude; bruised sensations. Disposition restless, angry, and quarrelsome. Administration.—In the same manner as Baryta. Conium-maculatum.—Swelling, induration, and suppuration of the external glands ; malignant scrofula ; caries of the bones ; scrofulous photophobia; diseased mesentric glands in children; enlargement and induration of the liver and pancreas. Scrofulous SAvellings, which evince a disposition to run into schirrous degenerations ; pains in the bones and in the malignant ulcerations; inflammation, swelling and pain in the ovaries; painful swelling of the uterus; pain in. the region of the liver, when walking; purulent expectoration from softened tubercles ; intolerance to light, in consequence of scrofulous ophthalmia; dull pain in the knee, when stepping; bruised and sore feeling in the calves of SCROFULA. 271 the legs ; pains worse during rest and in the night. Dullness of intel- lect ; Avant of memory ; irritability. Remarks.—For indurated glands, Dr. Johannsen asserts that " Co- nium in the second dilution stands highest as a remedy, and next to it Mereurius-solubilis." Clematis-erecta.—(Boenninghausen) Clinical indications for this remedy:—Indurations, resulting from inflammation; glandular indura- tions of inguinal glands; of the testicles ; of the penis ; of the urethra; interrupted emission of urine ; purulent urine ; purulent deposit in the urine ; general eruptions ; squamous exanthemata; squamous tetters ; herpes, with shooting pains; horror of bathing one's-self; exacerbation from application of lotions (in diseases of the skin); the same from Avarm fomentations. Clematis is particularly suited to persons of mature age, to those of florid complexions ; of relaxed, cachectic, and scrofulous constitutions. Administration.—Vie advise the third attenuation—a dose daily until its effects are apparent. Belladonna.—Glandular swellings, with suppuration; ulcers ; ema- ciation ; inflammation and swelling of the bones; eyelids inflamed; ulcers upon the cornea; photophobia; swelling of the lips, nose, tongue, uvula, tonsils ; bleeding at the nose ; swelling and spongy gums. In- flammation and pains in the enlarged glands, and in the periosteum and bones; diseased mesenteric glands, with atrophy; inflammation of the eyes, Avith heat, redness, and great intolerance to light; pain in the ball of the eye; double vision ; roaring in the ears ; painful swelling of the parotid gland; soreness of the throat; impeded deglutition ; lame- ness of the limbs, when moved; smarting and burning pains in the hip- joint, increased by contact or motion, and during the night; painful ulcers on the skin ; sensitiveness to cold air; adapted to the scrofulous affections of children and females of a mild temper. Irritability; amorous, nervous, excitable, talkative. Administration.—Same as Conium. Lycopodium.—For the scrofulous dyscrasia, and especially where the periosteum, bones, and cervical glands are affected. This remedy is adapted to lymphatic constitutions. Sepia will be found an efficacious remedy in scrofulous females AA-ho are troubled with irregularities in the menstrual functions. It has been employed successfully in indurations of the uterus, corrosive leucorr- hcca, and in pulmonary phthisis with profuse purulent expectoration. Calcarea-carb.—According to Hahnemann, Carbonate of Lime is indispensable in those cases where the menses appear too early and are too profuse. It is also appropriate in young persons of scrofulous habits. In children presenting the usual marks of the scrofulous dys- crasia, it is one of our most valuable remedies. It is highly recom- 272 DISEASES OF. THE SANGUINOUS FUNCTION. mended likewise in the scrofulous ophthalmia? of children, particularly after ulcers have formed on the cornea. Also in marasmus, arising from diseased mesenteric glands, it is an admirable remedy in alterna- tion Avith Iodine, Scrofulous eruptions and ulcers of children often yield to this remedy, after Sulphur, 2Iercurius, and Hepar-sulphuris haATe been used in vain. Hepar-sulphuris is adapted to the cure of scrofulous ophthal- mia with profuse lachrymation, and much mucous discharge from the meibomian glands, and in morbus coxarius or coxalgia, after a purulent discharge has occurred. This medicine is proper for scrofulous and lymphatic constitutions. " Arsenicum is one of the most important remedies in scrofula, for removing indurations of the glands and deformities of the bones, for regulating the discharges from the bowels, and for restoring the skin to a healthy state. Also in scrofulous ophthalmia it is of great ser- vice." (Dr. Johannson, Homoeopathic Journal, Vol. I., No. 11.) Administration.—As a general rule, the first to the third attenua- tions should be selected, and the doses repeated once or tAvice daily, until a satisfactory impression is produced on the affected structure. 21ercurius.—This remedy is advised by Hahnemann in scrofula, Combined with syphilis. The glandular inflammations will be charac- terized by a diffused redness, much SAvelling and gnawing, stinging or darting pains, worse at night in bed. It should be consulted in affec- tions of the bones, the joints, the eyes, and in eruptions and ulcers upon the surface. The following preparations of Mercurius we es- pecially commend in scrofula: 2Ierc.-sol., Merc.-iod., and 2Lerc.-proe- cip.-rubrum. Aurum-mur., Ferrum, and China are worthy of consideration in protracted and obstinate cases, Avhere the strength of the patient has become much impaired, and but little impression has been made by the previous remedies. Hartmann observes that he has derived essential benefit from Oleum- jecoris-aselli, (cod-liver oil) in every form of the disease, especially in the precursory stage, when no particular organ was affected; the patient looked pale, emaciated, the muscles became flabby, the patient showed an aversion to meat and vegetables, and wanted to eat bread and butter all the time. I gave it in tea-spoonful doses, morning and evening, almost always with success. In scrofulous affections of bones it likewise proved useful, but less so in other forms of the disease." (Hartmann's Chronic Diseases, Vol. III., p. 54.) Dr. J. H. Bennett, of London, has found the cod-liver oil of great service in scrofulous cases characterized by general or local atrophy. But in scrofulous affections in which the general health continues unimpaired, and the digestive functions are not deranged, It. B. BRONCHOCELE. 273 advises Iodine. We have employed the oil in doses of a drachm, three times daily, Avith eminent success in almost every form of scrofula. For scrofulous ulcers with callous edges, and fistulas, Silicea alone or in alternation with Phosphorus, Acid-phosphoric, and Conium were found by Dr. Johannsen most useful. When the ulcers are greenish and offensive, Carb.-veg., or Mer- curius-dulc. is advised. In scrofulous ophthalmia, indurated glands, and diseases of the bones, Arsenicum, Conium, Mercur.-sol., Hepar-sul. and Aurum, are the best remedies. BRONCHOCELE—GOITRE. This disease is characterized by a tumor on the front of the neck, seated betAveen the trachea and the skin, occupying principally the typhoid gland. It is a true hypertrophy and is divided into three prin- cipal forms, accordingly as the vascular, glandular, or connective tissues are involved. 1. Vascular Goitre.—a. Congestion of the Thyroid Gland.—■ This gland is abundantly supplied by large vessels distributed in lax cellular tissue ; and it is the organ, next to the spleen, most liable to considerable changes of size from congestion. The effects of congestion generally go no farther than simply to engorge the gland with blood. Sudden turgescence of the gland during life, is often found to have originated from suppressed menstruation, and in young persons from masturbation. In some cases it becomes permanent, especially after puberty in females subject to amenorrhoca. b. Thyroidean Apoplexy.—Excessive turgescence of the gland may cause a rupture of a vessel, and the effusion of blood. M.Bach says, he has found coagula of blood enclosed in a dense cellular pouch. The coagulum undergoes the same changes as in other apoplexies, and may lay the foundation of Avhat is called cystic goitre. The vessels of the gland may become atrophied by the pressure. The goitre may become smaller and harder. A cicatricial tissue may form and extend into other tissues and render the gland extremely hard. A calcareous deposit may be found in this cicatricial tissue. c. Aneurismal Goitre.—This has been described, but is extremely rare. d. Vascular Parenchymatous Goitre.—The part becomes isolated from the sound parts by condensed cellular tissue, so that the de- generated lobules may be easily enucleated. The lobule is deep red, the granular structure disappearing. The vessels are sometimes dilated and gorged with blood; the vessels toAvard t!>e centre are dilated, tho I 274 DISEASES OF THE SANGUINOUS FUNCTION. surrounding tissue becomes denser, the capsules almost disappearing. The minute vessels of the capillary system become encrusted Avith cal- careous matter. (Eckcri) 2. Parknchymatous Bronchocele.—This consists of hypertrophy of the thyroid gland, properly, an abnormal development of the glandu- lar capsules distended by a gelatinous fluid. Dr. Bach found some capsules containing within them others, the inner being separated from the outer one by a fluid, and being formed of cells like those constitut- ing the normal contents of the capsules almost all containing a nucleus, some enclosing one or more young cells. The centre of the capsule appears holloAv and contains young capsules. When these are a half millimetre in length they are already diseased. Gelatinous snbstance enters the capsules byendesmosis and distends the anhistous membrane. The young capsules are formed of cells by endogenous generation, and are clothed later by an anhistous membrane. The young cells of the young cysts only acquire nuclei at a later period. Rokitansky says, the thyroid gland is endoAved with great powers of reproduction. This hypertrophy of this gland is often endemic ; it may exist at birth. The child respires long and deeply, with a feeble plaintive tone, heard at considerable distance; expiration is painful; drinking may be im- possible. Bach saw a child suffocated by the pressure of the external part of the gland so far as to produce irritation on the pneumo-gastric nerve. A symptom indicating this was the excretion of an enormous quantity of bronchial foam. He thinks some cases of thymus asthma are due to a posterior development of the thyroid. Treatment.—Aconite in acute cases ; in chronic enlargement of the gland give Iodine, Iodide of Potash, Calcarea. 3. Transformations in the Structure of the Thyroid Tissues. —The stroma of this gland is a fibro-cellular tissue in which ramifies a net-work of blood-vessels. It is liable to be changed in part into fibrous tissue, and its primordial texture is the same as that of normal fibrin. One of the characters of accidental fibrous tissue is its retractibility; it may also undergo the fatty, osseous, or cretaceous (chalky) transformation. Air may also be effused amidst the cellular tissue, and other new products may be there developed. a. Cellular Goitre,—Hildenreich saw a goitre which grew very rapidly in a man aged sixty. It consisted of cells irregularly shaped, some of their cavities intercommunicating, and their Avails containing cartilaginous or osseous matter, and consisting mainly of new fibrous tissue. The fluid within them Avas serous, gelatinous, and bloody. The glandular element Avas not visible. b. Emphysematous Goitre.—Larrey's " aerien." It is produced by rupture of some portion of the air-tube. c. Cystic Goitre.—A cyst is developed in the midst of the normal BRONCHOCELE. 275 elements of the thyroid gland, and contains neAV fluid or solid for- mation. It may originate from a pathological blastema, inflammation, the transformation of an apoplectic coagulum, or the degeneration of glandular capsules. Scirrhus, Encephaloid, tubercle, and hydatids of the thyroid have not yet been proved to exist, though Larrey, and others, have described some of them. The walls of the cystic goitre consist of a layer of cellular tissue amidst which fibres are deposited. New vessels are developed within the walls, and its internal surface is lined with epithelium. Posteriorly the walls are very thin and transparent. The vessels pressing the wall forward become Aveakened and are often rup- tured from evacuation of the cell-fluid. The wall may pass into a state of cartilage, (enchondroma,) and in the course of years may become ossified. The contents of the cyst may be : 1. Serum from blood effused, or endesmosis; but it contains no fibrin, is incapable of or- ganization, but may be absorbed. Other products may be formed as the serosity disappears,—such as crystals of cholesterine, and salts of lime. 2. Colloid matter,' a colorless or yellowish gelatinous mass, containing no cells. (Bach. 2Iem. Imper. Acad. 2Led) Causes.—Bronchocele is an endemic disease, being remarkably prevalent in certain localities, as Derbyshire, England, and the deep damp valleys of the Alps. But the precise physical peculiarities of these localities has not yet been ascertained. It is not confined to certain elevations or latitudes, and has been observed in every climate in both hemispheres. Its origin is usually ascribed to the water used by the inhabitants of the region where it most prevails. Popular belief refers goitre to the use of snow-yvater, and Ave have seen the goitrous tumor enlarge during the use of snow-water in winter; but certain fountains and rivers are more notorious as sources of this disease, of which the SaskatchaAvan river, in British North-America, is one of the most remarkable. Dr. Richardson attributes its influence to the presence of magnesian lime-stone, which he found in that river. (Nar- rative of Franklin's Expedition to the Polar Sea, <&c) Dr. M'Clelland has endeavored to sIioav, that goitre in India is everywhere found in the localities in which the water is impregnated with carbonate of lime. In the United States Ave find lime-stone water in every part of many states, and in almost every locality we meet with cases of en- larged thyroid gland. They are more common in women, and especially those subject to ovarian activity. Trkatmknt.—At a moderately early period of this malady, we entertain no doubt, respecting the entire success of an expert homoeo- pathic treatment. The influence of minute doses of carefully selected remedies, over these glandular enlargements, is often truly astonishing But to prove most efficient the higher potencies must be employed. 276 DISEASES OF THE SANGULNOUS FUNCTION. The principal remedies are: Iodine, Calcarea-carb., Kali-hyd., Merc.-hyd., Hepar-sulph., Arsenicum-hyd., Kali-brom., Sepia, Silicea, Bromine, Conium, Spongia. We usually prescribe Iodine, Calcarea, Hepar, Arsenicum, Sepia, Silicea, Conium and Spongia in the high attenuations repeated at long intervals. Kali-hyd., Kali-brom., and Mercurius-hyd., at the first and second triturations, and the dose repeated two or three times a day. Iodine.—Its best powers are displayed in causing the absorption of the products of exudation, and of capsules in process of transformation into colloid matter. It never causes the absorption of voluminous cystic goitres containing colloid matter; it exerts no action on those cysts containing serosity, or such as have undergone tertiary trans- formations. If has no effect upon cellular goitre or in that accompanied by carcinomatous or other morbid products. Iodine may be expected to be successful in dispersing "the parenchy- matous cystic goitre, on condition that this is principally due to the degeneration of the capsules, and that the vascular element does not predominate." (2Iem. Imper. Acad, de 2led. Paris, 1855.) Dr. Henderson said in his first edition, that Iodine was known as a remedy for goitre before it was known to be capable of causing it; and homoeopathists prescribed it as a homoeopathic remedy, " because they believed, and had no doubt that experience Avould ultimately prove th-nt its curative action was dependent on its capacity to produce the disease ; though the circumstances necessary for such a pathogenetic effect have not yet been discovered." In his second edition he says: The expectation expressed in his former edition has has been ful-, filled. A man taking five grains of Hydriodate of Potash tAvice a day, after eight days became affected with "a rapidly groAving SAvelling of the thyroid gland." (Brit. Jour.) Spongia.—In the thirteenth century roasted sponge was employed in-this disease by Arnold de Villeneuve. It is used homoeopathically for the folloAving symptoms : Moral and physical debility; tendency to start; paroxysms of anguish: sense of weariness in the upper portion of the body, and numbness in the lower portion; alternate sad- ness and mirthfulness; fever with shuddering in the back and coldness all over, followed by dry heat, or accompanied with SAveat; dryness in the day-time; sleep full of dreams and fantastic A'isions, which some- times continue after waking; frequent Avaking Avith a start; itching of the skin, as if sweat would break out; red spots ; rush of blood to the head; vertigo as if one wduld fall sideways or backAvards ; oppressive headache, at the top of the head, at the occiput or temples; stitch in the temples; oppressive pain in the forehead from within outwards; fullness of the head, with heat, Avhich is perceived by the hand, and sometimes sudden flow of saliva ; semi-lateral headache ; sensitiveness BRONCHOCELE. 277 and itching of the hairy scalp; stitches in the eyes; redness and burning of the eyes ; lachrymation; heaviness and nightly agglutina- tions of the lids ; myopia; constrictive otalgia ; retention and thicken- ing of the nasal mucus ; nose-bleed; pale face, with sunken eyes and anxiety in the features; crampy pain in the articulations of the ja\v ; blisters at the edges of the tongue, and in the inner surface of the cheeks; stitches in the throat; pricking sensation above the throat- pit ; induration of the submaxillary glands and of the thyroid body ; sickness at the stomach; sensation of sickness and faintness at the stomach, as if one had drunk a quantity of warm Avater; sour re- gurgitations ; Aromiting ; constrictive pains at the stomach; pinching in the abdomen. Cutting colic after a meal; crampy pains in the groins; SAvelling of the inguinal glands; diarrhoeic stools, with tenes- mus; hard stools ; formication in the rectum; smarting at the anus ; increase of the urinary secretion; urine with a white yellow or grayish sediment; crampy pain in the testicles; induration of the testicles; premature and profuse menses. Great dryness of the larynx with short and barking cough ; embarrassed breathing as if the larynx and trachea Avere narrower; pain at the larynx Avhen touching it; hoarseness, dry, holloAv, Avheezing cough, worse in the evening; excited by a sense of tickling and burning in the larynx and trachea; grampy pains in the whole chest; vascular excitement on the chest on performing the least movements, Avith dyspnoea ; anxiety, nausea and weakness, as if one would faint; anxious pain on the region of the heart; crampy pain in the cervical muscles ; stitches in the shoulder-blades ; wrenching pains at the shoulder-joint; bearing down at the elbow; drawing stitches in the fore-arms and hands ; swelling of the hands ; numbness at the end of the fingers ; twitching of the glutei muscles ; acute stitches in the thighs, above the knees and in the feet; stiffness of the loAver ex- tremities. Spongia acts for several weeks, and is still more than Iodine a specific for goitre ; Hahnemann says : (Materia 2Iedica Pura, Vol II.)j " The particular SAvelling of the thyroid body to which the name goitre is given, and Avhich is peculiar to the inhabitants of Ioav valleys and the adjoining plains, depends upon a conjuncture of circumstances, whichj although mostly unknown to us, yet seem to remain pretty much the same, and for that reason, constitute a disease which remains es- sentially the same, and against which a drug Avhich has once effected a cure, ought to sIioav itself efficacious, it would seem in every case." Teste says, he found many cases of goitre to resist Spongia, and he treated them Avith Ipecac, Iodium, and Bromine. Camphor is said to antidote Spongia. Calcarea.—As Ave have seen that calcareous waters cause goitre, it is also found to be a remedy. A case of diarrhoea of eighteen 278 DISEASES OF THE SANGUINOUS FUNCTION. months' duration in a child, in which physical development Avas con- siderably retarded was cured by Calcarea 30. Another rickety child was transformed into ahealthy one by taking pounded egg-shells mixed with the food. Other cases might be given. Case by Dr. Croserio : — "A boy aged fifteen, extremely scrofulous, was stunted in his growth, and very thin. His limbs Avere slight, and his head too large for his body. He suffered from violent headaches when attempting to make any mental exertion. He Avas very timid, afraid to be alone in the dark. Two doses of Calcarea, after one of Sulphur, at the interval of four or five days, between the doses, brought about so favorable a change that in six months he gained great increase of height and strength as well as size of limb. » " The specificity of Calcarea on the system of nutrition indicates its general usefulness during the general period of development, and in diseases accompanied by excessive emaciation or obesity." Ipecac.—Dr. Teste gh'es occasional doses of Ipecac, Avith marked success in the treatment of goitre. For aggravations caused by it he regards Veratrum-album as the best antidote. 5. CRETINISM—STRUMA TYROLEXSIUM.—CAGOTISM. Description.—Imperfect formation or development of the body, es- pecially of the cranium; mental imbecility and physical deformity in various degrees; the organic or vegetative functions remaining in full activity; goitre present in some cases, though not in all. The stature of the cretin is seldom above four and half feet, gene- rally less; cranium deformed and of a conical shape,—the forehead being thrown backwards, narroAved and flattened; frontal sinuses large ; the occiput nearly on a line with the neck, as in ruminating animals ; flesh soft and flaccid; face broad and short; skin wrinkled, yellowish or pale and cadaverous, dirty, and covered with chronic eruptions ; the ears large, standing out from the head; the tongue is thick, hanging out of the mouth, which is large, open and slavering; the lower jaAv elongated strong and prominent; eyelids thick; eyes red, small, but prominent, Avatery, far apart and squinting; pupils contracted but not sensible to light; nose flat; and the whole countenance is idiotic, void of expression, or expressive only of lasciviousness ; the chest is narrow; the abdomen and mammas large and pendulous ; the neck is short and thick or long and thin ; limbs crooked, short, distorted; the loAver limbs shorter than the upper; fingers long; the gait imperfect and Avaddling. The senses are generally defective, hearing and speech imperfect; in- tellect absent or only partially developed; cretins are in all respects slovenly sensual, gluttonous and beastly. They die early, generally be cretinism. 279 low the age of thirty, before which time they present the appearance of advancing age. Causes.—Cretinism, like goitre, depends for its origin on endemic' causes. In the deep, narrow, damp, malarious valleys of the Alps, the people reside in small filthy houses built up under the ledges of the rocks; in those Avhich are most filthy, hot and close in the narrow ra- vines of the Valais, one of the SavIss cantons, where the air is stagnant, and the rays of the sun are intercepted or reflected from the mountains, cretinism and goitre appear in their most intense forms. "As we as- cend the neighboring mountains cretinism disappears and only goitre is seen. When we reach a certain altitude, or above 3000 feet, both maladies vanish." The principal cooperating agencies which aid in producing the disease are: poverty, bad food, drunkenness, indolence sensuality and Ioav debauchery of the parents, which naturally result in the infirmity of their children. The water in regions Avhere cretinism prevails, contain calcareous and other mineral substances in solution; and cretinism, as Avell as goitre are to a considerable extent patho- genetic effects, or drug diseases produced by these agents long-used. Treatment.—The first remedial measure in the treatment of cre- tinism is the removal of the patient from the influence of local causes Avhich have originated the disease. The experiment has been made on a satisfactory scale by Dr. Juggenbuhl, who has established a hospital for cretin children in a high and healthy region on the Abendberg in the Bernese Alps. By devoting his Avhole attention to the recovery of these mosthopeless objects of philanthropic compassion he has succeeded in restoring about one-third of all that came under his care to health and the exercise of reason, and greatly improved all others. Cretinism generally makes its appearance in the second year, and from three to six are necessary to effect a cure ; though at an early stage it is effected in one or tAvo. This institution gave to the world the first example of the poAver of education and health-promoting influences in removing the physical evils Avhich accompany idiocy; and it has been imitated in this country and elseAvhere in the numerous asylums for idiots. The influence of a proper physical training is no where better shown than in the cure of idiocy and cretinism. Dr. Odet, a physician of Switzer- land, avIio Avas himself a cretin, chose cretinism as the subject of his thesis, when examined at Montpellier, for the degree of M. D. In his dissertation he says, "it Avas by folloAving these curative means that a learned physician, Avhom I am proud to own as a near relation, has been enabled to replace me in the rank of a man." "It was also by forti- fving the physical system that Ave wTere enabled to develop, little by little, the intelligence of my youngest brother, who while still an in- fant, Avas separated from his mother by order of his physician. Cre- tinism seized upon his intellectual faculties under the mask of some of 280 DISEASES OF THE SANGUINOUS FUNCTION. the maladies incident to childhood. In the second stage the treatment was commenced, but time and patience were necessary. At the age of eight years he began to make himself understood, at nine he arti- culated some entire phrases, and at eleven he Avas fitted to enter an academy." Case by Dr. Juggenbuhl.—M. D. of Fribourg, Avas five years old on his entrance. His parents were healthy, but they inhabited the lower part of the town, Avhich Avas subject to cretinism; one of his brothers was also a cretin. M. Avas sIoav in learning to hold up his head, to stand and to Avalk. The glands of the neck Avere swollen. He had strabismus, a thick tongue and the rudiments of goitre. He soon learned the letters of the alphabet and to pronounce little phrases; but his memory was so feeble that he would often forget on one day that which he had learned the day previous. An exercise much prolonged could alone remedy this evil. But his physical strength progressed gradually with his moral powers. His complexion is noAV animated and has the tint of health; his step is firm and his body robust; thanks to gymnastic exercises and good air. He can already read a little and distinguish colors. Remedies.—See Scrofula and Goitre, p. 276. Genus VI.—CARCINUS.—CANCER, DISEASES CHARACTERIZED BY VITIATED OR DISEASED CELL DEVELOPMENT. The difference, says Williams, between a primitive cell and a mass of organized structure, is not simply one of magnitude. The primitive cell, though not strictly an organized body is infinitely less complex than the mass, and constitutes the ultimate limit of organized structure. When the formative blastema assumes the attributes of organization, a cell is the first visible form under Avhich it presents itself; it is an atom of organic matter; so that the ultimate cells of organs are the imme- diate agents of the organic processes; the elaboration of nutrient matter, in all its stages and disintegrations for the purpose of secretion and elimination, are essentially cell-phenomena. Organic laws to which the cells, in common with larger masses are subjected.—1. A definite scale of development is assigned to the primary organic cells proper to the various structures of the body. These cells pass through prescribed gradations of growth, the duration of their life period being equally pre-limited. The typical elements of a primary cell are three only; first an external sac (cell membrane) * then a smaller vesicle (nucleus;, Avhich contains a smaller (nucleolus). Apply this description to the ovum ; first is the vitelline capsule__the second the germinal vesicle, enclosing the third, the germinal spot. CANCER. 281 Mr. Budge, the German micrographer, reduced a frog to a state of emaciation and then laid bare a small muscle of the leg, and under the aid of a microscope counted with precision the number of its elementary fibres. By proper feeding he now restored the animal to health, and when its size Avas fully restored, he counted with the. same minuteness the elementary fibres of the same muscle. He found that the fibres were considerably increased, as well in number as enlarged in bulk. Primary cells propagate themselves by the reproduction of others like themselves. When the malignant tendency has been once es- tablished in a part by the organization of a cancerous primary cell, in virtue of this power inherent in the cell of multiplying its kind, the continuance of the destructive process in the part is certain and in- evitable. Diseased Manifestation of Cell-Development—Morbid tissue is generated within the economy in strict conformity with the laws that preside over foetal development. But, as we have already seen, both nervous influence and catalytical agency, give rise to a variety of dis- eases Avhen they are swayed by disease-causing influences from their natural course. Thus also in some cases the power of histological evolution may create positive disorder in the system. An immense and uninterrupted movement takes place within the organs of which the body is composed, for the purpose of supplying neAv tissue in the place of those which are no longer fit to accomplish the functions de- volving upon them; let this unceasing activity be diverted from its proper channel, and the production of tubercle, cancer, and all kinds of morbid deposits will be the immediate consequence. We here find, as in other cases, an evident connection between the phenomena of health and disease,—-betAveen physiological activity and pathological influence. It is in this light that Ave are led by the re- searches of Virchow to look at this subject. General View of Cell-Formation,—1. Some diseases result in the first place from total absence or considerable deficiency of normal evo- lution on a given point. The mucous membrane of the intestinal canal affords a fine example of incessant development. NeAv layers of epi- thelium are continually being secreted to line its inner surface; but the living medium, or blastem, is necessary to their production, and whenever this blastem itself happens to be altered in its essential properties—the modification Avhich always occurs in inflammation, the epithelium disappears, and is no loDger regenerated. (See Vol. I., p. 646, and Vol. II., p. 181.) Cholera also exhibits an example of this ; for it has been incontestibly proved that in this disease the vejsels that ramify in the internal surface of the intestines are completely laid bare. 282 DISEASES OF THE SANGUINOUS FUNCTION. 1. CANCER.—CARCINOMA. The name was given by the Greeks, and derived from tcaptuvog, a crab, from the large blue \Teins, resembling the crabs-claAvs, which appear upon its surface. A painful scirrhous tumor, which terminates in a fatal ulcer. (Culleni) Conditions Essential to the Production of Cancer.—1. Consti- tutional causes which lead to the development of the cancerous element in the blood by deranging the functions Avhich preserve this fluid in a healthy state : 2. Local causes Avhich separate the morbid material and transform it into cancerous deposit; which may replace the propei textures of the part or become incorporated Avith them. The cancerous element must first exist in the general circulating fluid before the local injury, or perverted nutrition from some other cause can produce cancer. When these proper conditions exist, any organized structure may be involved by the disease. Progress and Develepjment of Cancer.—Its earliest condition is that of a blastema, or fluid. It is described as a firm, compact amorphous substance, resembling coagulated fibrine, sometimes con- taining molecular granules of modified protein or fat. In this blastema, cells are developed which are supposed to be of a specific nature, presenting appearances different from the cells of the ordinary healthy tissues; the cell-wall and its nucleoli, and granules are generally larger, more varied in form, as round, oval, caudate ; the cell-wall is also extremely thin and pale ; and the action of acetic acid renders il so transparent as to display the neucleus and its nucleoli distinctly. Some of the granules, nucleoli, and nuclei, are without any distinct cell-Avail; they all progress to the stage of parent-cells ; each possesses amazing reproductive poAver, and is supposed to produce a second. In some cases a fibrous tissue is developed from the blastema, most probably from the cells; and when formed it resembles the condensed or indurated tissue of other parts ; but it is regarded as a new formation, and forms the chief portion of scirrhus, the most common variety of cancerous groAVth. (Southam, Virchow, Vogel. See Brit. Med. Jour. Jan. 1858, p. 5.) Though the specific character of cancer-cells may be suspected, it has not been demonstrated; and efforts to diagnose the ultimate naturo of cancerous groAvth by the microscope have led some observers into errors. (Nelaton, Clin. Surg., Phila. 1855, p. 457. See Velpeau, Lebert, Robin, Ifandl.) The cells found in cancerous groAvths may then be regarded as the same as those found in ordinary healthy growths ; but, the blastema derive^ from the blood being in a diseased state, the cells are developed under a specific influence. The cancerous blastema being more highly organized, that of tubercle may be CANCER. 283 transformed into the caudate or fibro-plastic cells with their nuclei and granules; and these may reproduce others like themselves, or may go beyond this and form fibrous tissues of imperfect organization ; and these have" only a brief duration. In the ordinary effused lymph of inflammation or of healthy granula- tions, the cell is endowed with the poAver of progressive development, from the fibro-plastic cell, into filamentous tissue, and then, into the healthy permanent structures. (Southam, Brit. 2Ied. Jour. Braithw. Retrosp. July, 1858, p. 28.) Diagnosis. — When the cancerous action commences in a tumor Avhich has long been inactive, it is attended with frequent shooting pains ; the skin that covers it becomes discolored, and, at length ul- cerated. Pearson says, " Avhen a malignant scirrhus or Avatery ex- crescence has proceeded to a period of ulceration, attended Avith a constant sense of ardent and, occasionally shooting pains, is irregular in its figure, and presents an unequal surface ; if it discharges sordid, sanious, fetid matter ; if the edges of the sore be thick, indurated, and often exquisitely painful, sometimes inverted, at others retorted, and exhibit a serrated appearance; and should the ulcer in its progress be frequently attended Avith haemorrhage, in consequence of the erosion of blood-vessels ; there will be little hazard of mistake in call- ing it a cancerous ulcer." When a cancerous tumor of the breast is ready to break open, it generally becomes prominent in some minute point, attended Avith an increase of the peculiar kind of burning shooting pain already felt in a slighter degree; a corroding ichor transudes through the skin forming an ulcer. Ulcers of the cancerous nature discharge a thin, acrid sanies Avhich corrodes the parts; the lips are thick, dark colored, retorted; and fungous excrescences often grow from them, attended Avith excruciating, pungent, lancinating, burning pains, and sometimes Avith bleeding. Though every hard tumor of toe female breast is not a cancer, all such as occur aftei the cessation of the menses may be regarded with suspicion. Pathology.—Thus far the microscope has only shoAvn that the primary elements of morbid growths do not materially differ from those of the normal tissues ; and that these constituents vary in the degree of their development, their mode of arrangement and in their relative proportion to each other. In innocent tumors the difference is slight; but in malignant groAvths there is a general Avant of order in the dis- tribution of all the elements and structures that enter into their com- position. The folloAving division of the varieties of cancerous groAvths is based on the microscopic disclosures of their minute structure: 1. Gelatiniform or colloid cancer; marked by an excess of blastema, 2. Cephaloma, medullary, or soft cancer; characterized by an ex- cess of cells. 284 DISEASES OF THE SANGUINOUS FUNCTION 3. Scirrhus, petrous, or hard cancer, in which the fibrous tissue pre- dominates. It forms a hard, unequal, indolent tumor, small in the beginning and increasing gradually. These different forms may occur separately or in different parts of the same tumor. The other varieties of carcinomatous disease are modifications of the above. Among them are : 4. Haeruatoid cancer, or fungus hoemcdodes, in Avhich there is an excess of blood, free or enclosed in vessels. 5. 2lelanosis, in Avhich there is a superabundance of coloring pig- ment within the cells; 6. Ostoid cancer, or spina ventosa, in which the osseous tissue predominates; 7. Cancroid, or epithelial cancer, containing an excess of epithelial cells; 8. Lardaceous, or reticular cancer, in Avhich fat-globules are infil- trated through the morbid deposit. (Southam, from Wedl's Pathol., page bSb) The microscope also shows that the cancerous deposit exists in the surrounding structures where it Avould not be suspected. The cells and granules extend along the areolar tissue, entering into the tissue itself, and even into the nerves and coats of the blood-vessels; the natural structures being absorbed the cancerous deposit supplies their place. (Paget, Pathol.) The transformation of a tumor innocent in character into one more malignant can scarcely ever take place, though a feAV instances are given, by Sir Astley Cooper, and Mr. Brodie, in which fatty tumors have taken on malignant action. (Lectures, Path, and Surg., 1846.) Simple cysts sometimes become the seat of cancer, both in the ovaries and mamma as well as other parts. (Southam, Manchester Dispens. Brit. Med. Jour. Jan., 1858.) The lest microscopists and pathologists of the present day deny the possibility of distinguishing the career-cell. Virchow assures us that he has never seen a cell-formation in cancerous structures of peculiar attributes. Bilbroth, Avho has paid great attention to the minute structure of cancerous groAvths admits that it is impossible to classify tumors from their microscopic appearance. He alludes to instances in which the same structure maybe healthful in one case and malignant in another. Virchow demonstrates that simple connective tissue Avith its natural cellular, bodies may become the focus of a structural metamorphosis ; and sees no reason why one shall not change into the other. He thinks then that cancer is by no means' a characteristic strictly defined, and under all circumstances the same process. In one part of the body it may at one time be a healthy structure and be CANCER. 285 cancerous at another time. The hyperplasy of cells does not apply to all forms of cancer. In scirrhus, the proliferation of cells is very scanty. Trkatmknt.—1. External Applications.—The success claimed by the advocates for the local treatment of cancer has nearly ahvays re- sulted from an error in diagnosis. Pretenders always claim to have some infallible specific, the composition of which they dare not reveal to the public ; but they generally succeed in curing a large number of trifling sores and tumors Avhich they declare to be cancers. Ignorant people do not question the accuracy of the impostor's diagnosis and Avonder at his success. When cancer really exists it can scarcely, at any stage, be treated by local applications without hastening the progress of the suspected tumor into an active cancer. The remoAral of the suspected part by the knife promises nothing better. " In a large proportion," says Sir Benjamin Brodie, " of cases, in which the operation is performed, the patient is not alive two years afterAvards ; and in a great many cases, instead of the operation stopping the dis- ease, it actually seems to hasten its progress ; moreover, the operation itself is not free from danger." The testimony of all prominent sur- geons of our time will be found to confirm the correctness of this opinion. It is a principle in surgical practice, says Mr. Syme, " that malignant tumors, or sores should be left free from disturbance, or completely removed, since tampering Avith them by irritating applications is the most certain means of exciting disease in the lymphatic glands or other textures." When the nature of the disease is settled, and its rapid progress inevitable it should be promptly removed AA'hen its lo- cality and extent are such that entire removal is possible. Even Avhen the nature of the tumor is doubtful, it is far better to remove it Avhen small, than to incur the risk of this most terrible of diseases ; though the disease may sometimes appear again, from constitutional tendency, or from the whole not being removed. "But when the tumor has been originated by some accident, not spontaneously; when it is not really cancerous in its nature; when the patient is other- wise healthy, Avhen no appearance of malignancy is seen in the cancer; when the adjacent glands and absorbents are still unaffected; and the parts involved do not require that very important nerves or arteries be cut, the operation may be expected to terminate successfully; but in such cases it is hardly possible to imagine one that Avould justify the use of the knife." The Treatment of Cancer by diustics has been more generally folloAved than any other; and up to the present time the profession cling to it as a lingering relic of the ancient faith. The best recent authorities fo;- a modified escharotic, or " enucleating" treatment of 286 DISEASES OF THE SANGUINOUS FUNCTION. cancer are Drs. Mac Limont and Marston. (See the British Journal of Homoeopathy. May 1864, p. 481.) After a preliminary treatment, Avith Avhich we find no fault, the following " 2Iode of Procedure for the Removal of the Cancerous Tumor of the Breast" is given. " When the skin was entire, the size and bearings of the tumor Avere carefully ascertained and mapped out on the breast Avith Nitrate of Silver or Vermillion-pigment. A mixture of ice and salt Avas in one of the cases applied to the tumor, so as to deaden the local sensibility ; this effected, and the parts carefully dried; the skin over the tumor Avas destroyed by means of undiluted Nitric-acid, the action of Avhich Avas kept up till the skin assumed a taAvny and yellow aspect; (about thirty seconds being generally suf- ficient to produce this condition.) The part Avas now Avell douched Avith cold Avater, and a piece of lint applied to the surface, spread Avith equal parts of a paste (composed of a strong decoction of Hydrastis root, poAvdered Hydrastis, Chloride of Zinc and Flour,) and Stramonium ointment. On removing this dressing at the end of tAventy-four hours, a yelloAV, hard, and dry eschar will be found to have formed. The amount of pain folloAving the application of the^acid varied with the ex- tent of surface to be destroyed ; but the congelation of the parts very materially lessened this suffering, which might otherwise be rather severe. But avc ahvays found that much after-suffering was saved by endurance of a little temporary smarting caused by the acid ; for Avhen applied too timidly, the skin was only partially destroyed, and the action of the paste thereon gave rise to some suffering. " On removing the dressing, a slight amount of erythema is some- times visible around the eschar, which presents a yelloAV, horny, and dry appearance. " Throughout the entire extent of this eschar A^ertical incisions are made with a sharp scalpel to the depth of about one-tAventieth of an inch, care being taken not to draw blood. These incisions should be parallel to one another, at a distance of about half an inch apart, and into each is inserted a thin slip of calico smeared with the paste ; over the whole a light compress should be applied, kept in its place by a strip of adhesive plaster. The incisions are deepened and the dress- ings renewed usually every day, and this is continued until the paste has percolated the entire mass of the tumor." The depth to which the incisions are carried " must be left to the judgment of the operator. If the knife be used too freely, the bleeding will embarrass and annoy both the surgeon and the patient," as well as materially increase the pain, produced in the living tissues by the paste. On the other hand, if the scalpel be too timidly used, the action may be too circumscribed or arrested too soon." The time required for the separation of the slough varies with the • CANCER. 287 size of the tumor. In general at about the end of a fortnight from the first operation a line of demarcation forms around the entire tumor, invariably commencing at its upper or least dependent portion; this deepens from day. to day; the living and healthy tissues beneath gra- nulate and rise, pushing the tumor out; so that at a period verging from four to seven Aveeks, the entire mass is throAvn off, leaving a much smaller chasm than might be expected judging from the size of the slough itself." The wound gradually takes on a clean and healthy aspect, free from even the secretion of pus Avhich follows the removal of cancer by the knife. And not only is the evil effect of the absorp- tion of pus avoided by this method of operating, but all putridity and effluvium are effectually counteracted by the antiseptic nature of the paste. The constitutional irritation which folloAvs the operation, is but slight; the dressing of the wound after the remoA'al of the slough consists only in the daily application of cotton-Avool spread with Stra- monium ointment. It is claimed that the process of removing cancers by enucleation is applicable in many cases in which even the old surgeons Avould have feared to employ the knife; that it permits the removal of only such portions of the diseased part as may appear ne- cessary at the time of operating. It is only regarded as likely to be unsuccessful or injurious in cases in Avhich cancerous disease has al- ready extended into the arm-pit, or to internal organs,—as the brain, uterus, mesenteric glands, stomach, or lungs; also in the cases in which local disease has extended to parts involving anatomical diffi- culties Avhich Avould render surgical interference unjustifiable. Canckr of the Face, Lips, Cheeks, Nose and Tongue. — Mediccd Treatment.—Cancer is said to be more common on the loAver lip, but it is often met Avith on other parts of the face. It de- velops itself out of a scurfy or ulcerated spot which gradually gives rise to scurfy excrescences, &c.; or a portion of the lip becomes hard and swollen; it then becomes intensely painful and breaks. The cancer gradually involves the skin of the chin, the mucofts membrane of the mouth, 'the gums, submaxillary glands, destroying the Avhole lip and the bones. Some ulcers of the lip become malignant Avithout being cancerous, especially syphilitic ulcers. Cancer of the tongue generally commences Avitha hard circumscribed swelling on one or the other side of the tongue; it is marked by lancinating pains, the swelling breaks, and extends rapidly. Ulcers in the spongy tissue of the tongue frequently become obstinate, or are rendered so from constant moistening by the saliva, or by the irritation of points of decayed teeth. The papilke frequently become hyper- trophied, forming spongy excrescences.—Syphilitic ulcers of the tongue often degenerate into cancerous ulcers. Cancers of these parts, as Avell as eA'ery other part, depend upon a 288 DISEASES of the sanguinous function. peculiar specific disposition of the organism Avhich may be hereditary. The disease may be developed by a bloAV or contusion; by treating an ulcer, an induration of or excrescence of the face, lips, or nose, by ex- ternal irritating applications. It may be developed by the progress of scrofula, syphilis ; or the suppression of habitual secretions, &c (Hartmann. Vol. 4, p. 31.) Prognosis.—When small, cancer of these parts may be cured; the prognosis is unfavorable when the cancer is large, the constitution en- feebled, and the disease has returned again after an operation. Ex- cision is generally useless, causes unnecessary suffering, and usually hastens the fatal termination. Arsenicum.—This is the most important remedy. We prefer the high potencies as Ave know the disease incurable by any crude medi- cines, hoAvever appropriate to the symptoms. We begin with the thirtieth dilution at least, repeating at short intervals, (every six hours) till some perceptible effect be produced. (Hartmann) Symptoms.—Burning swelling in the nose with pain on contact; tumor in the nose ; ulceration of the nostrils, high up, Avith discharge of fetid ichor; — ulcers in the Avhole face ; wart-shaped ulcer on the cheek ; dry cracked lips, brown streak in the lips, as if burnt; bleed- ing of the lower lip ; ulcerated eruption around the lips ; cancer-like eruption on the loAver lip, with thick crust, hard, pad-shaped edges, with burning pain, particularly when the parts become cold, and with a lardaceous bottom; spreading ulcer on the lip, painful in the evening, Avhen in the bed, Avith tearing and smarting in the day-time during motion, which is worst Avhen touching the ulcer and in the open air, disturbing the night's rest; corrosion of the edge of the tongue, in front, with smarting; the tongue is blackish, cracked. Arsenicum often needs some other remedy with it; but it is undoubtedly the principal remedy when the cancerous dyscrasia has tainted the system. It is specific for cancer of the nose, tongue, and alveolae. (Hartmann) Arsenic, says Hahnemann, is such a powerful agent, that Ave can not decide whether it is more hurtful in the hands of the rash than salutary in those of the prudent. It has effected remarkable cures of cancer of the face, as described by Fallopius, Bernhardt, Ronnow and others. Its true power in this direction depends on its homoeopathic power of producing in healthy persons very painful tubercles, which are cured with difficulty, as Avitnessed by Amatus Lusitanus; very deep and malignant ulcerations, according to the testimony of Hein- reich and Knape, and cancerous ulcers by Heinze. The ancients were unanimous in their praise of arsenical plasters against pestilential buboes and carbuncles; while Degnier and Pfann saw it give rise "to inflam- matory tumors which quickly turn to gangrene" and Verzascha and Pfann saw it produce "carbuncles and malignant pustules." cancer. 289 Buccal Cancer.—Cancer of Tobacco-Smokers.—Dr. Buisson, of Montpelier, has published sixty-eight cases occurring in smokers. The disease is becoming more frequent, having hardly been noticed in the last century. The loAver lip is most frequently affected; the Spanish habit of expelling smoke through the nostrils produces epithelial vege- tations in the nostrils. Dentists now find it difficult to fix the plates for teeth in the mouths of chewers and smokers on account of the softening and degenerescence of the mucous membrane and sub-mucous tissue. A. Vogel and Reischaur, (chemists,) found tobacco-smoke in- variably to contain sulphuretted hydrogen and prussic-acid. In syphilis it is often seen that smoking localizes the syphilitic virus, producing the mucous tubercle in the part of the mouth familiarly occupied by the pipe or segar. Lupus.—At a meeting of the Central Society of Homoeopathic Physicians, of Germany, (1861) Dr. Mayer related a cure of a lupus on the lower eye-lid by Apis 6. A few months afterwards lupus shoAved itself again on the ala nasi, but Apis was now of no avail. Kirsch remarked, that Apis is not indicated in lupus; but Apis stands in a closer relation to the eye-lid, than to the nose. Cancer of the Tongue.—Sempervivum-tectorum. —Live-for- ever.—1. Dr. Maly, of Glatz, says: a sickly Avoman, at the change of life, had a swelling at the margin of the tongue, as large as a bean; burning pain on shutting the mouth; occasionally bleeding; in- tolerable at night; disturbing sleep; made worse by acids; swelling like a cyst with two small knots, one bleeding; over the swelling three Araricose veins. Tried Aurum, Arsenicum, Carbo-veg., in fourth, tenth and sixth potency; but it greAV harder, larger, and impeded speech. Sempervivum-tectorum juice Avas applied externally three times a day. It made the tumor smaller, but it afterwards inflamed and became very sensitive. Then tried two drops of the second dilution internally.. This daily reduced the tumor to one-third in ten days, menstruation reappeared, which continued five days ; tumor gradually reduced in size to asmall pea; then less sensitive, and the patient did not return to the hospital. 2. General B. —■— had an ulcer on the tongue, left margin;. tried Alumina, and Mer.-corrosivus; ulcer three-fourths to one-half inch deep with sharp edges, hard foundation of bluish color with four knots size of lentils; two large veins, sensitive Avhile eating. Scmpervivum-tect., first centesimal dilution in Avater, twice a day, externally applied. Second day less painful, could eat; edges smoother.. In three or four days the veins smaller; small reddish tumors paler. Fifth and sixth day they disappeared, leaving the base of the ulcer covered Avith whitish membrane. Seventh to ninth day, medicine omitted, sensibility greater. Tenth day repeated; ulcer smaller; veins very small. Case lost sight of. Vol. h—19. 290 DISEASES OF THE SANGUINOUS FUNCTION. 3. A married woman, aged twenty-seven, had for ten days pain under the tongue, impeding eating and talking. On lower surface, near the root, is a bluish-red swelling, size of a half bean, smooth, but hard; on the other side a large vein ; at one point a membranous exudation. Semperviv.-tect. sixth. Two doses, one every other day, for four days ; no pain; after eight days much smaller ; menstruation restored though pregnant six months ; in three Aveeks nothing remains but a somewhat enlarged vein.—(Homoeopath. News.) Hydrastis Canadensis.—Dr. Bayes, of Cambridge, states, that he "has found the Hydrastis exercise a marked influence in relieving the pain of cancer, while at the same time, it has improved the general health of the patient." But he has also seen, " that very sudden pros- tration of strength has accompanied the continued use of the remedy 'beyond a certain point." Dr. Bradshaw, (Brit. Journal of Homoeo- pathy. Oct., 1861,) gives five cases in which Hydrastis was used with the folloAving results : In case No. 1. the patient suffered from " un- mistakable carcinoma" of the left breast. He " gave her one pilule of Hydrastis four-times a day," with benefit to her general health; and he speaks of the remedy as "evidently exerting an absorbing, counteracting influence over the scirrhous tumor." In another case of scirrhous tumor in the left breast the disease " remained stationary." " In a third case of cancerous ulceration of the cervix and os-uteri, there was some mitigation for a few weeks, but, ultimately the patient died." A fourth case received no benefit. In a sixth case of cancerous disease of the os and cervix-uteri, Hydrastis was given for six months. The patient " lingers on, suffering less, and the disease seems arrested." In the seoond case (by Mr. Bradshaw) he says : " the medicine made the patient feel so wretchedly ill that she feared it would kill her: the heart was beating irregularly and tumultuously, and she looked nervous and ill." Dr. Bayes iioav says, this corresponds with his observation of " the rapid prostration which often follows the administration of too large a dose of Hydrastis." This train of symptoms he has " met with in several cases where the mother-tincture Avas given." He therefore thinks, that the medicine should not be administrated in too frequent doses, or in too Ioav dilutions. The plan he has found most beneficial was " to begin with the thirtieth dilution, giving three globules every night, for a fortnight; then a pilule of the twelfth dilution twice a day for another fortnight, followed by the sixth, the third, and finally half- drop doses of the mother-tincture, in the same way, giving a fortnio-ht to each dilution, &c. He approves Dr. Pattison's suggestion to avoid rubbing the tumor, but to apply " a lotion over the parts by means of moistened linen rags." CANCER. 291 A cold infusion of the remedy is thus prepared: " six. of the pow- dered Hydrastis to a half pint of water. Allow it to stand four days, then strain and keep in a cold place." This is said to be of great ser vice as an application to ulcerated surfaces. The later experience of Dr. Bayes with this remedy is highly im- portant: A case of cancer on the left breast in a young unmarried woman, referred to in his first paper, came under his care, March 19, 1860. " The tumor was as large as a small hen's egg; the nipple retracted and the skin puckered. She had been for two years under allopathic care, and Avas strongly advised to submit to an operation. The tumor soon ceased to be painful, and had totally disappeared on Feb. 20, 1861. Cases at the Cambridge Homoeopathic Dispensary. Case first. A lady, aged forty-one, married—inflamed indurated breast—found on the seventeenth Feb. to be scirrhus. Hydrastis 3. iv. gtt. in a half pint of water. A table-spoonful tAvice a day. Up to March tAventieth no change. Hydrastis-tinct. gtt. xii. Aqua-dist. 3ii. a tea-spoonful every night. This treatment was continued Avithout much variation, till June eleventh. " The tumor has rapidly disappeared, there is still some slight pain. A pilule of Arnica every morning, Conium 30 every third night. July fourth, the breast remains quite well; some slight indigestion. Nux 6, &c. Case 2. —A married woman, has ovarian tumor of the right side, with severe pain, especially in walking. Has had a cancer excised in the right breast. May fourth, prescribed Hydrastis-can. 30. every third night. Aconite twice a day. May eleventh.—Pain lessened though still severe at night. Rhus. TAventy-sixth.—Pain almost gone ; tumor still remains, and is weighty. Hydrastis 3. given three times a day. June fourth.—Still better.—Continue. Thirteenth.—Much the same. Iodine 3. gtt. in a pint of water, a table-spoonful tAvice a day. June twenty-sixth.—Better. Mercur.-sol. 6. every night. July fourth.—Still better. Repeat—and give Merc.-iod. 1., gr. ii. every third night. July ninth.—Discharged cured. Case 3.—Mrs. L.—July 2, 1860.—Cancer of the right breast, hard, nodulated, very painful at times ; skin had a bluish appearance over the tumor, is puckered, and adherent over a portion of the surface the size of a shilling; tumor not adherent to the ribs. December tAventy-fourth.—She has been under the influence of 292 DISEASES OF THE SANGUINOUS FUNCTION. Hydrastis, and is better; the tumor under its use has decreased in size, and was scarcely ever painful, has still a bluish appearance, and is yet adherent to the skin. Occasional intercurrent remedies have been given to meet occasional symptoms. Case 4.—A Avidow, aged seventy-seven, has cancer of the right breast. The tumor is unattached to the skin or ribs. There is a small hard moveable tumor, also, just above the clavicle. She has occasionally severe pains. Hydrastis was used externally and internally from August 24, 1860, to October, 1861. The tumors have not increased, are less painful, and the patientls in excellent health. The Hydrastis has been used in the thirtieth dilution, also as low as the mother- tincture. A lotion of Hydrast. mother-tincture gtt. x. Aq.. dist. fxvi., has been applied twice a day. Case 5.—Mrs. B., aged twenty-five. Admitted Sept. 12, 1860. The cervical glands of the left side of the neck are enlarged, apparently three, and have a stony, hard feeling. A tumor of similar character Avas excised at the Allopathic Hospital, some years since, and a deep scar remains. Some months after the operation, these glands enlarged, and are now very painful. Calcarea-carb. 30, gl. iii. every third night, &c. Oct. third.—Better. Calc.-carb. 12, a pilule every second night. Twenty-fourth.—The hardness remains ; there is occasional shooting pain. Hydrastis, 3., a pilule every night. Nov. fifth.—Much better ; the swelling decidedly less. Continue. Twenty-third.—Better. Suffers from indigestion. Repeat Hydrastis, and Nux.vom., a pilule twice a day. Dec. seventh.—Greatly better. Repeat pil. Hydrast. TAventy-sixth.—Remains better; no pain. Repeat the pilule. Feb. thirteenth.—Still better, and feels so well she is allowed to re- turn to her home, (sixteen miles away,) to remain if there be no return of the pain or increase of tumor. Hydrast. mother-tincture 3ii. Two drops in a little water twice a day when in pain. Case 6.—Mrs. D., aged fifty-five. Admitted Dec. 10,1860. Tumor on the dorsum of the foot; occasionally painful; has had it two years ; it is stony-hard, the size of a walnut, and nodulated. Excision Lad been adAdsed at the Hospital. Hydras.-can. 3. a pilule twice a day. Tinct. Hydras. 3i. Aqua-dist. jijs. to be rubbed in every night. May sixth.—The tumor was almost removed, not being larger than a pea. Case 7.—Mrs. A., aged forty-five. Admitted Dec. 10,1860. Scirrhus of the breast. Hydrastis lotion, and Arsenicum 6; a pilule twice a day. This patient was suffering also from phthisis, for which she took Bryonia, Phosphorus and other medicines. The Hydrastis lotion al- CANCEE OF THE STOMACH. 293 Avays removes the pain in the scirrhous breast. Continues under treatment. Case 8.—Mr. G., aged fifty. Admitted April 28, 1864. Confined to bed Avith a large open cancer of the left breast. Under the use of Hydrastis she continued to improve till, on March 5, 1860, she was so far removed as to be able to go out daily and to do her house-work. " The cancerous ulceration has considerably diminished; it secretes a far healthier pus, and her general health has greatly improved. In her case the Hydrastis has been discontinued at times, from its pro- ducing the depressing effect on the heart's action alluded to before. Case 9.—Admitted July 21, 1860. Mr. Freeman, the surgeon's notes say: " Mrs. J., aged thirty-seven. Health good. Has stony- hard tumor in left breast, unattached to skin, perfectly moveable, the size of a large filbert, surface somewhat nodulated; suffers from lancinating pains. Had first Hydrastis 12, a pilule twice a day ; after- wards, Hydrast. mother-tincture, a third of a drop, three times a day; she had intercurrently, a few doses of Nux-v. for dyspeptic symptoms. The tumor became painless and gradually lessened till a portion, like a vein filled Avith coagulum, the size of a crow-quill, and a third of an inch long, remained. I wished her to continue the treatment, but she thought herself well and remained away. I saw her in May, 1861, and she then Avas quite well, neither pain nor induration remaining." Aconite.—In several forms of cancer we have observed essential benefit from the use of Aconite. Whether its ameliorating action has been due to its influence upon the circulation, the nervous system, or the pores of the skin, we know not; but that it possesses some peculiar poAver in modifying the constitutional ravages of cancerous degenera- tions, we have had ample proof. We are in the habit of prescribing the first decimal dilution in water. CANCER OF THE STOMACH. G kneral Rem arks.—Cancer of the stomach may begin in an elderly person, hitherto free from dyspepsia, by at first capricious, and after- Avards diminished appetite; by occasional nausea or vomiting, a sense of uneasiness and distention of the stomach. The complexion is first pale and unhealthy; it afterAvards acquires a muddy yellowish, or faint greenish hue. The gastric symptoms increase, and vomiting becomes more frequent and urgent; the local uneasiness deepens into pain; and both pain and A'omiting are aggravated by food. At a later period lnemorrhagc generally occurs. It is usually small in amount, and about the same time a tumor becomes perceptible in the middle of the epigastric region; as the disease progresses, all of these symrtoms 294 DISEASES of the sanguinous FUNCTION. increase ; debility and emaciation follow, and these soon lead to extreme prostration, anasarca, delirium and death. In many cases these symptoms are complicated by ascites, jaundice, perforation of the coats of the stomach, fistula, or phlebitis. In others there arise symptoms showing cancerous deposit in other organs, es- pecially the lungs and liver. The disease usually advances towards its termination with a speed and severity constantly accelerating; and, perhaps, most generally ends in death in about one year from its first invasion. (Brinton. Brit, and For. 2Ied. Chiv. Rev., Oct. 1857.) Diagnosis.—In cancer of the stomach the appetite usually fails en- tirely. In ulcer of the stomach it becomes capricious; sometimes in- ordinate ; but the patient learns to avoid eating as far as possible, in order to avoid the pain which follows it; though he still has s'ome degree of appetite. Whereas, in cancer the anorexia or absence of ap- petite seems to be a specific result of the disease. As such it seems to be affected through the same nervous channels Avhich ordinarily transmit the sensations of hunger and satiety. The anorexia, there- fore, is seen to commence at a very early stage of the deposits of can- cerous matter in the coats of the stomach ; and preceding all other local symptoms. It is most clearly marked in the younger subjects, and in the softer varieties of cancerous deposit, and is equally marked in the cases of males or females. The pain in cancer remits in violence frequently, but scarcely ever intermits. Its site does not indicate the seat of the cancer; though cancer of the lesser curvature seems to be connected Avith pain in the inter-scapular region, which is often peculiarly severe in some cases : and a marked inflammation of the posterior portion of the stomach seems to cause pain ranging from the middle of the dorsal to the lower part of the lumbar region. The pain in cancer of the stomach is first lancinating; beginning at an early stage and rapidly assuming a marked severity. In the course of a feAv days it becomes so severe as to leave most other symptoms out of view. The pain of gastric ulcer may intermit, and is increased by food ; but that of gastric can- cer neither subsides after digestion is accomplished, nor after the stomach is emptied by vomiting. In later stages of the disease the pain sometimes subsides or changes in character. Some patients de- scribe it as a dull, slow, gnawing, or burning, with a sense of weio-ht oppression, tightness, and distention and soreness on pressure in the epigastrium. The dull burning belongs rather to the stage in Avhich the process of ulceration is going on in the cancer, rather than in the stage of its deposition. It may then be increased by food, is referred to a small spot, and may be partially relieved by A'oinitino-. The vomiting more frequently attends cancer of the pylorus than that of any other part; it often begins when the cancerous deposit is CANCER OF THE STOMACH. 295 very small, and seems to be connected chiefly with local irritation of the nerves distributed to the seat of the disease. At a later stage, _ when the softening and ulceration of the cancerous deposit has re- moved the mucous membrane, we have vomiting of a different order. The subjacent tissue being exposed, becomes highly irritable; and vomiting is excited by almost every thing ta,ken into the stomach. It then generally occurs at short intervals throughout the disease, though not in every case. The matter thrown up is large in quantity, has a yeasty appearance, and contains sarcina torula and fragments of de- stroyed membrane and cancer-cells. There is often at this period of gastric cancer a torpor, or suspension of the peristaltic action of the stomach, either from paralysis of the nerves, destruction of a portion of the muscular fibres by the process of ulceration, or weakening by their undue extension. The haemorrhage occurs in, perhaps, half the cases, though some writers have observed it still more frequently. Of those in which it does occur, at least seven-eighths, shoAv the blood so mixed Avith the gastric juice, food, bile, or softened cancerous substance, as to present the appearance rather of coffee-grounds than of blood. The degree of congestion which causes the'haemorrhage is small in the earlier stage of the cancerous deposit; but it afterwards becomes more considerable ; and the flow of blood may then be so great as to cause death. When this occurs, dissection shows: 1. that the blood had proceeded from the sub-mucous plexuses, or from the minute capillaries of the inter- gastric surface, and not from any large arterial trunks ; 2. From ves- sels destroyed by ulceration; or, 3. From the erosion of large vessels external to the stomach. The coffee-grounds appearance may be observed in cases of ulcer of the stomach, though there is generally less of it than in cancer. The characteristic cancer-cell growth can be detected in the matters ex- pelled from the stomach, when the disease has reached the stage in Avhich these cells are throAvn off by exfoliation or sloughing. The microscopical examination can be made by diluting the fresh liquids expelled by vomiting, and placing a portion under the field of a micros- cope of sufficient poAver. The diagnosis may be further assisted by manual examination of the external surface of the abdomen. The tumor may at least be detected, though its nature must be made out by comparison of the various con- curring symptoms. The color of the skin in gastric cancer is " a muddy greenish pal- lor." The original or pathognomic cachexia is " regarded as the result of the humeral disease Avhich precedes, and brings about the cancerous deposit." (Brit i ton.) The cachectic asnect of gastric cancer often imitates that of ulcer 296 DISEASES OF THE SANGULNOUS FUNCTION. of the stomach, and the resemblance is sometimes so close as to defy distinction; both diseases involve a similar general condition, the joint product of ulceration, haemorrhage, vomiting, pain, starvation. WhereArer cachexia precedes these circumstances, or is present in a degree utterly disproportionate to Avhat their aggregate influence might lead us to expect, it becomes a leading, almost pathognomonic symptom. A case was published by Dr. Porter, of New-London, Conn., of a man aged sixty-six, who had good health up to two months before his death, though he had some regurgitation of food and slight fullness after eating, but no pain. The coffee-grounds vomiting commenced Dec. 19, 1847; but he continued to attend to business till January 3, nineteen days before his death. Jan. 14, he threAV oft* a large quantity of uncoagulated blood mixed Avith coffee-grounds, and this Avas often repeated afterwards. He had, however, scarcely any pain. Near the close of life there was an indefinable distress, a sense of sinking and emptiness, like faintness from want of food. Still there was none of the lancinating pain common in cancer, only some enlargement like a small tumor near the pylorus or duodenum. There Avas none of the "dingy, salloAv, exsanguinous, yet opaque appearance so common in cancerous diseases." On dissection a scirrhous tumor, the size of half a small orange, occupied the pylorus and adjoining portions of the stomach, someAvhat hypertrophied, mainly hard, but some ulceration had commenced. (Amer. Jour. April, 1848, p. 378.) Prognosis.—Cancer of the stomach may be regarded as one of the most hopeless forms of this most terrible of human diseases. It is dreaded, not so much because of its being almost uniformly fatal, but for the insufferable pain which attends on it throughout so much of its course. The duration, says Dr. Brinton, of cancer " may be estimated at about thirty-six months from the first appearance of the symptoms ; but feAV cases survive the twenty-fourth, and some have sunk under extreme suffering at the end of a single month. Treatment.—This can only be palliative. The mildest measures can alone be used without injury, though Arsenicum may be tried in homoeopathic doses far enough to test its powers, which are sometimes surprisingly great. Lime-Avater may often be employed in quieting the stomach ; but its remedial powers seem confined to the stage of ulceration from chronic gastritis. Although in fully developed cancer of the stomach, no just hopes can be entertained of effecting a cure, we may do much to palliate suf fering, and even to prolong life, with judiciously-selected homoeopathic medicines. Among these may be cited, Arsenicum, Cicuta, Conium, CANCER. 297 Veratrum-alb., Veratrum-viride, Kreosote, Mercurius-corr., Thuja, Carbo-animalis, Ipecac, Tabac, Cannabis-ind. Clematis.—Induration of the lymphatic glands of the breast, w'hen painful to the.touch; appearance of cancerous degeneration ; ulceration with pulsating, burning and lancinating pains along the borders of the ulcer, particularly upon being handled. CANCER OF THE UTERUS. Symptoms.—Incipient Stage.—Sharp and lancinating fugitive pains in the back and loins, across the supra-pubic region, or shooting along the front of the thigh, or along the course of the sciatic nerve, inducing numbness or debility of the Avhole limb. A tumor or decided fullness in one or the other iliac fossae, fixed pain or tenderness appearing to issue out of the abdominal ring, irritation of the bladder with dysuria ; sensation at the termination of the rectum like that of haemorrhoids. Menstruation may be regular, but there are often bursts of haemorrhage at the period or in the interval. After the disease has continued long the appetite is impaired, sleep disturbed, the flesh wastes and becomes softer, countenance pale and expressive of distress. The os uteri is hard at the margin, or fissured, projecting more than natural, and irregular in form. In the situation of the muciperous glands, several hard well defined projections like grains of shot under the mucous membrane; pressure on them gives pain or makes sickness at the stomach. The cervix is slightly enlarged and tender; circum- ference of the os uteri, especially between the projecting glandulae, feels turgid and presents a deep crimson color. No thickening or other alteration of the parts adjoining. At the connection Avith the cervix the movement is free ; no consolidation of the uterus Avith the neigh- boring contents of the pelvis. The morbid change seems entirely con- fined to the os uteri, with an anomalous tingling in front and inside of the thighs. These last for a few hours, or a day or two and then dis- appear, perhaps for Aveeks, but again and again return in the same situation, for a long time not increasing in severity. Internally the feeling of tenderness increases. There is noAV slight irritability of the bladder; but appetite, digestion and sleep may continue good; the pulse not changed, vis in many other uterine affections of serious character. The patient does not yet anticipate danger. When the disease assumes a more dangerous form the first change takes place in and around the muciperous glandules Avhich exist in such numbers in the cervix and margin of the os uteri. They become indurated by the deposition of scirrhous matter around them, and by thickening of their coats, in consequence of Avhich they feel at first almost like grains of shot or gravel under the mucous membrane. 298 DISEASES OF THE SANGULNOUS FUNCTION. The further symptoms correspond more nearly with those of cancer in other organs. &ee p. 282. Remedies, p. 285 to 297. FUNGUS H^MATODES. Case of Field-marshal Count Radetzky.—In July and August 1839, this distinguished Austrian general was attacked with congestion of the head and vertigo ; and soon after it passed off' there commenced a pressure in the right eye, inflammation of the eyelids, lachrymation, occasional protrusion of the eye, and pressure in the forehead. He was relieved by remedies, but the under eyelid remained inflamed. In May, 1840, there Avas another attack of vertigo; after it he was well except one eye. October 9th. The Marshal, on the occasion of a great review was exposed during five hours to extremes of temperature and fatigue. Towards evening his face became red, he had fever with great pain in the right side of the head; the right eye was inflamed and protruding from the orbit; pulse full and hard. He was relieved by homoeopathic remedies; but lachrymation of the right eye continued and there Avas a small swelling in the external angle. About the end of October further exposures were followed by the appearance of a small tumor commencing at the inner angle of the eye near the lower lid; the external tumor enlarged; the eye protruded, and there was pain in the head. Dr. Hartung, medical counsellor to his Excellency, pre- scribed the ordinary homoeopathic remedies, beginning with Aconite and all the symptoms of immediate urgency Avere, for the time, removed. But the growth of the fungous tumors could not be stayed. That above the external angle assumed a purple color, that between the eye-ball and the lower lid became fungus-like, elastic, granulous, purple, and painless. The eye became protruded and turned from its normal axis of vision, so that the pupil stood looking outwards and upwards, the ball restricted in its motions, but the power of vision uninjured. At the beginning of the next year, the case beginning to be regarded as incurable, Dr. Hartung made an official report to Vienna, and fur- ther medical counsel was ordered by the Emperor. The tumors had increased to one-third of an inch each in diameter, and the funo-oua growth was evident around the Avhole circumference of the eye-ball. which began to protrude more sensibly. Vision began to suffer; towards the external angle objects Avere only partially visible ; the conjunctiva was softened, and dark-red, approaching to blue ; lids glued together in the morning; sensibility to light increasing in the day-time * lachry- mation, heat, dryness and pain at night becoming Avorse. A consultation was held on the 26th of January, at which the consulting allopathic physicians, Drs. Jager and Flurer, declared the case as hopeless, " after forty years of experience." Dr. Hartung despondingly resumed FUNGU8 HAEMATODES. 299 the sole direction of the case. The distinguished patient was now eighty years of age. On the 19th of February, 1841, the appearances threatening scirrhus had changed; haemorrhage had begun, the tumors had diminished in size and were less painful. The report of this date, shows improvement in \dsion and general health; and diminution of pain. March 16th. The fungus which at its greatest size had been three inches in circumference had been reduced to a small tumor which was visible only on drawing down the under lid; the eye moved freely in the orbit, and the power of vision was restored. April 22d. The tumor had so far diminished that only a slight projection on the lid remained. The Marshal was employed in his usual duties, expos- ing himself to " a low temperature, and again in the increased heat of the sun. He continued in his former mode of life, without any injury to the eye. The disease was regarded as cured, and no further reports were required." • The remedies used during the treatment of the Austrian Field- marshal's case are recapitulated by Dr- Hartung in his communication of June 12th, 1841. They were : Arsenicum 10° ; PsorinlO3; Her- petin 10° ; Carbo-animalis 10° ; and Thuja-occident. He observed " that the first three remedies aggravated the disease." He then pre- pared Thuja 10°, one drop in three ounces of distilled water, a table- spoonful three times a day. " The first day appeared all the symptoms that his Excellency had occasionally suffered for years ; as : headache in the right side of the forehead, cough, particularly at night, slight diarrhoea, pain in the kidneys, with a sandy sediment in the urine, itching, and a reddish rash-like eruption on the inner side of the thigh; the nio-ht was quiet, Avith the exception of the cough. The second day the feelings Avere the same, but Avhen pointed to they were gone away like a breath. Third day no more pain; itching in the inner angle, secretion of a milky and rather cream-like moisture on the whole extent of the fungus. After this the eye was moistened with the solu- tion of Thuja every two hours. On the fourth day there was no pain; the secretion increased; the fungus appeared to be diminishing; fifth, sixth, and seventh days, no pain. The secretion inpreased, the lower part of the fungus diminished, to the astonishment of all who had pre- viously seen it. On the eighth day after the first use of the Thuja I gave Carbo-animalis 10°, 3.. Effect first and second days as after the Thuja ; the pain in the forehead appeared, only it extended itself to the left side, and to the ear, like a breath passing over. The secretion continued; n£ pain in the eye. The third, fourth, fifth, sixth, and seventh days, no headache; the secretion continued. I noAV every morning touched the protruding fungus with a fine pencil, moistened with the fourth dilution of Carbo-anim. The Thuja was continued on the circumference. The fungus diminished, and the eye retreated 300 DISEASES OF THE SANGUtNOUS FUNCTION. within the orbit." By continuing these two remedies in alternation every eight days, in the course of a month and a half the whole fungus had disappeared, and the eye moved as well as the other in its orbit. At the same time various other constitutional symptoms disappeared. The Field-marshal continued in good health to extreme old age ; and sent a public testimonial of gratitude to his physician. GENUS VII.—LUES.-1. SYPHILIS. This disease was unknown to the Greek and Roman physicians, as no allusion is made to it by any of their medical authors, historians or poets; and much discussion has taken place respecting its first intro- duction into Europe. All the modern authors who first described it, (collected by Luisinus, Astrue, and Girtanner) in the latter years of the fifteenth century comment upon it as " morbus novus," " morbus gnotus." Peter Pinctor traces the origin of the disease to the time of the conjunction of Mars, Venus, Jupiter, and, Mercury, A.D. 1483, at which time he thinks this disease must have originated ; but Fulgosi dates it at October, 1492; Sanchez and Hensler in 1493. Others contended that it originated in Hispaniola. It is certain, however, that it was first distinctly recognized, says Dr. Simpson, of Edinburgh, dur- ing the invasion of Italy by the victorious army of Charles VIII. of France ; and it first broke out extensively at Naples when the French took possession of that city in the spring of 1495. This army carried the disease with them to France, Switzerland, Germany, Flanders, &c. In 1497, it had reached Aberdeen in Scotland. Six months later the new disease was made the subject of municipal regulation in Edin- burgh. Infected persons were banished from the town to the sands of Leith,there to remain "till God shall provide for their health." Those who took upon then the cure of the infected were banished with their patients, and if either should return to the city in violation of the edict they Avere to be burned on the cheek with a branding iron. James IV. who was then king of Scotland was much engaged in experimental re- searches after the philosopher's stone, or the " quinta essentia," and Avas withal learned in the arts of medicine and surgery. In his practice of surgery he Avas more liberal than any philanthropist of our noble pro- fession of these days. He not only bled his patients for nothino- but gave them eighteen shillings Scotch into the bargain. The record shoAvs that his operations were not always successful. One woman with cataract Avas left entirely blind, for AA'hich a partial atonement was made by the usual eighteen shillings, Scotch. The experience of this king in the treatment of SA-philis is not recorded, but the sums of money given by him to patients affected with it are regularly set down to his credit. SYPHILIS. 301 Wm. Dunbar, the Scottish poet to the royal household, who preceded Burns by nearly three centuries, employed his genius in commemorat- ing the coming in of the new plague. Gunbrecht and Brandt wrote in 1496, that the disease had already invaded France, Germany and Bri- tain. In 1502, the privy expense book of Elizabeth of York, queen of Henry VII., shows that the benevolent lady paid a surgeon for curing a certain mendicant of the French malady the sum of twenty shillings. During a great portion of the sixteenth century, it was so contagious in some parts of Europe, that it Avas communicated by lying in the same bed, by the clothes, gloves, money, or breath of the patient. A variety of syphilis also prevailed in Canada some years ago, of so viru- lent a nature, that it Avas communicated by the breath and by contact. Dr. Thompson, " thinks it probable that the disease has existed, more or less, and under different grades of severity, in all ages, and that it has thousands of times been originated de novo." Professor Simpson, from a historical review of the earliest notices of syphilis on record, arrives at the following pathological opinion: I. That syphilis Avas a species of disease new to Europe when it first excited the attention of physicians and historians in the last years of the fifteenth century. II. That it is a species of disease distinct and different alike, first, from gonorrhoea; and, second, from Greek leprosy, (with both of which diseases it has been occasionally confounded); for both of these mala- dies existed and were abundantly recognized* in Britain long before the date of the introduction of syphilis. III. When the disease first broke out it was regarded by physicians and the public as communicable, and constantly communicated from the infected to the healthy by the employment of the clothes, vessels, baths, &c, used by those suffering Avith it, and by the slightest contact, or even breathing the same air with them. One of the gravest charges against Cardinal Wolsey when he was arraigned before the House of Lords in 1529, Avas, as given in the indictment; that "the same Lord- cardinal, knoAving himself to have the foul and contagious disease of the great pox broken out upon him in divers places of his body, came daily to your grace (the king) roAvning in your ear, and blowing upon your most noble grace, Avith his perillous and infective breath, to the marvellous danger of your highness, if God, of his infinite goodness, had not better provided for your highness," &c, &lc.* For many years after its outbreak sexual intercourse does not appear to have been suspected as the mode of its propagation; the primary affections of the several organs Avere not noticed as constant symptoms. Their attention was chiefly directed to the secondary symptoms, such as : The hideous eruptions on the skin, the ulcers of the throat, tho * Lancet, 1861, p. 172. 302 DISEASES OF THE SANGUINOUS FUNCTION. exostoses, and nocturnal pains in the bones, &c. The rapidity with which it spread over Europe led men to suppose that it travelled as an epidemic without waiting for the sIoav process of communication by con- tact. It was on the 4th of Dec, 1494, that the army of Charles VIII. entered Rome; they reached Naples February 21st, 1795, and eva- cuated the city May 20th. On the 24th the Spanish general Cordova landed in Sicily. The battle of Fuornovo was fought July 5th, king Ferdinand returned to Naples the next day. The last remnant of the French army returned to France about the end of the following year. Within less than two years the Aberdeen edict was issued (April 23d, 1497), only forty-eight days after that of Paris, which was dated March 6th. The disease soon swept off vast numbers of the dissolute princes and dignitaries in all countries. The emperor Charles V., Pope Alexander VI., kings and cardinals, princes and bishops, peers and priests, are recorded among its victims. Indeed the manners of the dignitaries of every nominally Christian country were so much worse than the masses were able to believe, that they stealthily transmitted this most loathesome of all diseases so rapidly from one city to another that the malady itself was at first mistaken for a pestilential epidemic. The causes which may have conduced to vary its character at differ- ent periods, are numerous; and we suggest the following as a feAV of them. It has been observed that exposure of the body to a cold, humid atmosphere, excessive fatigue, changes of diet and of climate, un- wholesome food, and neglect of cleanliness, favor the rapid progress and destructiveness of the malady; while a dry, warm and equable temperature, cleanliness, nutritious food, and comfortable lodgings are circumstances which conduce to render it comparatively mild. Thus its violence during the siege of Naples in 1495 may also be explained, when we bear in mind the forced marches, the changes of climate* and of diet, and the constant excitement and fatigue to which the soldiers were exposed. The same severity marked its prevalence in the British army in Portugal, while the natives themselves were but slightly affected, although exposed to similar contamination. One of our army surgeons recently informed us that the same diffi- culty was experienced among our soldiers during the Mexican campaign in 1847, and 1848; they contracted the disorder, while the Mexicans experienced but slight inconvenience, although exposed to the same virus. The argument also holds good Avith respect to sailors Avho are so constantly subjected to the vicissitudes of temperature, the noxious air of vessels, and the stale, salt provisions used at sea. May it not, then, be fairly inferred, that whatever causes impair the forces of the organism, serve also to render it less'able to resist the deleterious influence of the syphilitic poison ? SYPHILIS. 303 In regard to the doctrine of Hahnemann respecting the identity of syphilis and sycosis, we agree with Hartmann, that the mass of evi- dence upon the subject renders it almost conclusive that the two diseases are distinct in their nature. The origin of each is a specific morbid poison, capable of impressing the organism in a distinct and peculiar manner. Diagnosis.—There are unquestionably a great variety of ulcers Avhich make their appearance upon the genitals, communicated by contact Avith diseased subjects, which are, nevertheless, not syphilitic, and which will heal over Avithout causing constitutional symptoms, simply by the aid of mild dressings. The true syphilite chancre is now of rare occurrence, but the great majority of those intractable ulcers Avhich are looked upon as real venereal chancres, are nothing more, primarily, than simple non-infectious sores, which have been converted into an unhealthy condition by the abuse of mercury. Who can doubt this fact Avhen he contemplates the dreadful effects which a course of mercury often produces on the healthy organism? who could be tempted, in health to take the enormous quantities of this drug which are deemed necessary for the cure of syphilis? Let the provings of it —let the horrible consequences which its accidental absorption some- times occasions upon the surface,—in the mucous membranes,—the bones,—the glands and the nervous system, answer. For our part, we would prefer the syphilitic poison itself, rather than the uncontrollable ravages of such an enemy as mercury in allopathic administrations is admitted to be by the fair-minded of those even who most earnestly defend its use. < In order to be fully convinced that many of the effects of mercury are improperly attributed to the action of the syphilitic virus, it is only necessary to regard carefully the symptoms which are constantly presented to our observation in what are called venereal affections, and to notice the opinions of many of the most eminent medical observers. Thus, Sir Astley Cooper in his lectures, used to observe, " do not think that it is a rare occurrence for the penis to be destroyed by mercury; no, a chancre that has remained weeks in a healthy state, shall become irritable, and by mal-treatment, by the injudicious and improper use of mercury shall slough and end in the destruction of the penis; this is not a rare case, and is attributed to the venereal disease, but in reality is an effect of the improper use of mercury." (Castle's 2Ianual of Surgery, p. 280.) The great Hahnemann constantly alludes to the pernicious results of the abuse of this drug in the hands of the allopathist. There can be no question that those dreadful mutilatious of the penis, of the nose, the palate, the eyes, of the surface of the body, and the nodes and caries of the bones, which we occasionally obseiwe, are all effects of mercury and not of syphilis; and it is in the highest 304 DISEASES OF THE SANGUINOUS FUNCTION. degree probable that the immunity enjoyed by the Portuguese, the Mexicans, and certain other nations, from the severe forms of this malady, is attributable solely to the fact that they use no mercury in its treatment. Chancre.—The primary chancre usually presents itself on some part of the genital organs, in from three to seven days after contamination, in the form of a darkish red pimple, attended' with slight itching, and surrounded by an erysipelatous blush. In a short time matter forms in the centre of the pimple, and an excavated ulcer, Avith a yelloAvish surface, hard and ragged edges, and an indurated base, makes its ap« pearance, marking the sore as a true chancre. The most common seat of primary chancre is on the inside of the prepuce and the corona glandis, but it occasionally occurs on the glans and external parts of the genitals. Many varieties of venereal chancre have been described by authors, as the simple, the indolent, the irritable, the sloughing, the in- durated, the phagedenic of Carmichael, the superficial of Mr. Evans, the Hunterian, &c.; but as these diversities in the appearance of the chancre are not,owing to any difference in the character of the virus, but to the condition of the patient as regards constitution, tempera- ment, and mode of life, at the period of contamination, we should ab- stain from making those minute classifications which some writers have attempted. * The circumstances which may operate to modify the character and appearance of a simple chancre, or which may conduce to develop primarily an intractible and destructive one, are numerous. Individuals whose constitutions have been impaired by abuse of sti- mulants, undue exposure, hardship and fatigue, and insufficient nourish- ment, are liable to be attacked from the first with that variety which is denominated the indurated sloughing chancre. Those whose systems have been loaded with mercury, and enfeebled by previous disease, are peculiarly subject to that description which is termed irritable and sloughing. Persons who go from temperate to tropical climates, are especially in danger of the phagedenic variety. Scrofula and scurvy also predispose the system to this form of it. The simple chancre is by far the most common, particularly in tem- perate latitudes, and usually occurs to individuals of a sound consti- tution. Some have supposed the cause of this variety to consist in " gonorrhceal matter and other morbid vaginal secretions," brought in contact with the penis during coition; but of this there is no proof. The simple ulcer very often becomes converted into an irritable sloughing, or erysip>elatous one, by some excess or imprudence which impairs the vigor of the body, or by the abuse of mercury. On the other hand, so long as the constitution remains sound and unimpaired SYPHILIS. 305 resistance is offered to the action of the virus, and the secondary im- pression which it makes will be very slight, and in some instances im perceptible. It is in cases of this description that we sometimes wit- ness spontaneous cures of what was originally true syphilitic con- tamination. The most certain marks of a true syphilitic chancre are: the exca- vated surface, the hard, ragged edges, and the indurated base. These appearances, taken in connection with the preArious history of the,case, will generally enable us to decide Avith sufficient certainty respecting the character of the sore; but where any doubt exists, We would most strongly commend the practice discovered and successfully adopted by Ricord of Paris, of inoculating a sound part Avith matter from a sus- pected ulcer. In' case a second chancre is produced by this operation, there will no longer remain a question in regard to the true nature of the malady. After the syphilitic poison has passed from the chancre through the absorbent glands of the groin into the blood, it possesses a specific affinity for only three parts of the body, viz.: " The mucous membrane of the throat and nose ; the skin, or surface of the body; and the bones, Avith their periosteal coArerings," (Sir A. Cooper's lecture). Thus it will be remarked that the internal organs are never impressed by thi8 virus; and this fact should induce the allopath to pause before he loads the system with a poison which spares scarcely a single structure during its operation. Hunter taught that " the venereal disease" presented "no variety of species," and that " no difference can be produced in the manifesta- tion of the disease by a difference in the malignity of the purulent matter; the same pus exercises, on different individuals, actions totally dissimilar from one another, the diverse nature of Avhich depends on the constitution and the general state of the economy at the time of the infection.* M. Ricord, the most distinguished of French authors on this subject up to a recent date, held the same opinion. In his letters he says (p. 149.) " Up to the present time, Ave are justified in denying the existence of more than one virus."f But in his latest work which he bequeaths to posterity as his last legacy and the results of thirty years' experience, he admits that " the chancre is no longer a morbid unit, but a mixed manifestation, belonging to tavo distinct pathological species. The one of these is the simple chancre, the other, the indurated or infecting chancre. The latter creates consti- tutional symptoms, the former is one with soft base, an affection purely local, which limits its effects to the region Avhich attacks, which never exercises a general influence upon the system, which is never ac- companied by constitution-el affections. In other words it is a * Lectures on Chancre, by M. Ricord, 1859. p 34. f On Syphilitic Virus. Chap. I. Vc IL-20. 306 DISEASES OF THE SANGULNOUS FUNCTION. chancre which does not affect the economy—a chancre without sy- philis." Upon this theory a great number of the discrepancies in regard to the origin of the disease may be reconciled. "The simple chancre" existed in the early ages of the Avorld and may be the same referred to the in the Mosaic law, and also in the Avorks of Celsus and Galen; the contagious or more malignant disease originated in the 15th century and spread as an epidemic; it consists of the infecting chancre and its constitutional manifestations.* Diagnosis between simple and infectious Chancre. Simple non-contagious chancre. "The simple chancre has a soft base, or presents only an inflammatory thick- ening ; it does not react upon the glands, or influences them in a peculiar manner by producing almost certainly an inflam- matory, adenite. acute, mono-glandular mppuration, and furnishing most gene- rally an inoculable pus. " Chancre with edges neatly shaped, paid cut perpendicularly ; the floor irre- gular and worm-eaten. " Chancre ordinarily multiple, or mul- tiplying itself by a series of inoculations of the neighboring parts. "Chancre with virulent pus, conta- gious par excellence preserving during a long period, the characters which con- stitute its specificity. " Lastly, a chancre with a destructive and invading tendency ; the form of ul- ceration the most apt to experience the phagedenic complication." M. Ricord, p. 31. A simple chancre is not found on the head. Differential Diagnosis. Dr. Helmuth has gleaned from the works of M. Ricord the following characteristic symptoms of each form of chancre. Indurated Infecting Chancre. 1. Every part of the body liable to in- vasion (therefore chancre on the head may be pronounced infecting.) 2. Develops slowly. 3. Surface smooth ; floor lardaceous. 4. Edges sloping, as though made with a gouge. Simple Non-infecting Chancre. 1. Never noticed upon the cephalic region. 2. Develops rapidly. 3. Surface irregular ; floor fretted or worm-eaten. 4. Edges neatly shaped, cut perpen- dicularly, as if cut out with a punch. Helmuth, U. S. Journ. Horn, Vol. 2, p. 476. syrniLis. 307 Non-infecting. 5. Edges undermined. 6. Border abrupt. 7. No induration, 8. No induration. 9. Suppurates profusely ; the suppu- ration being one of the most fertile sources from which the pus is derived. 10. Pus in the highest degree con- tagious, persisting during the entire existence of the chancre. 11. Generally multiple from its origin, or becomes so by inoculation. 12. Tendency to invade the neighbor- ing structures. BUBO. 13. Not necessarily present. 14. Mono-glandular. 15. Suppurating almost certainly, and furnishing most generally an inoculable pus. 16. No fixed period of development Simple. 17. The simple chancre is most likely to undergo the phagedenic complication. 18. In virgin subjects transmitted in its form—that is a simple chancre. 19. Transmitted to syphilitic subjects either as a simple or an indurated chan- cre ; the form which is reproduced pro- bably depending on the nature of its ori- gin—that is to say, the chancre which gives birth to it."* Comparative number of cases. Infecting. 5. Edges adherent. 6. Border gradually lost in the floor of the ulceration, giving to the ulcer the appearance of a cupola. 7. Induration surrounding the ulcer on all sides, forming for it a kind of bed (pathognomonic.) 8. Induration commences from the first, (if not produced in a few days, will not become so.) 9. Suppurates little, producing but a small quantity of serosity, most fre- quently sanious and ill-formed. 10. Pus rapidly loses its specificity, at all events for the infected subject, who in a few days becomes refractory to in- oculation with his own virus. 11. Generally solitary. Inmost cases a single chancre giving rise to contagion. 12. Inverse disposition. Its limits are soon defined. BUBO. 13. No infecting chancre without an indurated symptomatic bubo. 14. Affecting several or all the glands. 15. Extreme hardness ; independent of each other; no tendency of them- selves to inflammation or suppuration. 16. Produced in course of first or second week ; rarely noticed later ; ge- nerally coincident with induration. Indurated. 17. Rarely assumes the phagedena deviation. 18. Transmitted in its species in vir- gin subjects ; that is to say, an indu- rated chancre. 19. Transmitted to previously infected subjects under the form of a chancre with a soft base, analogous in appearance to the complication.* 20. M. Fournier in three months at the Midi in Paris saw two hundred and fifteen cases. Of two hundred and seven of these cases sixty-five had bubo ; with- out bubo one hundred and fortv-two. 20. In the same period, one hundred and twenty-six of the indurated and in- fecting. * Prof. Helmuth, U. States Journal of Homoeopathy, Vol. 2, 480, 481. 308 DISEASES OF THE SANGUINOUS FUNCTION. The secondary, or specific effects of the syphilitic -virus, after its entrance into the blood, are: First. Upon the mucous membrane of the mouth and throat, which becomes red and inflamed, and covered in some parts with pimples, which soon degenerate into ulcers, resembling in many respects the primary simple chancre. These ulcerations extend into the nostrils, and sometimes even into the larynx itself, giving rise to loss of voice, severe cough, violent constitutional disturbance, and death. In cases which have been improperly treated, the bony palate and the nasal bones become affected, and exfoliate, and thus cause those disgusting mutilations of the nose and face w'hich so often stare the old-school- physician in the face. Second. Manifestations of the action of the absorbed virus m the skin: — These are: Slightly elevated copper-colored elevations of different sizes, attended with uneasy or itching sensations, sometimes coveied with a kind of scurf or scale, or, in other instances, Avith incrustations or ulcerations. These eruptions make their appearance on the face, head, breast, palms of the hands, and arms. Eruptions, which are called tubercular, often appear on the scalp, the eye-brows, the breast, back, and arms, and ultimately form very troublesome ulcers. In healthy subjects these secondary eruptions are not very troublesome, being simply copper-colored blotches, covered Avith a thin scurf; but in irritable and impaired constitutions they often assume the character of foul and sloughing ulcers. The particular variety of these secondary eruptions will be determined by the peculiarities of constitution in each individual case, and not from any original difference in the virus itself. Third. Action of the venereal poison upon the osseous structure and its periosteal covering. The morbid inflammation in the first instance upon the periosteum, causing severe nocturnal pains, and some tumefaction in the affected region. If the malady continues to increase, an osseous deposit will be formed between the periosteum and the bone, constituting what is termed venereal node. This node in its early stages, does not usually give rise to much inflammation of the surrounding skin, nor is it attended Avith a great amount of pain, but after it has existed for a considerable time, and particularly if the patient has been drugged with mercurial preparations, it becomes quite painful, especially during the night. The ordinary location of venereal nodes is on the anterior portion of the tibia, or on the • surface of the cranial bones. We believe that the above enumerated symptoms constitute all of the legitimate effects resulting from the action of the absorbed syphi- litic virus. The great variety of eruptions and ulcerations described SYrHILIS. 309 by Hartmann and others, are attributable to other causes, operating either by themselves, or in conjunction with the venereal poison. It is of vast importance in affections of this description to distinguish, with all possible accuracy between the syphilitic action and that of mercury, scrofula, and other causes. Farther on we shall endeavor to make this distinction as clear as possible. Bubo.—Another primary manifestation of syphilis consists in an enlargement of one or more of the absorbent glands of the groin, termed bubo. This enlargement usually succeeds the chancre, and is caused by the absorption of the virus of the latter. It is rare in real syphilis that more than one gland in each groin becomes affected with the virus, although some of the other glands now and then become slightly swollen from sympathy. The SAvelling ordinarily partakes of an in- flammatory character, and if not opposed by appropriate remedies, runs on to suppuration, and sometimes to sloughing. The disease has been supposed to be purely local, until after the swelling in the groin has preceded to the suppurative stage;, but this is evidently erroneous, from the fa.ct that secondary symptoms not un- frequently occur, Avithout there having been any preA'ious enlargement in the groin. (See Bubo, Sympathetic) Bubo sometimes makes its appearance without the preA'ious existence of a chancre, but such instances are by no means common. SAvelling of a non-venereal character may likewise occur in the groin from a strain, or from too great violence or bruising of the part. But as chancre for the most part precedes the bubo, there will rarely occur any difficulty in our diagnosis. Treatment.—2Iercury. Mercurial Disease.—Keller says, it can no longer be doubted, that the so-called syphilitic ulcers in the ex- tremities of the following character are the result of mercurial ca- chexia. They are characterized by their grouping and renal form, by their serpiginous advance at their convex border, and their healing and skinnin"- over at their concave border; the same is true of the so-called angina syphilitica, with serpiginous ulcers on the palate, throat, or root of the tongue, giving rise to aphonia, so often described as a characteristic of syphilis. The common reliance is on Iod.- potassa for eliminating the Mercury from the system. Hahnemann, Gross, Hartmann, Hunter, Abernethy, and many other distinguished members of the profession, entertained the opinion that the constitutional symptoms of syphilis are always progressive, and never disappear, unless opposed by medicine ; but the fact is noAV completely established, not only that Mercury is not necessary for the cure of eithcrvthe primary or secondary symptoms, but that they often terminate in a spontaneous cure without any medicine. We are assured by Dr. Ferguson, and other surgeons, who havo 310 DISEASES OF THE SANGUINOUS FUNCTION. observed the disease in Portugal, that the natives cure themselves per- manently of the primary symptoms by topical applications ; and of the secondary effects, by decoctions of sarsaparilla and sudorifics. They remark, that " the virulence of the disease has there been so much mitigated, that, after running a certain course, (commonly a mild one) through the respective order of parts, according to the knoAvn laAvs of its progress, it exhausts itself, and ceases spontaneously." (Med, Chir. Trans. Vol. IV., pp. 2 — 5.) This is still further cor- roborated by the numerous cures of the primary and constitutional symptoms recorded by Messrs. Rose, l)ease, Hennen, Guthrie, Good, and Whympor, without Mercury, or any other means than simple dressings. In the cases which they describe, no caries of the bones occurred, as is so commonly observed when Mercury is used; " and in no instance Avas there that uniform progress with unrelenting fury, from one order of symptoms, and parts affected, to another, which is considered an essential characteristic of true syphilis. (2Ied. and Chir. Trans. Vol. VIIL, p. 422.) Hahnemann, and most of his disciples, as well as Hunter and other eminent allopathists, entertained an opinion that the chancre is simply the vicarious symptom of the internal disease, and that by removing this ulcer by external applications, "the disease is forced to em- body itself externally, in the more troublesome and speedily suppu- rating bubo. And, after this, too, has been removed, as is foolishly done, by external treatment, the disease is forced to manifest itself throughout the organism with all the secondary symptoms of a fully developed syphilis. This unavoidable development of the internal syphilitic disease generally takes place after the lapse of two or three months."—(Hahnemann's Chronic Diseases, p. 116.) We speak advisedly when we pronounce this last assumption al- together erroneous; for we have repeatedly seen true venereal chancres cured by topical treatment alone, while the patients have remained entirely free from any secondary manifestations for years afterwards. When a student of medicine, the author passed some time at the United States Marine Hospital, Chelsea, then under the superintendence of the able and accomplished Dr. Stedman. In this institution the internal use of Mercury had been dispensed Avith in the cure of syphilis, for several years previous to my entrance; and I ascertained that it Avas a very rare occurrence to observe secondary symptoms in those Avho had been cured in the hospital, although patients Avere constantly returning Avith other complaints, Avho had been cured of chancre years previous. The treatment chiefly relied on consisted of topical applications of a mild charactsr, the internal use of-decoctions of sarsaparilla, and a rigid regimen. The ordinary 8YPHIEIS. 311 period for the cure of Mercury chancre, was from three to four weeks; and for bubo, from six to eight weeks. So long as the chancre exists, the matter generated in the con- taminated part continues to be re-absorbed, and so to supply new fuel to the mass of the blood; it is therefore important to change the morbid action of the ulcer, and heal it up as soon as possible. The matter formed in ulcers of the mucous membrane of the throat, which have arisen from the constitutional effects of syphilis, is also capable of propagating the disease by contact with abraded surfaces, or by being directly re-absorbed into the blood. There is reason to believe, therefore, if all these ulcers be speedily healed by topical treatment, so that the blood shall only contain a given quantity of the virus, this limited amount will gradually become diluted, by the constant addition of new and healthy blood, and by its frequent circulation through the lungs, so that its poAver to impress the structure is finally lost, and the parts which have already been affected, gradually recover their healthy tone. In advocating the practice of topical applications, however, we do by no means wish to be understood as placing entire reliance upon them, to the exclusion of other remedies. We only assert that local applications are capable of effecting speedy cures of chancres, thus of destroying these sources of contamination, and placing the blood in the most favorable condition to be purified by the inspired oxygen, by the neAvly-formed blood and by remedial agents. A morbid action is set up in the chancre, which causes it to generate matter of virulent quality. This is evident from the fact that the matter of buboes and other venereal abscesses, as well as the blood of syphilitic persons, is incapable of causing contamination in the healthy. We repeat then, heal the chancres as soon as possible, by destroying their mor- bid action, with some local application Avhich shall induce a healthy medicinal action, and Ave have already done much toAvards abrida-ina- the power of the disease. Our admirable specifics, will, then, readily accomplish Avhat remains to be done in perfecting a cure. The remedial agents which Ave have found most useful in the management of syphilis, are : — Topical: — Nitr.-argenti, Acid-nitric, Zinc-chlorid., Mercur.-prcecip.-rubrum., Kreosote, Internal: The preparations of 2Iercury, Aurum-mur., Thuja, Acid-ni.tr., Sulphur, Hepar-sulph., /Sarsaparilla, Silicea, 2Iezereum, Hydr.-potassce. In the treatment of chancre, our attention should be directed in the first instance to the cauterization of the sore, in order to change as speedily as possible the morbid action. For this purpose, either of the first-named medicines may be employed, although in most cases we prefer the Nitrate of Silver in substance. After a healthy action lias been excited in the ulcer, by these applications, lotions of simple 312 DISEASES OF THE SANGUrNOUS FUNCTION. water may be employed until the cure is established. It will be well to keep a dossil of lint moistened Avith water constantly upon the ulcer. This course, in conjunction with the remedies advised below, will generally effect speedy and permanent restoration. Treatment of Chancre.—In the treatment of the simple form of chancre, if we admit the correctness of the opinions deduced from the largest experience, we have a local disease, but it is a poisonous sore, which is secreting a poisonous pus, which must be destroyed. The treatment therefore is essentially surgical. As in cases where poisons have been taken into the stomach, we begin with dislodging, or neutralizing the poison before we try to cure the symptoms pro- duced by the poison, so in the case of the simple, non-infecting chancre, we must, says Ricord, " reduce the specific ulceration to the state of common ulcer, and transform a Avound possessing a special principle for its maintenance into a wound which has no longer such a resource." (Helmuth.) For the cure of the primary infecting sore Mercurius, third tritura- tion, in some form is certainly the most efficient agent. In the local treatment to be adopted in the simple chancre, Ricord says, we should "reject at once all mild caustics, which only act more or less as anodynes. That which is required in this instance, is a destructive agent." He says, he has successively tried the "Vienna paste, Potass, Nitric-acid, the actual cautery, &c." but proposes a neAv agent which is peculiarly efficacious. " This caustic consists of Sulphuric-acid, mixed Avith powdered vegetable charcoal in the pro- portions necessary to form a half-solid paste." It is proposed by this application to " destroy the poison, and convert the chancre into a simple wound, Avhich will proceed rapidly to cicatrization." Dr. Helmuth says, he tried this application in eleven cases of simple chancre Avith " the most surprising results. Define well the chancre, find it to be certainly the non-contagious xdcer, and no internal treatment is required." Of the internal remedies, Mercury is the most important. By comparing the pure effects of the different preparations of this druc upon the healthy human organization, with the constitutional effects of the syphilite virus, it will be observed that the former are capable of causing all the symptoms of the latter, as well as may others which are peculiar to the drug. According to Pereira, the effects of Mer- cury in large doses are: First. On the mucous membrane of the nose and throat: ulcera- tions of the mouth, gums, throat, and nose, which are often folloAved by extensive sloughing of the parts. Second. On the skin or surface of the body : eczema-mercuriale, erythema-mercuriale, spilosis-mercurialis, miliaria-mercuriaUs, SYPHILIS. 313 and other cutaneous eruptions which bear a close resemblance to herpes, impetigo, psydrasia, and the copper-colored eruptions of syphilis. Third. On the bones and their periosteal coverings: "inflammation of the bones or periosteum, and the consequent production of nodes (symphoresis periostei mercurialis.") C f all the medicines used in the treatment of lues, says Hahne- mann, Mercury is the only one that has stood the test of experience They coincide in their action in many points. Thus: The venereal poison produces on the skin pustules, scales and tubercles. Mercury produces similar defcedations of the skin. Sy- philis excites inflammation of the periosteum and caries of the bones. Mercury does the same. Lues produces inflammation of the iris ; the same is a very common occurrence as a consequence of Mercury. Ulceration of the throat is common from syphilis ; the same often re- sults from Mercury. Ulcers on the organs of reproduction result from both the,poison and the remedy; thus furnishing another proof of the doctrine of Hahnemann. Mercury, though a partial similimum to v*enereal disease, is not a per- fect one; and sometimes produces drug-symptoms which obstinately remain beside those of syphilis. There are frequently seen " cases of venereal chancrous disease, especially Avhen complicated Avith psora, and even with gonorrhoea sycotic a, which, far from being cured by considerable and repeated doses of inappropriate mercurial prepara- tions, station themselves in the organism alongside of the chronic mercurial disease, Avhich deArelops itself gradually, and form together a monstrous complication generally designated by the name of masked syphilis (pseudo-syphilis,) a state of disease Avhich, if not absolutely incurable, cannot, at least, but Avith the greatest difficulty, be changed into health." For, '* besides the morbid symptoms analogous to those of the venereal disease, Avhich would be capable of curing the same homceopathically, Mercury produces a croAvd of others, which bear no resemblance Avhatever to those of syphilis, and Avhich, when ad- ministered in large doses, especially Avhere there is a complication with psora, as is frequently the case, engenders fresh evils, and com- mits terrible ravages in the body." (§ 11.) By the above it will be seen that all of those parts capable of being impressed by the venereal virus, are also acted on by Mercury. That the operation of the latter is often more violent and destructive than the former, will not at this day be questioned. Erythema, lepra, erysipelas, miliary eruptions, herpes, and impetigo are mentioned by Pereira, and others, as skin-affections, Avhich have arisen from the ill effects of Mercury. These symptoms are: ulcerated mouth and throat, periosteal nodes, iritis, and mercurial cachexia, a 31*1 DISEASES OF THE SANGUINOUS FUNCTION. morbid state characterized, according to Mr. Travers, " by irritable circulation, extreme pallor and emaciation, an acute and rapid hectic, and an almost invariable termination in phthisis ;" a picture of the phenomenon following venereal infection, Avhich possesses the truth- fulness of a daguerreotype. The capability possessed by this medi- cine of producing in a healthy individual the special and collective phenomena characterizing the venereal disease cannot be denied; consequently, Avhen exhibited Avith the intention of curing the malady the indications of the laAv, " similia similibus curantur" are fulfilled in every particular; yet it is used by the majority of practitioners, who sneer at homoeopathy." Erichsen, when recommending this mineral, says : " Looking, therefore, upon Mercury as the only remedy we possess that influences directly and permanently the venereal poison, I think that it should always be administered in a full eourse, during some period of the treatment of constitutional syphilis," (Principles and Pract. Surgery, Erichsen, p. 426.) But in addition to the symptoms just enumerated, Mercury, in large doses, causes almost innumerable other symptoms, which have no bearing upon the subject of this chapter, except as indicating its danger in the hands of allopathists. In the above quotation from a distinguished allopathic writer the analogy betAveen the effects produced by the venereal poison and those produced by Mercury maybe seen ; and the difficulty of distinguishing betAveen mercurial and syphilitic in the old school mode of practice may be readily inferred. For an accurate and complete description of the pure effects of Mercury upon the health}7 organism we refer to the provings of Hahne- mann and other homoeopathists. Hahnemann preferred the fluid Quicksilver, carried up to the decillionth degree, over all other preparations in the treatment of both primary and secondary syphilis. For the cure of primary chancre, Hartmann recommends the first or third preparation of Mercurius-solubilis, in doses of one grain night and morning. If no improvement occurs Avithin the first eight days, he gives a lower trituration of Merc.-prrcecip.-rubrum, in doses of one-sixth of a grain, two or three times a day. In the Ilunterian phagedenic, and the elevated indurated chancres, Hahnemann em- ploys the Red-precipitate, in its lower attenuations, from the first. Dr. C. Miiller, of Leipsic, is also most decidedly in favor of the Red- precipitate, or the IIydr.-sulph.-rub., in the treatment of syphilitic chancres and buboes, in whatever state they may present the*mselves. He advises a grain of the first trituration to be given twice a day until the ulcers have nearly healed. For painful nodes and other syphilitic affections of the bones Hcdriod.-potassa? is advised. 8YPHILIS. 315 We have also made use of the Precipitate at the third attenuation, with marked advantage, in uncomplicated syphilis ; and have known the best results, also, from the Hydr.-m,ur.-cor., in both the primary and secondary forms of the malady. For the cure of troublesome secondary symptoms, in the form of cutaneous eruptions, glandular enlargements, and nodes, the Protoiodide of Mercury has extraordinary power. Speedy cures have been effected by it after the other mercurial pre- parations had failed. It may be used at the third attenuation, in doses of a grain, tAvice a day, until the eruptions disappear. Only against syphilis, says Dr. Wolf, Mercury and Iodine are in- dispensable. " Pure syphilis requires Mercurius; for the combination of syphilis and sycosis, Iodine—only one dose 30° must be given. Where a cure is not affected by it, it is a sure sign that one or the other of the folloAving three impediments hinders the cure : 1. Abuse of Mercury or Iodine. The first can be remedied by one dose of Mercury, 6000°, the second by Iodine one dose, 5000° ; Avhere both have been abused, it is necessary to give, first Mercury, 6000°, and afterwards Thuja, 1000°. 2. The second impediment is the predominating influence of the psoric poison. This requires one dose of Sulphur, 30°, or in case of abuse of Sulphur, Sulphur, 6000° (after the previous dose of Mer- curius 30° has left the case unfinished.) 3. The third impediment is the predominating influence of the sycotic poison. (See Sycosis.—Index.) Syphilitic ulcers require Kali-bichro- mate, 80°, one dose, Avhere the cure remains unfinished ; after it San- guinaria 30°." M. Diday, in advocating the treatment of infantile syphilis indirectly through the medium of the milk, (in ansAvering the objection that chemistry is not able to detect infinitesimal doses of medicines in the milk Avhen thus charged with Mercury, says :) "I am willing to admit that chemistry has for the present told us all it can tell. Must this infinitesimal quantity of Mercury be estimated in reference to its curative power, by that of the salts which Ave dissolve in our labora- tories ? An extremely small quantity of Sulphur or of Alkali con- tained in the waters of Bareges or Vichy cures, in twenty-five or thirty days, affections which had previously resisted the largest officinal doses of Sulphuret of Potassium or Bicarbonate of Soda. Has nature denied herself the same privilege in the combination which she effects in the living organism ? A vulgar adage tells us that a man lives by Avhat he digests, not by what he eats. In the same Avay, it is the re- medy absorbed, not the remedy ingested which effects the cure. And if a molecule of Mercury, reduced by the milky secretion to the state of combination most conformable to the special conditions presented by the child, and reaching the stomach continually arrives there in a 316 DISEASES OF THE SANGUINOUS FUNCTION. form and at times in which its passage into the absorbent system is ensured, — if, moreover, this molecule (as facts prove) suffices to cure it,—in the name of Avhat science can its effects be compared to those of the portion of a salt which Ave force it, twice a day, to swallow re- pugnantly, Avithout even knoAving Avhether it will not immediately be rejected and passed off Avith the stools." (Infantile Syphilis, Diday, "New Sydenham Society" p. 240.) When syphilis is complicated by psora, or any other chronic disease, suitable remedies should be alternated Avith the mercurials. 2Iuriate of Gold ranks next in importance to 2Lercury, as a re- medy in secondary syphilis. The late Taft, of NeAV-Orleans, employed it in secondary ulcers and eruptions Avhich would not yield to Mercury, with the most gratifying results. In syphilitic eruptions of long stand- ing, we have often administered it with entire success. The second or third trituration may be employed, in half grain doses, night and morning, as long as is necessary. Nitric-acid will be serviceable in many cases of ill-conditioned chancres, Avhich seem to withstand the curative force of Mercury. It is also of great value in contracted secondary cases, accompanied Avith emaciation, debility, caries of the bones, unhealthy ulcers upon the surface, and great derangement of the nervous system. If these symptoms have been aggravated by abuse of Mercurials, the indication is still stronger for the Acid. The first, second and third dilutions are to be preferred in these cases, a dose to be given tAvice daily until the disease yields. Sulphur, Hepar-sulph,, and Hydr.-sulph.-rubr., are the proper specifics Avhen the chancre occurs in psoric constitutions. As a general rule, the two first should be alternated with some mercurial prepara- tions. Hydr.-potassce, is eminently worthy of consideration in the indolent glandular swellings which sometimes originate from a combination of syphilis and scrofula, It is also an efficient medicine in the treatment of venereal nodes. Stlicea, 2Iczereum, and Sarsaparilla are often valuable auxiliaries in syphilis complicated with scrofula. These medicines should also be given in alternation with some other suitable specific. In conclusion, we call attention to the following reliable mark of cure alluded to by Hahnemann in his Chronic Diseases: " So lon<>- as the original spot upon Avhich the chancre had been developed, exhibits a reddish morbid looking, red, or bluish scar, we may be sure that th internal disease is not completely cured; Avhereas, if the chancre has been removed by the internal remedy, the original spot of the chancre can no longer be traced, on account of that spot beinw covered bv a healthy-colored a skin as the rest of the body." SYPHILIS. 317 Treatment of Secondary Syphilis.—Secondary syphilis consists in the introduction of a poison into the blood; and the cure of it, in the neutralization of that poison. The attainment of this object must be sought in the careful, judicious, and prolonged use of medicines ; and in the adoption of such measures, hygienic and dietetic, as are best calculated to sustain the patient's con- stitutional poAvers. First, then, as regards medicines. It is beyond a question that, as with the original sore, so with many of the constitutional symptoms which result from it, 2Iercury is one of the most efficacious remedies. We constantly meet with cases in which the primary and secondary diseases coexist, and in which the Mercury given for the one cures the other at the same time, several examples of this are reported further on. There is commonly in these instances this advantage, viz., that Mercury has not been previously administered and it is precisely in such cases that the curative action of the medicine is most decided. The same thing holds good Avith reference to the secondary symptoms. If Mercury has been given to any considerable extent for the cure of the chancre, the benefit to be derived from its administration in the treatment of secon- dary symptoms will be much less marked, than in those cases in which it has been given in very minute quantities, or not at all. In either of the latter instances, unless there exist some special circumstance to for- bid its use, Mercury is often of the utmost value in combatting the ear- lier secondary diseases of the skin; the erythema, papules, and squamae. Over the more inveterate eruptions, it has comparatively little power. When, therefore, a well-marked and undoubted case of secondary erup- tion presents itself, folloAving closely, or at no great distance upon the primary disease and in which the patient has not been mercurialized, it is Avell to commence the treatment with one of the loAA'er dilutions of the Iodide or Bin-iodide of Mercury—the second or third decimal, in two- grain-doses, tAvice a day. This should be steadily persisted in until the eruption has vanished, or until it appears certain that the medicine has effected all the good that can reasonably be looked for from it. In many constitutions these eruptive disorders are remarkably obstinate, and no remedy will exercise a sudden influence over them. The Mer- cury having had a fair trial, if it fail in effecting a complete cure, another medicine must be resorted to. Kali-hydriodicum claims our next attention; this is a remedy of undoubted poAver in treating the secondary diseases of syphilis; and in the majority of cases of skin affections, as well as affections of other tissues, its aid is required in expediting or completing the cure. In ob- stinate cases, especially those occurring in scrofulous constitutions—and they are the most obstinate, it is a good plan to give this medicine alter- nately with the Bin-iodide of Mercury, not in alternate doses, but during 318 DISEASES OF THE SANGUINOUS FUNCTION. alternate weeks, i. e. the Kali-hydriod. one week, the 2/.ercurius-bin- iodidus the next and so on. Excellent results will often spring from the alternate action of these and other remedies; and the more so, the less rapid the alternations. To obtain its full curative action in syphili- tic diseases, the Kali-hydriodicum, like the preparations of Mercury, must not be administered in too small doses. " I am in the habit of giving tAvo grains of the salt three times a day, in aqueous solution. The principal indications for its use are—a scrofulous and debilitated constitution ; enlarged glands in the groin, the throat or neck ; the previous exhibition of Mercury in excess, marked by red and inflamed gums, sore throat, foul breath, nocturnal bone-pains."—(Yeldham) It was at one time the almost universal persuasion, that secondary syphilis was incurable, and even now this opinion has its adherents. On the other hand, there are those who, more sanguine than wise, do not hesitate to promise their patients speedy and permanent cure. The truth, as in most other cases, lies between extremes. There is no doubt that in recent cases of secondary disease, occurring in good constitutions, and where the system has not been saturated with Mer- cury, complete and permanent eradication of the symptoms may be safely prognosticated. On the other hand, it is equally certain that, when the taint has once entered the circulation of persons of depraA'ed, scrofulous, and broken-doAvn constitutions, it may but too confidently be predicted, that, though secondary symptoms may, for a time, ap- pear to be successfully combatted, relapses Avill occur with more or less virulence for many years, and, possibly, for the remainder of the patient's life. " The treatment in former times, of primary syphilis Avith destructive doses of Mercury, by inducing the very state of the system, I have just described, had much to do with the development of secondary dis- eases in their most inveterate and intractable forms. Modern science, better instructed, obviates much of this mischief, by avoiding the use of Mercury altogether in treating some cases of primary ulcer, and by giving it in more moderate quantities, when it is employed. Still, I am convinced there is room for yet greater improvement, and that homoeopathy points out the Avay to it; and to this important point we now proceed to direct our attention." The connection of psora and syphilis, says Dr. Wolf, is proved by the fact that since the appearance of syphilis the lepra has become very scarce. The syphilitic dyscrasia has three characteristic peculiarities • 1. Want of flexibility- of the limbs, which refuse to obey the impulse of the will. The. joints, on moving, make a painful crepitating noise. 2. Shuddering when going to stool, and, 3. sleeplessnes Avithout apparent cause. SYPHILIS. 319 Dr. Wolf says, primary syphilis may remain stationary for twenty years; but if the chancre is treated actively, and Mercury in large doses be given, and the ulcer healed by force, the slow chancrous dyscrasia is generally the result. The outbreak of the secondary symptoms is, generally, caused by taking a severe cold, often showing itself in an attack similar to acute gout. The combination of the syphilitic and mercurial poisons greatly aggravates all pre-existing morbid conditions ; the liability to take cold is greatly augmented, the Avorst form of coryza, Avith offensive corroding secretion is produced, the glands are affected, and a great disposition to parenchymatous inflammations, ulcerations, dissolution of the blood, &c, is produced. But all this suffering Mercury alone can produce, without its com- bination with syphilitic poison. Mercury and Iodine are the very Avorst poisons, and should never be used but in syphilis. The affections of the mucous membrane, so often treated by Mercury, will also yield to Apis. Scrofula, tubercles, tumor, and goitre will also vield to Thuja,—(Wolf.) Treatment of the Diseases of the Mucous Membrane.—These diseases, as has been already suggested, are often, induced by exposure to cold. When so induced, if the patient be at the time, or has re- cently been, affected with syphilis, these cases acquire a peculiar char- acter from that circumstance—they become chronic, secrete copiously and the tonsillary glands may become much enlarged, and deeply ul- cerated. These attacks though of a syphilitic type, have their origin in catarrh and their early arrest may sometimes be effected by the usual remedies for catarrhal sore throat, viz.: Aconite, Bell., Apis, and Mer.-corrosivus. After Aconite has been exhibited to reduce any general febrile excitement, as well as to act on the local disorder, Apis is often very efficacious, in drop doses of the third decimal tincture. If it fail, Belladonna, Lachesis, and Merc.-corr. may be had recourse to. In cases of inflammation, or ulceration, of the same part, in company Avith other secondary symptoms—of the skin, for example—if Mercury have not already been administered to excess, the Iodide or Bin-iodide of that metal, in one grain doses of the second or third decimal should be administered twice a day. The throat will often get well pari- 2?assu Avith other symptoms ; but should the disease persist when these have vanished, the treatment may be directed against it especially. Acidium-nitricum is here a useful remedy, and may be given internally, in five-drop doses of the second decimal tincture, three times a day ; and at the same time a gargle, composed of the pure acid of half a drachm in six ounces of water, may be employed locally. This though beneficial in some cases, is far less efficacious than the Argentum-nit. 320 DISEASES OF THE SANGUINOUS FUNCTION. "This maybe applied in its solid form Avhen practicable, or in solution, in the proportion of five grains to the ounce of distilled Avater; the throat should be mopped Avith this once or twice a day. I employ this medicine in one of these forms in the majority of cases of syphilitic sore throat, and the comfort derived from it is immense." It is beyond dispute that some persons are more susceptible than others to constitutional syphilis. It is equally certain that the scro- fulous constitution is that AA'hich is most exposed to its attack. That being so, the importance of attending to the general health of the patient, during the course of secondary syphilis, is self-evident. He should carefully observe all those measures calculated to maintain his health in the finest possible condition. In those early secondary diseases of which Ave have been speaking—of the skin and throat— being, as they commonly are, inflammatory and febrile, he should in- dulge in alcoholic drinks very sparingly, or not at all, at least in the earlier stages. He should live on plain, good nutritious food. In keeping with this, as Avell as in reference to the depression of the ge- neral poAvers which commonly characterize constitutional syphilis, Cod- liver oil is an agent of first-rate importance. " Possessing the advantage of not being medicinal, and therefore not interfering with the action of medicines, I find it in many cases more than a substitute for the re- nowned sarsaparilla—a medicine which, when there is no particular indication for other remedies, may be prescribed Avith the greatest ad- vantage. A small quantity of cod-liver oil is sufficient—a dessert- spoonful, taken every night at bed time. Larger quantities, taken at other periods of the day, are apt to do more harm than good by nause- ating the patient, and destroying his appetite. If the throat or mouth be affected, he should strictly avoid smoking. He should not over- fatigue himself. For skin diseases he should take a Avarm bath tAvice a week. He should clothe himself judiciously, and carefully guard against the common causes of cold."—(Yeldliam.) The following medicines may, also, be administered Avith manifest benefit, A'iz.: Acid.-sulphur., Borax, Lachesis, Phosphorus, Hepar-sul- phuris, and Sulphur. Clematis erecta.—(Ruckert.) In one case of chronic bubo the tumor had persisted after the suppression of a Menorrhagia. It was of oval form, of the size of a walnut, and the integument Avas of a deep red for five years, allopathic remedies had failed; the Carbo-animalis Mercurius, Hepar, Sulph., Iodium, and Silicea were given for three months Avithout result. Clematis made a cure in eight days. Syphilitic diseases of the bones.— Syphilitic affections of the nose require Aurum 200° one dose every twenty-four hours for seven days.-( Wolf) Tophi, exostoses, &c.—They are only produced by the abuse of SYPHILIS. 321 Mercury, therefore Mercury 6000° must be given. Where caries has already set in and the cure does not progress after that dose of Mer- cury, Silicea 30° is the best remedy, and this potency is the best Where in the most severe cases Silicea cannot accomplish the cure, one dose of Sulphur 30° is yet required. Where the bone pains do not quickly yield the Mercury, Apis 30° in dilution, or Aconite and Apis in alternation will be likely to succeed. Softening of the bones, swelling and curvature, yield to Acid.- fluoric 2000 ;, one dose. (Dr. Wolf.) Brittleness, dessication, and fragility of the bones. These yield to Calcarea-carb. 200° in dilution, one dose daily for five days. Nodes.— Case by Dr. Helmuth.—A gentleman applied for relief for ulcerated nostrils, enlargement of the turbinated bones, and a node which gave intense pain. The patient had been mercuralized for sy- philis tAvo years previously. I gave him the third trituration of Aurum- mur., followed this Avith Mezereum, and Asafoetida, and cured him in four months. Syphilization.—In 1844, M. Auzias Turenne, of France, commen- ced a series of experiments with the object of testing the correctness of John Hunter's opinion on the non-communicability of syphilis to the lower animals. By inoculating monkeys with chancre matter Turenne succeeded in producing a disease having all the characteristics of a true chancre; also communicated true chancre from animals to the human subject. Finally he reached the conclusion that, by a prolonged series of successive inoculations with the syphilitic poison, a constitu- tional state or diathesis was at length produced in Avhich the system was no longer susceptible to the action of the syphilitic virus; as a person who has had small-pox cannot take the disease a second time. Though the proposition of Turenne to treat syphilis by repeated syphilitic inocula- tions was rejected by the French academy of medicine in 1850, the experiment Avas tried on a large scale in various hospitals. In May, 1851, Sperino of Turin reported fifty-tAvo cases treated by syphilization. These cases showed that by a regular course of successive inoculations, all venereal symptoms of all former infections were eradicated.. All old " ulcers healed, and buboes, recent nodular enlargement of bones, and cutaneous stains or blotches disappeared altogether." Professor Boeck, of the university of Norway, in a work published in 1854, says, he ha/; cured the "most inveterate cases of syphilis by sub- jecting the patient to a series of inoculations, at intervals of six, five, or three days, and permitting the chancres thus produced to run their usual course. This mode of inoculation consists of making several small punctures at one time on the arms or thighs. These punctures become real indurated chancres in about five days. Before these have reached the stage of induration, others may be initiated in the neigh- voi.. n.—21. 322 DISEASES OF THE 6ANGUINOUS FUNCTION. boring parts; and thus the process must be kept up until complete im- munity is attained; and when this point is reached all the old symptoms of syphilis gradually disappear. It is not proposed by these authors to practice syphilitic inoculation for the purpose of producing immunity from neAv attacks, but for the purpose of curing those terrible cases of the disease in Avhich all common measures Avould fail if tried, and in which extraordinary measures have proved worse than the original disease. Symptoms which have been Cured by Syphilization.—Ecthyma syphilitica of the whole body; syphilitic tubercles betAveen the toes, in the fauces, in the angles of the mouth; pains in the legs; pains in the clavicles and in the humeral bones; psoric eruptions on the palms of the hands; general debility ; large syphilitic sores on the left thigh in one case which had been treated with mercury in childhood for in- herited roseola syphilitica, and ulcers of the throat; papular syphilitic affection of the throat; syphilitic lichen; syphilitic tubercular affection with syphilitic serpinginous lupus ; fever with erysipelatous eruptions near the chancres caused by inoculation; sores on the lower limbs; roseola syphilitica on the face, breast, and thighs; mucous tubercles over the inner surface of the labia, and also on the mucous membrane of the mouth ; papular eruption over various parts of the body; ulcera- tion of the fauces and genitals; syphilitic iritis. In some cases in which mercurials and Iodide of Potassium had been tried Avithout be- nefit, syphilization only partially carried out, has rendered the system susceptible to the curative influence of either of these remedies. In all the cases reported, there has been an evident and progressive im- provement in the general health ; and no relapses occurred. Hoav far the process of syphilitic inoculation may hereafter succeed in eradicat- ing the venereal virus from the diseased constitutions of degenerate and suffering humanity remains to be seen. The destructive operations :of four centuries of progressive poisoning are around us. M. Auzias Turenne proposes to make the chronic miasm of syphilis available on a principle analogous to that under which vaccination triumphs over and averts the ravages of small-pox. . Transmission of Syphilis by Vaccination.—That the secondary symptoms of syphilis can be inoculated on persons who have never been infected with the disease, has been thoroughly proven by experi- ments and the clinical experience of a great number of observers in this country and in Europe. Until the time of Hunter syphilis in every stage was believed to be highly contagious, and contact with any of the secretions, or even exposure to the breath of those suffering from constitutional infection, was dreaded. Hunter tested the corn^ municability of the secondary lesions by numerous inoculations upon those who had already suffered from syphilis, and all failing he esta- SYPHILIS. 323 blished the dogma that the secondary manifestations of the disease are not inoculable. It was believed to be morally wrong to inoculate per- sons with syphilis Avho had not already experienced it, and the errone- ous conclusion of Hunter was permitted to pa.ss without correction. But recent and direct experiments "on persons who have never had the disease, and accumulation of evidence from clinical experience," have compelled the most persistent adherents of Hunter's teaching to acknoAvledge that the secondary symptoms of syphilis can be trans- mitted by inoculation to persons who have never been infected by it; and that the analogy between syphilis and some other infectious diseases is sufficiently demonstrated. Syphilis has been repeatedly communicated by means of pus from syphilitic ecthyma pustules, from the secretions from condylomata, and from specific ulcerations of mucous membranes by inoculating per- sons Avho never had the disease. " The blood of a syphilitic patient has also been made the means of communicating the disease by ap- plying it to a scarified surface on a non-infected subject," " It is perhaps from direct inoculation Avith the blood of a syphilitic patient, the lancet being charged Avith it, that the operation of vaccinat- ing has been the means of introducing syphilis; yet there is a consi- derable amount of evidence in favor of the possibility of inoculation through clear vaccine lymph and pus. A number of observers, mostly French, have given their attention to this subject, and the evidence certainly seems conclusive in favor of the propagation, not only when the blood of syphilitic persons had been used alone, or mixed Avith the virus, but when only lymph from the vesicle had'been introduced. " We believe that enough has been adduced in proof of the occa- sional infection of syphilis through vaccination, be it either blood, lymph, or pus, to induce practitioners to be exceedingly cautious in the selection of virus, and it is with the object of impressing this caution that Ave noAV discuss the subject." It is not an uncommon thing, as every practitioner knows, to see ordinary eruptions on the skin of children attributed to vaccination, yet it is probable that real syphilitic disease, introduced by vaccination, has sometimes appeared, and not been recognized, because not suspected. " It should be borne in mind by observers that vaccination with pure matter is sometimes the exciting cause of syphilitic eruptions in in- fants already under the syphilitic diathesis ; in the same manner that it gives rise to non-specific eruptions in strumous subjects. The his- tory of the case, and the order of evolution of the symptoms are generally sufficient to establish the diagnosis. For instance, the ap- pearance of the eruption within a few days or weeks after vaccination, without the ordinary period of incubation of syphilis, will render it 824 DISEASES OF THE SANGUINOUS FUNCTION. probable that the disease was already latent in the system."—(Bum- Stead on Venereal Diseases.) In regard to the selection of vaccine matter, with a view to insure Safety from syphilitic taint, the folloAving rules have been laid down: 1. Examine carefully the child from whom the lymph is taken. 2. Try to learn the state of the parents' health. 3. Choose, in obtaining lymph, such children as have passed the fourth or fifth month, as hereditary syphilis, in general, appears before •that age. 4. Do not use the lymph after the eighth day of the existence of the vesicle, as the lymph on the ninth or tenth days becomes dull, by mixture with pus, which latter may be of an infectious nature. 5. In taking lymph with the lancet, avoid haemorrhage, as there is less danger Avith pure transparent lymph. In a recent publication a record appears of the communication of syphilis to forty-six children by vaccination in the village of Rivolta, Piedmont. In these cases the symptoms of syphilis appeared on an average on the twentieth day. The symptoms of genuine syphilis by vaccination, after a regular incubation period, would be fever and debility, papules on the skin, pustules, swelled lymphatics, ulcerations of the mucous membranes, &c. The principal appearances noted after the disease had existed some time, in the forty-six cases alluded to, were mucous tubercles on the verge of the anus and genital organs, sores on the lips and fauces, swelling of lymphatics, syphilitic erup- tions, induration of the cellular tissue, &c. — (Med. and Surgical Reporter, 2lay 17, 1862.) Dr. Whitehead says, syphilis may be communicated through the at- mosphere. It may also be transmitted through lactation: the nurse may infect the child, and the child the nurse. It may be communi- cated by inoculation, by vaccination, and by contact of the raw surface. Bietts says, it may even be communicated through the sound skin: " that there are certain forms of syphilis with which every species of contact may prove dangerous." Tartar-emetic is recommended by Dr. Smee for syphilis. He gives the first and second triturations every four hours. Dr. Willebrand of Finland, says, it alone cured cases of primary chancre in from ten to twenty days; no application but water dressing was made to the sore. In a feAv cases it failed where there was much induration. It has cured secondary syphilis and syphilitic eruptions, aided only by clean- liness, repose, and regulated diet. In bubo it has succeeded in reducing the inflammatory SAvelling. Tartar-emetic often reduces the swelling and the pain in orchitis Nitric-acid.—Where the blood has already a o-reat tendency to dissolution, with great want of strength, sugillations of blood bleeding sycosis. 325 from the nose, lungs, or intestines, with a scorbutic state of the gums, Nitric-acid is the proper remedy. In chronic cases, says Dr. Wolf, one dose 30° ; in more acute cases, one dose 30° every twenty-four hours for three days; and in the worst cases, Nitric Acid 30° in dilu- tion, every one to three hours, till amelioration takes place. Inflam- mation of the lungs on syphilitic ground is also to be treated by Nitric- acid, and where this does not suffice, Sanguinaria 200°, every three hours. Lycopodium.—Where the syphilitic poison has concentrated itself on the liver, and consensually affects the spleen, kidneys and genital organs, Lycopodium 200° is the proper remedy. Magnesia-muriat. and Natrum-muriaticum only aggravate the symptoms in such cases, even where they seem to correspond to the symptoms. This explains Avhy the sea-bath is so injurious after syphilitic affections. Lycopodium is the best remedy in those dangerous uterine haemor- rhages in syphilitic and mercurial cachexia. We give the 200° in dilution every three hours ; and the same remedy holds good in cases of bloody urine, of hypochrondriasis and hysteria, originating in the above-stated combination of the syphilitic and mercurial poisons.—■ (Wolf) 2. SYCOSIS. Dr. Wolf says, " the third great impediment to the cure of syphilis is the predominating influence of sycosis, or the poison of sycotic gon- orrhoea'' The sycotic poison is the result of a combination of psora and syphilis in their highest potency. " It is a dyscrasia which has spread fearfully, and in a hitherto inexplicable manner, since the beginning of the present century; so much so, that if this progression should continue on at the same rate, the very existence of mankind ia in jeopardy." The sycotic poison greatly increases the disposition to all those every-day illnesses, and it renders all diseases more obstinate and pernicious. Affections produced by Sycosis on the different Organs.—Affec- tion of the teeth with loosening of the roots and falling out, with the most obstinate form of prosopalgia, alternating sometimes with the most insufferable cephalalgia; affections of the mouth, with cracks on the loAver lip, with peeling of the epithelium, small flat, whitish ulcers, &c. Hypochondriasis; pain in the muscles, spasms, gidchness, dead- ness of the tips of the fingers and toes; constipation, breath smelling like carrion, affection of the mucous membrane, and inferior character of its secretions ; tubercles, Avarts, fungous excrescences, varicose veins, deposition of bacon-like fat, gout, chronic catarrh of the urinary or- gans, Bright's disease of the kidney, diabetes meliitus. 326 DISEASES OF THE SANGUTNOUS FUNCTION. Dr. Wolf supposes small-pox to be the efflorescence of the sycotic poison, and that vaccination is the channel through which this virus is often communicated. He says the most prominent symptoms of sycosis, after syphilis or leucorrhcea, without any previous affection, are sometimes observed as the result of vaccination. There is also great tendency to self-abuse, affections of the testicles, ovaries, eyes, ears, teeth, and hairs, weakness of the nerves and head, giddiness, pa- ralytic affections, spasms, and asthma. Chlorosis, anomalies of men- struation, diabetes, tuberculosis, &c, appear as an immediate conse- quence of vaccination. And most of the above-named diseases are the standing and predominating diseases of the present day. Dr. Wolf says : Influenza, typhus, and whooping cough, with great tendency to tuberculosis, have also become standing diseases in a hitherto unheard of manner. The " progressive paralysis," a newly described disease; and a common mental disease, described by him as " grosserwahn," are prevailing diseases following upon the continual poisoning of successive generations by impure vaccine or sycotic poison. The Egyptian ophthalmo-blennorrhoea has become a standing disease amongst the soldiery, and very often folloAvs vaccination, and it is well knoAvn that gonorrhceal ophthalmia and the above mentioned form bear the closest resemblance. Condylomata.—A secondary affection complicated by syphilis and sycosis. Fig Warts.—" Flattish, pale colored, secreting a very foetid ichor, that come on almost every part of the body, as on the penis, behind the glans, on the scrotum, around the anus, on the thighs ; also on the hairy scalp, the corners of the mouth, the lips, especially their red part, on the tonsils, &c. On their apices there are not unfrequently small ulcers, scabs, blisters; those on the face sometimes resemble variolous pustules. Along Avith them occur syphilitic symptoms in the shape of a tuberculous pustule, like acne or variola, the base of which soems to be indurated. " On the hairy scalp they had a dark red base, were covered with scabs, or had a pustule in their centre." Occasion- ally, conclylomatous ulcers are present at the same time, the surface of Avhich is spongy, dry or moist, and white, not excavated, but nearly on a level Avith the surface of the skin, or sometimes elevated above it resembling a wart, and not only on the genitals on both sides but also like the condylomata themselves, on other situations. This form of disease is hard to cure, and when cured leaves behind it red elevated pimples, which depart gradually and often leave deep cicatrices. Treatment. — Tartar-emetic.—Dr. Kraul of Rastatt employed Tartar-emetic, twice a-day, in the case of a man who had extensive warty excrescences behind the glans. After a week the warts were dimin- SYCOSIS. 327 ished in size, and in five weeks a cure was effected.—(HufelanoVs Journal, Vol. V., p. 241.) In the 2Iiliturarztliche Zeitung, 3d year, pp. 239, 240, is a case in which Tartar-emetic was found useful' in urethritis ; also in syphilitic ulcers of the throat, sore mouth, ulcers of the fauces, and primary chancre of the penis. It also cured sy- philitic cutaneous affections, and one case of paraphimosis. Of thirty cases treated by it only one had a relapse. (See also Allg. Horn. Zeitung. Vol. 21, p. 276.) Dr. Baertl* says, he began to use this remedy in such cases as the above in 1S45, and has been generally successful. When condylomata could be traced to chancre and gonorrhoea, he gave the remedy, one to tAvo grains in six ounces of distilled water, a table-spoonful every three hours. After a Aveek he employed it externally ; from three to four grains dissolved in tAvo ounces distilled water; the warty ex- crescences were moistened Avith this tAvice a day by means of a thick roll of lint soaked in the solution. Another piece of rag or lint wet with the same Avas placed over this, and the part bandaged up. The patient was kept on rather Ioav diet, chiefly of vegetables, farinaceous food, rice, &c. He was prohibited from fatiguing exercise. The re- medy was continued perhaps for weeks, though, externally it some- times occasioned pain; but the patient found his diseaso improving, and bore it cheerfully. No relapse remembered. Thuja.—Dr. Wolf gives the folloAving general results obtained from the proving of this remedy on himself as Avell as on more than one hundred persons of every age and sex, the entire proving having de- veloped 1,050 symptoms. General results : 1. Irritation of the mucous membrane of the genital organs, extend- ing itself over all organs. 2. Changing of the naturally mild secretion into one of an acrid, corroding infectious quality. 3. Over-irritation of the nerves, Avith tendency to centripetal paralysis. 4. Disturbance of the digestion and sanguification, tendency to de- struction, dissolution of the fluids, and of the whole organism. It will thus be seen that Thuja corresponds in every respect with the sycotic poison, and thus offers itself as a remedy against the following dis- eases Avhich are the consequences of the sycotic poison. Sycotic Gonorrheea.—The genuine poisonous figwart gonorrhgea is best cured by Thuja 30D, one dose being given. In the more recent cases a few days, seven to fourteen, are required. When, however, the disease is hereditary, or Avhere abuse has preceded, a long time and the attenuations 3003 to 1000° are required. * Horn. Vierteljahrsschrift, Vol. I., poj-t 1. 328 DISEASES 0» THE SANGUINOUS FUNCTION. Iodine is the only remedy that antidotes Thuja. The actions of Thuja should be left undisturbed, and it is seldom necessary to give Aconite as an intercurrent remedy where inflammatory symptoms shoAv themselves. In some cases the sycotic infection does not show itself by gonorrhoea, but shows itself only in irritation of the genital organs, constriction of the urethra, urging to urinate, wetting the bed, and irresistible desire to self-abuse, which has become common among small children. It has been often traced as its cause to vaccination. The best remedy is Thuja 30° one dose. Catarrh.—The continued poisoning extending from the mucous membrane of the genital organs upAvard produce the most severe and lasting catarrhal affection of the intestinal canal first, and afterwards of the respiratory organs. Whitish ulcerations on the corners of the mouth, cracks on the lips, and flat ulcers in the inside of the mouth, &c, characterize it. Thuja produces all of these symptoms and cures them. Psoric and Syphilitic Dyscrasia, combined with Sulphurism and Mercurialism.—It seems that Thuja (in high potency) can cure even these cases. In a sycotic ground, the scrofula is changed into tuberculosis ; caries is changed into spina ventosa. All diseases have been rendered more or less pernicious and unmanageable by the Bycotic dyscrasia produced by the vaccination. The anti-psoric and anti-syphilitic remedies are Avithout avail against these cases. The Thuja alone makes the diseases curable, and the remedies which be- fore the administration of the Thuja, Avere of no avail, noAV become efficacious. Rules for the Administration of the Thuja,—The 30th, 300th, and 1000th potencies have proved the most efficient. In fresh cases, where the patient is free from all inherited or acquired dyscrasias and medicinal diseases, and tho younger or the older the patient, the more the thirtieth potency is in its proper place. The older the dyscrasia, and the more complicated the case is, the higher must be the potency. Only one single dose of one globule must be given; and all crises, particularly severe catarrhal affections, must be left to take their course. Only in cases of great necessity, the following remedies may be used: China, against great Aveakness. Ferri-acet., 2 , where there is a disposition toAvards dissolution of the blood. Severe pains may be treated by magnetic manipulations. Fevers mostly require Aconite, Nux, and Apis. All anti-psoric and anti-syphilitic remedies must be avoided." The action of Thuja must, in some cases, be aided. This can be done by Taitar-emetic, Avhich is also an antidote to the sycotic sycosis. 329 poison, at least as far as it is the result of vaccination. Dr. Wolf says, he obtained very favorable results from Tartar-emetic in in- fluenza, Avhooping-cough, croup, all sorts of catarrh, typhus, chlorosis, &c. To small children, where there is no danger in delay, one dose of Tartar-emetic 80"J should be given; in more acute cases, Tartar- emetic 30° in solution every one, two or three hours; in grown per- Bons Tartar-emetic every tAvo to six hours may be given. The most obstinate forms of megrim, prosopalgia and odontalgia are removed by Argentum-nitr. 200D. The folloAving remedies act favorably in some cases, though not direct antidotes to the sycotic poison. Cyclamen.—In diplopia., and one-sided headaches. Add-benzoicum, in some cases of diseases of the urinary organs and the heart. Anacardium in weakness of mind. The length of time required for a radical cure of sycotic disease differs greatly. In some cases from one, to three, four or five years may be required. But only by adhering to the above rules, which are the result of iong and extensive experience can a satisfactory degree of success be obtained ; and thus may be restored to mankind the greatest earthly boon that has yet been sought for—a sound mind in a sound body. Ilelminthia.—Worms in sycotic subjects are best removed by Thuja, Avhich, by antidoting the sycotic poison, cures also the dis- position to Avorms. Varices, varicocele, hgemorrhoidal tumors, black stools, &c, are becoming constantly more prevalent. When they are not cured by the old remedies, Sulphur, Pulsatilla, Lycopodium or Fluoric-acid, they have a sycotic origin, and are best treated by Thuja. Painfulness and swelling of the liver and spleen ; the former giving rise to depositions of fat and pigment and to the formation of sugar ; the latter causing chlorosis and leucaemia in women, and cadaverous look and hypochondriasis oftener in men; fatty tumors, the fatty liver, heart, &c, are all cured or prevented by a timely use of Thuja. The same is present in diabetes mellitus, which is often the immediate cons,(Mj"ence of vaccination or re-vaccination, and has been observed in children before the age of puberty, a case hitherto unheard of. All these affections of the liver run their course without any symptoms of jaundice. Defeneration of the skin, nails, and toes is caused by the sycotic poison ; also sweating of the hands and feet, panaritium, the pains in the soles or heels not depending on any organic lesions or disorganiza- tion of the parts, corns, chilblains, kc. All of these mostly depend on the sycotic poison and are therefore curable by Thuja, 'ihe con- 330 DISEASES OF THE SANGULNOUS FUNCTION. tinuation of the sycotic poisoning, reaching the resp'ratory organs, produces extraordinarily severe catarrhs of the nose, Avith a secretion similar in color and odor to the secretion of the sycotic gonorrhoea, and this Avith considerable relief to all other symptoms. Where, hoAV- ever, this natural crisis is in some way checked, it gives rise to a bronchial catarrh, which often increases to phthisis. Thuja.—Case by Dr. Kellogg, of Troy, New-York * A man aged forty, had a protruding pedicillated sycotic excrescence, one-third of an inch in length, on the verge of the anus, secreting a foetid mucus re- quiring the changing of his cloths during the day, and frequent ab- lutions ; a great source of irritation and annoyance. It Avas proposed to exsiccate and cauterize it; but presenting a marked case for Thuja, both in the local affection and in a general sycotic diathesis, as the patient shoAved several small excrescences of similar character on other parts of the body; Thuja was given in a dose of one drop of the tincture. The sycotic fungus disappeared Avithout receiving further attention, and was forgotten till no trace of it remained. The sycotic diathesis in this case was inherited from the mother who was subject to fatty tumors originating in the same morbid idiosyncrasy. In a case such as Avas here cured by a single dose of one remedy a spontaneous cure never occurs. GENUS IX. —ELEPH A N TI A. MORBUS PHCENICIENS. Morbus Phceniciens.—A disease so called from the limbs of persons affected Avith it growing scaly, rough, and very large, at an advanced period, like the legs of an elephant. The disease attacks the whole body, but principally affects the legs or feet, Avhich appear somewhat like those of the elephant. Some authors describe two species: 1. Elephantiasis graecorum. 2. E. arabicum. The first is described by Aretaeus, as beginning Avith tubercular swelling of the face. See Lepra Anoesthetica. 2. Elephantiasis Arabicum.—This is the true elephantiasis.• It consists in a slow hypertrophy of the skin, areolar tissues and bones and in their infiltration Avith a peculiar cacoplastic deposit. The epidermis is thickened and the papillae enlarged, though not much so: The true areolar tissue is thickened, its areolae expanded and filled Avith oily or gelatinous looking matter. "In cases Avhich Druitt examined, " the microscopical appearances Avere those of hypertrophy * U. S. Jour. Ilomoeop. Vol I. p. 57. * ELEPHANTIA. 331 of the tissue involved. The bones also of the affected limb became enlarged and heavy." This is a disease almost peculiar to hot climates though we have some cases of it in NeAV-York. The dark races are more liable to it than the fair. In India it is particularly liable to attack the scrotum which it converts into a huge tumor. In the West Indies the leg is its o o favorite seat; hence the term "Barbadoes le<*." It begins insidiously, with feverish or aguish symptoms; pain in the leg about to be attacked; firm, doughy swelling resembling phlegmasia alba dolens; and some tenderness of the lymphatic glands. In the course of months, or perhaps of years, the patient suffers a repetition of these attacks. The limb becomes permanently swelled, and in con- firmed cases, presents a huge, misshapen, useless member like the leg of an elephant, hard and almost insensible to the touch, yet pain- ful. A foetid discharge is liable to ooze from the skin; or ulcers may form, and if not very extensive, may diminish the pain, and seem to eliminate something noxious. (Elements of Surgery.) Symptoms : The skin becomes thick, rough, Avrinkly, unctuous, and void of hair, and gradually losing the sense of feeling. By many writers it is considered a species of leprosy; but it is radically distinct in its nature, and often exists many years without being accompanied with any of the symptoms characteristic of that disease. Elephantiasis comes on gradually without much previous indisposi- tion ; but generally the person is seized Avith a coldness and shivering, pains in the head, back and loins, with some degree of nausea. A slight fever then ensues, and a severe pain is felt in one of the in- guinal glands, Avhich after a short time, becomes hard, swelled and in- flamed. No suppuration, hoAvever, ensues; but a red streak may be observed running down the thigh from the inflamed gland to the leg. As the inflammation increases in all the parts, the fever gradually abates, and, perhaps, after two or three days continuance, it goes off. It, however, returns at uncertain periods, leaving the leg greatly swol- len with varicose, turgid veins, the skin rough and rugged, and a thickened memhrana cellulosa. Scales appear also on the surface, which do not fall off, but are enlarged by the increasing thickness of the membranes ; uneven lumps, with deep fissures are formed, and the leg and foot become at last of an enormous size. A person may labor under this disease many years Avithout finding much alteration in his general health, except during the continuance of the attacks ; and perhaps the chief inconvenience he will experience is the enormous bulky leg which he drags about with him. The incumbrance has in- deed induced many Avho labored under this disease to submit to an amputation; but the operation seldom proves a radical cure, as the other leg frequently becomes affected. Hilary observed, that he never 332 DISEASES OF THE SANGULNOUS FUNCTION. saw both legs swelled at the same time. Instances have, however, fallen under the notice of other physicians, in Avhich both legs be- came of frightful and prodigious size. Causes.—Elephantiasis has generally been supposed to arise in consequence of some slight attack of fever, on the cessation of which the morbid matter produces obstruction in the lymphatics and veins of the leg, occasioning distention and tumefaction of the limb, which is afterAvards OA-erspread with uneven lumps and deep fissures. Treatment.—The usual remedy proposed is the knife; Mr Dalton (of Guiana, Lancet, 1846, p. 458) sIioavs, that in the earlier stages the disease may at least be controlled if not checked. Prof. Carnochan, of NeAV-York, Avas the first to attempt to cure this disease by applying a ligature to the artery by which the diseased limb is mainly supplied Avith blood; and he has published a feAV cases in which he tried this practice Avith apparent success. Dr. Erich- sen, of London, has since pursued the same treatment by tying the anterior tibial artery to cure the disease in the foot. Other cases have also been reported, all of which are said to have been successful. (See Charleston 2Ied. Journal, March, 1860.) In Dr. Ogiers case, that of a negro, aged tAventy-six, the disease had existed for five years, and the size of the leg and foot Avas such, that they had be- come a burden, and amputation was desired. The femoral artery Avas tied with a hempen ligature. The next day the reaction Avas high, the pulse rising to 180 per minute. This Avas controlled by Veratrum- viride. The leg and foot decreased on the second day to half the size preceding the operation. Three months later they had subsided to nearly the natural size; the patient Avalked about and felt no pain or uneasiness. These cases, in which there is seen a gratifying result of surgical skill can not yet be accepted as satisfactory cures of disease. The original dyscrasia which existed in every case was still there; and a a long course of constitutional treatment was needed to remove it. The only remedies Avhich have poAver to remove elephantia are those which have been successfully used for lepra in its different forms. These are : Arsenicum, Alumina, Carbo-animalis, Carbo-veg., Caus., Graph., Natr., Petroleum, Phos., Sepia, Sil., Sulphur. Arsenicum has hitherto been most successful. (See Lepra-Ancr (Polygonum-hydrcpiper) Water-pepper, Smariweed —An infusion or decoction of this common plant has long been used by farriers for the cure of salivation in horses. On trying it for Mer- curial ptyalism, it has succeeded in all the cases in which we have known it tried. It has also cured the follicular stomatitis of nursing Avomen. 21 uriatic-acid.—Symptoms.—Dryness of the mouth, followed by free salivation ; the tongue becomes sore, with red, burning vesicles and blisters on the edges ; ulcers Avith black base and inverted edges; palate inflamed ; fauces raAV, burning, smarting; toothache, with pain in the malar bones, ears, and temples; burning pain, SAvelling, inflam- mation in the gums. Scorbutic Gums.—Hahnemann, in his Chronic Diseases, gives many more symptoms ; and Ave have still more scattered through the books; but among them all there has been no proving carried far enough to develop the peculiar and extreme effects which this corrosive acid is capable of producing; and it is only of these extreme effects which spe- cially concerns us in treating the present disease. In cases of acci- dental poisoning avc see many more symptoms applicable here, but in- 360 DISEASES OF THE SANGUINOUS FUNCTION. stead of collecting them now, we will bring up some clinical facts Avhich will sufficiently illustrate the operation of the remedy in curing gangrene of the mouth. Muriatic-acid.—Van SAvieten, the leading Professor of the Vienna Medical School in the middle of the last century, says he used "un- diluted Muriatic-acid with great success," as a local application to arrest gangrenous ulceration of the mouth. In this country it Avas in- troduced into practice by Dr. Jackson in 1826. In the Medical Recorder, Vol. XII., he says the result of its application in the cases in which he tried it:—" It presently stopped the gangrene; and soon after the eschar separated from the parts in Avhich there was life. Nor have I ever known its application to fail me, except Avhere the gums Avere entirely putrid, and the jaAv-bone Avas affected; for then I could not prevent its being carious ; but if the soft parts only in the inside of the mouth are gangrenous, it Avill certainly cure them." The most instructive reported case we have seen is given by Dr. James White in the Transactions of the " Fairfield Medical Associa- tion, Ohio:—*' " A boy, aged eight years, had measles, then epidemic. Fever, efflor- escence, heat of skin, slight chilliness, headache, pain in the chest, much increased by dry incessant cough; tongue coated and red at tip and edges; epigastrium very tender and tense. As a child, aged three or four years, had recently died in the vicinity from gangrene of the mouth, under all the horrible circumstances incident to that disease, no Calomel or Tartar-emetic Avere given in the treatment of this case. Some common measures, of Avhich bleeding end mild purgatives were the most objectionable, were considered sufficient, and the boy was thought to be doing Avell when the dreaded gangrene appeared. There Avas first seen a superficial slough on the gums covering tAvc of the molar teeth on the right side, upper-jaAv; gums on the opposite side sound. No foetor of breath or flow of saliva ; there Avas little danger apprehended. " In a few days the slough had increased ; the periosteum of the teeth and alveolar processes Avere implicated, the breath was slightly foetid; some irritative fever. Common antiphilogistic treatment was tried a feAv days, Avithout benefit." The Report proceeds :— " March 1st.—The gums eaten out between tAvo teeth. 2d.—One tooth loose, ulceration continues. 3d.—Spreading rapidly, and ex- tends to the cheek. 4th.—A tooth extracted. A lotion of diluted Muriatic-acid and honey applied. 5th.—The application continued * the swelling of the cheek increased. 6th.—The application continued* * Louisville .Medical Journal, Vol. 2, p. 433. GANGRENE. 361 flesh separated from the jaw-bone three-fourths of an inch by a half- inch. The lotion and charcoal applied. 7th.—The same treatment continued ; another tooth extracted." The case was noAV considered hopeless. No case after reaching this stage had in that region been known to recover. The right cheek was tense, SAVollen, pallid, and glossy; intumescence extending to the right eye, Avhich Avas closed, and to the lips, drawing the right com- missure to one side, from which the saliva copiously flowed. The whole expression frightfully distorted; the breath had the characteris- tic foetid odor. Caries had noAV seized upon the jaAV, from which the teeth Avere extracted, and the cheek appeared internally hollowed out in space equal to half a dollar, and covered with a black, thick slough. Mortification appeared to extend from the jaw and cheek, high upwards tOAvards the orbit, and Avas rapidly perforating the cheek. There was still fever, but the skin was soft and slightly moist; pulse of good strength, mind clear, apparently without pain. Appetite good: he takes chicken broth, gruel, panada. No tonics given; blisters also avoided, as in all cases in Avhich they had been tried they had appeared to increase the general irritation, and give unnecessary pain. '* March 8.— Undiluted 2Iuriatic-acid Avas then applied at 4 p.m., and repeated at 6, and then every hour till 3 a.m. The mortification was then found to be arrested, and reaction and sensibility of the parts acute. Application repeated twice on the 10th; sensibility still acute. From the 11th to the 19th Tincture of Myrrh and Alum Avere employ- ed. The appearances favorable." It is then proved that the undiluted Muriatic-acid, locally applied, can arrest the mortification of the soft parts, and even subdue the caries of the jaAv. 21ode of applying the Acid.—Make a swab by wrapping a soft rag on the end of a stick. Charging this with the acid, carry it up to every part of the mortified surface. It gives no uneasiness so long as it touches only the gangrened parts, except by the inspiration of the fumes of the acid. As the parts in Avhich vitality remains are reached, the pain begins to be felt, and soon would become intense if the Avash- ing with the acid Avere continued. At first it only dissolves aAvay the mortified flesh as Avater dissolves the snow. When it comes to the living flesh in Avhich the inflammation is at work, the new stimulant at once excites another though similar inflammation, and under this enlivening influence the old disease gives place to the neAv. The wound immediately puts on a healthy appearance; granulations and healthy pus are visible, the SAvelling subsides, and the general health in all respects immediately improves. In the case above detailed, some exfoliated portions of the jaAA'-bone 362 DISEASES OF THE SANGUINOUS FUNCTION. were removed before the process of -reparation could satisfactorily be- gin. The deformity remaining after recovery Avas slight. Nitric-acid has also been employed with success in the same man- ner as Muriatic-acid. The symptoms are nearly the same in regard to gangrene of the mouth. They both act by exciting a neAv but similar inflammation to that already existing. This new inflammation, if car- ried far enough, Avould end in destructive mortification of all the parts to which it is applied. But, if Ave stop the application of them as soon as Ave have dissolved all the parts already dead, and Avhen Ave have only touched' and aroused Avith the neAv stimulant the part that is not yet dead, but Avhich is rapidly progressing towards it, Ave only bring that portion of the structure sufficiently under the dominion of the new irritant to supersede the old one. It may be regarded as crude horn eo- pathy, and exceptions may be taken to the strength of the acids em- ployed. We do not say that dilutions of some other local stimulants would not answer in the Avorst cases: we know that the true homoco- pathist has many other resources that Ave have not yet mentioned ; and with some of them he will generally succeed without resorting to the acids at all. But he will still claim that in the local application of Arnica, Nitrate of Silver, or even Cantharides, for the prompt cure of local inflammations similar to those they are severally capable of caus- ing, he is still Avithin the jurisdiction of the Hahnemannian Law of Cure, of Avhich a full exposition is given elseAvhere. 5. PHOSPHOR-NECROSIS. The breathing of air containing the vapor of Phosphorus, causes va- rious forms of disease, as bronchitis, and even phthisis pulmonalis, caries of the maxillary bones, abortion, &c. Dr. Dupagnier found the air con- taining the agent to consist chiefly of Hypo-phosphoric-acid, Avith small quantities of Phosphoretted Hydrogen, and some Phosphoric-acid, or Phosphorus in the form of vapor. The breath of the people Avho suffer from inhaling it becomes luminous in the dark. Diagnosis.—The first complaint is of a slight soreness or pain in one or more teeth in either jaw. This pain varies in intensity, and soon extends to the entire maxilla. The periosteum, and in a later period, the soft parts begin to SAvell and become painful on pressure; the gums and cheeks swell, become tender, and erysipelatous inflammation extends over the surface of half the affected jaAv, progressing towards the ear and neck. With this local inflammatory condition the general system sympathizes; the latent causes of disease, Avhich have hitherto remained dormant in the system are roused into activity, and scrofula tuberculosis, or some other psoric or dyscrasic affection assumes ita preponderating influence over the blighted and disintegrating frame. PHOSPHOR-NUCROSIS. 363 Causes.—The disease originates only from Phosphorus or Phospho- ric-acid gas taken into the system by inhalation. Though the opera- tives in the match factories are employed during the day in rooms ill ventilated, and the noxious gas is brought into contact with the body generally, with the mucous membrane of the air passages as Avell as the whole cutaneous surface, it is only through the mucous membranp of the mouth that the poison obtains access to the bony structure Avhich is to become the principal seat of its ravages. Microscopic researches have shoAvn that the pathogenetic effects of Phosphorus begin in the periosteum Avhich covers the alveolor processes, except in those very common cases in which the recent extraction of a tooth, or a large i O cavity in a decayed one, furnishes to the destructive agent a more direct admission to the osseous tissue. Dr. Geist says that in all cases of phosphor-necrosis, he has found one or two carious teeth, Avhich fur- nished the first point of localization in the jaw. It is certain, hoAvever, that although there be no carious teeth, and none have been extracted, the poison, when habitually breathed in a condensed form, may be ab- sorbed through the mucous membrane covering the alveolar processes in sufficient quantities to imitate the true periostosis, which never ceases till necrosis is established in the bone beneath. The degree of rapidity with vihich it progresses may be influenced by the age of the patient, and the degree of concentration of the poisonous vapor. From the mo- ment that the periostosis begins, the nutrition of the bone is impaired, the periosteum is separated from the bone, and a morbid and offensive matter is formed between them. Pathology.—In every form of caries, says Rokitansky, the sanious bone, examined in the recent state, presents various appearances, according with the progress which the disease has made. In superficial caries, the compact bone is rough and corroded under a covering of sanies; its medullary canals are unequally dilated; the tissues con- tained in them are partly reduced to a mere friable mass, or flabby, warty excrescences, which readily bleed, are developed from them,Avhich shoot outAvard in considereble quantity over the rough surface of the bone. The bone ahvays appears porous or spongy, according to the contents of the medullary canals; in the first case discolored —in the second case rough in various Avays. In cases of caries of the spongy texture, when the formation of granulations is luxuriant, the bone as- sumes a dark livid redness ; it becomes soft, and resembles a piece of flesh permeated by a fine, delicate, bony texture. It is said by Delpech, Be- rard, Ponget and Sanson, that a peculiar fatty matter is produced; though according to Monret, the gelatin has not disappeared from the bone. The carious bone, in the macerated, dry state, appears rough as if corroded, and acquires a spongy, porous, worm-eaten appearance by reason of the unequally dilated medullary canals, which in several 364 DISEASES OF THE SANGUINOUS FUNCTION. places have formed into holes, and which perforate it. The cells of its spongy substance are dilated, and their parietes are attenuated and broken doAvn like the grating of trellis-Avork. The researches of Vauquelin sIioav that, in caries, the organic con- stituents of the bone are increased, Avhilst the carbonate of lime is slightly diminished, and the phosphate of lime reduced in a much larger proportion. In an osteophyte-like crust deposited around a carious tibia, the phosphate of lime was still more diminished. \ In France and Germany this disease has been common for several years, and it attracted the attention of the profession about 1847. In the United States it has increased rapidly since about the same period. Treatment.—Surgical.—The following case sufficiently illustrates the treatment given to these cases in the hospitals.* A wax taper dipper had been working in this business seventeen years before disease and ulceration of his gums commenced. Thirteen months ago he had pain and SAvelling about the lower jaAV, commencing in one of the right in- cisor teeth. An abscess formed and burst externally in the neighbor- hood of the tooth. Admitted to the Royal Free Hospital, Dec. 28, 1859. "His face generally was much SAVollen, exhibiting the peculiar pasty appearance Avitnessed in necrosis of the jaw arising from the fumes of Phosphorus. Several fistulas were noticed at the lower margin of the jaw, communicating with the dead bone, and giving passage to the matter. On opening the mouth the lower jaw was seen exposed, denud- ed of the periosteum, and quite black and clear; it was also slightly moveable. Operation.—April 9th, 1859. Chloroform was administered to the extent of producing complete anaesthesia. The surgeon then proceeded to saw through the symphisis of the loAver jaw, within the mouth, and by the aid of the forceps, the left half of the bone was drawn out entire, without its condyle, but with the ascending ramus. The same proceeding was then employed with the right half of the jaAv, which came away with equal facility, but with the condyle, Avhich appeared to be healthy. The haemorrhage avjs not great, and it spontaneously ceased. For three or four days after the operation there Avas some pain in the face, but this gradually diminished, and soon ceased entirely. The health now be- gan to improve under a liberal diet, and appetite and strength returned. The investing periosteum, from which the old bone had been carefully separated, soon began to throAV out fresh osseous material and a neAv lower jaAv Avas in process of formation. The pasty appearance of the face and. puffiness of the cheeks, however, still remained, and are the most prominent consequences of the affection. The patient left the hospital in a short time completely restored in health, and able to arti- culate his words with tolerable distinctness. * London Lancet Sept. 1859. p. 241. PHOSPHOR- N ECROSIS. 365 On examining the bone, when cleaned and dried, it was found to be fjpnte massive, and of nearly double the weight of the healthy bone. It was covered in some places with unhealthy lymph, which was under- going osseous transformation. The reproduction of bone by the natural action of the periosteum Avhich has been left behind when the bone Avas removed was practically demonstrated many years ago by Professor Dudley of Transylvania University, Ky. He found that the periosteum, when carefully sepa- rated from the old bone beneath, and preserved in a healthy state, pro- ceeded at once to the act of depositing the osseous material in regular layers, turns forming a new bone to take the place of the old one. This practice has now become common, and in a considerable degree success- ful. The periosteum throAvs out neAv layers of bone, which by invest- ing the old bone, give strength if not symmetry to the mutilated mem- ber. In these cases the old bone is seen within the new formation. A jaw bone thus reconstructed by nature, in following out the intentions of art, is generally someAvhat larger and more irregular in shape than that Avhich has been removed.* Homoeopathic Treatment.—The successful treatment by homoeo- pathic remedies of some cases of caries of the maxillary bones arising from different causes has shoAvn that our remedies when correctly em- ployed have a poAver over this fearful disease to an extent not yet fully appreciated. We have collected in the United States Journal of Ho- moeopathy some cases which illustrate the proper treatment. In the case of a scrofulous girl, aged nine years, in whom caries of the upper maxilla folloAving typhoid fever Avas progressing, and there was pain in the bones and teeth, Aurum-muriaiicuin Avas prescribed Feb. 12. On the 18th the pain had subsided after the extraotion of a large por- tion of the carious jaw bone. It was removed without pain, having spontaneously separated from the healthy portion of the bone. [Muri- atic-acid Avas afterwards used; then Anejustura for deafness and ri- gidity of the masseter muscle. Silicea 3° was employed from March 11, to April 10, after which no medicine was needed. In a case reported by Dr. Perkins (American Homoeopathic Review, N. V. Central Homoeopathic Dispensary) a man had necrosis of the jaw for four months. Dr. Mott had advised excision of the jaw; the side of the face was much swollen, and a discharge continued from an open abscess communicating Avith the diseased bone. Dec. 11th he took Phosphorus 30° in solution. On the 15th he was much better; discharge and swelling less. Repeat Phos. 303. He continued improving, took no medicine. Jan. 30. SAvelling almost gone; orifice healing up; gene- ral health, excellent. Feb. 15, no signs of disease. This subject, is continued at length in U. States Journal of Horn., Vol. 2. p. 303 to 314. " Phosphor Necrosis." 366 DISEASES OF THE SANGUINOUS FUNCTION. A case by Dr. Lilienthal, Northern Homoeopathic Dispensary, N. Y. A young man, aged 18. Chronic periostosis of the bones of the nose caused by Avorking a year and a half in a match factory. He commen- ced March 15th to take in alternation Aurum and Calcarea-carb. March 22, he Avas better. A dilution of Nitric-acid was applied locally. The medicine Avas continued till April 25, Avhen he Avas considered well. Several months afterwards he continued so. See Vol. I., p. 247. Oz tis has aiisen from the application of gleety matter. When a gleet has been permitted to continue for a long time, and particularly if the case has been injudiciously treated by inordinate do- ses of Copaibae, Cubebs, Turpentine, and the endless train of irritating injections, there often supervenes a Stricture of the Urethra.—This consists in a chronic thickening cf the liniim* membrane of the urethra, amounting in some cases to stricture; in others the mere irregularity of the canal, is a common source of gleet. When, after a fair trial of other means the discharge continues, the passage should be explored Avith a bougie. Whether the stricture be only partially or perfectly formed it may soon be dispersed by the use of the bougie introduced every three or four days, and per- mitted to remain a quarter of an hour or more each time. The slight irri- tation thus induced is suffu ient to cure. Too frequent introduction of the bougie excites too much inflammation, which is a medicinal aggravation, A stricture may occur during the height of acute urethritis, from tu- mefaction of the mucous membrane of the canal, or from the irritation caused by improper or unskillful introduction of bougies, and by strong injections. The obstruction in some cases of this description is so com- plete, that very painful retentions of urine, with the accompanying symp- toms, supervene, requiring the most prompt remedial measures in order to ward off the necessity of puncturing the bladder. 372 DISEASES OF THE SANGUINOUS FUNCTION. This variety of stricture may be removed in a short time by proper medicines, without the aid of a surgeon. There is a second variety of stricture not necessarily connected with infectious urethritis, termed spasmodic stricture. The disease consists in a sudden spasmodic contraction of some portion of the urinary canal, which impedes the Aoav, and sometimes causes a partial retention. These spasmodic contractions may arise from mechanical injuries, diseased prostate, or stimulating diuretics, but they are for the most part connected with permanent stricture. The third variety of stricture, Avhich is by far the most common and serious, is termed the permanent stricture. Its approach is so gra- dual and imperceptible, that individuals rarely suspect any thing of the kind until it has made considerable progress. The disease arises from a gradual thickening of the mucous membrane of the urethra, from badly-treated or long-continued inflammation. The first symptoms observable in this stricture are : a sensation after urinating as if a few drops remained behind, stream diminished in size, and issuing from the urethra in a spiral form or split in several parts; straining to pass water more rapidly through the obstructed oanal; aggravation of all the symptoms on wetting the feet, taking cold, over-exercise, fatigue and venereal excesses. In this stricture there is always more or less discharge of a ropy kind of mucus, which is often temporarily changed by excesses, into a purulent or bloody matter. This complaint is quite apt to induce inguinal hernia, from the straining efforts employed in urinating. It is probable that two-thirds of the cases treated as simple gleets and which so frequently baffle the physician are in reality dependent, solely on this kind of stricture. In bad cases of permanent stricture, the urine is passed drop by drop, the distention and pain in the region of the bladder become very severe, much constitutional irritation occurs, and the patient is unable to rest day or night. Whenever this state of things obtains, immediate recourse should be had to bougies. The removal of a permanent stricture can only be accomplished by means of the knife, or the application of caustic, or by gradual dilation by means of bougies. The cure by the latter means is, at the present time almost universally recommended. We have found a bougie made of the dry bark of the ulmus fulva or slippery elm to possess many advantages. By holding it in warm water the surface becomes muci- laginous ; it then passes with great facility; and by permitting it to remain but a feAV minutes, it expands and dilates the stricture. Almost all strictures are located far up the canal of the urethra, behind its bulb, but they may occur near the extremity of the penis or three, four, or five inches above this point. An occasional consequence of stricture is disease of the prostate gland. GONORRH(EA. 373 DISEASED PROSTATE May also be ranked amongst the occasional consequences of repeated attacks of urethritis. During the continuance of the latter affection, in an acute and obstinate case, not only the urethra, but the prostate, the bladder, and the testicles receive an unusual supply of blood, in consequence of which they become irritated, and often enlarged, from depositions of coagulable lymph. This condition of things may exist without attracting much attention until, the individual is advanced in years, when a scirrhous degeneration, or an abscess, is exceedingly apt to result. Either lobe of the prostate may become enlarged separately, or the whole three may be involved; but the most troublesome symp- toms arise from an enlargement of the middle lobe, on account of its proximity to the orifice of the urinary canal. This painful and trouble- some affection usually occurs in acute and obstinate gonorrhoeas in scrofulous and irritable constitutions. The inflammation beginning at the orifice of the urethra extends upwards towards the bladder, in- volving the prostate in its course. Symptoms.—HeaA-y, pressive aching in the peringeum extending often to the rectum, causing a degree of tenesmus. The patient can neither sit nor bear pressure over the prostate, which swells and may be felt internally. There is irritation of the bladder; partial or com- plete obstruction of the Aoav of urine, which is often mixed Avith blood. The gonorrhceal discharge generally diminished or suppressed. Sir Astley Cooper was of opinion, that enlargement of this gland is attributable to advanced age, rather than disease; but from the fact, that persons Avho have been afflicted in this manner have almost in- variably been subject to repeated venereal attacks in early life, we may fairly infer, that a predisposition is always established in the structure, which renders it liable to take on diseased action when the poAvers of the organism have become impaired by age. Enlargement of the lateral lobes of the prostate may be readily de- tected by introducing the finger into the rectum. The middle lobe may always be felt by the catheter Avhen much enlarged, and it will generally be found exceedingly difficult to pass it by the gland into the bladder. By directing the point of the instrument, (which should be of the medium size), slightly upwards, and deprossing the handle at the proper time, the object may usually be accomplished. But of all others, these cases require great delicacy of touch and practical tact to enable the operator to succeed facilely, and without doing injury to the irritated parts. Diseases of the prostate are quite liable to become aggravated by over-exertion, riding, acrid urine, exposure to wet and cold, and stimu- lating drinks. 874 DISEASES OF THE SANGUTNOUS FUNCTION. Another exceedingly unpleasant consequence of neglected or badly treated urethritis, is the disease termed sympathetic bubo. Sympathetic Bubo.—These buboes are called sympathetic, in con- tradistinction to those which proceed from syphilitic infection. The frequent occurrence of such tumors during the course of urethritis, probably first led medical men to confound this disease Avith syphilis. But on close examination, the sympathetic bubo vvill be found to be composed of several enlarged glands, Avhile that of syphilis is an en- largement of a single gland. The sympathetic bubo is not usually attended with great pain, nor does it run on to suppuration, unless the patient is decidedly scrofu- lous ; Avhile the syphilitic bubo is attended Avith much inflammation and pain, and is-very prone to advance to the suppurative stage. A very large majority of sympathetic buboes subside spontaneously, and re- quire no medicinal treatment. In females, all of the symptoms of the disease are lighter than in the male sex. Indeed, the similarity between this affection and leucorr- hcea is so great, that it sometimes is a matter of great difficulty to dis- tinguish betAveen them. Mr. Travers asserts that the urethra itself is rarely affected in fe- males, but that the inflammation attacks the clitoris, the inferior com- missure of the labia and rapha, the nymphse, and the parts (Cowper's glands,) around the orifice of the urethra. (See p. 307, 309, Vol. II.) In the worst form of the oomplaint, as it occurs in women, the labia, the nymphae, and the clitoris become SAVollen and painful, the inflam- •mation extends to the uterus and bladder, and there will be frequent inclination to urinate, severe scalding by the water, and a purulent ir- ritating discharge. But all of these symptoms are often met with in inflammatory leucorrhcea, and the discharge itself even acquires so acrid a character as to become capable of propagating a similar disease by contact. In many instances such results have led to unfounded suspicions. The following are the surest diagnostic marks with Avhich we are acquainted between the tAvo diseases : Leucorrhcea is gradual in its progress, and may be generally traced to constitutional debility, or to difficult and protracted labors, or mechanical injuries, especially from the use of obstetrical instruments. It is usually accompanied also by prolapsus uteri, or dragging pain, or tired feeling in the left side, bear- ing-down pains, and general feelings of relaxation and debility. Gonorrhceal inflammation is sudden and rapid in its approach and attacks individuals in the soundest health : the symptoms acquire their greatest severity in one or two weeks, and the discharge causes a deep-colored (yellow or greenish) stain upon the linen, surrounded by a palish color. GONORRHOEA. 375 A careful attention to the history of each individual case, Avill aid us materially in forming a correct diagnosis. Pathology.—In some cases the discharge issues from the lacuna magna, situated a short distance up the urethra. In that case a drop of the discharge may at most times be pressed out of the urethra with little effort. In other cases it proceeds from chronic relaxation of the membrane higher up the passage towards the bladder, or from the prostate gland, or more commonly still from a stricture. The explo- ration with a bougie reveals the existence of stricture ; if none be found on trying it, and if ordinary injections fail to arrest the dis- charge, we may infer that the disease has its origin in some irritation or relaxation of the deeper-seated portions of the urethra. Prognosis.—The duration of an attack of gonorrhoea cannot be estimated Avith any degree of accuracy. One case Avill get well in a few days, whilst another assumes the most aggravated character, de- veloping many complications, and hangs about for months. A scrofu- lous constitution, and an irritable nervous temperament are more likely to belong to those cases which take on the more serious aspects ; in some of these treatment has to be protracted " to an almost indefinite period." Treatment.—Infectious urethritis is at the present time almost universally regarded as a local disease,—confined in its first stages to a small portion of the mucous membrane of the urethra. It is true that the inflammation often extends up the urinary canal to the pros- tate gland, and to the bladder; but it is highly probable that these secondary symptoms are OAving to bad treatment, or imprudence on the part of patients, rather than to the natural and legitimate tendency of the malady. We adopt this opinion from having often observed spon- taneous cures occur in six or eight Aveeks without medicine of any kind, and without any structure but the urethra becoming affected,— the patients having simply placed themselves under a rigid dietetic regimen. For therapeutical purposes the course of the disease may be subdi- vided as follows : First. The preventive period, or that Avhiclv inter- venes between exposure and the first symptoms of the malady. The average duration of this period is about three days. Second. The forming stage, or the period which elapses from the commencement of the prickling, tingling or itching sensation, with slight redness and SAvelling of the orifice of the urethra, and a slight oozing of mucous or limpid matter, up to the period Avhen the inflam- mation has extended to the fossa navicularis, and become strongly pronounced, Avith a purulent discharge of a yellow or greenish color. This stage usually lasts from twelve to forty-eight hours. Third. The acute or inflammatory stage, including the period which 376 diseases of the sangutnous function. commences at the termination of the last stage, and the subsidence of the ardor urince, the acute inflammation of the urethra, the swelling and tenderness of the penis, and the change of the yellow or greenish secretion, to one of a light, transparent and ropy, or a muco-purulent character. The natural duration of this stage, when proper restrictions are used as to diet, stimulants, and exercise, is from one to two weeks. Fourth. The chronic stage, or that form of the malady termed gleet. Now as our object, in accordance Avith the homoeopathic doctrine of cure, is to produce in the tissue morbidly affected, a new and healthy medicinal action, which shall supersede the morbid inflammation, we apply our remedies directly to the diseased part, instead of bringing them in contact with it through the stomach, blood, and kidneys. The malady is not constitutional,—there, is no other structure of the econo- my affected, or upon which Ave wish to act,—but our sole object is to prevent or to remove a simple local inflammation. Our remedies then, during the first or preventive period, are the occasional injections into the urethra, of nitrate of silver (in the pro- portion of two or three grains to the ounce of distilled,) or of sulphate of zinc, in the proportion of four grains to the ounce of water. The occasional use of these injections after an exposure, with strict tem- perance and quiet, will usually prevent the occurrence of the disease. These remedies neutralize the absorbed virus before it has time to im- pair the function of the membrane with which it is in contact, and thus its power to do injury is summarily destroyed. Diet.—During the acute stage the diet should be light and unstimu- lating; all stimulating drinks and active exercise should be avoided. There is also a certain and speedy cure for the second or forming stage. The symptoms of this stage, as we have seen, are a tingling or itching at the end of the urethra, with a slight redness, and a slightly increased secretion of mucus. The remedy for this stage is a satu- rated solution of nitrate of silver, a small quantity of Avhich is to be applied, by means of a small syringe, or by a small bit of spono-e to the urethra for an inch in extent. The solution should be delicately and rapidly applied, and a quantity used just sufficient to give the portion of the membrane touched, a white cast. This causes a smart but healthy medicinal inflammation which subsides in about twenty- four hours, leaving the structure cured. This course is strictly ho- moeopathic, for we impress directly the tissue affected, produce a power- ful medicinal aggravation of the symptoms, and overwhelm the dis- ease by substituting temporarily, another inflammatory action. No un- pleasant consequences ever result from the use of this remedy when it is employed before the commencement of the third or acute staqe. Our experience with this solution has been extensive, and we therefore GONORRHOEA. 377 confidently recommend it as a perfectly safe and sure remedy in this stage of the complaint. During the third or acute stage, it is a question whether any reme- dies, either general or topical, can be employed Avith any material ad- vantage, Avith the exception of the internal use of Aconite, which may be given to shorten the inflammatory stage. This medicine is particu- larly applicable Avhen febrile symptoms are present. Throughout this stage, the patient should be restricted to the most rigid vegetable or farinaceous diet, to cold water, and prohibited from taking much exer- cise. Ablutions with cold water, should be often employed, in order to keep the parts as free as possible from the irritating discharge. After the urgent symptoms have subsided under the use of Aconite and the other means Ave have just pointed out, and the fourth or chronic stage has commenced, we may resort to injections composed of one grain of Sulphate of Zinc to f vii. of water. These injections, in order to be efficient, must be repeated every half hour during the day, until the discharge ceases. It will be of no service to use this solution three or four times in the day, for the chief object is to Avash out the urethra as fast as the matter forms, and thus prevent the constant reabsorption which which Avould otherwise take place. The principal reason why urethritis is so difficult to cure, when once fully established, is, that the matter itself being infectious, and liable to be constantly reabsorbed, thus operates as a continual exciting cause. If at any given instant, the Avhole urethra could be restored to perfect health, a single drop of the morbid secretion which it had been pouring out, applied to the part, would be sufficient to re-excite the dis- ease in all its violence. It is evident, then, that the discharge must be arrested abruptly by the remedy employed, or Ave must use our in- jections sufficiently often to dilute and remove the virus as fast as formed, and at the same time to change the morbid action of the membrane to a healthy medicinal action. In regard to the plan of making an application to the urethra, of a medicine so powerful as to arrest the discharge suddenly, like the solution mentioned under our second head, it is attended in this stage of the affection with many dangers. The canal of the urethra is gene- rally affected so high up as to render the certain application of this or any other sufficiently poAverful solution entirely impracticable. But the other method to which Ave have alluded is one of entire feasibility and safety, and is for the most part attended with success, when thfe discharge is entirely unconnected Avith a stricture. It is proper to observe that in all cases the patient should urinate previous to the use of the injections. Another injection which we have some- times used Avith marked success in this stage, is a mixture of Calomel 378 DISEASES OF THE SANGUINOUS FUNCTION. and Olive-oil, in the proportion of a drachm to the ounce, once or twice a day until the cessation of the diseased action. If however, notAvithstanding the thorough and persevering employ- ment of the zinc-solution and the mixture of calomel and oil, the dis- charge still continues, recourse should be had to the introduction of bougies, either plain or smeared Avith a cerate containing a sufficient quantity of pulverized Nitrate of Silver. These should be carefully in- troduced two or three times a week, until they have stimulated the diseased membrane to a natural and healthy action. The folloAving local remedies are effectual when judiciously em- ployed :— Hydrastis-canadensis.—An infusion may be made of indefinite strength, as of an ounce of the root to a pint of water. It may be thrown into the urethra through a syringe, and retained for two or three minutes. It may be tried every night at first, and afterwards oftener if the effect is satisfactory. Liquor-plumM-diacetas.—May be used in the same manner. Slightly cold, or tepid, water alone, used as an injection, is safe at any stage, and almost always hastens recovery. The above plan of treatment we believe to be more efficient, safe, and consonant AA'ith the true principles of cure than any other which has yet been promulgated ; yet we do not claim for it infallibility. We can only assure our readers that we have thoroughly tested every theory and process Avhich has been proposed by either school, and that after all of this practical experience, we have presented them with what Ave deem the best method of treatment in this disgusting malady. Dr. Blake, of California, has arrived at the following conclusions:— 1. Gonorrhoea is a purely local disease, vrith nothing specific about it. 2. That the principal cause of the difficulty experienced in curing it is in the contact of the urine with the inflamed surface of the urethra. 3. By always washing out the urethra after urinating we remove the cause that keeps up the inflammation, which can then be subdued by purely local means, in two or three days. 4. That there are different forms of gonorrhoea, as there are of oph- thalmia. It is proposed to wash out the urethra with injections of cold water each time after urinating. For the cure of disease, washes of sulphate of zinc ; for the more severe cases, the chloride of zinc ; in the most severe, of nitrate of silver. Chloride of zinc two to three grains to the ounce of Avater, diluting it if it cause much pain. (Pacific Med. and Surg. Journal, Feb. 1862.) Internal Remedies.— Cantharis, Cannabis, Mercurius, Tussila- go, Nux-vomica, Cubebs, Pulsatilla, Copaibce, Sulphur, and Ferrum, GONORRHOEA. 379 lhe selection will generally be made by constitutional rather than by local indications. There is generally a depressed state of general health, for which Nux-vomica and Suljjhur are important remedies. Cmnabaris is one of the best forms of mercury. ^ Pulsatilla in chronic affections of the urinary organs, in phlegma- tic and scrofulous constitutions. Aconite.—In the early stages of the disease, when the inflamma- tory symptoms are rapidly developed and run high, when the scalding is severe, the discharge copious ; erections at night frequent and pain^ ful, and general symptoms febrile ; Aconite+n drop doses, of second or third dilution, perhaps in alternation Avith another appropriate remedy. Mercurius-corrosivus.—ln the early stage may be alternated with Aconite ; in two or three drop doses of second or third dilution (deci- mal.) These two remedies seldom fail to subdue the more violent symp- toms. The Corrosive is apparently the most efficacious of the mercu- rials. The Merc-sol. seems less efficient. Cantharis.—In acute cases in Avhich the membrane of a large por- tion of the urinary tract is implicated; the irritation extends from the orifice of the urethra to the bladder; scalding and burning alon<>- the passage; frequent and painful urging to urinate. It may be alter- nated with Aconite. A drop dose of the third dilution every six hours is often effectual. Cannabis-sativa.—When the more active inflammatory symptoms have been mitigated by Aconite, Merc.-corros., or Cantharis, and there still exist considerable irritation and burning in micturition, SAvellino- and redness of the orifice of the urethra, copious white or yellow dis- charge. It seems to hold about the same place in homoeopathy that Copaiba does in the old school; but it is free from any of the incon- veniences of that remedy. Dr. Yeldham says, "to do any good it must be given in palpable doses. I am in trie habit of prescribing from five to ten, or even fifteen drops of the mother tincture three or four times a day. In my OAvn practice the dilutions have proved nearly or quite inert." Balsam of Copaiba.—All the standard authors testify to the merits of this remedy in blennorrhagia as well as in vesical catarrh, nephritis, ulceration of the kidneys, bladder and prostate, orchitis, cephalalgia, &c. These same men say, the remedy must be "used with prudence," for it is capable of causing swelling of the testicle, obstinate cephalal- gia and Aveight of the head. It has also caused, as well as cured 1 Hemorrhoids ; sharp pain in the urethra, inflammation in all the urinary passages, retention of urine, phlegmasia of the bladder. Copaiba is a poAverful homoeopathic remedy in gonorrhoea, but it acts chiefly as a. local agent y and thus, like Cannabis, it requires to be given in palpable doses, which its objectionable taste and smell, and 380 DISEASES OF THE SANGUTNOUS FUNCTION. its effects on the stomach render difficult to the patient. The best mode of giving it is in capsules, which conceal its taste. Dr. Yeldham says, he failed entirely with it in attenuations. That its action is only local was considered to be proved by the experiment of Ricord. This celebrated author says : " In one case there Avas urethral fistula at two and a half inches from the meatus," blennorrhao-ia occurred in the 7 O vesical portion of the urethra, but it spread itself forwards to the balanic region. The use of Copaiba caused the disappearance of the discharge in that portion of the urethra situated behind the fistula, viz., that which was under the influence of the urine. But the discharge from the portion anterior to the fistula, viz., that portion of the canal which did not come into contact with the urine persisted. Injections caused its disappearance." In another case of fistula of the urethra the result of Copaiba was the same. When taken in palpable doses and the urine was allowed to escape through the fistula at the middle of the urethra, the Copaiba coming in contact locally Avith the inflamed sur- face cured it; while the part of the urethra in front of the fistula, through which the urine with the Copaiba did not pass continued diseased as before. AfterAvards when the urine was made to pass all through the canal the Copaiba diluted in it cured that portion also. These experiments show that Copaiba is a homoeopathic specific for urethritis when applied directly to the inflamed surface. Whether it has any dynamic power over the same disease in attenuations remains to be seen. Cubebs.—Dr. L. De Parseval, (Bulletin de la Societe Medicate, 1860), gives the following symptoms : Specific action on the genito- urinary apparatus producing inflammation or phlogosis of the urethra, bladder, testicles; ardent fever; ardor urinse, redness of the face ; re- tention of urine, cutaneous eruptions; allopathic authors also say, the Cubebs produced all of these symptoms and " despite this the cure of the gonorrhoea has taken place." M.M. Trousseau and Pidoux say, Cubebs have become popular in the treatment of this disease " which rationally, this agent must greatly exaggerate." The facts of experi- ence show, " that Cubeba acts more beneficially the sooner its employ- ment is instituted after the beginning of the blennorrhao-ia." Thuja.—Corresponds generally with Cannabis, and may be employed in the same class of cases and in the same stages; particularly indi- cated when there are warty growths on the corona glandis, prepuce or about the anus. The above are generally the most useful remedies. Capsicum.—When the burning along the urethral canal is intense. Nux-vomica,—when the digestive functions are disturbed and when the irritation extends to the rectum, causing frequent and dis- tressing urgings to stool, with protruding haemorrhoids. Turpentine.—It excites inflammation of the urinary organs. M.M GONORRHOEA. 381 Merat and Leus say, the terebinthinates irritate the mucous membranes and the organs covered by them rendering their functions painful. Continued for some time they produce painful and bloody micturition. Dr. Despres who took a large quantity in the course of fifteen days died from inflammation of the urinary organs. Turpentine produces spasm of the bladder, strangury, bloody urine, violent pain in the re- gion of this organ. It also causes pain and heat in the lumbar and hypogastric regions, especially the kidneys, (Trousseau and Pidoux,) acute cystitis, vesical tenesmus, urethral pain, ardor urinae, dysuria, smarting sensation increasing to urethritis, scanty, red, bloody urine, painful erections as in gonorrhoea, with chordee. In all of these affec- tions it has long been employed with success, also in purulent and foetid gonorrhoea. Barbier, Trousseau, Pidoux, &c, all expected from their doses of turpentine some aggravation, but the good results were afterwards seen. They call its mode of curative action " a substitutive irritation. In proper attenuations the curative effects are reached without the aggravation. Chlorate of Potash.—" Dr. Irwin (an Army Surgeon) uses no other remedy in urethral inflammation than Chlorate of Potash. His method of using it is as follows: one drachm of the salt, dissolved in eight ounces of Avater, of which an injection is given every hour for twelve hours. At the end of this time, the discharge has become changed and diminished; allowing the remedy to be gradually discontinued un- til the second or third day, when the disease will be generally found to have ceased." This method is so harmless, so little likely to injure, by excessive irritation, causing a stricture, as compared with the caustics usually employed, that its merits should be tested. "I am now using it in one case with apparent benefit." (Dr. Hale.) Tartar-emetic has occasionally cured obstinate gleets Avith prompt- ness. Among its symptoms are : constant sticking pain in the pos- terior portion of the urethra, flaccidity of the penis, general debility, or complete impotence ; pustules on the thighs and scrotum ; pains in the testicles. Dr. Marcy says he cured tAvo cases of involuntary emissions which had occurred as often as once in twenty-four hours for many months. Ferrum.—:Tinct. Ferri-sesquichlorid. Several drops in water three times a day, in debilitated anaemic constitutions. The pyrophosphate of iron, third decimal trituration is about the best of the iron preparations. General invigorating influences, as change of air, temperance in living, local or general bathing with tepid or cold water, are important aids in the treatment. Injections may finish the cure imperfectly accomplished by general treatment. 882 DISEASES OF THE 8ANGUINOUS FUNCTION. Complications of Gonorrhoea.—The chief of these are : Irritation and inflammation of the bladder, of the prostate gland, phimosis, chor- dee, erysipelas. 1. Irritation of the Bladder,—Symptoms: Painful and incessant urging to pass water, pain increasing at the moment after evacuation. Urine generally loaded with mucus, and in some cases intermixed Avith blood; suddenness of the call to urinate, usually at short intervals; aching pain in the region of the bladder; accelerated pulse, loss of appetite, and debility consequent on the fever. Treatment.—Aconite and Cantharis in alternation will generally subdue the fever and inflammation in a few hours. Aconite may be alternated with Belladonna in ordinary febrile cases. In more chro- nic cases, Nux-vomica, Pulsatilla and Sulphur. Other chief remedies are Cannabis, Lycopodium, Terebinthinae, Uva-ursi, Copaibce, and Iodine. Camphor has been used with success in six-drop doses of the tinc- ture for the violent and spasmodic urging to pass Avater. (See p. 75 to 78, this volume.) 2. Phimosis.—This is less severe and obstinate than Avhen it re- sults from chancre. In some cases the prepuce becomes thickened and constricted, is difficult to be retracted and an irritating discharge may accumulate beneath it. Ample cleansings with warm water and fine soap. The general remedies appropriate for the disease in gene- ral Avill be sufficient to cure it. 8. Chordee.—This gives much pain and prevents rest. The usual treatment designed for the fever and inflammation will subdue it. 4. Orchitis.—Inflammation of the Testicle.—Causes.—It usual- ly occurs after the suppression of urethral blennorrheea, when the dis- charge either ceases entirely or becomes very slight. It arises in connection Avith gonorrhoea either sympathetically by propagation of the inflammation of the urethra to the testicles, or by metastasis after suppression of the discharge. The cause of the extension of the ure- thral inflammation to the testicles, is haAring gonorrhoea and not wear- ing a suspensory bandage when riding, dancing, &c, alcoholic liquors, coition, use of purgatives, cubebs, copaiba, turpentine, takino- a chill. The cause of metastatic orchitis is often injections with cold water or Avith saturnine solutions to suppress the discharge. In ordinary cases general fever begins with a hard stunning head-ache, which sometimes lasts, at least at intervals, for twenty-four hours, before the local dis ease becomes apparent. Then begin pain, swelling, extreme tender- ness of one of the testicles Avhich continues to increase durino- the first tAvo days, and reaches the size of a small closed fist. The scrotum be- comes red and tender; the spermatic cord extending from the testicle up the groin and round the loin of the affected side, becomes panful GONORRHOEA. 383 enlarged in size. In some cases the appearance of the scrotum cor- responds with that of scrotal hernia, the pulse is small, quick, and jerk- ing ; there is shivering, thirst, and loss of appetite in some cases; be- ginning with a soft spongy feeling, the testicle soon enlarges to the size of a fist and more. Sometimes it goes from one testicle to the other. The pain in it is often shooting or pressive. The discharge from the urethra is diminished or suspended during the attack, and often returns when the inflammation subsides. The epididymis is usually most in- flamed and swollen, and an examination of the orifice of the urethra usually shows its nature. Treatment.—Our first care in this complaint should be to suspend the inflamed organ by means of a suitable apparatus, in such a man- ner as to afford complete support in all positions, and thus prevent the enlarged gland from dragging upon the spermatic cord. The recum- bent posture should be strictly enjoined, and we should have constant- ly applied to the parts cloths wet with cold water. As soon as the cloths are Avarmed by contact with the inflamed testicle, they should be again dipped and reapplied until the heat and inflammation have disappeared. If the disease has arisen from sudden suppression of urethritis, or from the use of powerful injections during the acute stage, we may give Mercurius, Aconite, Nux-vbmica, Spongia, Clematis, or Iodine. When it has been caused by the injudicious introduction of bougies, Arnica, Aconite, and Pulsatilla, will be found applicable. In cases Avhere the inflammation has degenerated into a chronic in- duration of the testicles, our best remedies are, Aurum, Acid-nitric, Rhododendron, Sulphur, Mercurius, Spigelia, Iodine, and Cicuta. Aconite.—When the inflammation resists Belladonna, and the fever is prominent, alternate the two remedies. It may alone overcome the disease. Case.—A man aged twenty-seven years, contracted a gonorrhoea with inflammation at first in the left testicle, and afterwards at the ex- piration of six months the right testicle became involved. Both testi- cles considerably swollen, hard, hot, and A-ery sensitive to the touch ; scrotum red ; constrictive, tensive, pressive pains, extending even into the bowels and the thighs, augmenting by jerking paroxysms, and worse in the afternoon and night; moderate fever, increased thirst, sleep disturbed in consequence of the pain—Pulsatilla, Clematis, Nux- vomica and Nitric-acid were employed without success. Aoonite third one drop every three hours, effected a cure in four days. (Guyler, Archiv de Stapfi Vol. XIX. Cah. 2, p. 156.) 11 lladonna.—The patient should be confined to the horizontal po- sition, w( ar a suspensory loosely attached, so that the testicle should not hang down, and a thick soft linen cloth laid under the scrotum to 384 diseases of the sangutnous function. keep it in the horizontal position. With these adjuvants Belladonna has been generally successful, given only as high as the third dilution. If the pain does not rapidly yield, a cold wet compress applied to the part and renewed as often as it dries. Symptoms: the patient is ex- cessively sensitive and nervous ; there is intolerance of pain which partakes of the neuralgic character. Nux-vomica,. when shooting pain in the testicle persists after the use of the preceding. Nux-v. 6, has succeeded in removing it. Pulsatilla—May follow Aconite; and these two remedies alone often cure the disease. (ITeldham, p. ^8) Aurum—The pain in the spermatic cord is of a neuralgic character and is more severe in the cord than in the testicle, but is very distress- ing ; the cord is enlarged to two or three times its natural size, being larger toward the abdominal ring. (Yeldham, p. 29.) Arnica lotion to the painful region. Tartar-emetic.—In cases conjoined with gastric symptoms, as fur- red tongue, bad taste, eructations, Avant of appetite, constipation, &c. When orchitis, is very severe, Tartar-emetic has often a marked effect in reducing the inflammation and relieving the pain. Diet.—Light unirritating food similar to that allowed in ordinary inflammatory affections. When after the removal of the orchitis the gonorrhaea returns, Pe- troselinum and Sulphur may be given in alternation with advantage. When hardness of the epididymis remains, Sulphur 1, a grain daily for several days has succeeded. Iodine is often useful in alternation with Sulphur. Clematis.—Dr. Hirschel regards Clematis, as the principal remedy in the treatment of orchitis, especially when it supervenes on exposure to cold, after blennorrhagia, and if the testicle be indurated, sensitive to pressure, the scrotum red, swollen, with tearing, drawing pains, and retraction of the spermatic cords and region adjacent. Ruckert gives these indications for blennorrhagic orchitis: " painful induration with sensation as though grains of sand were disseminated upon the surface of the organ—sequence of ill-treated blenorrhagia." In a case after exposure to cold and damp, a blenorrhagia Avas accompanied with vio- lent pains in both testicles, nocturnal aggravation, with fever; testicles hard, swollen, and highly sensitive to pressure ; scrotum red and tense ; discharge nearly suspended. Clematis 12°, two doses in three days. The symptoms subsided during the interval, and the discharge re-ap- peared. The swelling of the epididymis continuing, Aurum 12°, com- pleted the cure. (Attomyr, by Leon Simon, jr.) In another case in Avhich, from fatigue in hunting, a blenorrhagia was succeeded by orchitis with phimosis, and ulceration of the pre- ulcer. 335 ly the left, became enormous; the scrotum red and tense as in hernia; fever intense with furious delirium. After Aconite, Clematis completed the cure. Indications : the testicle is hard, SAvollen and painful, with sensation of traction upon the spermatic cord. If it feels bruised to the touch, with tension of the groin, upper thigh, and scrotum, Ruckert gives Clematis 12° and Spongia 30°, or Clematis alone every twelve or twenty-four hours. Various indurations of the testicle, not of syphili- tic origin, have been cured by Clematis. Dr. Destirne disputes the power of Clematis in the above cases, and refers the recovery to natu- ral re^plution. Irritable Testis.—Clematis.—A case of gonorrhoea had lasted many years. Cold had developed orchitis, the part swelling to the size of a child's head. The patient became sad and misanthropic. The following year, moist itching spots appeared on the palm of the hand. general condition improved; when the spots receded he had colics! He had intermitting pains in the left testicle, faintness and retraction when the organ was touched. Other symptoms were relieved by other remedies; the pains of the testicle were relieved by Clematis 1° for a whole summer; when they returned the year following they were dissi- pated by the same remedy. GENUS XIV.—ULCUS.-ULCER. An ulcer is defined as a purulent solution of continuity of the soft parts of an animal body; (the name ulcus, derived from ekicoc, a sore). Ulcers may arise from any of the causes that produce inflammation from wounds, from irritation of the absorbents by specific poisons from any of the blood poisons already treated of, as scurvy, cancer scrofula, or the venereal virus. Causes.—The proximate or immediate cause is an increased action of the absorbents, and a spocific action of the arteries, by which a fluid is separated from the blood upon the ulcerated surface. Varieties of Ulcers.—1. Simjde ulcer, arising generally from a superficial injury, as a wound, bruise, abscess, or burn. (See Volume , L, p. 641; Vol. II., p. 181). 2. Sinuous ulcer, which runs under the integuments. Its orifice is narrow, but not callous. 3. The fistulous ulcer, or fistula, a deep ulcer, with a narrow and callous orifice. 4. The fungous ulcer, the surface of which is covered with fungous flesh. 5. The gangrenous ulcer, which is livid, foetid, and gano-renous. 6. The scorbutic ulcer, which occurs in persons subject to the in- fluence of scurvy. Vol. II.— 2^. 386 DISEASES of the sangutnous function. 7. The venereal ulcer, which occurs in the course of the venereal disease. 8. The cancerous ulcer, or open cancer. (See Cancer, page 282, Vol. II.) 9. The irritable ulcer, dependent on a psoric dyscrasia in the blood though excited by local causes. The edges of the sore are ragged, undermined, and sometimes serrated or notched. The surrounding surface is red or inflamed; the bottom of the cavity is composed of irregular hollows, Avhich contain a thin, greenish, or reddish, acrid matter, Avhich excoriates the adjoining skin. Instead of the healthy granulating surface, described in Vol. I., page 643, there is a white, or dark-red, spongy mass, Avhich is irritable, extremely painful, and bleed- ing on the slightest touch. This form of ulcer occurs in persons Avho eat and drink too freely, or have suffered from fevers. When seated on the leg or ankle it becomes extremely painful and difficult to heal, and is called a "fever sore." (See Vol. II., p. 181; Vol. I., p. 647). Indolent ulcers are common on the leg, in sloA'enly and intemperate persons. The surface of this form of ulcer is flat, has a shining ap- pearance, and is covered with a whitish or dark-gray crust, which is exceedingly tenacious. Generally there is a profuse discharge of vis- cous cohesive fluid. The edges of the sore are elevated, smooth and rounded, the surrounding parts are swollen or hard, and the whole limb enlarged ; but generally there is but little pain. 10. Carious Cancer, dependent upon carious bone. 11. The Scrofulous Ulcer Avhich occurs only in scrofulous consti- tutions. It is known by its having arisen from indolent tumors, by its dis- charging a viscid glairy matter, and its indolent nature. (See Scrofu- la, Vol. II. p. 259.) 12. Varicose Ulcer.—This occurs on the inner side of the leg or thigh in persons who have varcose veins. Treatment of Ulcers.—Ulcers are always curable by the simplest dressings, and the natural powers of reparation when they occur in healthy constitutions. Obstinate ulcers are invariably the result of some dyscrasia. of the organism Avhich should become the special ob- ject of attention. Even simple ulcers should be healed sloAvly, and under the use of proper internal remedies this can always be done. The folloAving are the principal remedies : Arsen., Lach, Asarum, Bell., Calc, Carb-veg., Conium, Cuprum, Graphites,- Lycopodium, Merc, Phos.-acid, Rhus., Sih, Sulph., Canth., Chel., Clematis, Solanum. Arsenicum.—Indolent ulcers on the leg, in old, feeble, or cachectic persons; scorbutic or scrofulous ulcers which are flat and superficial, or hard, callous and burning; ulcers which resemble cancer; fungous, ulcer. 387 varicose ulcers of gray color with red areoloe, black or whitish-spotted surface ; those that bleed readily, suppurate, are inflamed, putrid, pha- gedenic and very painful, itching, smarting, burning, tearing or draAving. Lachesis.—Indolent ulcers in old scorbutic or scrofulous subjects ; effects of Mercury, fungous ulcers; deep, varicose, indented, bluish spotted, discolored, with red areolae, turning black or spotted ; ulcers which bleed or become gangrenous, spread, and are surrounded by pustules. ' Sulphur.—Every form of indolent ulcer in psoric constitutions ; in persons subject to asthma, urticaria, herpes or scrofula; fistulous, ca- rious or cancerous sores ; fungous or varicose ulcers, with indented edges, or red areolae; ulcers Avhich turn black, suppurate or become putrid, Avithout pain, or Avith boring and throbbing pains. Carbo-vegetabilis.—Ulcers which burn and smell offensively; atonic or indolent sores in old persons ; scorbutic, fistulous, and scrofulous ulcers; those Avith hard callous edges; fungous, varicose ulcers of yellow or black color, Avhich bleed and become putrid, phagedenic and painless or torpid ; otherAvise very painful, ichorous, burning, and foetid. Cantharides.—Redness, inflammation and gangrene of the surface; excessive debility, languor, and emaciation ; exudation of a serous li- quid from a vesicated surface ; itching and lacerating ulcers of the leg ; strangury, and tenesmus of the bladder. Case by Dr. Burdick, New- York.—A gentleman who had suffered from paralysis for sixteen years had a chronic ulcer on the calf of the leo-. The surface presented a Avatery blister from Avhich Avas discharged about one quart of serum per day. He was cured by the internal use of Cantharides. Solatium.—All the species of this genus of plants are good remedies in malio-na.nt ulcers as well as carbuncles. One of the best local ap- plications is the tomato. The poAvers of Solanum-nigrum in gan- grene are referred to at page 346, this volume. 388 DISEASES OF THE NERVOUS FUNCTION. CLASS IV.—DISEASES OF THE NERVOUS FUNC- TIONT. ORDER 1.-PHRENICA.-AFFECTING THE INTELLECT. MENTAL DERANGEMENT. The brain and nerves constitute the master tissue of the human body. It is superiority of brain, either in structure or conformation, which mainly creates the distinction between different individuals and different races. A thorough knoAvledge of this wonderful structure would enable us to explain some of the most mysterious inconsisten- cies and contradictions in human character, and many of the strangest events in human history; and would also render us more capable of comprehending the grand destiny of the human family. The problem of man's objects and achievements on earth has only . been partially solved by history, because historians have but partially understood his physical or mental constitution. The ancients thought him "an intelligence served by organs." Modern philosophers have set themselves to investigate the " organs," and to explain away the "intelligence" into non-entity. We shall not enter into the contro- versy between them; but will endeavor to collect for practical uses the best results of observations and experiments which may illustrate the nature and treatment of the diseases which affect the human intellect. In estimating the probable future of our world, the mental peculiari- ties and capacities of different races and nations must be taken into the account. Modern research has shown that national characteris- tics have continued unchanged from the remotest ages. The Arabians are just what they were in the days of the patriarchs. Very recently it was declared by ethnologists, that the Hindoos had altered, in nothing since they Avere described by the earliest writers; and we knoAV that thirty-five hundred years have made no difference in the skin, the hair, or the features of the Negro. The characteristics of the Jew may be recognized in the sculptures of Luxor and Karnac in Egypt, Avhere they were depicted more than thirty centuries ago; and they bear the most striking resemblance to the Jews of the present day. Neither their residence in Palestine, nor their subsequent ban- ishment into every country and climate of the world have made any sensible change in the personal frame, the form of the head, the color of the skin, or the lineaments of the countenance. (Crania Americana) The permanence of national characteristics in the features of well- known races is displayed in Egypt for the longest period known in MENTAL DERANGEMENT. 389 history. By the researches of M. Auguzre Mariette, in 1854, the most perfect specimens of the Egyptians, as they Avere in the time of the Shepherd Kings and Pharaohs and the builders of the Pyramids are placed side by side with their modern descendants; and they are shown to be identical in form and every feature, though about five thousand years of time intervened betAveen them. (See. Morton, Gliddon, also Dr. Helmuth, U. S. Journal of Homceop., Vol. I., p. •682.) The primary origin of the diversity and peculiarity of races presents a question which Ave will not enter upon here. The present aspect of the nations gives reason for believing that the Caucasian race of men are soon to subjugate the whole habitable earth. Great Britain, says Dr. CaldAvell,* " is but a speck in the waves, and yet her power is felt and acknoAvledged in every corner of the ear to." The North American Republic exhibits a further development of the same Gothic Caucasian race, variously modi- fied by Celtic additions. Its future is not to be calculated until other elements than those which appear in past history are brought to bear upon a problem yet unsolved; it will at least be a power among the nations, of Avhich no one will fail to feel the influence. And what is the source of all this power? Its manifestation depends on the mental characteristics of the Anglo-Saxon mind in its union Avith "the largest, best developed, best conditioned brain belonging to the human family. No matter hoAV good the forms of other parts of the body may be, they owe that also to perfection of brain." Anglo-Saxons are knoAvn to compose the most highly endoAved division of the Caucasian race; "their brains are larger, better proportioned, and, from temperament and exercise they are in better condition for efficient action." (Cald- well.) It is of the deranged action of this wonderful structure that we come now to speak. Under the general term Insanity it is common to speak of all or any of the usual perturbations of the intellect. There is no correct definition of the word. Perhaps, as Halford says, " insanity, like sense, admits of no definition." One of the best efforts at a definition is that of Dr. Wright, of the Bethlehem Hospital. '* Insanity is a dis- ease of one or more faculties of the mind, of the diseased manifesta- tion of which the individual is unconscious, or not able to control." Some of the existing definitions would nearly depopulate all the asylums ; others would confine in straight jackets, not only their authors, but nine-tenths of their readers. The Roman law spoke only of two species of mental derange- ment, 2Iento Capita, et furioso. The Prussian law distinguishes * Louisville Med. and Physical Journal. 390 diseases of the nervous function. maniacs and idiots. The French law speaks of amenia, insanity, idiocy, without defining the divisions. Genera and Species of Intellectual Derangement.—Morbid physical conditions may produce derangement of the intellect in vari- ous modes and degrees, to some of which the following names may be applied: Species. 1. Erratic Genius. 2. Empathema entontica.—Impassioned ex citement. 3. E. atonica.—Depression, Absence of pas- Genus I. Empathema, Ungovernable Passion. sion. 4. E. inane.—Hair-brained passion. 5. E. nostalgia.—Home-aickness. Genus II. Ecphrosia. Insanity. 1. Insanity of the affective faculties. 2. Insanity of the reasoning faculties. 3. Insanity involving both the affective and reason- ing faculties. 4. Mania may include any one of the species, and indicates fury combined Avith insanity. 5. Melancholia,—either of the above species of in- sanity combined Avith fear and anxiety. 6. Monomania. I.—That the brain is the organ through which the intelligent mind carries on its intercourse Avith the external world need not noAV be proved. The great desideratum for which all men perpetually seek on earth is " a sound mind in a sound body'' Diagnosis.—Mental alienation includes all cases where the mind is incoherent or deficient in comprehending those plain facts which require the least exertion of understanding, whether from natural or morbid imbecilit}', or morbid perversion of its faculties or operations, by which the mind becomes incapable of distinguishing between the right and Avrong of certain principles, which are generally admitted. No general definition will include every case. The mind in the in- sane has either lost or perverted its accustomed powers, or never had them. We include not under the term insanity the common mental eccentricities which often appear in the strongest intellects ; they may often arise from abstraction of the mind from passing scenes and events and are called absence of mind. Every thinking man experiences this to some extent. But when they usurp supremacy from continually revolving in one set of ideas, and overcome the judgment, and impair understanding, generally, the individual comes under the scope of mental alienation. 1. Erratic Genius.—Men of genius, in all ages of the world's ..history, mental derangement. 39] have very generally been in some abnormal condition; and much of what they did do has been fairly attributed to constitutional peculiari ties or to the morbid activity of some of their mental faculties. We mention a feAv examples only. 1. Richard Porson, Professor of Greek in the University of Cam- bridge, Avas distinguished for great acuteness and solidity of judg- ment, intense application, and a stupendous memory. His immense erudition had rendered him an object of general admiration; and his head, being the subject of general curiosity, was subjected to a post-mortem inspection by the anatomists. The account given of the dissection says that, " to the consternation of all phreno- logists, but to the consolation of all blockheads, his skull was found to be thicker than that of any man that had been dissected in Europe." The phenomenon was considered inexplicable, and Dr. Gall was con- sulted. The founder of phrenology regarded the case as a perplexing one, and only answered: "How so much knowledge could get into such a cranium as that I cannot indeed comprehend; but I can Avell under- stand that, having got into it, it would never be able to get out again'1 2. Dr. Gall, the founder of the science of phrenology, died at Paris in 1828. It was thought proper that the man who had examined so many heads should have his own examined also. Again, the anatomists were astonished to find a cranium thicker than had ever been seen since the death of Porson—at least twice as thick as any other they could find—and the channels, worn by the throbbing of the arteries of the dura-mater on the inner surface of the parietal bones, Avere deeper than had ever before been seen. The soul had made a happy escape from a massive prison where it had long struggled with storms Avithout and physical disease within. The last enemy that assailed it waa allopathic medicine. The disease Avas a true gastritis which should not have been fatal. But a conclave of physicians gave him twenty grains of Quinine per day, for five days, and the tenant of the strong old castle surrendered it into their hands. 3. We find many examples among illustrious men, of intense activity of mind, accompanied by some extraordinary development of the bones of the head. Cardinal Ximenes, Archbishop of Toledo, and Prime Minister of Spain, wherever he went, Avhether toiling incessantly for the reform of the Spanish government, under Ferdinand and Isabella, converting the Moors to the Catholic religion, or leading a military expedition to the coast of Africa, Avas continually tormented Avith a pain in the head which no remedy Avould remove. The Avarrior states- man, in the costume of an archbishop, Avith a suit of armor over it, was little more than a " living skeleton." He is described as " gaunt, grace- less and unprepossessing; his austerities had reduced him to a walk- ing anatomy, though his carriage Avas erect, his forehead unAvrinkled, 392 disease* of the sanguinous function. his features sharp and thin, his eyes small, dark, and deep set, and the general expression of his countenance repulsive and severe." Such was the appearance of the tall and ghostly leader who stormed the Moorish fortress of Moran, in Africa, and put the garrison to the sword. When tortured with neuralgia, he governed Spain by the force of his iron will; and Avhen asked by what authority he ruled, he only pointed to his cannon. The Cardinal died in 1517, and his head was examined forty years afterAvards. It was found so compact and solid that every vestige of the sutures was obliterated, and the Avhole cranium formed one hard and firm bone. To this peculiarity of his skull the Abbe Richard attributed the statesman's sufferings during life. 4. The same author says that when Cardinal Richelieu died in 1642, the reason why he had never suffered from headaches was seen; twelve small circular perforations were found penetrating the skull; " and through these the vapors from his brain had continually exhaled." This Avas the statesman who carried on wars for and against the differ- ent sects and governments of Christendom, and then " covered up all his crimes with the red mantle" of murder and assassination. To such a man life is unhappy and death terrible. Baron Larrey, the chief surgeon of the first Napoleon, says his illustrious associate in the army in Egypt, Monge, made him a visit many years after the downfall of the Empire. " The good old man," says Larrey, " shed tears of sorrow" when he spoke of the loss of all his former patrons, offices, and titles. Profound melancholy and in- tolerable Aveariness of life darkened all his later years. After death, it was found that the arteries of his brain were ossified, many of them hardened into bone. The mind and the body had acted and reacted fcpon each other. Fourcroy, the chemist, closed his life, also, in gloomy wretchedness; and in his brain, also, the arteries were found ossified. Among the English poets there has been no one of whom everybody knows so much, and at the same time understands so little, as Lord Byron. The mere phrenologist inspects all the portraits, busts and memorials of the poet that can be found, and feels but partially satis- fied. There is evidently something both higher and deeper in Byron's genius than physical conformation of the head would ever reveal. There is a loftier spirituality, as Avell a loAver sensualism in his brilliant works, than the shape and size of the brain could alone have shown us. He had other physical peculiarities than those displayed there; he was the subject of disease through many years of his life; he in- herited a feeble, irritable constitution, and suffered all his life the pen- alties of ancestral vices; and all that he achieved or endured on earth only cultivated a morbid activity of the brain and nerves. Inspired by a misanthropic hatred of much that was wrong in his own country, and by admiration of some remnant of the ancient patri- ERRATIC GENIUS. 393 otism in the modern Greeks, he devoted his life, energies, and fortune to the liberation of the land of Demosthenes. There, under the influ- ence of malaria, great mental exertion and despondency, he exhausted the powers of his over-active brain, and died on the 19th of April, 1824, having reluctantly submitted to a "copious bleeding," which settled the question of life and death with a reasonable degree of promptness. The post-mortem examination solved many of the mys- teries of his life, and partially unravelled the perplexed web of the many contradictions in his character. The skull, like that of Cardinal Ximenes, presented the most remarkable compactness, having no sutures between the several parts of it; but all the different bones were perfectly consolidated into one, Avithout any intermediate diploe,— the head resembling that of a man half a century older than the poet; the medullary substance preponderated largely over the cortical por- tion; the convolutions very numerous ; the fissures deep. There.Avere also evidences of long-continued irritation, such as could not fail to influence his mental capacities and feelings. It was this state of the brain that heightened and intensified his passions, and produced many of the wildest aberrations of his erratic genius. It was this, added to the usual morbid sensibilities of the digestive organs, and the long- persistent constipation and torpor common to literary men, that made the man who possessed the loftiest poetical genius of his time wish for death at a period of life Avhen men, whose minds and bodies are more in harmony, are only beginning to live. Disease, which neither he nor the physicians could understand, drove him to desire severance from all the relations of a Avorld Avhich promised so little for humanity, and nothing for him. Ignorant himself of any rational medical treat- ment, he made no effort to relieve himself from any of his miseries. A true estimate, then, of the character and genius of Byron, can only be made by taking into the account the size, form and relative activity of the brain; the causes which operated through all his life to render him morbidly irritable; his British education and travels in classic lands ; his inherited rank and wealth ; the physical constitution which he inherited, encumbered by the diseases and vices of an aristo- cratic ancestry. When we have seen some of the same passions and Avayward tendencies developed by himself, and have measured the power of all the surrounding influences to cultivate all that Avas good and all that was evil in such a man, then, and not before, may we claim that Ave understand him. But the physicians of our period regard all perversions of the men- tal faculty as mere symptoms of some morbid condition of the brain. Indeed so completely have these physical causes find mental effects been classified, that the precise location and the kind of morbid action in the brain, which produce nearly all mental disorders, can be designated, 394 DISEASES OF THE NERVOUS FUNCTION. The practical medical man of to-day looks only to the material brain itself in order to solve any question of perverted or deranged intellect He combats the ravings of the fierce and violent maniac, by throwing a dose of Belladonna upon his inflamed tubercula quadrigemina ; or the tremulous movements and the frightful visions of the inebriate, by bringing into contact with his excited brain and nervous system, Opium and Cannabis-indica; or the melancholy and despair of the hypochon- driac, by doses of Aurum and Ignatia; or the homicidal or suicidal perversions of the monomaniac by Stramonium, Aurum, Hyoscyamus, or other appropriate remedy. Intellectual perversions, Avhich were formerly regarded as mysterious spiritual afflictions of Providence, are noAV known to be only symptoms of some disease of the brain and nervous system, and to be just as amenable to medical treatment as any other malady. Genus II.—DERANGEMENT OR PERVERSION OF THE REASONING FACULTIES—INSANITY. Derangement of the intellect has always been regarded as a mysterious disease. Dr. Rush said, that in attempting to write out his own observations on the " Diseases of the Mind," he felt that he was about to venture on consecrated ground. No theory of the phi- losophy of the mind, either in health or disease, has ever been gene- rally accepted; and a question of the sanity or insanity of the mind in a given case, often presents the most difficult problem ever presented to the physician. Knowledge and wisdom have generally been confounded; and even now the distinction betAveen the metaphysical or higher reasoning power, and that which reasons on the facts furnished by the evidence of the1 senses is not generally recognized; but it is believed that the separate existence and action of these two powers of the mind admit of demonstration. A feAV compressed statements on the subject are sufficient for our present purpose. It has been believed by the wisest philosophers of all ages, that the human intellect possessed a higher reasoning power than that em- ployed in reasoning on the material objects around them. It was ob- served by the earliest students of human nature, that some men Avho could reason acutely on all questions presented to the senses could neArer comprehend anything of higher abstract truth/ and a distinc- tion was drawn betAveen physical or sensuous, material subjects and those which were metaphysical—that is beyond or above the physical. It Avas this higher reasoning power, which was known as pure reason which the Greeks deified under the name of Minerva, or the goddess insanity. 395 of wisdom. She was the impersonation of that highest faculty which perceives truth intuitively, before it has time to demonstrate it through the sIoav processes of the external senses. Instead of having groAvn up during the course of successive years through the ordinary stages of life, she is represented as having sprung forth from the brain of Jupiter, armed Avith the spear of victory, and the far-seeing eye of inspired Avisdom. The ancients distinguished between the higher reason and the lower reason, called by many authors judgment or understanding. Plato, Seneca, and Aristotle made this distinction; and in modern times, Leighton, Harrington, Lord Bacon, Kant, Coleridge, and all other philosophers, except such as are imbued Avith the materialism of Locke, have confined the understanding to the office of reasoning on the objects of the external Avorld, and called it " the faculty of judging according to sense." Animals, say these authors, have the power of understanding, as applied to the things of time and sense, but they have no perception of the subjects of metaphysical or spiritual con- templation, Avhich are the proper objects oi pure reason. In its highest condition of development the nervous mechanism has a three-fold operation: 1. objective ideas, Avhich arise in external facts; 2. subjective ideas, which exist in registered impressions; 3. impres- sional ideas, as the abstract truths of geometry, the issue of pure reason, and are therefore to be attributed to the essential nature of the soul. It is believed that an impression made upon either of the senses is conveved by a nerve connected with it to one of the ganglia at the base of the brain. Upon the vesicular contents of this, the change, whether chemical or mechanical, is made, Avhich afterAvards in some way corresponds to the outAvard and material object which caused the impression. Not, by any means, that this change impressed upon the ganglia necessarily at all resembles its material correspondent in form and color, &c; it is simply conventional Avith the mind, as are the letters of a book, or in the dots and dashes of the telegraphic mes- sage. The act of remembering, then, is nothing but fixing the atten- tion upon those ganglia, and thus discovering the changes which have taken place. We may conjecture that these impressions on the ganglia are finally transferred to the mind proper, and form, therefore, an integral portion of it, thus constituting the faculty usually called memory. Ginkkal Symptoms of Insanity.—In total or partial perversion of intellect the concatenation of ideas is broken, as in dreams,—pro- ducing incongruous combinations, Avhich are repugnant to reason and common reflection. The person in whom the intellect is thus deranged may manifest it in different ways, and very often it is difficult to decide 396 DISEA8ES OF THE NERVOUS FUNCTION. whether any of the visible symptoms constitute positive evidence of insanity. "The tearing of clothes so common in this disease was one of the usual manifestations of deep distress among the Jews, probably from its being one of the natural signs among the nations of the east. The hallooing, stamping, and rattling of chains common among mad people are designed to excite counter-impressions upon their ears, to suspend or overcome the anguish of their minds; they wound and mangle their bodies for the same purpose. Even Avhen there is sing- ing and laughter, there is reason to believe that the heart is oppressed Avith sadness. The sadness and seeming apathy of manalgia are not always evidence of the absence of misery. ' The willoAV weeps,' says the poet, ' but cannot feel;' the torpid maniac feels, but cannot Aveep. One insane person declared, that his sufferings from imaginary evils were vastly greater than any real ones could be." Insanity appears in various aspects, according to the causes in which it has originated. Some are gay and seemingly happy; some imagine themselves superior beings, and assume the importance of their supposed situation; some are delighted Avith floAvers, some Avith play- things; some are revengeful and furious; others are silent. Thus they drag out their miserable existence. In one respect they are all alike; all have incoherency of conception and incongruous ideas on at least one subject, which may have caused their malady. Some con- sider themselves utterly miserable, and resort to various efforts to drive out their anguish of mind; they laugh, scream, cry, and especially seek to obtain ardent spirits and tobacco. Some, though previously silent and gloomy, become lively and loquacious as soon as tobacco is given them, or ardent spirits promised; they are cunning, suspicious, alive to injury, and quick in avenging it. Insanity Involving the Affective Faculties or Feelings, while the Intellect or Reasoning Power remains sound.— Austerity of conduct and tyranical disposition often present the principal visible evidence of a grade of insanity which no defect of reasoning poAver betrays. " In a well-attested case, a father systema- tically persecuted his children for many years, during Avhich time he passed in the world for a man of great talent and probity; and it Avas only after the history of his life had been sifted by the best physicians that a tinge of insanity could be found in it." He had started in life with impractical notions of propriety of conduct, which he failed to realize in his children. He therefore conceived such a hatred for them that he persecuted them even to destitution and charges of the worst crimes. His success in prosecuting his plans, and in common business evinced anything but insanity (Halford). A strongly-marked INSANITY. 397 case of this kind is finely painted by M. Chateaubriand in the person of his father.* M. Pinel gives the case of a man who had periodical fits of insanity, in which he was seized with incontrollable fury which inspired him to a propensity to take up any weapon he could find, and knock on the head the first person who came in his sight. He experienced a kind of internal combat between this propensity to destroy, and the pro- found horror that arose in his mind at the contemplation of such a crime. There was no mark of wandering of memory, imagination or judgment. Although devoted to the happiness of his wife, he came near killing her, and had only time to bid her run to avoid his fury. " He said to me," says Pinel, " during his seclusion, that his tendency to commit murder was absolutely forced and involuntary. All his lucid intervals were marked by expressions of melancholy and remorse; and so great did his disgust of life become, that he often wished to put an end to his own existence. ' What reason,' said he, 'have I to wish to destroy the superintendent of the hospital who treats me with so much kindness; and yet, in my moments of fury, I am tempted to rush upon him as Avell as others, and plunge a dagger into his heart.'" (Sur LAlienation 2Ientale, p. 202). Hospitals for the insane are never without some examples of mania, marked by acts of extravagance or even fury, with a kind of judg- ment preserved in all its integrity', if we judge of it by conversations. The lunatic gives the most just and precise answers to the questions of the curious; no incoherence of ideas are discernible; he reads and writes letters as if his understanding were perfectly sound ; and yet, by a singular contrast, he tears in pieces his clothes and bed-covers, and always finds some plausible reason to justify his wandering and his fury. Such cases have been referred to as proving the plurality of the organs of the brain. It is remarked that it is common for the insane to. reason correctly, though from false premises. The man who believes himself to be composed of glass, reasons correctly in being afraid of being broken to pieces. ' The Prince of the House of Bourbon, Avho believed himself to be a plant, reasoned correctly in standing in a garden, and insisted on being watered with the other plants. The lunatic in the cell of the Pennsylvania Hospital, who thought the wheel-Avork of the universe moved only by his direction, was right in being afraid to withdraAV his regulating hand from it; " for," said he, " it depends on me to move the balance-Avheel of heaven, and if ever I should stop, the whole universe would stand still." The point at Avhich the mind may be said to become unsound is not * Memoirs of M. Chateaubriand, 1861 398 diseases of the nervous function. easily ascertained, and strange mistakes arise in trying to draw the exact line. The people of the city of Abdera believed Democritus in- sane, and sent for Hippocrates to cure him, but Hippocrates decided that not Democritus but the people of Abdera Avere insane. Much learn- ing was thought to have made the Apostle Paul mad, because from persecuting the Christians he became a strenuous advocate of the same doctrines he had opposed. Whatever opinions are not generally re- ceived are charged to the insanity of those who accept them, till rea- son and experience overpower our prejudices and convince us that " we the people," have for once been wrong. In religious as well as political controversies each party pities the weakness and disordered minds that can be satisfied Avith the creed of the opposing party. Whenever an individual is merely apparently absurd in matters of opinion which do not affect Avhat may be called the elementary prin- ciples of feeling or conduct, we need not fear that these errors will lead to insanity. An illusion may exist in regard to particular sub- jects in the mind of a man of genius, and it may lead him to indulge in eccentric whims and fancies; whilst the points on Avhich the illusion exists are utterly indifferent to the well-being of all about him, and on every other subject his conceptions are clear and his conclusions cor- rect. Pythagoras believed that he had lived in former ages, had in- habited different bodies, and in th« shape of Euphorbus, had assisted at the siege of Troy, where he was killed by Menelaus. Tasso believed that he was visited by a familiar spirit with Avhom he conversed aloud. The hero of Cervantes, Don Quixotte, is a good specimen of this grade of insanity. " If," says a celebrated writer, " the circle in Avhich this absurdity revolves is so small that it touches nobody, a man is only called singular. But if its orbit is so extended to run across the path of others, he is insane."* When the body is healthy and the mind sound, our beliefs, emotions and actions are induced by mental processes more or less complete, more or less accurate, but in all cases there is some kind of foundation for our belief, we believe because we have evidence, good or bad. But the insane believe without evidence. Persons Avho have recovered from mental de- rangement, say they had no reason at all for believing as they did in ab- surd and impossible things ; there was the thought in their minds Avith the undoubting confidence in its truth ; buthoAV it came there they knoAV as little as how it Avent aAvay. Some persons on the verge of melancholy say they are wretched, but knoAV not why; that they have everything to make them happy and yet feel no interest in life, they feel a wretch- edness for which they can give no reason. Some who have murdered those who never offended them, say they are urged to it by a strange * Medical Recorder. 1827, p. 481. MANIA. 399 impulse, totally different from that which urges a sane man to commit such acts. Legal authorities say that to prove insanity it is necessary to prove " insane belief." But in Avhat does insane belief consist ? Is it some- thing either physically impossible or totally groundless ? Many igno- rant persons, not insane, can be led to believe in physical impossibili- ties, while many of the insane are possessed Avith one absorbing idea for which there is a foundation in reason and in fact. The East India captain, mentioned by Gooch, Avho, while a law suit concerning his father's will Avas pending, became insane, and imagined that he had suddenly come into possession of £100,000 a year, had no foundation, whatever, for that belief; but he immediately acted upon it; com- menced an extravagant style of living, offered his physician a carriage and horses ; and at length went abroad to dethrone the Turkish Sul- tan, promising his friend a magnificent seraglio ; all of Avhich, of course, failed of accomplishment. But there are other cases in which" in- sane belief" is founded upon real facts. Legal Definition of Insanity.—" It is our duty to recognize no form of mental unsoundness which is not positively the product of dis- ease." (Dr. Winslow, Lettsomian Lecture, 1855.) A "delusion" is not to be acknowledged unless it be the product of a diseased intellect. Dr. Winslow says : " No notion of the mind how- ever ridiculous, illogical, fallacious, and absurd, should be admitted to be a delusion, or evidence of unsound mind, unless it be obviously and unmistakeably the product of a diseased intellect." The test of insan- ity in all cases should be " the comparison of the mind of the alleged lunatic, at the period of suspected insanity, with its prior, natural, and healthy manifestations;" the consideration " of the intellect in relation to itself to no artificial a priori test." This example is given :—Dr. Forbes (Brit, and For. Med, Chir. Rev., July, 1855, p. 214,) Avas called by a husband to certify to the in- sanity of his Avife, Avhom he found at the first interview raving inco- herently. On further inquiry, and on a second intervieAV, he "learned from her ordinary medical attendant that her raving Avas a very fre- quent and usual exhibition of uncontrolled temper, and that what at first appeared as incoherence was derived from the trifling nature of the cause of the offence. There was nothing whatever unusual in her conduct at the time,hoAvever strange it might have appeared when com- pared Avith the average standard of lady-like manners." 1. MANIA, Consists of an entire perversion and derangement of the intellectual faculties. The patient seizes at the same time upon topics the most 400 diseases of the nervous function. dissimilar, passing from one to the other, without order or arrangement, and reasons, draws inferences and forms opinions without any regard to logic or common sense. The intellect is deranged on all subjects; and the moral qualities indicate their perversion, by ferocity, unnatural hatreds, rage, quarrelsomeness, continual desire to do mischief, and an urgent propensity to carry into immediate effect any fancy which may strike the imagination. At the same time, the patient is perfectly conscious of his identity,—has a kind of idea of right and Avrong, and is fully aware of what he is doing; but the mind operates through a diseased organ, the healthy equilibrium is lost, vague and absurd fan- cies take the place of true perceptions, and the individual is impelled to obey the dictates of his diseased imaginings. Mania is usually unaccompanied by fever, except, perhaps, at its very commencement, although there is a great exaltation of the mental and muscular pow- ers. It has also been observed that maniacs are capable of enduring the most severe bodily inflictions, and the most intense cold, without evincing much consciousness of pain,— also extreme and protracted hunger and thirst, without serious inconvenience. " Insanity," says Dr. Brigham, " often commences in a very insidious manner. Some appear to be deranged only as regards their feelings or moral qualities. They are noticed to be different from what they formerly Avere; to be more restless and sleepless, or unnaturally morose and irritable. Some manifest an unfounded dread of evil, say but little, shun society, and are suspicious of their dearest friends and relatives; while others are unusually vivacious and pleasant, or quar relsome and abusive. Such changes of character and habits will usually be found to be subsequent to some reverse of fortune, loss of friends or sickness, and should excite alarm. Persons thus affected will converse rationally, and in company, or before strangers, will con- ceal their peculiarities; and thus are known to be insane but to very few, until some violent act leads to an investigation, and then it is found they have long been partially deranged. This is the case with most of those who commit suicide. Often insanity exists in a slight degree for months, and it is only noticed by the most intimate friends or relatives, and then suddenly assumes an alarming form, leading, in some instances, to homicide, and in others to self-destruction." Frank asserts that "mania may alternate with hypochondria, melan- cholia, or dementia; that it may be continued, remittent, or intermit- tent. Intermittent mania returns every eight days, every month, every three months, every year, every two years," &c. According to the same author, " mania may terminate by many crises, mucous or bloody stools, vomitings, ptyalism, leucorrhcea, epistaxis, re-establishment of the menses or of suppressed haemorrhoids, varices, eruptions, ery- sipelas and boils. It may terminate by continued or intermittent MONOMANIA. 401 fevers. It may degenerate into melancholia, or dementia. The dis- eases with which maniacs finally succumb, are: cerebral fever, apo- plexy, inflammation of the meninges, phthisis pulmonalis, and ulceration of the intestines." Complete exhaustion, also, of the physical and mental forces is a common termination of insanity. 2. MONOMANIA, Is characterized by derangement upon some particular subject, which constantly occupies the thoughts, to the almost entire exclusion of everything else. When the patient's attention is diverted from the subject of his insanity, he reasons correctly and converses rationally upon all other topics presented to him; and even upon the subject of his derangement he reasons correctly upon his false data. Monomania may be of a gay or of a sad character, but in a majority of instances the monoma.niac dAvells upon a painful train of ideas. Sometimes a prey to the most absurd fears and dreads, as of poverty, being vio- lently killed, suicide, homicide, of having committed the unpardonable sin, or of some serious impending calamity. Sometimes he imagines himself a clock, and stands in a corner of the room through the day, swinging his arms like a pendulum; or an animal, and imitates,.as far as possible, its peculiarities; or that he has no legs or arms, and there- fore refuses to Avalk or help himself; or that he is full, and therefore cannot eat or drink any more; or, like J. J. Rosseau, that all men are his enemies, and are seeking to ruin him. At other times he imagines- himself to be the Savior, or a great prophet, or the emperor of the Avorld, or some renowned statesman, philosopher or general, and swells about, issuing orders suitable to his fancied dignity. Monomania may exist in a light form for a long period, without attracting particular attention. We have at the present time under our care two patients who have tormented themselves a good part of the time for years, and who have reduced themselves to a Avretched state of health, with the dread of committing suicide or homicide; and yet they had the firmness to conceal their morbid condition from their friends. We have knoAvn other individuals Avho have been throAvn into phthisis pulmonalis by silently brooding for a long time over some apprehended misfortune, like loss of property. The mind, like the bodv, requires rest and diversion; one set of muscles cannot be constantly exercised without becoming impaired in their functions; nor can the mind dwell upon a single train of ideas exclusively and for a long period of time without becoming deranged. This malady, like mania, may be continued, remittent, or intermit- tent. The cure is generally preceded by some crisis, either physical or moral. The physical crises are : eruptions, sweats, vomitings and voi. H.-2G. 402 diseases of the nervous function. diarhoeas, tumors, fevers, acute inflammations of the brain. The moral crises consist of all those emotions or passions which, by violently pressing the brain, are capable of exciting a new action, Avhich shall supersede the morbid affection. Under this head may be ranked sud- den and startling news, fright, rage, violent grief, &c. In some cases the reasoning power is impaired, but not Avholly lost. Such persons sometimes reason with extreme acuteness, at the same time that they are deficient in the poAvers of perception. They reason from false premises, as we see many persons who are acknoAvledged to be sane, though their minds are not of the strongest. In the truly insane, the imagination very generally usurps authority over the rea- soning faculties ; and then the mind is like a ship in a stormy ocean without helm or rudder, driven before every wind. All persons in Avhom the imaginative faculty, or "Ideality" is very active, occasion- ally betray something of its preponderance over the reasoning power; thus,—as said by Dryden : '* Great wit and madness nearly are allied, And thin partitions do their walls divide." Insanity presents itself in various aspects, according to the causes in which it has originated. Some are gay and seemingly happy; some imagine themselves superior beings and assume the importance of their supposed situation; some are delighted Avith floAvers, some with play- things: some are revengeful and furious; others are silent. And thus, under their various delusions and imaginary joys or sorrows, they drag out the Aveary months and years of a blighted life. In one respect they are all alike : all have incoherency of conception and incongruous ideas on at least one subject, which may have caused their malady. Some consider themselves utterly miserable, and resort to various efforts to drive out their anguish of mind. They laugh, scream, cry, and especially seek to obtain ardent spirits and tobacco. Some previously silent and gloomy, become lively and loquacious as .jsoon as tobacco is given them, or ardent spirits promised; they are cunning, suspicious, alive to injury, and quick at avengino* it. The legal decision of the question of insanity is one of the most im- portant as well as the most difficult ever presented to a court of justice. It may involve the punishment of an individual with death for the com- mission of an act. the moral guilt of which he is, from his unhappy state of mind, unable to judge ; or the imprisonment of a sane man Avho, driven by rage, and perhaps impetuosity of temper, may exhibit some of those manifestations which the inexperienced and ignorant may call signs of madness. In either of these cases, and a vast num- ber more, the greatest injustice and cruelty have been committed through the ignorance of physicians and the wickedness of desio-nino- MONOMANIA. 403 men. In every case we should be extremely cautious. The inexperi- ence 1 should never give a positive opinion in a doubtful case. The probable motives by which an accused person could have been actu- ated must always be thoroughly studied, remembering that the state of mind at the time of the trial may differ widely from its condition at the time of committing the crime. The investigation of a case of insanity requires the highest degree of professional skill, the most scrupulous delicacy in approaching the subject, an exquisite tact and ingenuity in tracing symptoms to their source, the most profound knowledge of the secret springs of human action, and all the diversified considerations by which the mind may be arrested, awed or conciliated. It will only be by acquiring an almost despotic ascendancy over the individual whose intellect is " lost in the stormy desert of the brain," that the physician can penetrate to the deeply hidden fountains of mental disquietude, and secret sources of physical disease. It will only be by gaining an intimate knowledge of the reciprocal action of mind and body on each other that the mystery of a perverted intellect can be comprehended. Distinction between Real and Feigned Insanity. Real Insanity Feigned Insanity. When the paroxism of the real mad- man is over, he tries to conceal his ma- lady ; he feels the unhappy infirmity . of his nature, and shrinks from obser- vation. There is 4 peculiar cast of countenance which the experienced can detect, and which is difficult to counterfeit, parti- cularly the sudden transition in the ex- pression of the eye, from an unmeaning vagueness to a flushing intensit}', when particular actions or passions are ex- cited. All the organs of sense are perverted : he will bear the most offensive effluvia and the most violent noises. He is wholly inattentive to physical wants, can endure long watchfulness ; though all insane patients cannot equally en- dure privations. He tries to convince you that he is not insane, and this effort furnishes the strongest evidence that he is so ; he alwaj-s betrays a morbid watchfulness to see if you suspect him of it. So far from endeavoring to give convincing proofs of his insanity, he The pretender to insanity is apt to overact his part. In company he is boisterous; when alone silent. He finds it difficult to sustain his assumed character for any length of time. He endeavors to give convincing proofs of his madness. Some are so acute as to deceive us in this point; but so badly does he imitate the expression, and so difficult is it to keep up the de- ception that his powers of endurance fail, where one truly insane would per- sist for an indefinite time. He finds it a difficult task to srramit to the long watchings, fastings, and ex- posures to cold that the really insane endure without noticing them. He can- not avoid sleeping; he cannot mimic the solemn dignity of real madness, nor imitate the peculiar expression. 404 DISEASES OF THE NERVOUS FUNCTION. shrinks from observation ; but betrays in every look that he is afraid you think him insane, just as a dishonest man fears somebody will suspect him of dis- honesty ; and when reason returns he avoids the most remote allusion to his malady. He feels the humiliating con- dition which it has pleased the Al- mighty to permit to fall upon him ; and instead of being clamorous and deter- mined to obtain his freedom, he seems insulted if his disease be alluded to ; he is silent, submissive, unobtrusive, and deeply humiliated. In real insanity we often see displays of astonishing intellectual efforts exhibited in a great many different aspects; but we more fre- quently see these displays in the exercise of the imaginative than the reasoning faculties. The dramatic poet Lee, wrote the Tragedy of Nero and several other plays in the Bethlehem Hospital for lunatics; and was, at times, excited to the fury of the wildest maniac. And yet all his plays were acted with applause before the same people who were only beginning to appreciate Shakspeare. Another English poet wrote a poem descriptive of his melancholy situation. Christopher Smart wrote his verses on the walls of his cell. Shakspeare, the mas- ter of the human passions and of the human heart, delineates in Ham- let and in King Lear the different forms of madness arising from grief. In Lear we see the characteristics of an arbitrary monarch, defying the fury of the elements ; in the beautiful Ophelia the fondness,for floAvers, and the various emblems of sorrow. In Hamlet Ave have a form of in- sanity more feigned than real, Avhich has perplexed jurists as well as physicians. Physical Symptoms of Insanity.—The eyes are more frequently dark; and the hair dark and dry; complexion SAvarthy, secretion from the nose diminished. Dr. Hill says maniacs have a peculiar foetid odor emitted from the body. This is certainly not universal, but we have personally remarked it in a large number of cases. Arterial action is generally increased in the insane. Dr. Rush says it is generally stronger than in health. In 1794, two men Avere con- demned to die for high treason against the United States, in one of the western counties of Pennsylvania. One of these was said to have be- come insane after sentence of death had been pronounced upon him. A physician consulted declared the insanity feigned. President Wash- ington ordered a consultation of physicians. Drs. Shippen, Griffiths, ^nd Rush examined the man and were not satisfied Avith the symptoms presented. Dr. Rush thought that the acceleration of the pulse " to monomania. 405 more than twenty beats above what it would be in health," would justify the decision that the man was insane. Dr. Shippen ascribed the quick- ness of the pulse to fear. We could not now accept the opinion of either of these great men as correct. But the influence of Dr. Rush prevailed Avith the President, and the man was pardoned. But the most difficult cases that come before the court, involving the existence of insanity, are those in which it is the desire and interest of the insane person to conceal his malady. On this point Lord Erskine on one occasion said: "It is agreed by all jurists and is established by trie laAV of this country and every other country, that it is the reason of a man which makes him accountable for his actions, and the absence of reason acquits him of crime. This principle is indisputable; yet so fearfully and wonderfully are Ave made, so infinitely subtle is the spiritual part of our being, so difficult is it to trace with accuracy the effect of diseased intellect upon human action, that I may appeal to all who hear me, Avhether there are any causes more difficult, or which indeed-so often confound the learning of judges themselves, as Avhen insanity or the effects and consequences of insanity, become the sub- jects of legal consideration and judgment." On another occasion the same great lawyer said: on one case he used every effort in vain before a court to prove an individual insane, until Dr. Sims came in and ex- plained the nature and cause of the malady. His lordship then ad- dressed the patient on that point, and he quickly evinced insanity to the full satisfaction of the court. The descriptions of melancholy by Shakespeare are always accu- rate : " I have of late, wherefor I knoAV not, lost all my spirits,—for- gone all custom of exercise; and indeed it goes so heavily with my disposition, that this goodly frame, the earth, seems to me a sterile promontory; this most excellent canopy, the air,—look you, this brave overhanging firmament, this majestic roof fretted with golden fires— why, it appears no other thing to me than a pestilent congregation of vapors." In all the forms of madness Shakespeare's portraitures are acknowledged to be as faultless as his intuitional analysis of human characters as exhibited in men in their normal state. It has be'en supposed that he made the subject of insanity a particular study, as Crabbe and Scott certainly did after him. The various forms of the malady he has described—the perfect keeping of each throughout the complications of dramatic action—the exact adjustment of the pecu- liar kind of madness to the circumstances which introduce it, and to the previous character of " the sound man," leave us lost in astonish- ment. His test of madness giA'en in Hamlet has been employed by physicians in determining the existence of the malady when other tests had failed to detect it. -406 diseases of the NERVOUS function. " Ecstacy! My pulse as yours doth temperately keep time And makes as healthful music. It is not madness That I have uttered ; bring me to the test, And I the matter will ee-woru which madness Wouldyambol from." A case of this is given by Halford. Of the authors of our time none have more correctly described in- sanity than George Crabbe. He made it a subject of such special study that he has been styled by a philosopher " the anatomist of the human soul;" and Byron characterized him as "nature's sternest painter, yet the best." Pathology.—The pathology of insanity has perplexed all writers who have attempted it. Men afraid of encouraging materialism have represented the mind as so entirely independent of the body and so far above it, as to be entirely beyond its influence. And, finding no means of reaching the mind, except through some of the sentient avenues of the body, they have abandoned the subject of insanity as one that the physical agencies of material medicines cannot reach. Our theory is that insanity ahvays, when not dependent on, is, at least, associated with physical disease of the body. The extent of physical derangement is different in individual cases, and hence, its mental manifestation may be various. 1. The gradual development of mind from infancy to manhood, and then its diminution in poAver as old age approaches, is in exact propor- tion to the development of brain,Avhen the influence of education and disease are taken into the account. 2. Insanity is a hereditary disease, as weak digestion, deranged hepatic systems, and other peculiar organizations descend from parents to children, and no one hesitates to refer these to the organization. 3. Insanity occurs at all periods of life when the mind is at the highest activity, Avhen the organization is most perfectly developed, and in the highest degree of activity; hence it is more liable to be over-excited and thus become diseased. 4. Bodily injuries do often produce insanity. Early dyspepsia, hard study, or labor without rest produce it. Females, during menstruation pregnancy, and after delivery, often become insane from the influence of poAverful and peculiar actions going on in the system. 5. The influence of the weather on insanity, shows it to be a disease affected by those influences which operate upon the body. The sup- posed influence of the moon on this disease gave rise to the name " lunacy." Cerebral Hemispheres.—Physiologists are agreed " that the gray matter of the cerebral convolutions is the true middle point at which PATHOLOGY. 407 mind touches matter; where impressions become sensations; and the will develops itself into action; and in whose generated force alono (in the present state of being) the intellect finds its means of opera-' tion. With the gray matter of this centre no nenre is directly con- nected ; but multitudes of white fibres pass from its cells to unite it with the motor and sensory centres, the ganglia at the base of the brain. " Morbid affections of the gray substance of the cerebral hemis- pheres alone, Avill manifest themselves in various derangements of in- tellect. They arise either from deficiency or super-abundance of the quantity of blood supplied to them, or from vitiation of its quality; from the irritation of various poisons, generated within or introduced from Avithout, or from idiopathic inflammation of the substance itself. To this head belong syncope, coma, and delirium in their various shades and complications. Whenever these symptoms appear, whether as the result of disease or of drug-action, Ave may be sure that the cerebral hemispheres are directly or indirectly affected."* To understand these morbid conditions, if Ave imagine the process of secretion " arrested by cutting, off the supply of blood," Ave have syncope. The Avant of blood may arise either from insufficient action of the heart, or from contraction of the cerebral arteries; the former being the cause of the syncope of Digitalis, the latter that of Hy- drocyanic-acid. On the other hand, when the cerebral hemispheres are oppressed by abnormal congestion, Ave have coma, not the "spurious hydrocephalus of Gooch and Marshall Hall, which is merely a state of cerebral 'exhaustion, for Avhich Zinc is, perhaps, the pathogenetic analogue," but the true coma, corresponding to oppressed secretion from congestion or effusion; and it corresponds in the former case to Opium, and in the latter, perhaps, to Hellebore. Simple inflammation of the brain gives, first, increased generation of force, on account of active determination of blood, and secondly, perverted secretion through the irritation of the cells. The first effect of Opium is increased secretion Avithout perversion; while Belladonna, with its congeners, Ilyoscyamus and Stramonium, produce perverted secretion, without increase (delirium) or with increase (mania)." Induration of the brain, from long-continued sub-acute inflammation, is a frequent cause of insanity. In recent and slight cases of this malady, the intellectual faculties exhibit no very prominent derange- ment, but as the induration progresses and extends, the hallucination becomes more strongly pronounced, until eventually complete fatuity is the consequence. Solly believes that chronic inflammation of the dura mater is a very frequent cause of insanity. In post-mortem ex- * Dr. Richard Hughes, on the Nervous System, London, 1S61. t 408 DISEASES OF THE NERVOUS FUNCTION. animations of those who have died demented, Esquirol has observed softening or increased density of the brain, adherence of the arach- noid, thickenings, atrophy and defective organization of the brain or cranium. See Vol. L, p. 702. In monomania, Pinel, Frank, and Esquirol assure us, " that organic lesion of the lungs and abdominal viscera, are more frequent than alterations of the brain." The latter writer supposes displacements of the transverse colon, to be amongst the most common of these derangements, and this is supposed to account for the constipation and the pains in the epigastric region, which are usually present in this variety of insanity. Many cases have been reported in which no organic lesions have been found after death, either in the brain or the a.bdominal cavity, and on this account some authors recognize a nervous or vital mono- mania. It is probable, hoAvever, in all cases of mental derangement, that either the brain or its membranes are in a diseased condition, although our ordinary modes of examination may not enable us in all cases to detect it. But Avhether our perceptions be able to detect the departure from true physical health or not,, we are satisfied that every form of mental derangement is associated with physical disease of the brain. It may not in all cases, or even in a majority of cases, originate there. It is a true neurosis, at least, and often originates in the diges- tive system. The nervous system of the stomach is, in every case of morbid sensibility of the stomach, reflected on the encephalon, which is then secondarily affected, giving rise to all the extravagant and in- congruous imaginations of the hypochondriac. The direct influence of the condition of the brain upon the mind may be seen in a few well- marked phenomena, observed by unquestioned authors. Sir Astley Cooper says : " A young man had lost a portion of the skull just above the eye-brow; I distinctly saw the pulsation of the brain; it Avas re- • gular and slow; but at the same time he Avas agitated by some opposi- tion to his Avishes, and directly the blood Avas sent with increased force to the brain, and the pulsation became frequent and violent." If we omit to keep the mind free from agitation, our other means in the treatment of injuries to the brain will be unavailing. (Lectures on Surgery, Vol. 2, p. 279). Effect of Sleep on the Action of the Brain.—Blumenbach saw in one case the brain sink when the patient AA'as asleep, and swell a^ain Avith blood the moment when he di\s6ke.— (Elliotson's Edition, p. 283.) Dr. Perquin says he saAV in the Hospital of Montpellier, in 1821, a female who lost a portion of the scalp, skull, and dura mater. When she Avas in a dreamless sleep, the brain Avas Avithout motion, and lay within the cranium. When sleep was imperfect and agitated by dreams, the brain moved and protruded without the cranium, forming CAUSES OF INSANITY. 409 lernia cerebri. Vivid dreams protruded it considerably; wakefulness still more. A similar case is given in the Med. Chir. Review, (Oct., 1833, p. 336.) When excited by fear or anger, the young man's brain protruded greatly, so as to disturb the dressings, and throbbed tumul- tuously. Thus the brain, like the muscles, is more fully supplied with blood when in a state of activity than when at rest. Change of Size of the Brain.—Sir Charles Bell says : (Anat. Vol. II., p. 390), "We have found that the bones of the head are moulded to the brain; and the peculiar shapes of the bones of the head are determined by the original peculiarities in the shape of the brain." Again : " I have seen one striking instance of the skull de- creasing in size with the brain. It occurred in an individual who died at the age of thirty-two, after having labored under chronic insanity for upAvards of ten years, and Avhose mental weakness advanced in proportion to the shrinking of the skull. The diminution of his head in size attracted his own attention during life." CuvieT is still more explicit. He says : " In all mammiferous animals the brain is moulded in the cavity of the cranium which it fills exactly. So that the description of the osseous part affords us a knowledge of, at least, the external form of the medullary mass within." " Magendie says "the only Avay to estimate the volume of the brain in a living per- son is to take the dimensions of the skull." Delirium .characterizes inflammation of the periphery and is com- monly Avanting in inflammation of the deep-seated portions. Delirium marks disease in that portion of the brain in Avhich the mental organs are located by the phrenologists. Arachnitis.—" There is a remarkable difference between the symp- toms of arachnitis of the convexity of the brain and that of the base. The researches of some celebrated French pathologists led them, after a most careful series of investigations, to adopt this opinion, which is borne out by my OAvn observations and appears to me to be founded in truth. In arachnitis then of the convexity of the brain, we have per- manent and violent symptoms ; early and marked delirium; sleepless- ness, and then coma. But in arachnitis of the base of the brain the symptoms are more latent and insidious; there is some pain,'and the coma that follows is profound; but there is often no delirium. Patho- logy shows that we may have most extensive local disease in the central parts of the brain, that we may have inflammation,suppuration, abscess, and apoplexy, without the slightest degree of delirium." In- deed the central portions of the brain appear more connected with another function of animal life—that of muscular motion and sensa- tion.—Dm Stokes, Dublin. Cai;sks. — The causes of insanity may be divided into physical and moral. Physical Causes.—Injuries inflicted upon the Head.—Dr. 410 DISEASES OF THE NERVOUS FUNCTION. WinsloAV says; " The importance of this subject cannot be exaggerated. Repeatedly have I found cases of epilepsy bidding defiance to all treatment, tumors, abscesses, cancers, and softening of the brain, as well as insanity in its more formidable types under my care, whose origin could unquestionably be traced back, for varying periods of one, tAvo, five, eight, ten, fifteen, and even twenty years, to damage done to the delicate structure of the brain by injuries inflicted upon the head! Injuries of this character occurring in persons of a strumous habit,.or to those suffering from long-continued debilitating diseases, impaired and perverted nutrition, over-wrought and anxious minds, or inheriting a constitutional liability to mental or cerebral disease, are frequently followed by serious and often fatal results."-* Poisons, hysagria.—Persons not of sanguine temperament. Anger, with just indignation. Staj>Jiysagria.—Vexation, accompanied by just and violent indigna- tion, and abhorence of the thing that has occurred; he rejects every thing that is offered him. IHatinum.—Derangement of mind from anger. Chamomilla.—Violent rage in children, causing convulsions. "±0* DISEASES OF THE NERVOUS FUNCTION. Arnica.—Children A'iolently excited, weeping, Avith frequent attacks of cough. Ignatia.—Grief or shame, the consequence of vexation Bryonia.—The same, followed by cold or chills; the patient is irritable. Colocynth.—Vexation, accompanied with pain in the boAvels, in- creased by taking food. Chamomilla.—Vexation, attended with violent fits of anger and great heat, cough, palpitation of the heart, asthma, spasms in the chest, threatening suffocation; derangement of digestion, manifested by bitter taste, cutting pains in the boAvels, vomiting of bile, headache, fever with heat and thirst, redness of the face and eyes, agitation, bilious fever or jaundice. Pulsatilla.—In persons of a naturally mild disposition, Avhere Colocynth or Chamomilla hove failed. Influence of the Mind on the Body.—Plato says, in his Char- mides, that "all diseases of the body proceed from the soul." The expression of the countenance is mind visible. Bad news Aveakens the action of the heart. Disgust oppresses the lungs and partially suspends all the functibns of the system. An emotion of shame flushes the face; fear blanches it; joy illumes it, and an instant thrill electrifies a million of nerves. Surprise hurries the pulse, delirum in- fuses giant energy. Violent emotion sometimes causes instant death. The influence of depressing mental emotions is too often overlooked. " If a man dies," says M. Reveille-Parise, of the Paris Academy of Medicine, " we open his body, rummage among the viscera, and scru- tinize most narrowly all the organs and tissues in the hope of discover- ing lesions of one sort or another; there is not a small vessel, mem- brane, cavity, or follicle which is not examined ; nothing escapes the eyes of the anatomist." But one thing beyond his eye-si Hit does escape him. "He is looking at merely organic effects, forgetting all the while that he must mount higher to discover their causes. These organic alterations are observed, perhaps, in the body of a person who has suffered deeply from mental distress and anxiety ; these have been the energetic causes of his decay; but they cannot be studied in the dissecting-room. Many physicians of extensive experience are desti- tute of the ability of searching out and understandino- the moral causes of disease. They cannot read the Book of the Heart • and yet it is in this book that are inscribed, day by day, and hour by hour all the griefs, and all the miseries, and all the vanities, and all the fears, and all the joys, and all the hopes of man, and in which will be found the most active and incessant principle of the frightful series of organic changes which constitute pathology." Monomaniacs may sometimes be eured, hoAvever, by indul^ino- them INFLUENCE OF THE MIND ON THE BODY*. 433 in their delusions, and encouraging them in the hope of being able to remove the cause. The late Dr. George McLellan once had a case in point: a highly intelligent merchant Avas firmly possessed with the idea that there was a living eel in his stomach; and he so tormented himself with the delusion that he became seriously ill, and was obliged to abandon business. He had employed many eminent, physicians who all ridiculed his delusion, and endeavored to convince him of its ab- surdity, but all to no effect; the idea continued firmly fixed, and his general health continued to suffer, Avhen as a last resort, and in disgust at the ignorance and obstinacy of all physicians, he called on Dr. McLellan, Avho, on investigating the case, decided to indulge the patient in his delusion; he accordingly assured him that he had a monstrous living eel in his stomach, but that he could gh'e him a me- dicine which would destroy the animal, and carry it off by way of the bowels. Accordingly, a long prescription was written, amounting to a powerful drastic purgative, and the patient directed to take it. At its operation, the attendant was advised to slip a mutilated eel into the vessel, and convince the invalid that it had passed from him. The stratagem succeeded admirably, and the man was directly restored to health, mental and bodily. Frank mentions the case of an individual "who did not wish to urinate for fear of producing a neAv deluge; he was told that if he persisted in his sad resolution, a fire Avould occur and burn up the universe. He hastened to urinate, and his delirium vanished." Another monomaniac believed himself damned; one of his friends, habited as an angel, entered his chamber during his sleep, holding in one hand a flambeau, and in the other a glistening sword. He an- nounced to him in behalf of God the pardon of his crimes, and the patient Avas restored to health. "Another monomaniac imagined there were rabbit-burroAvs in his head. To cure this illusion, they made a crucial incision in his scalp, and showed him bloody rabbits, which they said had retired from the wound." Much, hoAvever, must depend upon the peculiar circumstances at- tending each particular case, in applying our moral treatment; but as a general rule, uniform kindness, respectful treatment, proper discipline, and a perseverance in all those means Avhich tend to direct the mind into new channels, as games, music, gymnastic exercises, mechanical or agricultural labor, exhibitions, &c, will enhance very materially our success in the treatment of this class of maladies. Medical Treatment.—In entering upon the medical treatment of a case of insanity it is necessary: 1. To take notice of all the symp- toms presented in the case before the mental phenomena attracted attention. We need the previous history of the patient. 2. To compare these symptoms with- the physical symptoms which vcu n.—28. 434 DISEASES OF THE NERVOUS FUNCTION. remain, though at present nearly overshadowed by the mental ones, which alone attract the attention of the friends. 3. To note, Avith minute accuracy, all the mental manifestations in detail; and, 4. To compare the totality of the symptoms of the entire case with those of such remedies as can come nearest to furnishing a similar train of symptoms. Thus, Aconite seldom effects a rapid and permanent cure Avhen the temper of the patient is quiet and even; or Nux-vomica, when the disposition is mild and phlegmatic; or Pulsatilla, when it is lively, serene, or obstinate; or Ignatia, Avhen the mind is unchangeable and little susceptible of either fear or grief. Almost all affections of the mind and disposition are nothing more than diseases of the body, in Avhich the changes of the moral faculties (more or less rapidly) become predominant over all the other symp- toms, Avhich are diminishing; they finish by assuming the character of a partial disease and almost of a local affection. Diseases of the 2Lind and Temper, when serious and persistent, are almost always associated Avith some psoric or constitutional dyscra- sia, and can only be effectually cured by antipsoric remedies. But in all other diseases the mind is more or less involved; and none of them are successfully treated by remedies that do not cover all the mental as well as physical symptoms. Sometimes, in a psoric constitution, the mind is calm and gentle until the painful part of the affection is cured ; and then the patient becomes ungrateful, obdurate, or mali- cious, as he had formerly been before the so-called bodily disease shoAved itself. If, in such cases, curing the bodily disease develops another phase of the inveterate psora, Ave must continue our treatment until it is driven from the mind as Avell as the body. Fortunately, Ave have, not only numerous remedies that act directly on the " Mind and Dis- position," in these cases, but we have none that do not so act when mental symptoms exist to call out their powers. In every disease the mental symptoms must be provided for. Remedies.—Insanity.—Aeon., Agar., Ant.-Crud., Arsen., Bell. Cann., Canthar., Caust., Coccul., Con., Cupr., Dulc, Ilyoscyam. Opium, Sec.-cornu., Strain., Sulph., Veratr., Zinc. Insanity, with haughtiness: Hyoscy., Stram., Veratr. " Mirthful: Crocus., Ignat., Stram. " Mild : Croc, Veratr. " Religious: Veratr., Stramonium, Platinum. " Talkative: Stram. '* Furious : Hyoscy., Stram. The remedies which have perhaps been most frequently successful m the cure of insanity are : Opium, Belladonna, Nux-vomica Aeon- INFLUENCE OF THE MIND ON THE BODY. 435 ite, Ignatia, Ilyoscyamus, Stramonium,, Pulsatilla, Veratram, Pla~ tdna, Conium, Ilelbborus, Aurum, aud Aurum-muriaticum. Opium is suitable in all cases of dementia, attended with sopor, stupefaction of the senses ; general loss of mind and sensation; indif- ference to pain or pleasure; strange visions; laborious respiration- constipation, Avith bloating of the abdomen ; face pale, or red, or brown- ish ; diminished temperature of the skin; full and slow pulse; spas- modic movements and trembling of the limbs ; rage with fixed ideas; lethargic droAvsiness Avith loss of consciousness ; mania, with fantasti- cal or fixed ideas, Avhich induce a belief in the patient that he is from home ;' frightful visions, of mice, scorpions, &c.; convulsive movements and trembling of the limbs, anguish, fury; inability to go to sleep, though there exists great sleepiness; constipation with meteorisma; congestion of the head with redness of the face, &c. Delirium tremens. Aconite. — When there are frequent and full pulse, hot and dry skin, thirst, and other febrile symptoms, with congestion of blood to the head, and a general exaltation of the muscular and mental powers, Aconite may be employed to remove this condition. Nux-vomica is suitable for suicidal monomania, attended Avith great anguish, and desire to go from place to place ; also in nervous hypo- chondria arising from derangement of the stomach and liver; also men- tal derangement arising from mortification ; from excessive study; from suppressed haemorrhoids. It is sometimes useful to remove the constipation which is so frequently present in insanity; also Avatery diarrhoea. Nux-vomica is generally the best remedy when insanity follows the excessive use of coffee, Avine or spirits, a night debauch, or excessive mental labor; when menstruation is too frequent; the stomach de- ran <>-ed ; the temper irritable; sad and desponding mood, he is rest- less, feels anguish and desires to destroy himself; 'or is apprehen- sive of death; loss of consciousness, raving, frightful visions, sleepless- ness, unreasonable ansAvers and actions ; paleness and bloatedness, redness and heat of the face, with congestion of the head: stammering, starting and trembling of the limbs, bewilderment and heaviness of the head* fullness and inertia of the abdomen; pressure, heaviness, and squeezing in the pit of stomach, epigastrium and hypochondria; retch- ing or vomiting of ingesta, or of bilious matter; sleeplessness, with starts; is excessively sensith'e to noise, odors, &c, also to light and music; he moans and scolds during the pains; is inconsolable on ac- count of trifles ; is offended at little faults or neglects ; is disposed to censure and quarrel. Hyoscyai^ys.—This drug is capable of producing a species of men- tal derangement characterized by a kind of stupefaction, as observed by many authors cited by Hahnemann. It Avas this form of mental 436 DISEASES OF THE NERVOUS FUNCTION. disease that was cured with this plant by Fothergill, Storck, Ilellwick and Ofterdinger. Hahnemann says: " A man avIio became deranged through jealousy, Avas for a long time tormented by Mayer Ahramson with remedies that produced no effect on him, Avhen under the name of a soporific he one day administered Ilyoscyamus which cured him speedily. Had he known that this plant excites jealousy and madness in persons Avho are in health, and had he been acquainted with the homoeopathic laAv, (the only natural basis of therapeutics), he Avould have been able to select this remedy at the beginning of his experi- ments. Symptoms.—Anxiety and fear; is apprehensive of being betrayed, poisoned, sold or bitten by animals. Loquacious, jealous; phrenzy, rage; thinks he is possessed by evil spirits; throAvs off his clothes; ges- ticulates, makes grimaces, taps upon his head and nose, makes foolish and unmeaning jestures. The mania comes on in paroxysms, alter- nately with epileptic fits; or the patient is sleepless; there is con- tinued delirium, great anguish and fear, especially at night; a desire to run aAvay; visions of dead persons ; fury; raving about business matters ; trembling of the limbs. Belladonna.—Furious and violent derangement, or merry and silly craziness; face red and hot; expression gay, or ferocious with fixed look; eyes brilliant, pupils dilated; head hot; spasms; startings; sanguine choleric temperament; impressible nervous system; derange- . ment after suppression of erysipelas, after meningitis, typhus or apo- plexy. Despondent and wishes to die ; moaning and crying ; anxious, restless, cannot remain quiet in one place. Vertigo ; headache from congestion of blood to the head; sleeplessness with great distress, agitation, unquietude uneasiness and anguish ; frightful dreams, start- ing suddenly from sleep; spasms or stiffness of the limbs; constant inclination to change the position of the limbs; visions, thirst, general sensation of uneasiness and discontent; timidity, disposition to cry or hide himself: he is distrustful and apprehensive of imaginary things, is excessively sensitive. Furious mania; rage, or sadness, despair, un- consciousness, frightful visions of spectres, devils, soldiers, war, bulls, with impulse to run aAvay, or to hide ; mistrust, timidity, fear of death or quarrelsomeness, disposition to spit, strike, bite, and tear everything, or to pull out the teeth; cries, barking, and conversing Avith the dead ; apprehension and fear of death, preference for solitude, Avishes to be alone ; repugnance to conversation; laconic style of speech; apathy, ill humor, irascibility and moroseness; he is irritable; howls and screams, is quarrelsome, breaks out in a rage with convulsions and grit- ting of the teeth; staring look; he does not recognize his own rela- tions; tears, bites, spits, strikes about. He is fitful; excessively mirth- ful, frantic ; he sings, whistles, smiles or laughs; he sees visions of INFLUENCE OF THE MUND ON THE BODY. 437 beautiful or frightful images, ghosts, black dogs ; is delirious, raving; expresses himself in moanings, lamentations, and prayers; ridiculous buffoonery; haggard eyes, with fixed and furious look; puffed face; strong desire to gaze at the sun, or a fire; slaver and froth at the mouth; stammering ; burning thirst or repugnance to drink, with dys- phagia ; jerks and starts; trembling of the limbs and especially of the hands; sleeplessness with agitation, &c. Pathological Anatomy.—Congestion of the vessels of the brain; injection of the vessels of the dura mater, pia mater, and substance of the brain Avith black blood. Clinical Cases.—Dr. Norton says, a case of mania, caused by dis- appointed love, was cured with Ignatia and Belladonna. A case of puerpural mania was cured with Belladonna alone. In this case there was great excitement; also jealousy and quarrelsome mood; the lochia and milk were suppressed; the patient had a destructive tendency, and attempted to strike; was spitting at others. It may be remarked that nearly all cases of puerperal mania are characterized by jealousy, which shows the uterine source of the disease. A third case of mania, attributed to sunstroke, was also cured by Bell. only. The symptoms were : fear, dread, Aveeping, restlessness, talk- ing nonsense, making grimaces. A fourth case of mania Avas cured Avith Bell, only, in four days, after having been long under allopathic treatment. Symptoms: crying, rav- ing, spitting, staring eyes, fearful oaths and imprecations, delusions, foaming at the mouth, difficult deglutition. (See Dr. Belluommi's Monograph on Belladonna) Agaricus-muscarius.—Delirium, stupor, blindness, convulsions, muscular debility, paralysis, and drowsiness. Gastro-intestinal irritation,. nausea, vomiting, purging, and abdominal pain. Depression of the vascular system; pulse small and feeble, extremities cold, body covered with a cold sweat. In some, local irritation alone is seen; in others, narcotism. (Pereira. 2Iater. 2led.) ' Dr. Black* says: "This, like others of the poisonous fungi, exerts a violent action on the brain and spinal cord; it produces excessive sensitiveness to all external impressions ; with Aveakness, tAvitching of the muscles, irregular convulsive movements; desire to dance; so far resembling the action of Belladonna, Stramonium, Cuprum-aceticum, and Lachesis. It excites great sensibility of the skin (in this respect the opposite of Plumbum, Avhich causes cutaneous anaesthesia), so that the slighest pressure produces intense pain; and a very slight blow causes eccbymosis, resembling in the former symptom Silicea, and in the latter Conium and Lachesis. * Brit. Jour. Iloraoeop., Vol. V. 438 DISEASES OF THE NERVOUS FUNCTION. Tartar-emetic has been recommended by Dr. Fleming when there is full hard pulse and hot dry skin, with maniacal excitement. Hepro- poses it in doses that shall produce a general relaxation of the system, free perspiration, soft pulse, and clear skin. He also advises it in puerpural insanity. We do not approve of his use of the remedy in such doses as produce only antipathic effects; but Ave regard it as homoeopathic to many of the physical manifestations accompanying mental derangement: for these its use is highly important. But the crude doses of this drug or any other, though they may occasionally afford temporary relief by creating revulsion to healthy parts, always result in reactions which aggravate the original malady. We should never be misled by apparent benefits arising from the primary action of remedies. The reaction of the recuperative forces against the primary action of all crude drugs, always tends to the production of an opposite and permanent group of symptoms; and the perturba- tions to healthy structures, caused by these primary actions, must necessarily complicate, to a serious extent, any disease already present." (New JIateria 2Iedica. p. 419.) Aconite.—Fear, and presentiment of approaching death; impulse to run aAvay from the house, or from the bed; gloominess, taciturnit}', and laconic style in speaking; paroxysms of anguish, convulsions, cold perspiration, congestion of blood in the chest or head, palpita- tion of the heart, and praecordial anxiety; delirium, Avith laughter and tears alternately. Hahnemann shows that, although Aconite is the true remedy for acute insanity in a febrile or inflammatory form, it can only be suc- cessful in cases in which the characteristic symptoms of Aconite con- stitute the whole case. In other cases it only removes its own part of the disease, leaving the patient only in that state of ill-health in which the acute attack found him. Thus : A patient who previously manifested some dyscratic bodily disease, without remarkable mental peculiarities, is suddenly thrown into strong mental excitement by overpowering emotions, as fear, grief, intoxi- cation, &c.; and is at once pronounced by the friends insane. In such cases, Aconite, Belladonna, Stramonium, Hyoscyamus, or Mer- cury may remove the transient but violent furor, and bring back the psora to its former latent condition. In this condition the friends receive the patient from the asylum and regard him as cured. Though really the real malady has only changed its base of operations, and is not cured, even though he may have taken homoeopathic specifics for the state of mental excitement. A perfect cure can only be effected by the persistent use of antipsorics, Avhich cover both the mental and the physical symptoms." (Organon, § 121.) Case by Dr. Lutze.—An idiotic youth, aged 17, had been pro- SUICIDAL MONOMANIA. 439 nounced incurable at the Royal Prussian Lunatic Asylum. Had in childhood been well; but several years ago an eruptive disease on the head was suppressed by an external application. He then became sleepless; then saw frightful spectra; became delirious with paroxysms of rage and trials to escape. Finally he became taciturn, peevish, and lastly, completely apathetic, so that he was unconscious of his natural wants. Sulphur being indicated by the cause and Belladonna by the symptoms, I gave both medicines (30 in dilution) in alter- nation, six pellets, in a cup full of water, a spoonful morning and evening for four days. On the eighth day he showed improvement, in four weeks gave occasionally a rational answer; in three months he talked coherently, wrote letters to his friends and discovered mistakes in the accounts of an employee. He was completely restored, after all other treatment had failed. Suicidal Monomania.—Dr. J. P. Jousset,* reviews the remedies, which, when tried on a healthy subject, produced phenomena resem- bling those seen in suicidal monomania. 1. Anxious Suicide.—Anxious desire for death. Arsenicum, Aurum, Bell., Carbo.-veg., Hepar.-sul., Merc, Nux-vom., Pulsatilla, Rhus-tox., Silicea. Arsenicum, Nux-vom. and Pulsatilla produce, anxiety with palpi- tations or constrictions of the heart. Bell, and Mercur. develop a longing for death, accompanied by hysterical phenomena and involun- tary crying, which is aggravated at the monthly periods more particu- larly : Arsenicum.—Suicidal and even homicidal monomania. Hahnemann says: The prover is tormented by a fear of not being able to refrain from committing murder; the anxiety is habitually accompanied by heats, tremors of the limbs, palpitations of the heart, oppression; it is generally manifested at night and after meals. On the Moral Treatment of Religious Melancholy.—The following remarks are made by M.Frank: "The physician should endeavor to substitute a neAV passion in the place of the dominant one; for example, hope for despair, mildness for rage, &c. He should care- fully prohibit monomaniacs' from listening to mystical lecturers, or conversations, and all religious discussions. In the mean time, when the delirium consists in the fear of the judgments of God, or want of confidence in his mercy, Ave can sometimes cure the patient by instruct- , ing him in the true principles of religion. But it is not necessary to insist, if the melancholic, instead of relishing the solid reasons which Ave give him, finds in these conversations a new aliment to his delirium. The consolations of religion are ahvays useful to persons whom Medicine Practiquc par J. P. Frank. 440 DISEASES OF THE NERVOUS FUNCTION. reverses of fortune, domestic chagrin, unfortunate love, etc., have plunged into a melancholic state. We have seen a case of melancholia with propensity to commit suicide, fixed by excess of study, and of masturbation; the patient suffered moreover much from hypochondria. Voyages, distractions, and rigid diet produced only momentary relief. The consolations of religion, a rigorous observance of continence and of other Christian virtues gradually operated a cure. We have re- examined this patient at the end of six years ; he enjoys perfect health, and when a sad idea comes to darken his imagination, the most simple practice of religion suffices to restore his mind to calmness and serenity. Religion is capable of operating similar cures daily: it acts upon the heart of man with much more force than all the argu- ments of philosophy. But its happy influence is unknown to the sceptical; and it can hardly be employed on those who need to be argued into a belief in the truths of Christianity, inasmuch as such reasons may confuse the already beAvildered mind of the lunatic. To such we can only hold out such consolations as virtue and true philo- sophy afford. The study of the natural sciences, especially such as cultivate the observing faculties and make small draft on the thinking- powers are ahvays useful in such as can be interested in them." Many cases of religious insanity are successfully treated by moral measures alone; but there is nearly always present some degree of physical disease; and we always have it in our power to prescribe remedies which have power over the physical as well as the mental symptoms. In every case, therefore, some one or more of these reme- dies should be tried. The following are supposed to deserve special attention: Platinum, Sepia, Aurum, Pulsatilla, Lycopodium, Belladonna. In selecting a remedy, the principal difficulty is in the ascertain- ing precisely the seat and source of the melancholy, the corporeal malady Avhich in most cases commenced long anterior to the mental affection. Hence the mere covering of the mental symptoms is not enough for the cure. It is necessary not only to treat skilfully the melancholy which gives the prominent feature of the case, but also all physical diseases that happen to have preceded, or to exist with it. But the greatest obstacles to the cure of religious melancholy arise in the patient's mental surroundings and his social position. The phy- sician avIio does not in himself combine the Avisdom of the physiologist, psychologist, philosopher, as Avell as the theologian, can neither exert the true healing influence upon his patient, nor counteract the inju- rious iufluences of indiscreet friends or incompetent clergymen. Platina.—RaA'ings respecting past events, with singing, laughing, weeping, dancing, grimaces and gesticulations; obstinacy or iras- cibility and quarrelsomeness, vanity, with disposition to reproach SUICIDAL MONOMANIA. 441 others with their defects; contempt for other persons, with inordinate self-esteem; increased sexual desire; constipation and inertia in the abdomen ; excessive anguish and depression of spirits, with palpitation of the heart, timidity and great dread of death; frightful visions, with fear, fixed ideas which lead to a belief that all persons are demons, trembling of the hands and feet; anguish of the heart; absence of mind ; dread of death ; furor uterihus ; constipation; small and feeble pulse. Dr. Gross * gives a remarkable case cured by this remedy. An unmarried lady of sixty years, in the Alpine Valley of Algau, brought up in wealth, but educated to active industry and the forms of religion, became chlorotic at the age of eighteen; menses too early, profuse, painful; had headache, toothache, pains in stomach and abdomen; constipation for years, weakness of the back, weariness of arms, legs, chilliness, expecting death; leaving off work made her worse. She then became low-spirited, weeping, anxiety, nausea, distention of the abdomen; trembling of lower limbs, leading her to seek relief in the open air; thus excited, she could neither sit nor lie ; slept only three or four hours per night; forced to run about much among the people, though repugnance to people remained; before the menstrual periods globus hystericus/ at the age of thirty-two she became enciente; her child soon died. She became taciturn, solitary, devotional. At the age of forty-eight, when the catamenia had been absent for months, followed by leucorrhcea, she confined herself to her room. For twelve years she remained in it. Spent her time in deep meditation, or praying aloud, complaining, weeping, rejecting cooked food. She took no notice of anything; but at night ran about her room Avithout object. A physician bled her, and rubbed croton oil on the stomach. She con- fessed to the priest that she suffered unspeakable pangs of conscience for her former error, believed she had incurred the penalty of dam- nation. "The priest increased her terrors and demanded of her that she should be more devotional and more benevolent. She became so more and more; and, having lost all hope, she approached nearer and nearer to absolute despair. In the still night-hours she bemoaned her misery to the dumb walls of her room, praying aloud, wringing her hands, and beseeching that she might be delivered from the hell of her conscience." Twice during these years she attempted self- destruction ; once by leaping from the Avindow and running toward the river, and next day by attempting to hang herself upon the iron grat- ing of the Avindow. Still she feared death, and did not like to hear allusions to it. In this state treatment Avas commenced by Dr. Gross. In consideration of " the anamnesis, the hysteria with Avhich she had * Homoeopath. Vierteljahrschrift, Vol. IX., part 4. 442 DISEASES OF THE NERVOUS FUNCTION. grown up; the atony of the uterine system, and torpor of the vege- tative sphere, the trembling convulsively from Aveakness ; the weak- ness, almost paralysis ; her being always cold, though the open air did good, rest intolerable; there was no vascular excitement, as during her manifold' nervous attacks she was ahvays pale and shivery; all of these symptoms indicated Platina." Nov. 30, 1855, Platina 6 (decimal,) a doSe given every sixth day. She Avas ordered to be treated Avith affectionate forbearance; allusions to death to be avoided, and injudicious efforts at religious teaching prohibited. Dec. 20. She no longer prayed at night, seemed to sleep more calmly; was less indifferent to what transpired around her; she had improved in other respects. January 4th. She dressed herself; from January 14th she took Platinum 6, one dose a week. It Avas only towards the end of January that she began to speak. Early in March she is completely cured of her melancholy, remembered Avhat she had done, her profuse and unjustifiable alms-giving, with the many masses at the expense to her family of a thaler each. Further Symptoms of Platina.—Fear of devils in pursuit, with calling for help. "Inclination to sit retired in a corner without speak- ing. Want of interest, absence of mind, and short, broken answers. Great anxiety of mind, as if death Avas approaching, Avith great fear of it." Aurum.—Corresponds to religious melancholy, mortification and sorroAV for having done Avrong; grief caused by shame; sorroAV and depression, with desire for solitude; fear that he has lost the love and esteem of others; Avith great grief and weeping; religious anxieties, with weeping and praying; anthrophobia and pusilanimity. Hahnemann says he "cured by means-of gold, several cases of melancholy in persons who earnestly thought of killing themselves. They took in all about the three-hundredth or nine-hundredth part of a grain of gold. I have also cured several other important affections, which Avill be found enumerated among the symptoms of gold." (Chronic Diseases, Vol. I.) A further experiment shoAved him the efficacy of still higher attenuations, and convinced him that the " ten- thousandth part of a grain of gold will manifest a most powerful cura- tive action, especially in cancer of the palate and nasal bones, consequent upon the abuse of the acidulated preparations of Mercury." According to his experience the poAver of gold Avas still farther in- creased by farther trituration and dilution; and he at last gave " only the smallest part of a grain of the decillionth potency." He con- sidered Aurum as especially useful in the following affections : " Hypochondriasis ; melancholy ; loathing of life; disposition to suicide; rush of blood to the head; cancer of the palate bones and nasal bones; obscuration of sight, by black spots hovering before the OINOMANIA. 443 eyes; toothache from rush of blood to the head, with Jieat in the head; inguinal hernia; induration of the testes of long, standing; pro- lapsus and induration of the uterus; rush of blood to the chest; falling doAvn unconsciously, with the face becoming blue; attack of suffocation, Avith severe constrictive dyspnoea; injuries inflicted by abuse of quicksilver; pains in the bones at night; nodosities of the gout." Great anxiety, proceeding to thoughts of suicide; with spasmodic constriction of the abdomen. Hermel says, " Aurum has cured maniacal suicide." (p. 23.) Aurum-muriaticum.—For the treatment of suicidal monomania, accompanied Avith extreme depression of spirits, unrefreshing sleep from frightful dreams, dread of some impending calamity, loss of ambition and energy, diminution of virile strength and a constant disposition to dAvell upon imaginary ailments, 2Iuriate of Gold is a remedy Avorthy of the very highest consideration. Indeed, in cases of this description, no other medicines can bear any comparison with it. Insanity Produced by Alcoholic Drinks.—Oinomania.—The "moral perversion under which many persons labor who are given up to inebriety, disposes some to look upon it as a form of insanity rather than a vicious habit. The change of character often manifest; the periodical abandonment of excessive drinking, till reaching a full de- bauch; the penitence and promises afterAvards ; the craftiness in steal- ing away from friends at these periods of self-indulgence ; the ultimate loss of self-respect in some, and disregard of duties and responsibili- ties of life in all; the maintaining of an irresistible impulse to drink to complete gratification, and Avhen arrested in the midst of a debauch to return to complete it. All these are by some placed to the credit of mental disease, and the destructive vice of intemperance is thus sheltered, and in some persons excused. Unfortunately, not only in the medical profession, but in the pulpit, Ave have advocates for the recognition of this A'ice, in some of its phases, as belonging to some of the forms of insanity." The term Oinomania has been applied to an " irresistible impulse to drink to drunkenness, in disregard to con- sequences or character."* It is only a respectable name, under Avhich this vice seeks a refuge from moral responsibility, and claims the sympathy and indulgence of society in the gratification of an exces- sive appetite, self-induced. Some give way to these paroxysms of intemperance, claiming that the appetite becomes too powerful for re- sistance, others under some slight trouble because somebody has slighted, or Avounded, or Avronged them; or because they have been in some Avay disappointed; or because the world or society have failed to appreciate them, or because they have been weary of life. * Dr. Gray, N. 1". Statu Lunatic Asylum Report of I860. 444 DISEASES OF THE NERVOUS FUNCTION. We look upon each of these cases as the voluntary abandonment of self to appetite as progressive drunkenness, producing Avhat might be well anticipated by vicious self-indulgence, namely, the loss of self- control, and the gradual but sure degradation, and final demoralization of the individual. There can be no doubt that intemperance produces insanity; but this temporary form of it should never be encouraged by admitting that it is in any degree excusable. True insanity is not characterized by " an irresistible impulse to self-indulgence, disregard of consequences, and general demoralization;" on the contrary, " in- sanity," says Dr. Gray, "is an immolation of self. An irresistible tendency exists to thoughts, feelings and actions at variance with the demands of the appetite, and the course of life is anything but pro- motive of self-gratification. In insanity there is but an apparent and temporary demoralization, induced by beclouding of the mind in its knowledge of the relations of things, and the consequent loss, more or less complete, of the abstract ideas of right or Avrong. In insanity, the irresistible tendency has a motive or purpose in view above the simple gratification of appetite; and here disregard of consequences is the result of an absorbing active delirium, or a conviction that the wrong is, under the circumstances, right. We do not desire to with- draw sympathy from the unfortunates who have fallen under intempe- rance, but merely to disavow the theory that it is a form of insanity. Moral and Physical Effects of Intemperance.—-M. Morel says: " One class of men arrivi, at length, by a series of well-marked lesions, physical and intellectual, at general paralysis." Another class, al- though profoundly affected, as regards the innervation, remain station- ary at a point of invalidism, leading a miserable existence, character- ized physically by a special condition of cachexia and marasmus, morally by a manifestation of the Avorst tendencies and the lowest brutishness.* In these melancholy cases Ave see displayed the capa- city of this potent agent in causing degeneration of all the tissues, including the brain and nerves; even when it is not carried so far, similar symptoms are conspicuous: " The hands tremble, especially in the morning; at a later period the tremors continue through the day, being increased by slight exertion, and only relieved by alcoholic stimulants. There is dimness of sight, as if a veil Avere suddenly passed before the eyes; the tongue is tremulous and speech is indis- tinct; the patient is troubled Avith frightful dreams; sensation of in- sects creeping over the skin ; tremors and shuffling gait when Avalkino-* diminished muscular power in the lower limbs, finally, in every part; diminished sensibility of the skin; vertigo, staggering; hallucinations * On the Physical, Intellectual, and Moral Degenerations of the Human Race p. 113 * OINOMANIA. 44 J bo startling and exciting as to banish sleep altogether. He imagines that he sees persons or objects, or hears voices; the pupils become dilated and less sensible than in health."* " The drainer of oblivion, even the sot Beholds blue devils in his morning nrrrors ; And though on Lethe's stream he seems to float, He can not sink his tremors or his terrors. The ruby glass that sparkles in his hand, Leaves a sad sediment of time's worst sand." The deleterious effects of alcohol are transmitted, like other blight- ing influences, to successive generations. M. Morel says, he never witnessed a cure of the disease caused by alcohol in a patient who derived the tendency to alcoholic excesses from hereditary predisposi- tion. In one family he noticed that habitual intemperance in a great- grandfather, entailed upon the first generation : "immorality, depravity, intemperance and brutish disposition; in the .second, hereditary drunkenness, attacks of mania, general paralysis ; in the third, sobriety. hypochondriasis, lypomania, systemic ideas of persecutions, homicidal tendencies ; in the fourth generation, intelligence Avas but slightly de- veloped ; access of mania at sixteen years of age, stupidity running into idiocy, and into a condition involving the extinction of the race." Similar remarks have been made by Drs. Cox, Adams, and Whitehead.-}* INI. Morel, after showing that the use and effects of alcoholic drinks are rapidly extending in the various countries of Europe, as England, Scotland, Ireland, Prussia,, and also in the United States, and in Cen- tral and South America, thus sums up their degenerative influences on the race : "They have invariably the same character in all lati- tudes. New maladies are generated and old ones take on increased fatality; the average duration of human life is lessened ; the vitality of new-born children is less to be depended on, and the disturbances of the moral and intellectual nature become at length signalized by the highest rates of insanity, of suicide and crime." (p. 389.) The effect of habitual intoxication on the mind is thus desoribed by a distinguished politician of this country, who suffered it: '* In that world of all that is high and noble, the human heart; that consecrat- ed temple of 'glorious hopes, and generous purposes, and god-like aspirations and countless joys, known only to the heart of man, the alcoholic poison breaks up the fountains of the great deep of human passion, and converts the mind into a wild and distorted receptacle of passions, lashed into monstrous and phantom forms, by flames, which distil the fountains of human love, and charity, and chastity, and kind- ness, into the red lava of hell's Avorst hate.' And that bright princi- * Dr. Huss. t On Hereditary Diseases, p. 31. i46 DISEASES OF THE NERVOUS FUNCTION. pie of the human intellect, which comprehends the laws that govern the universe and our own mysterious being, instead of being blotted out in darkness, is transformed 'into the wild architect of a Avorld distorted and ideal, peopled with fiends, such as perverted mind alone can conceive, and fraught with sufferings and aironies for Avhich breath- ing nature furnishes no type nor parallel.' " Treatment, see Delirium Tremens. GENUS III.—ALUSIA.—HALLUCINATIONS. 1. Alusia Elatio. Sentimentalism. Mental Extravagance. 2. A. Hypochondriasis. Low spiritedness. 3. A. Hallucinations. Illusions. Dr. D'Boismont, gives the folloAving classification : 1. Hallucinations which co-exist with a sound state of mind. Facts are adduced Avhich serve to prove that the reproduction of cere- bral images may take place without deranging the intellect; and these serve to explain the hallucinations of those illustrious men avIio haA-e been charged with insanity. 2. Simple Hcdlucinations, associated with a greater or less amount of mental derangement. The sufferers are convinced that they see, hear, smell, and taste or touch things imperceptible to others. It is remarkable that these false impressions may exist, even where the organs of some of the senses are defective. Thus the Blind will say that they have seen angels and devils; and the Deaf repeat conversa- tions which they profess to have overheard, and so on. 3. Hallucinations associated with another affection of the senses, to Avhich the name of Illusions is given. Its objects exist, but they produce impressions different from the reality. 4. Hallucinations combined Avith monomania. 5. Hallucinations that occur in delirium tremens. 6. Those associated with catelepsy, epilepsy, or hysteria. 7. Those accompanied by night-mare, or dreams. 8. Ecstacy. 9. Those complicated Avith fevers and other chronic diseases. 10. Epidemic hallucinations. 1. ILLUSIONS OF THE SENSES. Optical illusions are so common that men of science have been often perplexed in endeavoring to account for all the remarkable cases on scientific principles. Dr. David Brewster remarks that, "When we look with one eye there is some object to which we are perpetually blind. With the right eye this point is about fifteen decrees to the ILLUSIONS OF THE SENSES. 447 fight of the object looked at. Place two white wafers three inches apart, on a black ground, at tAveh'e inches distance. Look at the left wafer with the right eye alone, and the other Avafer will disappear. This illusion is caused by the parts of the retina, where the optic nerve enters, being insensible to light." He supposes by this fact may be ex- plained some of the cases of vanishing spectres. Of such cases we shall here only notice such as are obviously connected with disordered health. A literary lady saAV illusions of her husband, of distant friends; she saw a coach driving up, and then the Avhole company it contained changed into skeletons and ghostly visages, and then vanished. At the time of seeing any of these phenomena she felt a pecular sensa- tion in the eyes, and during the six Aveeks, within three of Avhich these illusions Avere seen, she was much reduced by a cough; and long ex- perience proved that they Avere caused by disorder of the digestive organs. She Avas naturally morbidly sensitive. She could feel pain, sympathetically, in a part in which others said they suffered pain ; and can feel pain in the limb Avhich she is told is amputated. She taiks in her sleep, repeats long passages of poetry when in ill health, never failing to quote lines beginning Avith the final letter of the last line, till her memory is exhausted. She thinks she understands the philo- sophy of her own case. A gentleman, of Edinburgh, believed that he was, regularly every day, exactly one hour after eating, knocked cloAvn by an old Avitch-look- ing hag, like one of those that haunted the heath of fairies. Dr. Gregory watched him after he had dined at five o'clock. Exactly at six p. m., the doctor saw him fall into a fit of apoplexy, Avhich always recurred at that hour. A gentleman of the Law Avas Avearing doAvn under an imaginary dis- ease. He at first thought he saAV constantly near him a black cat. At a later time, he saAV always at his side a gentleman usher, dressed as if to Avait upon the Lord Lieutenant of Ireland; this change was folloAved by another more unwelcome—it Avas a human skeleton. And Avhen his physician placed himself in the spot where the skeleton waa seen, the patient said he still saAV the ghost peeping over the physi- cian's shoulder. At this the man of science was startled also, at the thought of the ghost so near. He resorted to other means of cure, but the patient died, having sunk into deeper and deeper dejection. Gleiditscb, the botanist, having charge of the Cabinet of Natural History at Berlin, entering the Hall of the Academy one day, saw the apparition of Maupertois, who he knew was dead. Dr. Brewster says Maupertois had long been President of the Academy, and much favor- ed by Frederick II., till he Avas overAvhelmed by the ridicule of Vol- taire. He then retired almost in disgrace to Switzerland, and died in the family of Bernoulli, the mathematician. And now Gleiditsch per- 148 DISEASES OF THE NERVOUS FUNCTION. ceives him as Avell defined and as perfect as he ever saw him in the body, appearing to one who appreciated him in life, in the hall of his former greatness. Illusions of the Ear.—These are alluded to by Milton as " The airy tongues that syllable men's names, In groves and desert lands and wildernesses." The "Wild Huntsman," was an imaginary sound resembling that of hounds and the noise and other accompaniments of hunting heard in the forests of Germany. That alluded to in a poem of unknown au- thority called Albino, is something of the same kind among the Scots. The hunter imagines he hears the sounds of huntsmen chasing the deer, but can see nothing. " Nor knows, o'erawed, and trembling as he stands, To what or whom he owes his idle fear. To ghost, to witch, to fairy or to