Wm. Radde, Publisher, 322 Broadway, New-York. BOOKS BY THE SAME AUTHOR. ROKYTANSKY'S PATHOLOGICAL ANATOMY ; Translated from the Gor- man, with additions on Diagnosis, from Schonlein, Skoda, and others, by Dr. John C. Peters. 75 cts. Opinions of the Press.—" Dr. Rokytansky's book is no more than it professes to be : it is morbid Anatomy in its densest and most compact form, scarcely ever alleviated by histories, cases, or hypotheses. It is just such a work as might be expected from its au- thor, who is said to have written in it the result of his experience gained in the careful examination of over 25,000 bodies, and who is possessed of a truly marvellous power of observing and amassing facts. In the course of our analysis we have said comparatively little of its merits, the best evidence of which is found in the length to which our abstracts have been carried without passing beyond the bounds of what is novel or important. Nor would this fault have been committed though much more had been borrowed, for no mo- dern volume on morbid Anatomy contains half so many genuine facts as this; it is alone tumcient to place its author in the highest rank of European medical observers."—British and Foreign Medical Review. RUECKERT, TH. J., A TREATISE ON HEADACHES; with Introduction, Appendix, Synopsis, Notes, Directions for Doses, and eighty additional cases, by John C. Peters, M.D., 1853. Bound. 75 cts. "Dr. Peters' book owes its existence to the work of Dr. Riickert just alluded to, but it is no mere translation, indeed it may almost be considered as an original and independent treatise on Headaches. To a certain extent the author has followed Riickert's arrange- ment, and given all his cases and clinical remarks, but Dr. Peters' volume is enriched by more than eighty additional cases taken from sources not accessible to Riickert, to wit, the Frenoh, English and American homoeopathic publications. Scattered throughout the work are many useful practical remarks in the form of notes, and at the end is a good synopsis, of the indications for the employment of the different remedies for headache. There is also an excellent introductory chapter on the nature and causes of headaches, which con- tains much curious and interesting information. We may give the reader some notion of the immense amount of original matter in Dr. Peters' volume, when we state that the number of pages in Riickert's work occupied by headaches is but 68, whereas Dr. Peter's book contains 173 pages of nearly equal size. " Dr. Peters promises a second volume, on Apoplexy, Encephalitis, and Hydrocephalus, still founded, we presume, on the work of Riickert; and if he shall follow Riickert through all his diseases in the manner in which this volume is executed, we shall be forced to admit that the German original has, like a bishop, gained by translation."—British Journal of Homoeopathy. RUECKERT ON APOPLEXY AND PALSY. Successful Homoeopathic Cures, collected from the best homoeopathic periodicals. Translated and edited by J. C. Peters, M.D. With full descriptions of the dose to each single case. 1853. Bound. 75 cts. This is another of the series of able monographs, for which the medical profession is in- debted to the learning and zeal of Dr. Peters. It is founded on Rueckert's Clinical Ex- perience, but contains such large and important additions as to make it essentially a new contribution to medical literature. The number of pages in Riickert's work occupied by Apoplexy is but 18, while Dr. Peters' book contains 164 pages of equal size. The editor or rather author has availed himself freely of the labors of Rokytansky, Hasse, Simon, Lehmann and other foreign medical writers of distinction, as well as his own experience in fifteen years study of Homoeopathy. He is not, however, to be regarded as a professional sectarian. In the treatment of such terrible diseases as Apoplexy, Palsy and Softening of the Brain, he strenuously urges the importance of discarding all considerations of preju- dice, theory or system, and of aiming only at the welfare of the afflicted patient. The Appendix on Softening of the Brain is peculiarly valuable, although the numerous and novel remarks upon the action of many medicines, should not be overlooked.—Medical News. DISORDERS OF MENSTRUATION.—By John C. Peters, M.D. 1853. Bound. 75 cts. This work, which is the first part of a Treatise on " Diseases of Females," by Dr. Peters, we have perused with much pleasure, and have derived information from it. It fulfils in a great measure, the object which the author seems to have had in view, viz.: to ac- quaint us, with all at present known, relative to the functions of menstruation, and the Wm. Radde, Publisher, 322 Broadway, New-York. diseases consequent upon its derangement and irregularity. We may say that we concur generally with the author in his views, as expressed in this work ; in fact we consider the work before us as one of the best, if not the very best, on the subject of which it treats. As a compilation, we cannot too highly commend it. The opinions of the various writers of the highest authority are fairly given, and this without any attempt whatever, to force upon us his own judgment of their views. Allopathy and Homoeopathy are alike dealt with. The style is easy and flowing, and yet clear and pointed withal, which, in a work of this kind, is of no little consequence. Did space permit, we should have liked to have favored our readers, with a few extracts ; but, as from what we have said, the majority of them will, doubtless, deem it their duty to purchase the work, we regret this our ina- bility the less. We look forward with pleasure to the next part of this publication—British and For- eign Journal of Homoeopathy. A TREATISE ON THE DISEASES OF MARRIED FEMALES, including the Disorders of Pregnancy, Parturition and Lactation, by John C. Peters, M.D. Bound. 75 cts. The works of all the leading authorities, upon the subjects treated of, have been freely used, in connection with Dr. Peters' own varied and valuable experience. The treatise has obviously been compiled with industry, care and judgment, and with an eye to sup- plying >a substantial deficiency in the medical library. The subject in its various com- partments is treated clearly and copiously, with no parade of learned and technical terms, but with the simplicity and directness that are essential to the perfect understanding of it. This work is compiled and arranged upon the same plan as the Treatise on Disorders of Menstruation and contains the highest medical authorities upon the subject in question. The various diseases and derangements are considered in a way that will prove acceptable to the profession.—Philadelphia Journal of Homoeopathy. RUECKERT ON DISEASES OF THE EYES, translated by John C. Pe- ters, M.D. Bound. 75 cts. This work is characterized by the same industry and fulness of knowledge, which are found in all the works issued by Dr. Peters. Its style is simple and clear, but comprehensive. The American editor has evidently aimed at the performance of a valuable service to the pro- fession, and at any rate he has accomplished something which may be a valuable beginning. The work will be found a useful one; it is a compilation from the best authorities, and those who have had the most elaborate experience in the treatment of Diseases of the Eyes. The Profession has long wanted a work particularly upon the organs of sight, and we commend this work of Dr. Peters' as being suitable to supply the want; it will be found a convenient manual.—Philadelphia Journal of Homoeopathy. RUECKERT ON NERVOUS DISEASES AND MENTAL DERANGE- MENT, by John C. Peters, M.D. Bound. 75 cents. This is one of a very interesting and valuable series of Treatises for which the medical pro- fession is indebted to the ctreful study, the untiring industry, and discriminating judgment of Dr. Peters. Seven have already appeared and three others are announced as passing through the press. This essay is highly interesting as much so to the non-professional as to the pro- fessional reader. It has a value beyond its merely pathological disquisitions, for it treats of habits of thought and feeling and physical life, with a union of keen philosophical insight and straight forward common sense, which seems to be rare in proportion as it is desirable. The fruits of an extended course of medical reading on the part of Dr. Peters are apparent on every page, and considered as an evidence of scholarship in his profession, the book is highly credit- able to him and to the medical literature of the country.—Medical News. Just Published. RUECKERT ON INFLAMMATORY AND ORGANIC DISEASES OF THE BRAIN, by John C. Peters, M.D. Bound. 75 cents. A COMPLETE TREATISE ON DISEASES OF THE HEAD, including Headaches, Apoplexy, Vertigo, Palsy, Softening, Congestion, Irritation, In- flammation, Dropsy, Tubercular, Hydatids and Cancerous Diseases of the Brain, and Mental Derangement. By John C. Peters, M.D. Bound $3. In Press. A TREATISE ON DISEASES OF THE EYES. VOL. II. Preparing for Press. A TREATISE ON DISEASES OF THE EARS, THROAT AND NOSE. DISEASES OF FEMALES. VOL. III. Or a Treatise on the Diseases of the Womb, Ovaries, &c. A TREATISE ON THE INFLAMMATORY AND ORGANIC DISEASES OE THE BRAIN. INCLUDING: IRRITATION, CONGESTION AND INFLAMMATION OF THE BRAIN, AND ITS MEMBRANES, TUBERCULOUS-MENINGITIS, HYDROCEPHALOID DIS- EASE, HYDROCEPHALUS, ATROPHY AND HYPERTROPHY, HYDATIDS, AND CANCER OF THE BRAIN. BASED UPON TH. J. RUECKERT'S "CLINICAL EXPERIENCE IN HOMOEOPATHY." By JOHN C. P^ETEKS, M.D. NEW-YORK-: WILLIAM RADDE, No. 322 BROADWAY. Philadelphia: Rademacher & Sheek.—Boston: Otis Clapp. London: J. Epps, 112 Great Russell-st., Bloomsbury. Manchester : Turner, 41 Piccadilly. 1855. ?48ztr 185 5 Entered according to Act of Congress, in the year 1855, by WILLIAM RADDE, In the Clerk's OflSce of the District Court of the United States for the Southern District of New-York. Henry Ludwig, Book & Job Printer, 45 Vesey-st. ON THE NATURE AND CAUSES OF IRRITATION, CONGESTION, INFLAMMATION, AND DROPSY of the BRAIN, and its MEMBRANES. I.—IRRITATION OF THE BRAIN. IN CHILDREN. Dr. W. Nickoll has thus designated a state of brain oc- curring in children, which appears to hold an intermediate place between hydrocephaloid disease and that of inflammation. It may on the one hand run into inflammation if neglected; and on the other hand is apt, if treated too actively and allopathi- cally, to be followed by symptoms of exhaustion, and of the Hydrocephaloid disease of Gooch and Hall. In simple irritation of the brain the child is wakeful, scarcely ever sleeping, irritable, highly sensitive to every object of sight and sound; the pupil is in many instances more or less con- tracted, the limbs are in action, the head tossed about; the child cries without any apparent cause ; there is unusual liveli- ness and animation; it wakes suddenly from sleep, and starts at the least noise when awake; the fists are generally clenched, with the thumbs turned in, and the forearms bent upwards on the arms ; and sometimes a degree of opisthotonos is observed, the legs being drawn up, while the head is thrown back. This state of things is usually, though not always, accompanied by increased temperature of the head and of the skin generally, and by an accelerated pulse. A 2 IRRITATION OF THE BRAIN. Some children seem to be much more prone than others to this affection, and it is in the nervous, weakly and scrofulous that it is most frequently seen. There is apparently an origi- nal difference or excitability of the nervous constitution, which predisposes them to be thrown into this state of Erethism; and when this natural predisposition is not present, defective nour- ishment, and a debilitated state of the system are apt to induce it. Any long continued irritation of the nervous extremities, particularly of those distributed upon the mucous membranes, may be the exciting cause of this affection ; hence, painful den- tition, worms, an unhealthy state of the stomach, bowels or liver, or chronic and troublesome eruptions, or sores, or some disease or impurity of the blood, may prove the exciting cause of irritation of the brain or nervous system. When this state obtains, convulsions, it is well known, are apt to occur. The most deceptive part of the disease js, that the preter- natural excitement and mobility of the nervous system is apt to give rise to excitement of the heart and arteries, and determi- nation of blood to the head, from the excited condition of the brain. If the case be regarded as one of active congestion or commencing inflammation of the brain, and treated allopathical- ly and antiphlogistically, irrespective of the peculiar state of the nervous system, exhaustion win speedily follow, and the symptoms of reaction and excitement from loss of blood will be added; if the same treatment be still pursued, the case will soon end fatally, and probably be attended with effusion of water into the ventricles of the brain. If the body be examined after death, the effusion will of course be detected, and will be presumed to have been the cause of death ; but the real truth is, in certain states of the nervous system, unpreceded by any great cause of exhaustion, an increased quantity of blood may be thrown to the brain, and give rise to all the symptoms of the first stage of an inflammatory affection, but which cannot be removed by the ordinary allopathic antiphlogistic means, as these will aggravate the original excited condition of the brain and nervous system, inducing new and still more dangerous symptoms, causing the case to terminate- fatally, with all the signs of an advanced stage of dropsy of the brain. In older patients these cases are apt to be attended with / IRRITATION OF THE BRAIN. 3 much delirium; Watson says they seem to be, but are not, cases of Meningitis of any kind. Abercrombie refers to them as instances of a very dangerous modification of inflammation of the brain, which shows only increased vascularity, without any of the other signs or effects of inflammation. Watson very decidedly asserts that he entertains no doubt whatever, about the nature of these cases, viz.: that they are not exam- ples of inflammation at all, for they neither show the anatomical characters of inflammation, nor do they yield to the remedies for inflammation. In short, they were made to terminate fatally by Abercrombie's outrageous system of extravagant blood- letting. Apoplexy according to Abercrombie, may also arise from exhaustion, and terminate fatally, when treated actively by blood-letting, &c, without any morbid appearance being found in the brain after death, or with appearances so slight as to be altogether inadequate to account for the symptoms, or fatal termination of the case. (See treatise on Apoplexy.) Abercrombie himself admits that in four fatal cases of Apoplexy, all the usual allopathic remedies were used in the most active manner without the least effect in alleviating any of the symptoms, and on inspection after death, either no ves- tige of disease could be discovered in the brain, or at most there was but slight fulness of the blood-vessels, insufficient to ac- count for death, which was doubtless caused by the too active treatment. Treatment.—Nicholls says that judicious treatment will throw muchl ight on the pathology of these cases. If there be any manifest cause of irritation present, either from teething, or a disordered state of the bowels or liver, and this be removed and the child then placed in as quiescent a state as possible, by excluding it from light and noise, and every source of excite- ment, giving a dose or two of some sedative, and nourishing but unstimulating diet, and subsequently a gentle tonic, all the symptoms of brain disease will vanish. The most homoeopathic remedies are: Coffea, Cannabis, Thea, Ignatia, Nux. If these fail to afford relief; Conium, Hyosciamus, Opium, Asafoetida, Chamomilla or Valerian may be tried. Coffea, Thea and Cannabis may be used when the attack 4 CONGESTION OF THE BRAIN. has been brought on by excessive and pleasurable excitement, when the child is so excited and lively as to be almost uncon- trollable, with sleeplessness, i. e. when the grey substance of the brain, and the senses or intellectual faculties are principally aroused, and stimulated. Nux and Ignatia are the principal remedies, when the white substance of the brain, and the motor track and nerves are implicated ; when there is a tendency to twitching, starting, &c, especially if the attack has been brought on by a fit of passion, vexation or disappointment. Hyosciamus and Opium are the antagonistic remedies for Coffea and Thea, and may be used when these remedies seem indicated but fail to afford relief. Conium is the antagonistic remedy for Nux and Ignatia, and may be given when these fail to afford relief. # II.—CONGESTION OF THE BRAIN. IN CHILDREN. According to West, Congestion of the Brain is a very fre- quent disorder in young children; he quotes Dr. Mauthner in proof, who on examining the bodies of 229 children, dead of various diseases, found a congested state of the blood-vessels of the brain, in no less than 186. West assumes that the brain in infancy is much more exposed to congestion and irritation, than that of the adult, owing to the far wider variations of which the cerebral circulation is susceptible in early life than subsequently. Nor is the cause of this difficult to discover. The skull of the adult is a complete bony case, and the firm substance of the brain, affords a comparatively unyielding sup- port to the blood-vessels by which it is nourished. The varia- tions in the quantities of blood which the brain of the adult contains, must needs be circumscribed within far narrower limits than in the child, whose cranium, with its membranous fontanelles and unossified sutures, oppose no such obstacle to the admission of an increased quantity of blood, while the soft brain keeps up a much slighter counterpressure on the blood- vessels than is exerted by the comparatively firm parenchyma CONGESTION OF THE BRAIN. 5 of the organ in the adult. Hence, if the circulation in the child be disturbed, whether from difficulty in the return of venous blood, as during a paroxysm of whooping cough, or from increased arterial action, as at the onset of a fever, or during the acute inflammation of some more or less distant organ, the brain becomes congested, and delirium, or stupor, or convulsions often announce the severity of the consequent disturbance of its function. The same causes too, which expose the brain to be over-filled with blood, render it possible for it to be drained more completely of its blood, than in the adult. This fact should always be borne in mind, when treating the diseases of infants, for debility, exhausting discharges, and especially ex- cessive allopathic depletion will often quickly induce a blood- less state of the brain, and all the symptoms of Hydrocephaloid disease. Hence, in the treatment of diseases of children, the physician must be constantly on the watch against congestion of the brain, as a condition which is very likely to come on, in the course of the most various diseases, and of affections even of quite distant organs. But it is not merely as a serious compli- cation of many other diseases, that this congestion of the brain in children deserves notice : its importance depends still more on its constituting the first and curable stage of many diseases of the brain, which, unless arrested at the outset, soon pass beyond the resources of our art.—West. Congestion of the brain may arise from irritation; from the presence in the blood of the poison of some eruptive disease, such as scarlet fever, measles, or small-pox; or the brain may become actively congested at the time of teething, or from fe- verish irritation of the whole system, or from exposure to the sun, or from a blow upon the head, or from the fever of inflam- mation of some distant organ, such as the lungs, stomach, or bowels, &c. Or a state of passive congestion may be induced by some mechanical impediment to the return of blood from the head, such as the general spasmodic compression of the blood- vessels such as occurs in general convulsions, or during a fit of whooping cough ; or from the pressure of an overloaded stom- ach, or liver, or enlarged thymus or bronchial gland. Finally, passive congestion, may be merely the result of a languid cir- 6 CONGESTION OF THE BRAIN. culation, arising from debility, or exhaustion, or want of pure air, or of nourishing and sufficient food, such as occurs in diarr- hoea or summer complaint, in which the child not only has a great drain upon the system, but either is unable to take or does not receive a sufficient of nourishing food, from a mistaken policy on the part of the physician. Intense congestion of the brain is not a very unusual conse- quence of the irritation of the brain and nervous system, from the presence of the poison of some eruptive disease in the sys- tem, or from the acceleration and disturbance of the circulation at the outset of the eruptive fevers. Convulsions and apoplec- tic symptoms then, sometimes, come on suddenly in a child, previously to all appearances, in perfect health, and may even terminate in death in less than twenty-four hours. The brain will be found loaded with blood, but all the other organs of the body are quite healthy. We may be at a loss to account for such sudden and severe symptoms unless measles, scarlet fever or small-pox are prevailing, or some other child in the family or neighborhood is soon after attacked by one or the other of them. That this train of symptoms often arises from the pre- sence of some morbid poison in the blood, is still more evident from the occasional results of repelling eruptive diseases of the scalp. Thus, Golding Bird relieved a child of Porrigo with external applications in three weeks; for a time it appeared in perfect health, but in the act of crying "Papa," it was at- tacked with a kind of spasm and dropped dead. Dr. Dendy has seen four similar cases, in which death occurred as sudden- ly, all in the respectable classes. When congestion of the brain and convulsions precede the eruptive diseases, these symptoms as alarming as they generally are, comparatively seldom end in death; for they generally disap- pear almost as if by magic, on the appearance of the eruption, ex- cept in those few cases in which the quantity of the poison is so great, that it cannot all make its escape upon the surface; or in which the congestion of the brain is kept up by the intensely feverish state of the whole system. The presence of some irritating substance in the blood, also obtains in those cases in which convulsions, or irritation of the CONGESTION OF THE BRAIN. 7 brain arises from suppression of perspiration, scantiness of urine, deficiency of bile or some other secretion. Another cause may aid in keeping up or increasing the pressure upon the brain in feverish disorders, viz.-: an absolute expansion or increase of the volume of the blood; the most marked instance of this is in congestion of the brain from expo- sure to the heat of the sun, even though the head has not been unprotected from its rays. Of this West saw a striking in- stance in the case of a delicate boy, who when a year old, was taken out by his nurse, during one of the hottest days of sum- mer. He was quite well and cheerful when fie left the house, but, after being out for some time, began to breathe hurriedly and irregularly, and his nurse in consequence brought him home. He was restless, fretful and alarmed; his surface generally hot, and his head especially so, the brain pulsating forcibly through the anterior fontanelles ; the pulse too rapid to be counted; the respiration hurried, labored and irregular, and there were constant startings of the tendons of the extremi- ties. The child was on the eve of convulsions, but the tepid bath relieved the heat of the skin, and the expansion of the blood, the pulse fell and the twitchings diminished. Light and sound were excluded ; he fell asleep and awoke in a few hours refreshed and tranquillized, and on the next morning a little languor was all that remained of an illness which seemed likely to prove so formidable.—West. Cooling and soothing reme- dies are required in almost all cases of irritation, congestion, or expansion of the blood. Disorders of the nervous system are very frequent during the period of teething. Many of the symptoms which then occur, are the direct result of irritation of the tri-facial nerve, but others are the immediate consequence of congestion of the brain. Febrile disturbance almost always attends upon the process of dentition, and when the circulation is in a state of preternatural excitement, a very slight cause may suffice to overturn its equi- librium, and occasion a greater flow of blood to the brain than the organ is able to bear. Suppression of perspiration, defi- ciency of bile and scantiness of urine, often occur during denti- tion arid leave the blood overloaded with effete and irritating substances. 8 CONGESTION OF THE BRAIN. According to West, congestion of the brain may come on very suddenly, its symptoms being alarming from the first, and such as to call for immediate interference; or general uneasi- ness, a disordered state of the bowels, which are generally, although not invariably constipated, and feverishness may pre- cede the more serious attack by a few days. The head becomes hot by degrees, the child grows restless and fretful, and seems distressed by light and noise, or sudden motion, while children who are old enough sometimes complain of their head. Usual- ly, too, vomiting occurs repeatedly, a symptom which is not only confirmatory of others, but also may exist before there is any well-marked indication of the head being affected, and when, though the child seems ailing, there is nothing definite about its illness. The degree of fever which attends this condition va- ries much, and its accessions are irregular ; but the pulse is usually much and permanently quickened ; and, if the skull be unossified, the anterior fontanelle (or soft spot on the top of the head,) is either tense and prominent, or the brain is seen and felt to beat forcibly through it. The sleep is disturbed, the child often waking with a start, while there is occasional twitch- ing of the muscles of the face, or tendons of the wrist. The child may continue in this state for many days, and then re- cover its health, with or without medical interference; but, a slight cause will generally suffice to bring back the former in- disposition. Striking instances of this are often seen while children are teething; the fever may subside, the head grow cool, and the little patient appears quite well as soon as a tooth has cut through the gum, but the approach of each other tooth to the surface will be attended by a recurrence of the symptoms. Yet, we cannot alwajs reckon on such a favorable result occur- ring ; for the symptoms above mentioned are sometimes the indications of the system generally having begun to suffer from mischief which has been going on for months unnoticed, and which is now about to break out with all the formidable charac- ters of acute dropsy of the brain. Or, should they have no such serious import, yet congestion of the brain is itself a se- rious and sometimes a fatal malady. Even though on treat- ment being adopted, the heat of the head may diminish, and the flush and heat of the face grow slighter and less constant, still CONGESTION OF THE BRAIN. 9 the countenance may become very heavy and anxious, the indif- ference to surrounding objects may increase, and the child final- ly lie in a state of torpor or drowsiness ; from which, however, it can at first be aroused to complete consciousness. But after being aroused, it soon subsides into its former drowsiness ; the bowels generally continue constipated, and the vomiting seldom ceases, though it is sometimes less frequent than before. The pulse usually becomes smaller than in the first stage, and though there is often irregularity in its frequency, no actual intermission occurs. An attack of convulsions sometimes marks the transition from the first to the second stage ; or the child passes without any apparent cause, from its previous torpor into a state of convulsions, which subsiding, leaves the torpor deeper than before. The fits may return and death take place in one of them, or the torpor growing more profound after each convulsive seizure the child at length dies comatose. The second stage, if it may so be called, is usually of short duration, and if relief be not afforded by appropriate treatment, death is seldom delayed beyond forty-eight hours from the first fit, though no graver lesion may be discovered afterwards than a gorged state of the vessels of the brain and its membranes, and perhaps a little clear fluid in the ventricles and below the arachnoid. Occasionally, death does not so speedily follow these symp- toms ; but they may continue slightly modified for days, or even weeks, and contrary to all expectation, recovery now and then takes place, especially in very young children, in whom the congestion having relieved itself by a copious effusion of water into the ventricles of the brain, the yielding skull accommodates itself to its increased contents. This chronic dropsy of the brain may even admit of cure. Treatment.—The principal homoeopathic remedies are : Glo- noine, Opium, China, Ferrum, Belladonna and Stramonium. If these fail, their antagonistic remedies, Aconite, Digitalis Conium or Veratrum-viride may be used. (See Treatise on Apoplexy.) 10 INFLAMMATION OF THE DURA MATER. INFAMMATION OF THE MEMBRANES OF THE BRAIN. I.--INFLAMMATION OF THE DURA MATER. According to Rokitansky, primary inflammations of the dura mater to any extent, such, for instance, as would lead to the formation of matter, are of rare occurrence, with the excep- tion of those which are brought on by injury. On the other hand, inflammations of slight degree, and usu- ally combined with moderate inflammation of the bones of the skull, are frequent. They are characterized by vascu- larity and rosy-redness of the dura mater, and by softening of its texture ; they give rise to interstitial infiltrations of the membrane with the products of inflammation, as well as to exudations upon that surface of it which adjoins the bone ; such exudations become organized into loose cellular, or thick fibrous tissues, or at length, especially if there be any attendant inflam- mation of the bone, into bone ; and they bring about a preter- natural adhesion to the inner surface of the skull. These patches of inflammation are often widely spread, especially along the sutures ; but sometimes they are confined within a smaller compass, so as to form circumscribed islands. Exuda- tions which become converted into bone are generally spread out into a thin layer like that of puerperal osteophyte ,r they are first spongy, but gradually become compact: sometimes they form a mass of bone which looks as if it had flowed or dropped upon the membrane, and then coagulated; while, not unfre- quently there are circumscribed plates or nodules, which, though they in course of time become intimately united to the bone, yet originally adhered firmly to the dura mater. When the inflammation is more intense, and runs a chronic course, the dura mater acquires an increase in thickness, some- times to the extent of three lines, and even more ; it becomes indurated and callous, and usually adheres more closely than natural to the bone. When the inflammation is brought on by injury, or extends to the dura mater from the neighboring tissues, it frequently INFLAMMATION OF THE DURA MATER. 11 terminates in the production of pus, and in suppurative degen- eration of the membrane. These cases are of great importance, for they are generally secondary to inflammation and suppura- tion of the bone, or of the neighboring ligamentous structures. They are especially apt to occur in certain localities ; thus, the dura mater often inflames, suppurates and sloughs from caries of the bones of the internal ear, and the labyrinth of the eth- moid bone of the nose; from caries of the upper bones of the spine, and suppuration of their ligaments. In the dura mater these processes remain limited and circumscribed, but when they reach the inner membranes of the brain, they usually spread rapidly into general meningitis. Symptoms.—Inflammation of the dura mater according to Watson rarely occurs as a spontaneous disease, but is not at all uncommon as a result of external injury. Its symptoms have been excellently well described by Pott : A man receives a blow upon the head; the blow stuns him perhaps at the time, but he presently recovers himself, and remains for a certain period, apparently in perfect health. But after some days he begins to complain; he has pain in his head, is restless, cannot sleep, has a frequent and hard pulse, a hot and dry skin, his face becomes flushed, his eyes red and ferrety; chills, nausea and vomiting supervene, and towards the end, convulsions and delirium. Meanwhile the part of the head which has been struck becomes puffy, tumid and sometimes tender, and if this tumid part of the scalp be cut through, the pericranium beneath is found separated from the skull; and the bone of the skull itself is observed to be altered in color, whiter and drier than the healthy bone; and if a piece of the bone be removed, it is also seen that the dura mater, on the under side of it is de- tached from the skull, and sometimes smeared with lymph or puriform matter. This is a disease which is often met with by the surgeon. According to South and Chelius inflammation of the dura mater may be acute or chronic. Acute inflammation of the dura mater appears most com- monly from the third to the fifth day after the injury; the pa- tient complains of severe oppressive headache, which spreads from the injured part over the whole head; the heat of the 12 INFLAMMATION OF THE DURA MATER. head is increased; the pulse is small, compressed and rather hard; the patient is heavy and difficult to arouse; his ideas become unconnected, and quiet delirium comes on; and lastly, when the inflammation proceeds to suppuration, the patient falls into a state of continued stupefaction, from which he cannot be easily aroused ; convulsions come on, with continued shivering and irregular pulse; the pupils are wide and fixed; the breath- ing snoring and slow; the sphincters are paralyzed and finally the patient dies. On dissection, the dura mater is found reddened, covered with exudations, and separated from the inside of the skull; pus may be found between it and the skull, and at this part the dura mater is often gangrenous. Chronic inflammation of the dura mater, from injury to the head, often commences only after a long space of time, often after seven or fourteen days, often after a month; it begins With headache, mental and bodily depression, heaviness, un- steady walk, derangement of the stomach, quick pulse ; and in its further course a circumscribed painful swelling of the scalp commonly arises at the place of injury; or, if there be a wound, it becomes pale, and secretes a thin, sanious fluid, which sticks fast to the bandages; The pericranium suppurates around the wound, and the inflammation soon runs into exudation of a yel- lowish, ichorous, purulent fluid, which collects either between the skull and the dura mater, or between the latter and the surface of the brain. The patients sometimes die twelve or eighteen months after the injury. South has seen several cases of this chronic inflammation, which is always a serious disease, and very difficult to control; often indeed entirely un- manageable under allopathic treatment. The patient then goes on slowly from bad to worse ; sometimes with intervals of im- provement, and sometimes without, and will frequently live for many months in a constant state of suffering. According to Watson the next most frequent cause of in- flammation of the dura mater, after injuries of the head, is dis- ease of the internal ear, and of the petrous portion of the temporal bone. Sometimes acute inflammation arises within the tympanum, when there has been no previous disease of the ear : the patient has severe earache ; at length a gush of mat- INFLAMMATION OF THE DURA MATER. 13 ter comes from the external meatus, but the pain does not cease, as it usually does in such cases; it continues, or even increases in intensity; the patient begins to shiver, becomes dull and drowsy; slight delirium perhaps occurs, and by degrees he sinks into stupor. In some instances no pus issues externally. More commonly symptoms of the same kind supervene upon a chronic discharge of purulent matter from the ear, especially as a sequel of scarlet fever. In some of these cases there is no symptom to mark the extensive mischief going on within the head, except the intense pain ; the pulse may not be quickened, the skin may be warm but moist, and there may be neither fe- ver, delirium or convulsions. In other cases, besides the intense pain in the head, there may be vomiting, intolerance of light, slight and transient delirium, a degree of stupor, and slight con- vulsions. In some cases, pus is absorbed from the ear, and diffuse in- flammation of the veins with terrible consequences in various parts of the body may ensue. In such cases the complaint is marked by pain in the head, fever and chills which intermit; and so regular sometimes are the intermissions that the physi- cian may be led to believe that he has fever and ague to deal with ; then pain and swelling of some of the joints may come on, leading to the belief that the case is complicated with rheu- matism ; but the true and alarming nature of the case will soon become apparent; abscesses form in and about the affected joints, and if they be opened, foul, grumous and dark colored matter will be let out. The patient will generally have more or less fever, with dry parched tongue, rapid and feeble pulse, with more or less diarrhoea. In short, in these cases the patient has pain in the ear, with discharge of pus from the external meatus, followed by pain in the head coming on with fever and chills, and followed after a short interval by destructive suppuration in several distant parts ; all forming a chain of presumptive evidence that the fatal mischief finds its entrance into the head and rest of the system through the porches of the ear. Although quotidian paroxysms of fever have been noticed in several cases, still in one case at least the fever bore a tertian type : A young man previously healthy was attacked with fits 14 INFLAMMATION OF THE DURA MATER. of shivering, accompanied by pain on the left side of the head; at first the paroxysms were rather irregular ; but they soon assumed the form of tertian ague, coming on every other day, at about the same hour; the cold fit commencing at noon and lasting about half an hour, followed by a hot fit of somewhat longer duration, and terminating in profuse perspiration. In the intermissions the pain in the head was trifling, there was no thirst or fever, but the patient did not sleep. A tumor formed over the mastoid process, and was opened, giving issue to a quantity of extremely offensive brownish pus, followed by great relief; but in about ten days the pain in the head and ear be- came very severe, with violent shivering fits many times a day, great thirst, heat of skin, vomiting and delirium ; his face was flushed and pulse hard; he soon died. Suppuration of the tympanum and consequent disease of the bone, are more common in scrofulous persons than in others ; and they are more apt to occur as sequelae of scarlet fever, than in any other way. Treatment.—The remedies which act principally upon the sero-fibrous tissues are most specific in this disease, viz.: Aco- nite, Bryonia, Mercurius, Mezereum, Colchicum, &c. When it arises from a mechanical injury to the head, the treatment may be commenced with Arnica, internally and ex- ternally ; when fever arises, Aconite should be used internally, and the Tincture of the Root should be applied freely and re- peatedly to the external surface of the head, avoiding the cut or wounded surfaces ; if the case progresses steadily, Mercu- rius should be given in alternation with Aconite ; if signs of effusion of serum and fibrine from the inflamed membrane arise, Bryonia, Mezereum, Hellebore or Colchicum, should be used in alternation with Mercurius, or the Iodide of Mercury; if the symptoms of purulent exudation arise, Tartar-emetic, or Hepar- sulph., Sabina or Thuya should be given. INFLAMMATION OF THE ARACHNOID. 15 INFLAMMATION OF THE ARACHNOID. ARACHNITIS. The arachnoid membrane is a shut sack, the parietal layer of which is attached to the dura mater, while the cerebral or visceral layer is for the most part blended with the pia mater of the brain. Inflammations of the parietal layer of the arachnoid, are on the whole of frequent occurrence; their pathological import, however, is according to Rokitansky, mostly subordinate; they are met with, from injuries of the skull, from what is called a phlogistic state of the blood, in pyncernia, in the course of acute eruptive diseases, in Bright's disease, and acute biliary dyscrasia. They are commonly slight in degree; the inner surface of the dura mater is then found streaked with delicate red vessels, and is of a clear rosy tint; it is lined with an exu- dation, that may be delicate or greyish, and soft like a layer of mucus; or more consistent and membranous, or yellow, loose and pus-like. In some rarer cases, this inflammation of the parietal layer has all the appearance of being primary, and judging from the amount of its products, also severe. These processes usually take place, and furnish their products without being accompa- nied by any similar disease in the cerebral layer : even in the intense primary inflammation, just alluded to, the change which takes place in the cerebral layer is limited to cloudiness and thickening; the false membrane very rarely produces any ad- hesion between the two surfaces. Inflammation of the cerebral layer of the arachnoid presents peculiar appearances, in respect to the condition of the pia mater. We find 'on the one hand, that, as arachnitis is not usually fatal in itself, or at least not in an early stage, it sometimes leaves traces of its existence, in pretty extensive thickenings of the membrane; in free exudations on its surface, which become converted into circumscribed tendinous patches, or diffused false membranes, &c, whilst very trifling changes are discoverable in the pia mater, to indicate that an inflam- 16 INFLAMMATION OF THE ARACHNOID. matory process occurred at the same time in it. When, on the other hand, the pia mater is acutely inflamed, and there is profuse exudation into its tissue, the subjacent arachnoid is in no marked degree affected, and its surface is entirely without any free exudation. Showing that the inflammations of the two membranes are entirely different and distinct, and that specific remedies must be found to act curatively upon each. Purulent exudation on the free surface of the arachnoid takes place on the parietal layer only when the dura mater is very acutely inflamed in consequence of injury of the skull and caries, proving that remedies which act specifically upon the bones and dura mater, will also probably act specifically in in- flammations of the parietal layer of the arachnoid ; and on the cerebral layer, only when a simultaneous acute inflammation of the pia mater also gives rise to an exudation of pus ; proving that remedies which act specifically upon the pia mater, will also probably act specifically upon the cerebral layer of the arachnoid. It is remarkable that true tubercular exudations do not occur on the arachnoid; proving that remedies which act specifically upon the arachnoid may prove antidotal to tubercular disease. Finally, according to Rokitansky, on whichever layer of the arachnoid these processes take place, that portion which cor- responds to the convexity of the hemispheres of the brain is exclusively affected; and in proportion as they approach the base of the brain, (which they occasionally do), the intensity of the inflammation, and the quantity of their products is palpably diminished ; again proving that remedies which act specifically upon the upper surface of the brain, and upon the arachnoid are antagonistic, or antidotal to tubercular disease, which acts principally upon the base of the brain, and upon the pia mater. Symptoms and Treatment.—These are very similar to those of simple inflammation of the pia mater, and cannot be definitely given in the present state of our knowledge. INFLAMMATION OF THE PIA MATER. 17 INFLAMMATION OF THE PIA MATER. MENINGITIS. This is the true meningitis, and the most important disease of the membranes of the brain. According to Rokitansky it is impossible to depict its general features without distinguish- ing two totally different forms of the disease. a) First form.—This is a true inflammatory affection; it usu- ally extends over the convexity of the brain, and diminishes in intensity as it approaches the base. It rarely occurs at the base of the brain at all. The individuals who present this form of disease are gene- rally in the youthful period, the bloom of life ; they are usually strong, at any rate they show no trace of the tubercular dys- crasia. The disease is usually unaccompanied with acute dropsy of the brain ; at least the exudations and effusions found in the ventricles are mostly slight; so also, softening of the stomach does not usually accompany or result from it. Except at its periphery or convexity, the brain is unaltered by it, especially no softening of the brain arises or results from it. It is a pure inflammatory affection and if any specffic reme- dies against simple inflammation are known in any school of medicine, it ought to be a perfectly manageable disease. In fact Rokitansky says, although this form of meningitis is frequently fatal, yet it often terminates in resolution. A chro- nic form of it is frequently found in mental disease, especially in cases of secondary imbecility ; yet it is frequently acute and even epidemic. b) Second form.—This is the most frequent and fatal dis- ease of the membranes of the brain, especially in children. It occurs according to Rokitansky almost exclusively at the base of the brain, and the peculiar opaline, flocculent, albumino- serous, gelatinous, sero-purulent effusions and exudations which attend it, accumulate especially between the hemispheres of the brain on each side, from the optic commissure in front to the B 18 INFLAMMATION OF THE PIA MATER. pons, and even over the medulla oblongata behind. From thence they may be traced into the fissure of Sylvius, and the longitudinal fissure of the brain, and so on to the convex surface of the hemispheres ; for the fibrino-tuberculous product accu- mulates along the vascular trunks which run in the fissures, viz.: the arteries and veins of the fissure of Sylvius and Cor- pus-callosum, and the latter often appear completely enveloped in the exudation. From these points the inflammation always extends also to the choroid plexuses and the lining membrane of the ventricles, particularly the lateral ventricles, and there gives rise to the effusion and exudation of similar products, from wThich a distinct purulent sediment is often deposited ; hence it is almost always combined with acute dropsy of the brain; and very often it is also associated with softening of the stomach. The brain itself is always in a state of acute oedema, or se- rous infiltration, with hydrocephalic swelling. At those parts where the disease is most intense, and particularly in the fis- sures of Sylvius, the convolutions of the brain, especially at the superficial parts, become the seat of red, or yellow softening. The subjects of this form of the disease are mostly children, although it is also frequent at later periods of life. The indi- viduals who are attacked with it are generally persons already suffering with the tuberculous dyscrasia, or those in whom tu- bercle is actually deposited. The base of the brain is the chief seat of this form of tuber- culosis ; from thence it extends towards and over the hemi- spheres ; it is rare to find the convex surface of the brain the principal seat of its development.—Rokitansky. It is the most frequent and fatal disease of the head; as it is generally associated with the deposit of tubercles in other, and often many other organs, with extensive dropsy and softening of the brain, and with decided softening of the stomach, there is almost necessarily scarcely any chance of recovery. Symptoms of primary meningitis.—This disease is most frequent in persons from the age of sixteen to forty-five years ; next, in children from five and a half to eleven years; it is very rare in infants, and more common in males than females. It is most frequently caused by exposure to the sun, by excessive INFLAMMATION OF THE PIA MATER. 19 intellectual labor, by intemperance in drinking, and by depress- ing mental emotions; in children it is most common during dentition, or from suppression of eruptions of the scalp. In the simple, primary form of the disease, the pain in the head is always very prominent, and sets in at the very begin- ning of the attack ; it is violent and continued, with more or less severe exacerbations ; it often obliges the patient to cry out; it is complained of spontaneously and unceasingly ; the patient insists that his disease is solely in his head, can point to the exact seat of it, and complains of it until he falls into a state of unconsciousness. The intelligence is very quickly involved in the great majori- ty of cases ; there is great mental agitation, soon followed by active delirium, which is sometimes violent, or even furious. The patients are apt to get out of bed, and attempt to jump out of the window, (fee. This is soon followed by somnolence, which alternates at first with the delirium, but finally settles into a profound coma, or complete loss of consciousness. The eyes are sensitive to light, the pupils are almost always dilated, but at times they are contracted or irregular; they finally become immoveable, and in some cases vision is entirely abolished; squinting is also frequently observed, especially in children. The nerves of motion do not ordinarily present any peculiar symptoms, especially in the early stages of the disease, except that the patient is apt to totter and fall if he attempts to rise; at a later stage, however, we often notice stiffness of the limbs, or spasmodic contractions, or even convulsions; but these symp- toms are not constant. Towards the end of the attack, subsul- tus, carphologia, and convulsive movements are generally pre- sent. It is rare that we observe partial stiffness of one limb, or paralysis ; when these are present, there generally is a simul- taneous affection of the brain itself. Sometimes the nerves of sensation are blunted, either through- out the whole body, or in more or less extensive parts; at times, however, there is an increase of sensibility, at least for a time. The countenance is generally animated, the eyes haggard and brilliant; there are frequent alterations of color, from red to violet, and thence to pallor, more or less intense. Sometimes 20 INFLAMMATION OF THE PIA MATER. the features are contracted and grimacing, at others they are relaxed. The eyes often express astonishment, fright or fury ; at others they seem dull, glassy, and without expression; at times they are prominent, at others sunken. An unintelligent smile often flits over the features. The nostrils are generally dry ; the lips pale and parched. Of the symptoms of the digestive organs, the vomitings are without doubt the most remarkable ; they are generally bilious, and often abundant; they often cease on the second or third day of the attack, but sometimes persist to the end, although they may intermit for a time, to be renewed again. The tongue is generally dry, often red, or covered with various kinds of coating. Constipation is also one of the most constant symp- toms ; it generally sets in from the beginning, and may even precede the other phenomena. The breathing is generally remarkably irregular. Fever is always well marked, the pulse, is quick and hard at first; afterwards it becomes small and irregular. The skin is hot and remarkably dry. Secondary meningitis occurs during the course of some other disease, especially typhoid fever ; the headache is apt to be not very well marked; the vomitings are often absent; the most remarkable symptoms are the softness, and irregulari- ty of the pulse and respiration, the paleness and expression of anxiety upon the face, and the extreme agitation which precedes the delirium. The course of the disease is onwards, and although there are some exacerbations, yet the remissions are not as notable as in tubercular meningitis. The duration of the disease is very short; it does not last longer than from three to nine or eleven days. Diagnosis.—Inflammation of the pia mater may be mistaken for tubercular meningitis, or for typhoid fever. But in tuberr cular meningitis there are generally preceding signs of ill- health, or of tubercular disease ; the symptoms of inflammation of. the pia mater set in more suddenly, are more severe from the onset, and persist more actively ; the headache is more violent, also the heat of the head, redness of the face and intolerance of light; the delirium is also more intense; the vomitings are INFLAMMATION OF THE PIA MATER. 21 more frequent and abundant; the fever more severe and con- stant. The symptoms progress more rapidly and regularly. It may be distinguished from typhoid fever by the less fre- quent vomiting, more frequent pains in and distension of the bowels, with diarrhoea, which are so characteristic of the latter disease; enlargement of the spleen may also be distinguished by percussion ; bleeding from the nose and ringing in the ears, the rose colored spots, sudamina, the regularity of the pulse and breathing, and absence of rigidity or paralysis of the limbs will also serve to distinguish the two diseases. Treatment.—If the symptoms of arachnitis or meningitis begin to show themselves, or even if the disease be fully de- veloped we may begin the treatment with Aconite ; it acts spe- cifically upon the serous and fibrous membranes, and is thought to be homoeopathic to all acute inflammations, while physicians of the dominant school suppose it to be as antipathic to all acute inflammations and congestions as Digitalis or Veratrum- viride. According to Kreussler it is not a question of fever or no fever, for an acute inflammation of the brain as well as of the meningeal membranes requires the use of Aconite, from the commencement of the disease until the period when essential changes develop the full characters of the affection. He says it is always safe to commence the treatment with a few doses of Aconite, even if it be possible to discern the homoeopathicity of another and apparently more specific remedy from the very be- ginning of the attack. DoSCt—Of course, in so serious a disease, the remedy should be used promptly and thoroughly; it should be given not only internal- ly, but also applied externally, and that right freely. I have been in the habit of applying the Tincture of the Root of Aconite, over a large portion of the scalp, every 2, 4, 6 or 8 hours, according to the severity of the symptoms. The Tincture of the Plant may be given in repeated doses, every £, \, 1 or 2 hours, in acute and rapid cases ; every 2, 4 or 6 hours, in sub-acute and slighter attacks.* If the case progress, so that it is probable that exudations of plastic lymph or sero-fibrous effusions have already commenced to take place, then Bryonia and Mercurius are the most im- portant remedies; if there be much vomiting with obstinate constipation, great heat of head and much fever, one or two full * The dilutions and pellets are probably not useful in cases of meningitis of any kind. 22 INFLAMMATION OF THE PIA MATER. doses of Mercurius may be given so as to bring about free action upon the bowels. Small doses of Tartar-emetic may also serve to allay the irritability of the stomach, to moderate the fever, tend to produce perspiration and aid the action upon the bowels : but they must not be continued long, or else too great prostration may be produced. The Tartar-emetic must be quickly changed to alternate doses of Bryonia, and small but repeated doses of Mercurius. If Mercurius be at all indicated it may also be allowable to apply a weak solution or ointment upon the scalp, in the immediate neighborhood of the seat of the disease. If it becomes apparent that a large effusion of serum, has taken place from the inflamed membranes, Helleborus, Digita- lis, Kali-hydriodicum, and Mercurius-iodatus, become the principal remedies. If Hellebore and Digitalis, either singly or in alternation fail to produce an alleviation of the symptoms, Kali-hydriodicum may be applied over the whole of the scalp in solution, or in the form of an ointment, and frequently repeated small doses may be given internally. If these also fail, Iodide of Mercury may be applied in the form of an ointment over the scalp, and small doses of this, or of Mercurius-corrosivus may be given internally. If an almost entire suppression of urine occur, Cantharides will prove the most homoeopathic remedy. It is far more ho- moeopathic to inflammations of the membranes of the brain than either Belladonna, Stramonium or Hyosciamus, which only pro- duce congestion,.rarely inflammation of these parts. Cantha- rides has caused congestion of the vessels of the brain ; thick- ening of the arachnoid of the brain, but especially of the cere- bellum, which is covered with a very thick layer of lymph, while a large quantity of serum has been found at the base of the brain. As the suppression of urine in arachnitis and meningi- tis, does not depend upon an inflammation of the kidheys, but upon a torpid or semi-paralytic state of these organs from pres- sure upon the brain, Cantharides which acts far more specifi- cally upon the kidneys, than upon the brain or its membranes may arouse the former organs from their torpor, and bring on a secretion of urine which may relieve the pressure upon the brain ; at the same time it will not exert an injurious or too ( INFLAMMATION OF THE PIA MATER. 23 irritating effect upon the brain or its membranes, as the stage in which it is most indicated, and hence is most useful, is that in which the profuse exudation of fibrine and copious effusion of serum from the meninges of the brain has brought about a resolution of the inflammatory congestion of these organs, and left them in a state of torpor from over-exertion and secretion, which will not bear debilitating remedies, and may tolerate ex- citing or stimulating ones ; the depressed state of the general system when copious effusion has taken place, marked by sopor with complete insensibility to external impressions, with a small feeble and intermitting pulse, coldness and clamminess of the skin, calls for the use of stimulants, and Cantharides may prove the best, from its specific relation to the seat and nature of the disease, and its marked power over the secretion of the kidneys, which it is so important to restore. If the case be not abso- lutely hopeless, and the internal use of Cantharides does not produce the desired effect, and the physician and parents are willing to inflict some suffering in the hope of saving life, which might otherwise be lost, a blister of Cantharides may also be applied to the back of the neck, or even to the scalp. But such an extreme and severe measure should only be used in cases of pure or simple arachnitis, or meningitis ; if it be at all probable that tubercular meningitis be present, all temptations to severe and active measures should be steadily rejected by the physi- cian, whose sole endeavors in such almost invariably hopeless cases, should be directed towards soothing and allaying any and every painful symptom of the case ; narcotic remedies, such as Belladonna, Conium, Hyosciamus, Opium, or Stramonium, or Cannabis-indica, or Chloroform should be used freely and without hesitation. To save life is next to impossible ; to allay suffer- ing is both possible and imperatively demanded. It may be allowable to mention here that Dr. Hahn has sue ceeded several times with the cold affusion, in arousing and curing children, after the supervention of complete coma. He has also succeeded in 14 cases, after the patients were in an ap- parently hopeless state of coma, with frictions of the scalp, with Tartar-emetic ointment repeated every two hours, until pustu- lation was established; it is a severe measure and occasionally induces gangrene of the scalp, yet it is perhaps allowable in the advanced stages of simple inflammatory meningitis. 24 TUBERCULAR MENINGITIS. TUBERCULAR MENINGITIS. IN CHILDREN. This is one of the most common diseases of the brain or its appendages in children. It is by far the most common cause of so-called acute- or sub-acute dropsy of the brain, and furnishes a satisfactory reason why this disease is so frequently fatal under every variety of treatment, at the same time that it ren- ders it self-evident that any physician or class of physicians who pretend to cure the majority qf their cases of dropsy of the brain, are either self-deceived, or are absolute impostors. Green says that at least one-fourth of all the diseases of the brain in children are tubercular in their nature ; Becq.uerel in 30 cases of meningitis, found tubercular granulations in the membranes of the brain in no less than 28; Jackson found them in 4 cases out of 6; Green discovered them in 56 cases out of 60 ; Rilliet and Barthez in 29 cases out of 33 ; Bou- chut in 6 cases out of 9. Hence in 138 cases of so called acute hydrocephalus, tubercles were found in no less than 123 instances. Hence it is evident that until within a few years, tubercular meningitis, simple acute meningitis, independent of tubercularization, and simple dropsical effusion within the cavity of the skull, independent of inflammation have been con- founded together under the single term of hydrocephalus or water on the brain. Symptoms.—Unlike acute simple meningitis there is more or less of a premonitory stage. According to West, in the first or premonitory stage there are many indications of cerebral con- gestion, coupled with general febrile disturbance ; and present- ing exacerbations and remissions at irregular periods. The child becomes gloomy, pettish and slow in its movements, and is but little pleased Avith its usual amusements. Or, at other times its spirits are very variable ; it will sometimes cease sud- denly in the midst of its play, and run to hide its head in its mother's lap, putting its hand to its head, and complaining of headache, or saying merely that it is tired or sleepy, and wants to go to bed. Sometimes, too, it turns giddy, as may be known, not so much from its complaint of dizziness, as from its sudden- ly standing still, gazing around for a moment as if lost, and TUBERCULAR MENINGITIS. 25 then cither beginning to cry at the strange sensation, or seem- ing to awake from a reverie, and at once returning to its play. The infant in its nurse's arms betrays the same sensation by a sudden look of alarm, a momentary cry, and a hasty clinging to its nurse. If the child can walk, it may be observed to drag on& leg, halting in its gait, though but slightly, and seldom so much at one time as at another, so that both the parents and the physician may be disposed to attribute it to an ungainly habit which the child has contracted. The appetite is usually bad, though sometimes very variable, and the child, when appa- rently busy at play, may all at once throw down its toys and beg for food; then refuse what is offered, or taking a hasty bite, may seem to nauseate the half-tasted morsel, may open its mouth stretch out its tongue, and heave as if about to vomit. The thirst is seldom considerable, and sometimes there is an actual aversion to drink as well as to food, apparently from its exciting or increasing the nausea. The stomach, however, sel- dom rejects everything, but the same food that occasions sick- ness at one time is retained at another. Sometimes the child vomits only after taking food; at other times, even when the stomach is empty, it,, brings up some greenish phlegm, without much effort, and with no relief. These attacks of vomiting seldom occur oftener than two or three times a day, but they may return for several days together, the child's head probably growing heavier, and its headache more severe. The bowels are generally constipated from the first; the evacuations are usually scanty, sometimes pale, often of different colors, almost always deficient in bile, frequently mud-colored and very offen- sive. The abdomen is seldom full or distended, but the child sometimes complains of pain in the belly, which may be tender to pressure. The tongue is not dry, generally rather red at the tip and edges, coated with white fur in the centre, which becomes yellowish towards the root; occasionally West has seen it very moist, and uniformly coated with a thin white fur. The skin is harsh, but there is no great heat of surface. The nostrils are dry ; the eyes lustreless ; the pulse accelerated, but seldom exceeding 120 in children of four years old and up- wards, not full and strong, but often unequal in the force and duration of its beat. 26 TUBERCULAR MENINGITIS. The child is apt to be drowsy, and will sometimes want to be put to bed two or three times in the day; but it is restless, sleeps badly, grinds its teeth in its sleep, lies with its eyes partially open, awakes with the slightest noise, or even starts up in alarm without any apparent cause. At night, too, the existence of intolerance of light is often first noticed in conse- quence of the child's complaints about the presence of the candle in the room. West truly says, that we must not expect to find all these symptoms in every case, neither indeed, when present are they persistent, but the child's condition is very apt to vary greatly in the course of a few minutes ; cheerfulness alternating with depression, and sound sleep being now and then enjoyed in the midst of the unrefreshing dozes of the night. Hartmann says, the precursory stage does not offer any of the characteristic symptoms of acute dropsy of the brain. Thus the child, which was previously able to run about with ease, has an unsteady vaccillating gait; he raises his feet high from the floor, or is liable to fall on the level ground, even in the room. This unsteadiness communicates itself to the whole body. We observe, moreover, a sudden change of disposition ; in the place of the former cheerfulness and lightness of heart, the child is apt to become morose and peevish. On moving the head sud- denly, or raising it from the recumbent posture, vertigo or a sense of stupefaction is experienced. In some cases the secre- tion of urine is scanty, in others it is turbid, flocculent or opal- escent. Some authors number a fine, dry, colorless eruption on the outer side of the upper arm, on the cheeks and lips among the precursory symptoms of dropsy of the brain. Besides these symptoms there are others which are more or less characteristic; such as a loss of the previous blooming ap- pearance ; restless sleep during which the child is apt to moan, groan, start up as in a fright, alternations of creeping chills and flushes of heat; a pulse of the ordinary rapidity, but one which intermits at times, or beats irregularly or more feebly. If many of these symptoms be present, the physician should be led to suspect the impending approach of dropsy of the brain and to watch the development of the symptoms with anxious and redoubled attention. If the child be descended from scrofu- TUBERCULOSIS. 27 lous or consumptive parents it may already be too late to save life : the tuberculous dyscrasia may already be so fully de- veloped, or the blood be already so fully overloaded with tuber- cular matter, or the capillary vessels may have lost their power and function of forming or separating healthy materials from the blood, that it will be impossible to prevent the formation and deposition of tubercle in the membranes of the brain, or even in many other organs. Still the trial must be made, late though it be. But in order to treat the tuberculous tendency or dyscrasia with the faintest hope of success, we must first un- derstand, thoroughly understand, of what tubercle consists, and what it really is. TUBERCULOSIS. TUBERCLE. The physical description of tubercle is well known to every physician, the chemical is not so. According to Hasse, Who drew his conclusions from numerous analyses carefully compiled by Cerrutti and Vogel, the organic component parts of tu- bercle are principally Caseine, with some fat, and^ little albu- men. According to Preuss the animal portion of tubercle is principally made up of Caseine, with some fat in the form of Cholesterine, and a trifle of Phymatine. Guterbock found much Caseine, some Albumen, Phymatine and fat. Less accurate observers, such as Thenard, found Albumen in excess; while Hecht and Scharlau. who probably did not separate the cellular and other tissues, or products of inflamma- tion found intermixed with the surrounding tubercular masses, found nearly equal proportions of Gelatine, Albumen and Fi- brine, in their analyses of tubercular substance. Ancell, justly says, if we admit that tubercle is a definite chemical compound, which is very probable, still this compound must be subject to changes and to admixture with numerous extraneous and accidental materials, as with those composing the tissues in which the tubercle is deposited, and which by pressure and otherwise, become disintegrated and blended with the essential constituents of tubercle, or with the products of inflammation, such as coagulable lymph, or fibrine, or pus from 28 tuberculosis. inflammation of the substance of the tuberculous organ, or with mucus or pus from the mucous membrane of the lungs, or with blood itself. It is always difficult, and frequently impossible, for the chemist to separate these different products, or to esti- mate their proportions. Tubercle must also, from the same causes, exhibit differences, according to the nature of the tissue in which it is seated. Still, he says, chemical analysis leaves no doubt that tubercle contains a protein compound as an essential constituent, which appears to bear a close analogy to, if it be not identically Caseine. Tubercle has a decidedly cheesy ap- pearance to the naked eye, and tuberculous pus resembles a mixture of soft cheese and water both in color and consistence. Ancell repeats that the caseous quality of tubercle and scrofu- lous pus indicates the presence of a nitrogenous compound of a caseous nature in the liquor tuberculi, showing that from the liquor sanguinis of tuberculous blood a caseous blastema is exu- ded, differing from the ordinary healthy blastema. Its caseous quality renders it unfit to nourish the tissues, and gives^ it a tendency to solidification. Another large class of medical chemists think that tubercle is essentially albuminous in its nature. Thus Hecht found in crude tubercle : Fibrine 30 parts ; Albumen 23 ; Gelatine 27 ; water and loss, 27. Boudet found : Caseine, Gelatine and a considerable quantity of Cholesterine ; when tuberculous sub- stance was treated with cold water it yielded : Albumen, a sub- stance resembling Caseine, and a fibrinous residue. Guter- bock found : Pyine, Phymatine, Albumen and fat. Scharlau, Albumen, Gelatine, Fibrine, fat and water. Vogel, Fibrine, Albumen and Caseine, with fat, a material analagous to Pyine, &c. Glover, Pyine, Albumen, (but no Caseine,) fat, (fee. L'Heretier found softened tubercle to consist of Albumen, very soft Fibrine, fatty matter and lime. It is easy to account for many of these discrepancies ; thus Preuss in the most complete chemical analyses of crude tuber- cular pulmonary substance which has yet been furnished, found Gelatine in the residue of the pulmonary tissue, which he care- fully separated from the tuberculous substance, but none in tubercle itself. If other chemists had been equally careful, they probably would not have found much or any Gelatine in TUBERCULOUS BLOOD. 29 tuberculous matter. Again, Ancell says that Pyine is by no means a constant constituent of tubercle; it is a trit-oxide of Protein, the result of inflammatory action on tuberculous blood resulting in the super-oxidation of the Protein compounds, such as Caseine, or possibly Albumen or Fibrine, which make up the bulk of tubercle. The Fibrine is also probably the result of inflammation, hence, we can easily narrow down the two essen- tial constituents of tubercle to Caseine and Albumen. Caseine and Albumen are analagous substances ; both are compounds of Protein ; Albumen consists of 10 atoms of Pro- tein, 2 atoms of Sulphur and 1 of Phosphor.; while Caseine consists of 10 atoms of Protein, 1 of Sulphur and none of Phos- phor. Hence it is very easy for careless or not very expert chemists to mistake one for the other. TUBERCULOUS BLOOD. As tubercle is evidently derived from the blood, we have next to examine the character of the blood in tuberculous subjects. According to Ancell tuberculous blood is defective in vital properties ; the red globules are deficient in number and de- fective in structure ; the globulin, haematin and iron are all deficient. The serum of the blood is vitiated in quality, the water, Albumen and lime are in excess, and the Albumen also defec- tive in quality. Caseine does not exist normally in the blood, and hence the defect in the Albumen may consist in its tenden- cy to be converted into Caseine. The Fibrine is rather deficient in quantity and defective in quality, the fats probably deficient; the alkaline and earthy salts, especially the chlorides and phosphates of Soda and Potassa decidedly deficient. DIETETIC TREATMENT OF THE TUBERCULOUS DYSCRASIA. Hence the indications for the improvement of the quality of tuberculous blood, are : 1st, to increase the quantity of iron, fat, alkaline- and earthy-salts and Fibrine, and to improve the quali- ty of the latter ; 2d, to diminish the quantity of water, lime and Albumen, and improve the quality of the latter. 30 DIETETIC TREATMENT OF As blood is formed from the food by the processes of diges- tion, chymification, chylification and sanguinification, tubercu- lous blood may be produced from improper food, by a peculiar form of indigestion, or by a defect in sanguinification in the lungs or other parts of the body. In the first place vegetable Albumen, according to Mulder is perfectly identical with animal Albumen, and hence it is probable that the whole quantity of Albumen required for the purposes of the body is delivered to it already formed, and does not require to be elaborated by the processes of digestion or sanguinification. Great care should be exercised in the selec- tion of the albuminous articles of food for consumptive persons, that they be of the best quality ; as there is already a tendency to excess of* Albumen in tuberculous subjects, articles of food should be selected which contain comparatively little of already formed Albumen. According to Prout the following quantities of Albumen are found in the subjoined animal substances. East India Isinglass, - - 7.2 to 13.5 per cent. White of Egg, - 15.5 " Yolk ".....17.47 " Liver of Ox, - 20.19 " Sweetbread, .... 14.00 " Caviare, ----- 31.00 " Hence the above articles are more or less objectionable in the diet of scrofulous, tuberculous or consumptive persons. The muscle of Beef contains only, - 2.2 per cent. " Mutton " - 2.6 " " Venison " - 2.3 " Veal " 2.6 to 3.2 " " Chicken '• - 3.0 " " Fish " 4.4 to 5.2 " " Pigeon " - 4.5 " Hence, beef, mutton, venison and chicken form the best ani- mal food for tuberculous subjects. Again, as the Fibrine of the blood is defective and deficient articles of food which contain much Fibrine should be selected. The muscle of Beef contains 20 per cent, of Fibrine. " Mutton " 22 " « " Chicken " 20 " « the tuberculous dyscrasia. 31 The muscle of Veal contains 19 per cent, of Fibrine. " Pork " 19 " " " Fish " from 13 to 15 " " " Sweetbread, only 8 " '• Again, articles which contain Caseine should be avoided in the diet of tuberculous persons—milk, curds and cheese are objection- able, cream and whey are allowable. Asses' milk is the least objectionable as it contains only 1.82 per cent, of Caseine, while cows' milk contains as much as 4.48. The milk of cows fed on hay, turnips and potatoes contains only 3.3 per cent, of Caseine, and is perhaps less injurious than some other kinds.. Vegetable Caseine is chiefly found in the leguminous seeds, such as beans, peas, lentils, &c, hence these may have to be avoided. Vegetable Albumen is present in considerable quantity in most vegetable juices, such as the juices of carrots, turnips, cabbages, cauliflowers, asparagus, &c.—Potatoes contain far less Protein and Albumen than any other vegetable substance used for food,—only 1 per cent. Vegetable Fibrine is most abundant in the seeds of the cereal grasses, such as wheat, rye, barley, oats, maize, rice; it also exists in buckwheat; the juice of grapes is especially rich in it, &c. As the fat is. deficient in the tuberculous dyscrasia, the oily alimentary principles should be used. Filberts contain 60 per cent, of oil. Walnuts " 50 " " Olive seeds 54 " " Cocoa and Earth-nuts 47 " " Almonds " 46 " " Maize " 9 " " Dates " - - only .02 " " Yolk of Eggs - - - 28.75 " " Ordinary meat, with cellular tissue 14.3 " " Liver of Ox - - only 3.89 " " Caviare - - " 4.3 " " Cow's Milk - - " 3.13 « " Asses " - " .11 " " 32 tuberculous indigestion. Butter and olive oil, fats, meats and marrow may be used, suet puddings, salmon, herrings and eels abound in oil, choco- late and cocoa, hashes, stews and broths contain much fat. As the fixed oils and fats are difficult and slow of digestion many physicians may consider them objectionable. It is well known that in many delicate persons fat does not become properly chymified. It floats on the contents of the stomach in the form of an oily pellicle, becoming odorous, and sometimes highly ran- cid, and in this state excites heartburn, most disagreeable nausea, and eructations, or at times actual vomiting. These effects are owing to the development of volatile fatty acids, and may be prevented by the use of alkaline and earthy salts, such as the chlorides and phosphates of Soda and Potassa which are also required to make up the deficiency of them, which has been shown to be present in the blood of tuberculous subjects. As the Iron of the blood is also deficient, a certain quantity must be supplied to the system. TUBERCULOUS INDIGESTION. Such is the theoretically correct system of diet in tuberculous dyscrasia and affections ; but it is very evident that healthy animal or vegetable Caseine or Albumen will not be converted into tuberculous Caseine and Albumen if all the functions of digestion and sanguinification be perfectly and healthily per- formed. According to Bennett, many observing physicians have not failed to notice that tubercular disease is ushered in with a bad or capricious appetite, a furred or morbidly clean tongue, unusual acidity of the stomach and bowels, loss of appetite, constipation alternating with diarrhoea, and a variety of symptoms denominated dyspeptic, or referable to a deranged state of the digestive' organs. It is probable that tuberculosis is a disease of the primary digestion, causing, 1st, impoverish- ment of the blood ; 2d, loc.il exudations from the bloodvessels presenting the characters of tuberculous exudation; and third the consequent softening, ulcerations and destructive results which distinguish it. Bennett also asserts that further ob- servations show, that circumstances which remove the mal- assimilation of food frequently check further tubercular exuda- tuberculous indigestion. 33 tions, while those which previously existed become abortive, and that occasionally more extensive excavations may heal up and cicatrize. A healthy nutrition of the body cannot proceed without a proper admixture and proportion of the albuminous and oleagi- nous elements. This may be inferred from the physiological experiments of Tiedemann, Gmelin, Leuret, Lassaigne, Ma- gendie and others ; from an observation of the constituents of milk, (caseine, butter and sugar,) the natural food of young mammiferous animals ; from a knowledge of the contents of the egg, (albumen and oil,) which constitute the source from which all the tissues of oviparous animals are formed before the shell is broken; and from all that we know of the principles con- tained in the food of adult animals. The peculiarity of tuberculosis, however, is that an excess of acidity exists in the alimentary canal, whereby the albuminous constituents of the food are rendered easily soluble, whilst the alkaline secretions of the saliva and of the pancreatic juice are more than neutralized, and rendered incapable either of trans- forming the carbonaceous constituents of vegetable food into oil, or of so preparing fatty matters introduced into the system, as will render them easily assimilable. In consequence, more albuminous than fatty matters enter the blood, and the necessary waste of structure is supplied by the absorption of the adipose tissues of the body. Hence the emaciation which characterizes tubercular disease ; hence also, as the fatty matters introduced into the stomach are not digested and assimilated, but are sim- ply taken up into the vena porta and carried to the liver, the fatty liver which occurs so frequently in the tuberculous dys- crasia. In the meanwhile local congestions occur in various parts, leading to an exudation containing a super-abundance of albumen; which in its turn being deficient in the necessary proportion of fatty matter to form elementary molecules, remain abortive and form tuberculous corpuscules. To improve the faulty nutrition which originates and keeps up the tubercular disease it is of all things important, therefore, to cause a larger quantity of fatty matter to be assimilated. The use of alkalies or other solvents or digestives of oil are all- important, although a mere increase in the amount, or even c 34 tuberculous meningitis. quality of the food will often accomplish this. The treatment practised some years ago by Dr. Stewart, which consisted in freely administering beef-steaks and porter, and causing exer- cise to be taken in the open air, excited considerable attention from its success. Bennett has been informed, that in some parts of America the cure consists in living on the bone-marrow of the buffalo, and that the consumptive patient gets so strong in this way, that he is at length able to hunt down the animal on the prairies. All kinds of food, rich in fat, will not unfre- quently produce the same effects, and hence the value long at- tributed to milk, especially ass's milk, the produce of the dairy, as cream and butter, fat bacon, caviare, &c. But, in order that such substances should be digested or assimilated, solvents of fat (alkalies) must be used, if the powers of the stomach and alimentary canal have undergone any great diminution. Unless this precaution be used, it will be found in many cases that the patient is unable to tolerate such kind of food, and that it either lies undigested in the stomach, or is sooner or later vomited. Children born of tuberculous mothers should be weaned early; unless a perfectly healthy and robust wet-nurse can be procured it is better to feed them with diluted or undiluted cream. FULLY DEVELOPED TUBERCULOUS MENINGITIS Is marked by three important symptoms, viz.: by headache, vomiting and constipation, to which is added in the great majority of cases, some acceleration of the pulse; the intelli- gence may remain perfect, showing that the brain itself is not yet involved; the strength may not be greatly diminished, nor the appetite entirely lost, and the thirst may be moderate. These symptoms usually last but two or three days before others make their appearance, showing that the attack is con- firmed. In some few instances, however, the precursory symp- toms last, with irregular intermissions, for several weeks. In some cases the invasion may be preceded for three months by occasional cough, irregular attacks of fever, progressive emacia- tion, paleness, languor alternating with extreme irritability, tuberculous meningitis. 35 disinclination to take exercise, and during the latter part of the time by partial lameness, and in fact by all the signs of general tubercular disease. In other cases the invasion may be pre- ceded for several months by frequent complaints of intense headache, especially after taking active exercise, and by unusual languor, and by no other symptoms ; there may be long inter- vals of health, and the child then be taken down suddenly. According to Meigs, headache is a nearly invariable symp- tom in children old enough to describe their sensations, and is therefore very important. In infants its presence is to be in- ferred when the child frequently carries its hands to various parts of the head, and presses strongly against it, and when the head is constantly rolled from side to side. It is usually re- ferred to a point just over one or both brows ; in other cases it extends over the whole head. It is commonly severe so that the child, when old enough, complains of it spontaneously; they may even cry frequently and bitterly, beg to have the doctor sent for, and submit willingly to any remedy suggested for its relief. It is thought that the acute, shrill cry of the disease depends upon the acuteness of this pain. It usually lasts throughout the first stage, and ceases only as the delirium and coma of the second stage come on. As long as the membranes of the brain are alone involved the headache is not attended with delirium. In truth, the intel- lectual faculties remain undisturbed in the majority of cases during the first few days ; and this fact, which is so contrary to what is generally supposed, is apt to mislead the physician in his opinion and treatment of the case ; he is generally too apt to give remedies which act more specifically upon the brain, than upon its membranes. I trust that it has been rendered evident that a correct sys- tem of diet is as necessary in tuberculosis as in diabetes- or adiposis. There is frequently time sufficient to make the trial, for the healthy and robust are comparatively seldom attacked by dropsy of the brain, and in many instances the evidences of declining health, precede for weeks or months the real premoni- tory symptoms of the disease. We often observe a gradual decay of the child's strength and wasting of its flesh, it becomes subject to irregular febrile attacks, coughs a little,, loses its 86 tuberculous meningitis. appetite, its bowels are almost always disordered, and generally constipated, it makes frequent vague complaints of pains in its limbs, or of weariness or headache. Medical treatment.—Hartmann correctly states that one of the most homoeopathic remedies for the precursory stage of tubercular meningitis is Pulsatilla; it corresponds more especially to the derangement of the stomach, to the inability to digest rich and fatty food, to the gradually failing health, loss of flesh and ill-conditioned look, to the tottering gait, the vertigo, and deranged secretion of urine, to the headache, nau- sea and vomiting. Still it is not positively known to have a specific curative relation to the albuminous or tuberculous dys- crasia. Hepar-sulphur. deserves great attention when the albumi- nous excess, or dyscrasia is fully developed, at least, according to Sobernheim it renders the pulse softer and slower, the blood darker and decidedly deficient in albumen ; its powers in this respect are so decided that Hartwig asserts, in half an hour after taking Hepar-sulph. in massive doses, the blood of horses will be found from three-fourths to four-fifths deficient in albumen. When small doses fail, the following prescription may be used: Hepar-sulphuris, grs"! 18. Cocoa Butter, drachms 2. White Sugar, " 3. Oil of Almonds, ounce £. One or more tea-spoonsful per dose. This prescription will meet many of the requirements in the tuberculous dyscrasia, viz.: the alkaline, oleaginous and anti- albuminous treatment. Busch of Strasburg, has cured several cases of confirmed tubercular consumption, with Aconite in the first stage, and Hepar-sulphuris in the subsequent periods. Prof. Bang, of Copenhagen, has had similar good fortune • also Dr. Harel de Tancrel. Treatment of the headache.—It fever and other symptoms of inflammation be present, Aconite will be the most important remedy. It may be given internally in the usual doses ; be- sides, as the seat of the disease is at the base of the brain' Aconitine ointment, (from 1 to 4 grains to the half ounce of tuberculous meningitis. 37 simple cerate,) may be rubbed behind and below the ears, and on the back of the neck where it joins the head; or Tincture of the Root may be applied freely in the same localities, every two, four or six hours, according to the severity of the symp- toms. In simple acute meningitis these remedies should be applied to the top of the head. The next most important remedy is Belladonna or Stramo- nium ; they may be given internally; and the Extracts or Tinctures may be used externally, as directed for Aconite. If these fail to afford relief, Hyosciamus or Opium may be used both internally and externally; as soon as the physician is decided in his opinion that the case is one of Tubercular Menin- gitis, and hence almost necessarily hopeless, his principal en- deavors should be directed towards soothing the sufferings of the patient. But Glonoine should be tried faithfully before palliative remedies are given ; especially when there is violent congestion to the head, throbbing in the forehead, temples and vertex, vio- lent beating of the carotids, redness of the face, quickness of the pulse, &c. Vomiting is the next most important diagnostic symptom, and almost a constant one; Barrier found it absent in only 15 cases out of 80, or in less than a fifth. It generally makes its appearance on the first day, rarely later than the second or third, and lasts two or three days, and sometimes longer; it may, however, last ten or twelve days; the matters ejected con- sist of food, mucus and bile in various proportions; it is com- monly repeated two or three times a day. The vomiting is often, although not always, of a peculiar character, viz.: projec- tile, i. e. it occurs without much or any nausea, and the con- tents of the stomach are propelled suddenly with great force, often to the distance of several feet from the person of the patient. The vomiting may arise from irritation of the Pneumo- gastric nerve at the base of the brain; or from commencing disease in the Corpus-striatum, (see treatise on headaches, p. xiv.); or from gelatinous softening of the stomach. Treatment of the vomiting.—This may subside under the use of Aconite or Belladonna. If these fail, Cuprum or Zin- 38 TUBERCULOUS MENINGITIS. cum are best suited to the peculiar spasmodic vomiting, at- tended with little nausea. Zincum is also supposed to exert a specific action on the brain, (see treatise on Mental Derange- ment, p. xxiv.) and Hartmann says it is very useful in the first stages of the disease, when the children become irritable in the evening, are somewhat delirious during their sleep, but become more quiet after midnight, and are quite bright again towards morning; also when the bowels are costive, violent headache sets in, the eyes become sensitive to light, the nose dry, retching, vomiting and insatiable appetite occur, the urine becomes scanty, turbid and loam-colored, with evening fever, frequent pulse, heat and anxiety, and twitchings of the muscles. Zinc has also a well-established reputation against many sub- acute and chronic inflammations, many nervous and spasmodic affections, such as asthma, St. Vitus' dance, epilepsy, convul- sions of children, constipation, flatulence, (fee. In vomiting from softening of the stomach, Kreosote is the best remedy. Constipation is said to be even a more important symptom than vomiting; according to Barrier it is absent in only 7 cases out of 87; it generally persists obstinately for several days ; and sometimes is not present at the very beginning of the disease, but sets in soon afterwards. It generally depends upon the disease at the base of the brain, more especially seated in the Corpora-quadrigemina, (see treatise on headaches, p. xiv.) Treatment.—In children predisposed to dropsy of the brain, the condition of the bowels must be most carefully watched, constipation must not be allowed to exist even for a day, and the least indication of gastric disorder must be regarded as a serious matter. If constipation has already been present for several days before the physician is called in, some simple but efficient purgative or injective medicine should be given at once. When this has been done, Zincum and Opium will probably keep them regular ; at least Dr. Strong, (allopathic physician) ably advocates the use of Zinc and Opium in flatulence, and in con- stipation. West thinks that the value of purgatives in the treatment of ordinary hydrocephalus can scarcely be overrated ; but he says that they must be given so as not merely to obtain free action of the bowels, but to maintain it for some days. In tuberculous meningitis. 39 tubercular meningitis any very harsh and active measures for this purpose are entirely misplaced and useless. The urine is scanty, frequently turbid and cloudy in the first stage; afterwards it may deposit a chalk-like sediment, and finally it is passed involuntarily. Other authors say that it is apt to be of a deep amber hue, of high specific gravity, some- times milky depositing a slimy sediment, and it is apt to smell offensively after being passed and to cause pain in the urethra. In simple meningitis or phrenitis, the urine is of a dark-brown or porter-color, containing an excess of urea and less of lithates; the sediment is generally reddish or reddish-brown. Again hydrocephalus has been known to commence and pro- ceed to the last stage with scarcely any other symptom than slight fever, with little or no pain in the head, but a constant and nearly ineffectual desire to pass urine ; in one case not above a gill of urine was passed in twenty-four hours for five days, and no other symptom of consequence was present. Monro and Eberlee have observed such cases. On the other hand Guersent observed five cases in which the profuse secretion of urine was quite remarkable, and in these tubercles were found in the kidneys in every case. Treatment of the urinary disorder.—Many physicians think that the peculiar milky urine, with chalk-like or slimy sediment indicate an endeavor on the part of nature to drain off some noxious substance from the blood: if this be the case, Phos- phoric-acid will prove the most homoeopathic remedy to milky urine, with gelatinous lumps, or appearing as if flour were stirred in it. This remedy is also indicated against softening of the stomach. Carbo-vegetabilis, and Iodine when the urine is thick and milky. Chin.-sulph., when there are slimy flocculi, and a clay-colored greasy sediment. Tart.-emet., when it is pale, with a flour-like sediment. [ Rhus-tox., pale urine with a snow-white sediment. Zincum, when it is turbid and clay-colored. Muriatic-acid, when it is white and turbid like milk when passed. China, when it is white and turbid, with a white sediment. 40 tuberculous meningitis. Graphite, when it is turbid, with a white sediment. Dulcamara, when it is turbid and white. Mercurius, when it is turbid as if stirred with flour; or clear at first, and then becomes white as if mixed with chalk, with burning in the urethra. Zincum, yellow urine, depositing whitish flocculi. Some physicians think it very important that there should be - a free flow of urine, and erroneously suppose that the brain is safe as long as the kidneys act freely, (see above). Among the brain remedies, Belladonna produces a free flow of urine. Dr. H. M. Gray thinks that it exerts a tremendous diuretic power; is confident that its power over the secretion of urine is very great, as he passed three pints of urine in the course of an hour, attended with slight strangury, while under its influence. Cantharides is perhaps the most homoeopathic remedy to » meningitis, and its action upon the kidneys is well-known; it is most indicated when the urine is full of mucus, with flocculi and filaments, or mixed with sand or clots of blood. Arnica, when clear urine soon becomes white and turbid. Zincum has already been alluded to. If these remedies fail Digitalis and hydrodate of Potash will almost certainly produce a free flow of urine, but that will very often not ward off a fatal termination. The next most important symptoms are observed in the pulse and respiration; they do not accord; the pulse is apt to be rapid at first and the respiration disproportionably slow; ir- regularity of breathing is often noticed by an attentive observer, long before there is any irregularity of the pulse ; one, two or three respirations may be taken at equal intervals, but the breathing is apt to be quite superficial, the upper ribs only slightly rising and falling, but then there comes a full deep in- spiration, very often attended with a sigh: again, there are one, two, three or four, superficial inspirations followed by a deep loud one. At other times the inspiration is quick, hurried and convulsive, followed by a marked increase in the duration of expiration and the period of repose ; the inspiration is consider- ably shortened and a deep prolonged sighing often supervenes, tuberculous meningitis. 41 and considerably diminishes the amount of respiratory move- ments. In the first stage the pulse is much accelerated, full but com- pressible, with a perceptible variation in the rythm of the ar- tery, and in the regularity of the strokes ; the pulse sometimes beating as quick during one-third of a given time as it had pre- viously done during the former two-thirds; thus, in a pulse of 140, one-half, or 70 strokes may be performed in 40 seconds, and the other 70 in 20 seconds. This is often noticed before there is any intermittence noticed. Then some slight inter- mission will be noticed every 7th, 17th or 20th stroke ; finally the pulse will begin to change its character, one or two strokes in quick succession being soft, weak and fluttering. In the second stage the pulse becomes slow, labored, inter- mitting and irregular, but is easily quickened by motion or mental disturbance to double its previous amount of pulsations. If the pulse beat only 60, 80 or 90 per minute, we may be cer- tain that life will last for some days; but as soon as a new acceleration ensues, death will occur in two or three, or at most in five or six days. In the second quickening of the pulse it generally rises to 112 or 120 on the first day, and will be from 140 to 160 on the very day of death, it increases in frequency up to death. The pulse always begins to become slow after the headache and vomiting have lasted sometime, and before somnolency sets in; it falls from 120 or 140, to 80 or even as low as 54. These alterations in the breathing and pulsations are doubt- less produced by irritation, followed by pressure upon the par- vagum at the base of the brain. Treatment.—Mercurius-corrosivus is indicated when the breathing is difficult and irregular. Belladonna, when the respiration is natural at times, at others almost extinct; also when it is labored, irregular, some- times hurried, at others slow. Opium, when the inspirations are slow, long or sighing; or the breathing is irregular and suffocative ; or deep and strong, followed by difficult and feeble breaths. Stramonium, when the inspirations are slow, followed by sudden expirations, with frequent sighing. 42 TUBERCULOUS MENINGITIS. Camphor, when the breathing is slow and deep. Laurocerasus and Hydrocyanic-acid, when it is slow, moan- ing and rattling. Iodine and Spongia, when it is slow and deep, as after ex- haustion. Aconite, when it is slow during sleep. Nitric-acid, when slow and feeble, with wheezing. Scilla, when it is slow and heavy. Lobelia-inflata, when there is an inclination to sigh. As regards the Pulse: Belladonna is indicated when it is quick and strong, or slow and full. Aconite, when it is slow irregular and intermitting. Opium, when slow and full, afterwards becoming weak. Stramonium, when irregular, frequent, quick; intermittent, tremulous and weak. Laurocerasus, when irregular, slow, down to 30. Digitalis, when irregular and small; irregular and unequal, or slow; very slow, down to 35 or 40; intermitting and slow. Agaricus, when it is unequal, slow, feeble and intermitting. Hyosciamus, irregular and weak; intermittent, small and quick; falling from 80 to 59. Cuprum, irregular, small and contracted. Conium, unequal in strength and quickness. Secale, irregular, at times slow and full, then small and con- tracted ; intermittent, slow and small. Tartar-emetic, irregular and weak; slow, down to 50. Tobacco, slow, small and intermitting; down to 45, and very weak. Mercurius, irregular and small; feeble, slow and tremulous. Plumbum, irregular, first quick, then slow; sluggish and in- termittent. Phos. and Nitric-acid, irregular and intermittent. Muriatic-acid, intermitting every 3d beat. Hellebore, slow and very small. Cough.—A slight false cough which partly resembles a sup- pressed effort to vomit, and not unlike the morning liver cough TUBERCULOUS meningitis. 43 of drunkards, is not unfrequent in all three stages. When it occurs in conjunction Avith the peculiar breathing before de- scribed, it is supposed to be a sign of effusion in the ventricles. It may depend upon irritation of the pneumo-gastric nerve at the base of the brain; or upon the deposit of miliary tubercles. Treatment.—It is stated that nothing will relieve it; but Conium is often a useful remedy. Retraction of the abdomen is a valuable diagnostic sign ; it usually occurs about the sixth day; the belly becomes depressed at its centre and takes on the form of a boat; it is almost a constant symptom, and does not arise from the constipation, as it is equally present when diarrhoea sets in ; it is almost pecu- liar to this disease of the brain. Treatment.—Plumbum and Zincum are the most homoeopa- thic remedies, although Nux, Ignatia, Angustura, Alumina and Colocynth may seem to be indicated. I have been in the habit of placing great stress upon the presence of stiff neck, occurring every afternoon or evening, and disappearing in the morning. It probably arises from irritation at the base of the brain, near the origin of the twelfth pair of nerves, as this supplies the muscles of the nape of the neck and shoulders. If this symptom occur in a person born of tubercu- lous or consumptive parents, and is attended with headache, fever, vomiting, constipation and signs of irritation of the brain, it always excilres our liveliest apprehensions as to the result. Treatment.—Zincum and Plumbum are the best remedies. The precursory stage above alluded to is of variable duration, but on the average does not exceed four or five days. When the second stage sets in, the nature of the affection becomes very apparent. The child no longer has intervals of cheerfulness, nor attempts to sit up, but wishes to be left quiet in bed, and the face assumes a permanent expression of anxiety and suffer- ing. The eyes are often kept closed, and the eyelids are knit, the child endeavoring to shut out the light from its morbidly sensitive retina. The skin continues dry, the face is sometimes flushed, and the head often hot; and though these two symp- toms vary much in their duration, coming and going without 44 TUBERCULOUS MENINGITIS. any evident cause, yet there is a permanently increased pulsa- tion of the carotids, and if the skull be not ossified, the brain may be seen and felt forcibly beating through the anterior fon- tanelle. The child is now very averse to being disturbed, and often lies in a drowsy condition, unless spoken to; when old enough to answer, it usually complains of its head, or of weari- ness or sleepiness. Its replies are generally rational but short; and if it needs anything, it asks in as few words as possible, in a quicjk, pettish manner, and shows much irritability, if not at once attended to. At other times it lies with its face turned from the light, either quite quiet, or moaning in a low tone of voice, and now and then uttering a short, sharp, lamentable cry, which is regarded as characteristic of the disease, and hence termed the cry hydrencephalique. To this, however, there are exceptions, and children sometimes scream out with the inten- sity of the pain. As night comes on, there is almost always a distinct exacerbation of the symptoms, and the quiet of the day is frequently succeeded by a noisy and excited state, in which vociferous cries about the head alternate with delirium. At times, however, an increase of restlessness is the only difference from the state of stupor in which the child lay during the day. At the commencement of this stage the pulse is quickened, sometimes very much so. The child sometimes keeps its eyes so firmly closed that we can scarcely see the state of its pupils. Usually they are not much affected, but sometimes one is more dilated and acts more sluggishly than the other; or, in other cases squinting exists, though perhaps in a very slight degree, or confined to one eye. It is seldom that vomiting continues beyond the commencement of this stage, but its cessation is not followed by any desire either for food or drink. The bowels usually become even more constipated than they were before, and the evacuations continue quite as unnatural, while all flatus disappears from the intestines, and the abdomen thus acquires that shrunken form on which much stress has been laid by some writers, as characteristic of dropsy of the brain.—West. Treatment.—In this stage Mercury and purgatives are gene- rally given freely and barbarously by allopathic physicians. But the most efficient allopathic remedies are a few small doses of Mercury or Proto-iodide of Mercury, followed by Hydriodate TUBERCULOUS MENINGITIS. 45 of Potash internally, aided by the free and frequent application of Ilydriodate of Potash ointment over the whole of the head, and back of the neck. In desperate cases Dr. Hahn has seve- ral times succeeded in arousing the child with the cold effusion, after the supervention of complete coma. Friction of the scalp with Tartar-emetic ointment, repeated every two hours until pustulation was established, enabled Dr. Hahn to save fourteen cases, when in an apparently hopeless state of coma; even in tuberculous meningitis cures were obtained in several cases by the Tartar-emetic frictions under the most unpromising circum- stances. The third stage commences when the brain itself becomes involved and becomes softened. The transition is sometimes effected very gradually by the deepening of the state of drowsi- ness, till it amounts to a stupor, from which it is impossible to arouse the child. At other times, the stupor comes on very suddenly, immediately after an attack of convulsions. These convulsions usually affect one side much more than the other, and after the fit has passed off, one side is generally found partially or completely paralyzed, while the child makes con- stant automatic movements with the other, carrying the hand to the head, and alternately flexing and extending the leg. The side which is the most affected during the fit, is generally, though not invariably the most palsied afterwards. When the third stage is fully established, the child lies upon its back in a state of complete insensibility, with one leg stretched out, the other drawn up towards the abdomen. The tremulous hands are either employed in picking the lips or nose until the blood comes, or one hand is kept on the genitals, while the other is rubbing the face or head. The head is at one moment hot, and the face flushed, and then the heat disappears and the flush fades, though usually there is an increase of heat about the back of the head. Sometimes the skin will be dry, at others though the extremities are cold, a profuse sweat will break out on some part of the body, or on the head. The pulse becomes regular again, but grows smaller and more rapid until it can only be counted at the heart. The eyelids close only partially; there is some squinting; light is no longer unpleasant, for the dilated pupils are motionless. The child now often makes auto- 46 TUBERCULOUS MENINGITIS. matic movements with the mouth as if chewing, or as though endeavoring to swallow something, and it generally happens, that although sensibility is quite extinguished, the little patient will still swallow anything that is put into its mouth, and the power of deglutition is in most cases one of the very last to be abolished.—West. Many of these symptoms are sometimes very stupidly re- garded as signs of worm disease, and Cina and Spigelia or other worm remedies are administered. But these are signs of sof- tening of the brain, and cannot be removed by any remedies, although Zincum, Plumbum, Nux and Arsenicum are the most appropriate medicines. An attack of convulsions now sometimes puts an end to the painful scene; but often the child lives on for days, though wasted to a skeleton, and its features so changed by suffering that those persons who had seen it but a short time before would now scarcely recognize it. The head often becomes re- tracted, and the child bores the back of its head into the pillow; the eyelids are wide open, and the eyes are turned upwards, so as to conceal three-fourths of the iris beneath the upper lid, while the countenance is still further disfigured by a horrible squint, or by a constant rolling of the eyes. The pupils are now fixed and glassy, the white of the eye is extremely blood- shot, and their surface besmeared with a copious secretion from the meibomian glands, which collects in their corners. One arm and leg are stiff and motionless; the other in constant spasmodic movement, while the hands are often clenched, and the wrists bent upon the forearm. Subsultus and spasmodic twitchings of the face are common. Cold clammy sweats break out, the breathing is labored, swallowing becomes difficult, and the child almost chokes with the effort to swallow, or lets the fluid run out at the corners of the mouth. It is uncertain how long this condition may endure ; sometimes many days will pass, during which death is hourly expected and earnestly prayed for, to put an end to the patient's sufferings. Treatment.—In this stage, palliatives only should be used, such as Opium, Conium, Hyosciamus, Cannabis-indica, Chloro- form, Ether, &c. In some instances I have applied anodyne fomentations to the head, and used anodyne inhalations after the little patient was unable to swallow. TUBERCULOUS MENINGITIS. 47 TUBERCULOUS MENINGITIS. IN YOUTHS AND ADULTS. Dr. Kennedy, of Dublin, has seen about 30 cases in the course of nine years; and thinks that it is more common in females than males, in the proportion of 2 to 1. Of 80 cases of tubercular meningitis observed by Guersent. 33 were over 15 years of age ; and of 12 cases by Jackson, 7 were adults. Of 10 cases, 6 were in females, aged 27, 20, 28, 28, 26 and 23 res- pectively ; and 4 in males, aged 22, 20, 21 and 24. According to Kennedy, in the majority of cases the disease commences with the symptoms of a mild, continued or remittent fever, which goes on without change for 10, 12 or 14 days. It occasionally begins by a distinct complaint of the head, the patient still being able to go about. When it commences with fever, the symptoms are usually very mild; there is some quickness of the pulse, heat of skin, furred tongue and headache. The case seems to go on favor- ably, remedies seem to avail, and the patient may even be pro- nounced convalescent; or the symptoms may become so slight that the tongue is scarcely furred, some appetite may be present, and the patient may sleep well at night. When the disease commences by fever, the first sign of any- thing going wrong commonly takes place at night; a marked increase of fever may then be observed, the tongue becomes more furred, the skin feverish and the pulse rises to near 100. Kennedy has sometimes been led to suspect the serious nature of the case, by the nurse casually stating that on the previous night the patient had not slept so* well, had talked in her sleep, or awakened with a scream; these symptoms may return for four or five nights in succession, and yet the patient seem com- paratively well during the day. Alterations in the movements or expression of the eye, are often among the earliest signs, pointing to coming trouble. Squinting may occur, and yet be so slight as to be doubted or disputed, or it may be intermitting, i. e., present at one moment and absent the next; or else it only occurs when the patient is left to herself, but disappearing the moment she is spoken to; 48 TUBERCULOUS MENINGITIS. these slight changes may occur in one or both eyes, and are better observed at a little distance. One eyeball may be almost immovable, and yet it is easy to overlook this; or one pupil may be somewhat larger than the other; neither are dilated, but they differ in size. Sometimes the eyelids have a tendency to droop, and this ptosis may be most marked in one eye. These eye symptoms are among the most constant and impor- tant signs. At times the first symptom is vomiting, occurring most fre- quently in the morning; it may happen one or more times, but never takes the prominent part it does in the hydrocephalus of childhood. The head is now more apt to be complained of; perhaps there may be pain, only when the patient coughs ; as a rule it is re- ferred to the forehead over the eyes, but sometimes extends to the whole head. This state may continue for four or five days when the symp- toms will become more serious ; the patient is apt to wander a little while awake, generally towards evening, but only momen- tarily, as she is quite herself again when spoken to. The countenance is also apt to become heavy, as if she were inclined to doze. The next sign which attracts attention is the pulse; in the course of 24 hours it may fall remarkably, viz.: from 100 or 108 to 60, 55 or even 48. After the lapse of 48 hours more it begins to rise again, often getting up to 130 or 140, and now the case progresses rapidly; the patient becomes obtuse, difficult to rouse, and the signs of confirmed dropsy of the brain are soon added. In the advanced stages it is very common to find the patient's hand applied to the head, and the brows strongly knit, even in sleep. In some cases the patient will sing the same tune all night, or may grit her teeth with a degree of violence almost insupportable. The entire duration of these cases is about three weeks; the disease seems to run in families, several mem- bers, young and adult being affected; three-fourths of the pa- tients have naturally a heavy aspect; their faces are apt to be large in proportion to their heads, the lips to be large, and the skin rather coarse. In fact if a mild remittent fever occur in a HYDROCEPHALOID DISEASE. 49 young person, especially in a girl about fifteen years old, born of scrofulous or consumptive parents, and slight brain symptoms show themselves, be upon your guard. Treatment.—See Tuberculous Meningitis of Children. HYDROCEPHALOID DISEASE This is a most frequent and often fatal affection, though if rightly treated it is a very manageable one. It is especially common in this country, where infantile diarrhoea and summer- complaint occur frequently and severely, and blood-letting and other reducing treatment are resorted to so commonly, quickly producing that state of general exhaustion which leads to a train of symptoms about the head, closely resembling those of dropsy of the brain. According to West, hydrocephaloid disease is that condition which is induced when the brain is somewhat suddenly deprived of its usual supply of blood. Even in the adult a profuse loss of blood is often followed by an extremely severe headache, and by various other brain-symptoms ; while in the child, whose brain needs a proportionably larger quantity of blood for the due performance of its functions, the symptoms that follow its excessive loss are of a corresponding gravity; often indeed they present a striking similarity to those which1 betoken inflammation, or dropsy of the brain. Marshall Hall even says that in young children, bleeding, purging and giving calomel enough, in any disease, will bring it on. Ap-ain, there is no disorder in which the two conditions of considerable sympathetic disturbance of the brain, coupled with rapid exhaustion of the vital power, are so completely fulfilled as in infantile diarrhoea, and summer-complaint, and in no other affections do we meet with such frequent or such well-marked instances of the supervention of the hydrocephaloid disease. Symptoms.—This affection may be divided into two stages : the first, that of irritability ; the second, that of torpor. These two stages resemble in many of their symptoms the first and second stages of dropsy of the brain. In the first stage the infant becomes restless, irritable and feverish; the face is flushed, the surface hot, and the pulse frequent; there is an undue sensitiveness of the nerves of feel- D 50 HYDROCEPHALOID DISEASE. ing, and the little patient starts on being touched, or from any sudden noise; there are sighing and moaning during sleep, and screaming; the bowels are apt to be flatulent and loose, and the evacuations are mucous and disordered.—M. Hall. If the affection arises from the exhaustion caused by diarrhoea, and if from an erroneous notion as to the nature of this disease, nourishment and cordials be not given, or if the diarrhoea be allowed to continue, or be kept up by medicines, the exhaustion which ensues is apt to lead to a different train of symptoms : The second stage then sets in : the countenance becomes pale, and the cheeks cool or cold ; the eyelids are half closed; the eyes are fixed, and unattracted by any object placed before them; the pupils unmoved on the approach of light; the breath- ing from being quick becomes irregular and sighing; the voice be- comes husky, and there is sometimes a husky, teazing cough; and eventually, if the strength of the little patient continues to de- cline, there is a rattling in the breathing, and the feet become cold. Again, according to West, under no circumstances are mis- takes more easily committed, and never are their results more mischievous, than when primary and real congestion of the brain has been somewhat over-treated allopathically, and the conse- quent symptoms of exhaustion are supposed to be those of ad- vancing disease of the brain. In such a case, however, it wTould usually be observed that great faintness had been induced by the profuse depletion, and that the quiet which succeeded it was that of exhaustion, as much as of mitigated suffering; the fontanelle sunk below the level of the bones of the skull, in- stead of being tense and pulsating; the cool surface, and the pulse presenting no other characters than those of frequency and feebleness, would all point to the real nature of the case. To deplete further under such circumstances would be to de- stroy the patient; food is needed, not physic ; the sunken powers of life must be rallied, and as strength returns the functions of the brain will again go on harmoniously. The early stages of inflammation of the lungs, are also often attended with so much sympathetic disturbance of the brain as to throw the other symptoms into the back-ground. The child may vomit, refers all its sufferings to the head, and possibly have an attack of convulsions almost at the onset. The routine HYDROCEPHALOID DISEASE. 51 allopathist will naturally assume the case to be one of conges- tion of the brain, and treat it accordingly with free local deple- tion ; the next day the indications of disordered breathing are more apparent, and more leeches are applied to the chest. The urgency of the symptoms may be relieved by these means, or at least the child may seem to suffer less ; but soon the restless- ness of exhaustion comes on, and then follow the soporose con- dition and the apparent coma ; if the antiphlogistic treatment is resumed to arrest this imaginary dropsy of the brain, the little patient will die. Treatment.—A large number of cases of hydrocephaloid disease are not only caused, but absolutely killed by allopa- thic treatment, while a proportionately large number will die under purely homoeopathic treatment: for as West truly says, food and stimulants are required, not medicine. Although the diagnosis of this affection is sometimes attended with difficulty, the rules for its prevention and cure are happily very simple. Bearing in mind the possible supervention of hydrocephaloid disease, an infant should never be kept from the breast, nor a young child put upon spare diet for several days without the most absolute necessity. Especial attention must be paid to the food of young children, if the disease from which they suffer be diarrhoea, or some other which interferes directly with their nutrition; if the child be 'given nothing more nutritious than barley-water in small quantities, because the irritability of the stomach which results from weakness, seems to be the indication of disease in the brain, the restlessness will before long alter- nate with coma, and the child will die either comatose, or in convulsions. The irritability of the stomach is best overcome by giving nourishment in extremely small quantities, as a desert-spoonful of ass's milk, or equal parts of milk and barley- water for an infant, or of strong veal tea, for an older child, given little by little, every half hour. If the exhaustion be very great, and a state analagous to stupor impending, a hot mustard bath is sometimes very serviceable in rousing the child, while, at the same time, a few drops of Spirits of Hartshorn, or 5 to 15 drops of Brandy may be given every few hours. It is desirable, however, to suspend the use of the more powerful direct stimulants as soon as it can safely be done, though a nutritious diet will be necessary for some time.—West. 52 ATROPHY OF THE BRAIN. WASTING OF THE B R AI N.—(AT R OP H Y.) IN CHILDREN. Smallness of the brain sometimes occurs in consequence of a premature closure of the sutures and fontanelles. Such cases are apt to be attended with frequently recurring convulsions; loss of taste, so that the child cannot distinguish between what is nice and what is nasty, swallowing all things with the same readiness; the body and limbs may seem well nourished and well formed, yet the patient cannot stand or use his limbs pro- perly ; the urine and faeces are apt to be passed involuntarily and unconsciously ; and gradually every glimmering of under- standing will disappear. Treatment.—These cases are generally quite hopeless; Phosphoric-acid in full doses may do some good. According to West those cases are of much higher practical importance in which the brain of the child wastes or grows smaller during long-continued ill-health. The scalp will usual- ly be found pale, thin and bloodless, the fontanelles sunken, and the process of ossification of the skull unusually tardy; fluid will be found effused into the sac of the arachnoid and the sub- jacent pia-mater; the substance of the brain is pale and its texture firmer than usual. The important point about such cases is, that brain symp- toms and frequently recurring convulsions may be observed in a child whose brain is not absolutely diseased, but merely too feeble and too wasted to perform its functions. Treatment.—In infants who have been exhausted and wasted by previous illness, the physician must not interpose too hastily with remedies directed against a supposed brain-disease, but pursue a tonic and nourishing plan of treatment. Iodide of Potash may be used internally and externally to remove the fluid effused, and may possibly have some effect upon the har- dening of the brain, although Plumbum is the most homoeopa- thic remedy. Partial atrophy will be marked by symptoms most decided in particular parts, or on one or the other side of the body. enlargement of the brain. 53 IN ADULTS. According to Rokitansky this disease is also common in old age, and is within certain limits a natural process of shrinking or decay; it becomes, however, a pathological condition even in old age, if it proceed to a very great extent, and still more if it come on prematurely at an early period of life. The grey substance of the brain is apt to become of a dirty, or rusty brown color, running into yeast yellow; its consistence may be natural or distinctly softer than usual. The white substance loses its clear color and becomes of a dirty white ; it is denser too than natural, and is sometimes as tough as leather. The vacuum within the skull, produced by the shrinking of the brain, is filled up chiefly by a clear colorless serum ; the vessels of the pia-mater become enlarged and varicose. It leads to congestions of the brain, or Hypercemia ex-vacuo, causing transient or protracted attacks which simulate apo- plexy, and are so frequent in old age; or to actual apoplexy, with haemorrhage within the brain; or to oedema of the brain. Treatment.—Iodide of Baryta, Plumbum, and Iodide of Iron are the principal remedies. ENLARGEMENT OF THE BRAIN.; HYPERTROPHY. According to Rokitajnsky enlargement of the brain is sometimes congenital and is then often combined with dropsy of the brain; still it more usually comes on after birth, and is almost exclusively confined to the period of childhood. It is occasionally met with about the time of puberty, and sometimes, although exceedingly rarely, even in manhood. It is the white substance of the brain which is increased in volume; it is always dazzling white, and remarkably pale and bloodless, showing that it is not caused by congestion. When it comes on in childhood, and at puberty, it is combined with general enlargement of the lymphatic glands and partial obliteration of the thymus ; it is also apt to be attended with rickets and feeble muscular development. Its course is generally chronic, but not unfrequently it is 54 enlargement of the brain. somewhat acute; the cause of the acute symptoms when they occur, is a rapid and tumultuous addition to the bulk of the brain ; this only takes place in some instances. The majority of cases of enlargement of the brain which have fallen under West's notice in London, occurred in infants about six or eight months old. Their history has usually been, that without any definite illness, they had lost their appetite, and grown by degrees dull and apathetic, though restless and un- easy. Notwithstanding the general apathy, this restlessness is often very considerable, though it does not show itself in cries as much as in a state of general uneasiness, and in fre- quent startings from sleep. Short gleams of cheerfulness occur when the children are awake, but these are usually very tran- sient. The head seems too heavy to be borne, and even when its size is not much greater than natural, it hangs backwards, or to one side, as if the muscles were too weak to support it. If placed in its cot, a child who is thus affected, bores with its occiput in the pillow, while its head is almost constantly in a profuse perspiration. Convulsions sometimes occur without any evident cause, but threatenings of their attack are much more frequent than their actual occurrence, the child awaking sud- denly with a start, and a peculiar cry, like that of spasmodic croup, the surface turning livid, and the respiration becoming difficult for a few moments, and the symptoms then subsiding of their own accord. Such attacks may issue in general convul- sions, which may terminate fatally; but infants thus affected do not by any means invariably die of the cerebral disorder, but, being weakly, they are often cut off by the first malady that attacks them. If life be prolonged the child loses flesh, and looks out of health, while enlargement of the wrists and ankles, shows the connection between this disease and rickets ; a connection which becomes more evident in the second and third years of life. When the child survives infancy, or when as occasionally hap- pens the symptoms of enlargement of the brain do not come on until dentition has been in a great measure accomplished, con- vulsions are of very rare occurrence. Complaints of headache, however, are frequent and severe; and, though drowsy in the daytime the child generally rests ill at night, and often awakes enlargement of the brain. 55 crying and alarmed. Besides these symptoms, too, the child has occasional attacks of feverishness, with great increase of headache and giddiness, which last for a few hours or a day, and then subside of their own accord, while it grows by degrees more and more dull and listless, and its mental powers become obviously impaired. It happens in some cases, that, as the child grows older, these ^symptoms become less and less severe, the health im- proves, the ricketty deformity of the limbs gradually disap- pears and the infant who had excited so much solicitude be- comes at length a healthy child. Chronic dropsy of the brain is the only affection with which enlargement of the brain is liable to be confounded. The diagnosis between the two affections is often by no means easy, though it is of much importance with reference to the treatment. The symptoms of chronic dropsy of the brain generally come on earlier, and soon grow much more serious than those of en- largement of the brain, and the disturbance of the brain is throughout much more marked in chronic hydrocephalus than in hypertrophy. Convulsions, sopor and restlessness attend the early stages of chronic hydrocephalus, while spasmodic affections of the respiration are among the earliest indications of enlargement of the brain. The form and size of the head, too, present peculiarities by which we may often distinguish between the two conditions; both diseases are attended with enlargement of the head, and in both the ossification of the skull is very tardy, but the head does not attain so large a size in hypertrophy of the brain, neither are the fontanelles and sutures so widely open. The skull also presents some remarkable peculiarities ; the head not only shows no tendency to assume the rounded form characteristic of chronic hydrocephalus, but its enlargement is first apparent at the occiput, and the bulging of the hind-head continues especially striking. The forehead may, in the course of time become prominent and overhanging, but the eye remains deep sunk in its socket, for no change takes place in the direction of the orbitar plates, such as is produced by the pressure of fluid within the brain, 56 enlargement of the brain. and which gives to the eye that unnatural prominence, and that peculiar downward direction which are so striking in cases of chronic hydrocephalus. In chronic dropsy of the brain the anterior fontanelle is tense and prominent, owing to the pressure of the fluid within, but when the brain is enlarged, there is no prominence but an actual depression in this situation. West has more than once observed this condition in a remarkable degree, the depression not being limited to the anterior fontanelle, but being also ob- servable at all the sutures. When enlargement of the brain occurs in the adult, the symp- toms that arise are in a great measure due to the compression which the organ undergoes from its bony case being too small to contain it. The symptoms are of course exceedingly obscure. —Mauthner and West. Treatment.—Vinum-ferri, Ferro-citrate of Quinine, Iodides of Iron and Potash and Cod-liver Oil, have been used most fre- quently and successfully. Agaricus, Calc.-phos., Kali-carb., Mezereum and Rhododendron are the principal homoeopathic remedies. Daphne-indica is suitable when there is a sensation as if the outer part of the brain were inflamed and striking against the skull. Sulphur, Staphysagria and Stannum when there is pain as if the brain were beating against the skull, or a painful pressing of the brain against the skull a*hd occipital bones, in the evening, even after going to bed. Chelidonium when there is a pressing in the brain, as if the skull were too narrow, and the brain would be pressed out of the eyes, nose or ears. Baryta and Conium when the head seems too full as if it would burst; especially in both frontal eminences and in the orbits. hydrocephalus. ,57 HYDROCEPHALUS. DROPSY OF THE BRAIN. In by far the greater number of cases the fluid collects in the interior of the brain, constituting Avhat is called internal hydrocephalus in contra-distinction to other cases in which the fluid is contained in the sac of the arachnoid, and to which the name of external hydrocephalus has been given. INTERNAL HYDROCEPHALUS. The internal membrane of the ventricles of the brain is composed of a very delicate continuation of the arachnoid and pia-mater, and a layer of epithelium. The most frequent and important diseases to which it is liable, have, from one most striking characteristic which they present, viz.: an excessive accumulation of fluid, been included together under the title of hydrocephalus. The disease may be acute or chronic, inflammatory, or non- inflammatory. In the acute inflammatory form, a turbid fluid is found in the ventricles, composed of serum and lymph or pus ; the lining membrane of the ventricles becomes dull, opaque, softened and even diffluent, so that shreds of it often appear in the inflamma- tory effusion in the ventricles. The substance of the brain is in a state of acute oedema, and infiltrated to such a degree that it seems as if it were in a state of watery softening ; hence the brain itself is swollen and ac- tually increased in volume, so that its convolutions are forced against the skull and flattened. It is very apt to be associated with tubercular meningitis.— Rokitansky. In the acute non-inflammatory form, a clear, colorless, se- rous fluid, varying in quantity from one or two to six ounces, is found in the ventricles. Although the disease is often acute, it cannot be admitted to be inflammatory; it arises from conges- tions of various kinds, viz.: such as are connected with the development of the brain in childhood, or those produced by chronic eruptions on the scalp, by the irritation of morbid v 58 hydrocephalus. growths within the skull, (fee.; or it may be occasioned, too, by the congestions which follow concussion of the brain, or mechani- cal obstructions of the heart, chronic catarrh of the lungs, or bronchi, except that the tongue ap- peared somewhat clearer, and he was not so thirsty ; continue Arsen. 6., every four hours; in three days more there were only some shades of amendment. Then Hellebore 6. was given every four hours, and in two days there was a decided improve- ment, and in a few days more he was perfectly restored.— Yeldham. CASE 60.—A boy, aged 3 years, was taken sick three or four days ago, with disordered bowels, and soon fell into a drowsy and heavy state, in which he hangs back on his mother's arm, shewing the greatest repugnance to being moved or dis- turbed ; his brow was knit and frowning ; his eye-lids drooping, pupils contracted, eyes dull and unexpressive; his head as well as body generally hot and dry; breathing short and quick, pulse 160 and throbbing; was very thirsty, could not bear the least noise and avoided the light; his tongue was white and thickly coated; bowels loose; he was exceedingly weak, and had commenced to emaciate. Treatment.— Aconite 12. and Bellad. 12. in alternation every four hours ; the next night he was quite delirious, but much im- proved in the morning, his skin was cool, pulse only 100, thirst less, eyes still heavy and frowning; omit Aeon, and continue Bellad.; on the next day there was an increase of stupor, but his skin was still cool and pulse laboring; gave Hellebore 6. every four hours with marked improvement in twenty-four hours and rapid recovery.—Yeldham. CASE 61.—A girl, aged 7, had been failing for some time; bowels relaxed and passages unhealthy. Treatment.—Mercurius 6., three times a day; in two days was considerably worse, stupid, heavy and lethargic; started and screamed; her head was hot, and she was feverish and thirsty; her tongue coated brown and dry. Bellad. 6., every 122 HYOSCIAMUS. four hours ; at the end of three days more she was still worse, was perfectly lethargic and unconscious of everything; she Bcreamed and started terribly, and rolled her head; her lips, tongue and teeth were black and dry, and covered with a thick, hard and offensive matter; pulse very rapid, and skin and head very hot. Then took Hellebore 12. and Rhus. 12., every four hours in alternation, with decided improvement at the end of two days, when her lips and tongue were moist and cleaning, mind more quiet and intelligent, no more screaming. The medicines were continued for five days more, when she was quite restored. HYOSCIAMUS. The most marked effects observed by Greding were: 1. Perspiration. Seven patients out of forty had a profuse dripping perspiration on the first night; and two-thirds of all the others had more or less sweat; they perspired not only in Bummer, but also in the fall and winter; the perspirations were sour at times. 2. Sleep. A quiet, refreshing and deep sleep, generally at- tended with breaking out of the perspiration; many patients slept the first night, but more, viz.: twenty out of forty, slept better afterwards. 3. Happiness of mind, activity of body, and greater clearness of intellect; fourteen out of forty patients experienced the for- mer, and nine the latter. 4. Dulness and heaviness of the head occurred in four cases. 5. Headache in fifteen cases. 6. Dizziness in eight cases. 7. Torpor of mind in three cases. 8. Eruptions occurred in five cases, viz.: brown spots, or liver-spots, small pustules, boils, and also swelling of the left parotid gland. 9. Profuse urination occurred in three cases, on the first day; and finally in at least one-third of all the cases. 10. Diarrhoea more or less profuse and continuous occurred in twenty-three cases ; with expulsion of worms in three cases; HYOSCIAMUS. 123 with vomiting of bile and mucus in ten cases ; with colic and rumbling in six cases ; with nausea in five cases. Constipation only took place in two cases, and then only in a slight degree. 11. Menstruation was brought on, or increased in twelve cases; in one case it was brought on after a suppression of five months. 12. Salivation occurred in one case. 13. Profuse catarrh in one case. 14. Rheumatic pains in seven cases. 15. Dry, convulsive cough in two cases. 16. Hiccough in three cases, in one with involuntary urina- tion. In one case, in an adult woman, an overdose of the Root pro- duced, slight and then increased stupefaction; flimmering be- fore the eyes, brilliancy of the eyes, double vision ; considerable dilatation of the pupils; dimness of sight; dizziness; great dryness of the mouth ; trembling of the limbs and staggering ; small, scarcely perceptible, frequently intermitting and mode- rately slow pulse. In a girl, aged 4 years, a large quantity of unripe seeds, pro- duced unsteadiness of gait, small, white blisters on the lips, and flushed face ; at the end of three hours the face was very red, the eyes injected, the pupils extremely dilated and insensible to light, the tongue coated, pulse small and moderately frequent; heart beating violently and irregularly; there was entire loss of consciousness ; frequent groaning ; grasping about, with out- stretched fingers, as if something had to be seized suddenly; frightful gritting of the teeth; frequent jerking of the hands and feet; constant incomprehensible babbling; skin almost na- tural ; abdomen soft. In a boy, aged 3 years, the seeds caused him to fall down senseless upon the floor; he thrashed around him; frothed at the mouth ; his face was much reddened ; and he had alternate convulsive movements of the face and limbs. In a girl, aged 6, the seeds caused paleness of the face with- out heat of the head: great dilatation of the pupils ; smallness and quickness of the pulse; throbbing of the heart; coldness of 124 HYOSCIAMUS. the hands and feet; slight convulsions of the limbs ; squinting ; gritting of the teeth ; and unconsciousness. In a girl, aged 6, the seeds caused: heat of the head and whole body; redness and bloating of the face; fulness, without quickness of the pulse; violent and irregular action of the heart; protrusion with great redness of the eyes and much dilatation of the pupils; the most happy delirium, so that she sang and spoke and babbled constantly, but very hastily and indistinctly; but she became very violent, and struck around her whenever she was spoken to loudly or taken hold of. In an adult, three ounces of the seeds, made the face bluish; the eyes red, wild and sparkling; the veins of the neck and limbs, but especially of the face, much distended; the whole body was convulsed ; frequently returning subsultus ; and such a furious delirium that no one could hold him. During the in- termissions the patient was occupied in trying to catch flies which seemed to be flying about, or in picking shreds out of his quilt. Afterwards he seemed much exhausted and breathed like one in an apoplexy, from which he was aroused by still more violent convulsions ; the pulse was small, quick, contracted and distinctly intermitting ; tongue dry and clean ; hypogastric region much distended and very painful; urine very scanty; there was such excessive itching that he expended his little strength in scratching himself until the blood came ; invincible horror for all liquids ; afterwards perspiration sat in very pro- fusely and lasted for two whole days, over the whole body, but especially on the legs, and a pimply eruption broke out upon the thighs, both before and behind, from the hips down to the knees; the pimples were large, red and confluent, like those of small-pox, but did not contain any fluid. His sight remained very dim for some time.—Frank. A coachman, from the herb, experienced confusion of the head, and such stiffness of the arms and legs that he could scarcely stand, and finally fell down; his eyes seemed inflamed for a long time afterwards.—Frank. Schneller from four grain doses of Extract, experienced: mist before the eyes and weakness of sight; dryness of mouth; HYOSCIAMUS. 125 yellow coated tongue; great distension of abdomen, with incli- nation to breathe deep; sour eructations; scanty stools ; rather slow pulse; also left frontal headache, with ambliopia, frequent inclination to yawn and sleepiness, with evening nausea. Some of the doses were not followed by head-symptoms, but merely by frequent inclination to sneeze, with the feeling as if a catarrh of the head would set in; also frequent sour eructations, some little constipation, and good sleep. In other experiments he had: tickling and burning in the throat, with increased secretion of mucus, dryness of the mouth, white tongue, hoarseness, loss of appetite, and some colic; also peculiar drawing and rending pains in the joints, especially in the wrists and knees. Five grain doses caused: thick coating of the tongue, insipid taste, offensive breath, eruption of small boils upon the face, dimness of vision and redness of the eyes. Eleven grain doses caused: vertigo, gauze before the eyes, headache on the right side of the forehead, prickling feeling in the arms, followed by sticky perspiration, with heat, redness and turgor of the face. At other times he experienced: dryness of the nostrils, pain at the root of the nose, and excretion of a very little mucus mixed with blood, &c.—Frank. In an adult soldier, the young shoots caused some burning in the throat, stupefaction, and a dropsical swelling of the arms and hands. Two other soldiers experienced: very violent dizziness, and they finally fell down as if deeply intoxicated ; their eyes were wild, pupils much dilated, expression fixed and stupid, respira- tion difficult, pulse small and intermitting; loss of voice, lock-jaw, risus sardonicus, loss of sensation, typhomania, coldness of the limbs, paralysis of the legs, carphologia and convulsions of the arms. The patient who vomited least, had mania with delirium, but without fury, although it was difficult to hold him, when he sought to escape. A girl, aged 4£ years, ate one root, and seemed as if intoxica- ted ; she was awake, but without consciousness, did not answer questions, but looked around the room as if seeking something, 126 HYOSCIAMUS. made frequent, but not convulsive motions with the hands and feet; if she attempted to take hold of anything she grasped to one side of it; her eyes were wide open, pupils dilated, pulse natural, and face reddened.—Frank. Four children, from 4 to 8 years of age, ate of the leaves: They began to stagger, then fell down in convulsions; their faces were bloated, skin dry, pupils excessively dilated, eyes turned upwards and inwards. In one child the abdomen was so much distended that it seemed as if it would burst, but without pain ; the tongue was stretched far out of its mouth, turned up, and occasionally thrown spasmodically against the nose. In the two youngest, such violent convulsive movements sat in at times that a strong man could scarcely prevent" them from injuring themselves; when free from convulsions they spoke much, very hastily, and unconnectedly. The two oldest were affected quite differently; they lay quite quietly in a perfectly stupid and unconscious state. None of them seemed to be in pain; all seemed comfortable, and one was occasionally merry and silly.— Frank. Two girls, aged 5 years, ate several capsules, and were at- tacked with trembling of the limbs, anxiety, restlessness and confusion of words and actions ; in six or eight hours they were talking incessantly and confusedly, they laughed and sang at times, did not know their relatives, had frequent spasms of the facial muscles, especially if one attempted to hold them or take anything out of their hands, when they became violent and at- tempted to bite, pinch and scratch; they seemed very strong in their hands and feet, and at times attempted to dance; they gritted their teeth, and had a spasmodic stretching out of their tongues, with a peculiar trembling motion of it; their eyes were brilliant and rolled about unsteadily, and were reddened; the pupils exceedingly dilated and insensible to light; pulse almost extinct, small, and very quick.—Frank. CASE 62.—A man, aged 24 years, healthy and strong, got sick after a severe chill. On the second day the malady was the following: Symptoms.—He lay senseless with closed eyes, did not open them when spoken to; his mouth could be opened with diffi- I0D NE AND HYDRIODATE OF POTASH. 127 culty; tongue, covered with a white, foamy slime ; he dreamed about business affairs, animating his servant to work; he sang unintelligible songs ; murmured, laughed and then became quiet again, started often, worked with his hands, as if he intended to prick on the ceiling; pupils enlarged, eyes dull, face red, skin dry and parched, breathing quick and anxious ; pulse regular, but full, abdomen somewhat contracted, but he did not complain of pain if touched and pressed. Prescription.—Hyosc. 6., one drop per dose, in half an hour after, slept for four hours, passed urine involuntarily; seven hours after, awaked with consciousness. On the following day, some signs of inflammation of the lungs were soon removed by Arnica.—Mossbauer. CASE 63.—It was useful in an affection of the brain, at- tended with convulsions of the whole left side of the face and body; the right arm and the right leg constantly affected, al- though not spasmodically, while the limbs of the left side, with- out being paralysed, lay quite still. Ipecac, was of no use, but Hyosc. effected a speedy cure, and caused a quiet sleep.— Gross, Jr. Review.—The presence of redness of the face, delirium, picking at the bed-clothes, fright, convulsions, are indications for the use of this remedy. IODINE AND HYDRIODATE OF POTASH. Iodine acts principally upon the absorbent system, and the particles absorbed are quickly ejected through the kidneys, as the urine is generally much increased in quantity; some per- sons experience this latter effect so instantaneously that Iodine has been detected in the urine almost immediately after each dose has been taken. This excessive absorption and drain from the system may lead to great emaciation, or it may excite an in- creased demand for food so that one of the first and most impor- tant effects of this remedy may be a great increase of appetite, which will enable us with ease to invigorate the constitution by wholesome and sufficient nourishment. Again, although it is well-known to all practical men that Iodine acts as a diuretic, it 128 IODINE AND HYDRIODATE OF POTASH. is not equally known that the Iodine-urine contains large quan- tities of urea. Now, urea is the product of the decomposition of the albuminous tissues, and as it has been clearly shown by chemical analysis that tubercle is composed chiefly of albumen and caseine, we can understand how Iodine acts by carrying a large quantity of albumen out of the system, thus retarding the growth and promoting the absorption of tuberculous matter.— Glover. We have already seen that Hepar.-sulphur dimin- ishes the quantity of albumen in the blood ; it might be advisa- ble to put a tuberculous subject upon alternate courses of Hepar.-sulph. and Iodine; the one to diminish the quantity, and the other to expel the excess of albumen from the system. Waring says: In tubercular meningitis or acute hydro- cephalus Iodine has been used with benefit. Drs. Christie and Woninger relate two cases which had reached the paraly- tic stage, but which recovered under the external and internal use of Iodine. Dr. Bennett has derived decided benefit from Iodine and its preparations in this disease; and Dr. Willshire bears similar testimony; he advises the use of Iodine external- ly and internally in the early stages of the disease, before there is much evidence of congestion and inflammation; he applies the Iodine-ointment to the shaven scalp, and gives internally, gr. tV of Iodine and gr. iij. of Potass.-iod. in solution, every three hours ; this, aided by turpentine enemas will be found in most cases a palliative, and in some a curative mode of treat- ment. Dr. Rilliet advises the use of Iodine frictions to the shaven scalp in the second and third stages of hydrocephalus. Rowland Hoskins relates a very aggravated and apparent- ly hopeless case which yielded to the Iodide of Potassium in half-grain doses, every four hours; but Scammony was given at the same time as a purgative. Another case illustrative of the efficacy of this salt, is related by Dr. Gueroud. Dr. Cope- land also states that he has prescribed it in small doses with evident advantage. CASE 64.—A child, aged 2£ years, was attacked with fever and vomiting, followed on the third day by convulsions, and all the signs of dropsy of the brain; on the fourth day the eyes were open, squinting and dim; the pupils much dilated; there IODINE and hydrio'date OF POTASH. 129 was unconsciousness with incessant screeching, without weep- ing; entire blindness; the eyes were moist, the edge of the lower lid relaxed and inverted, (entropium); the little patient lay on its back, with its head pressed back into the pillow; when it was raised up its head fell back hopelessly; there was entire paralysis' of the right limbs, with partial palsy of the left; frequent, involuntary and automatic motions were made with the left arm and leg; drinks passed over the clean and dry tongue into the windpipe and excited spasmodic coughing; the urine was scanty, the cheeks which had been pale yesterday were red to-day ; the pulse which had been slow and irregular yesterday was very quick to-day ; the whole body was in a drip- ping perspiration, notwithstanding that ice was applied to the head. The last febrile reaction had taken place previous to dissolution. Treatment.—Kali-hydr. 1 drachm in 2 oz. of water, 30 drops per dose, every hour; notwithstanding the difficulty of swallowing, the whole of the above medicine was given in less than twenty- four hours and the prescription repeated, without alteration of the symptoms except an increase of the dryness of the mouth and thirst; but on the tenth day of the disease, and the Becond day of this treatment, the first traces of improvement were observed in commencing contraction of the pupils; on the seventh day consciousness was restored, there was regular move- ment of the pupils, natural position of the eyes, the countenance was expressive, the little patient began to move the left hand and arm, and two days afterwards motion was also restored to the right side; peat appetite set in, and many small boils broke out on the face and neck. Finally this critical eruption of boils became a perfect torture to the child, for at least one hundred large and small ones appeared first and last upon the head, back, neck, face and chest; shortly after the pimples appeared, they quickly changed without much redness or inflammation into larger or smaller abscesses, some of which attained the size of a hickory nut and then burst. At the end of four weeks the child was perfectly well of dis- ease and eruption, after using about ten drachms of Iodide of Pot- ash in the course of eleven days.—Frank's Magazine, Dr. Roeser. CASE 65.—A case of hydrocephalus progressed notwith- 130 IODINE AND HYDRIODATE OF POTASH. standing the most active antiphlogistic and derivative treatment into the second stage, but after the use of half an oz. Iodide of Potash in the course of three days, consciousness had returned, the pulse was no longer irregular and intermitting, but still fre- quent ; a perfect cure was effected in six days by smaller quan- tities—about two drachms more. Tartar-emetic ointment had also been applied to the nape of the neck.—Dr. Veit. CASE Q6.—A girl, aged 6 years, after eight days of sick- ness, lay in a deep stupor, from which she occasionally started up with screaming; the pupils were dilated, one considerably more than the other; the eyes were insensible to light, with squinting; she could be rendered conscious for a short time by shaking and loud talking; she gritted her teeth in her sleep; the pulse was quick and irregular; she could still move her limbs, hold up her head, and swallow. Treatment.—Kali-hydriod. was used without aid from any other medicine; at the end of two days and after taking drachms ij., all dangerous symptoms had disappeared, the po- sition of the eyes was natural, the pupils normal, and stools regular. But great redness of the cheeks and strong pulsation of the carotids set in, calling for the omission of Kali-hydriod. and the use of Calomel, leeches and cold applications to the head; on the next day this congestive and febrile paroxysm had subsided, and the face was again pale, but the stupor sat in again, and the pupils became dilated and sluggish. Kali-hy- driod. was resumed, and in five days more perfect recovery had taken place.—Dr. Veit. CASE 67.—A boy, aged %\ years, of strong constitution and active temperament, but who had frequently suffered with crusta- serpiginosa and catarrho-scrofulous opthalmia, was attacked with incipient inflammation of the brain, and treated with Calomel, &c, from the 17th to the 26th of June, when all the signs of effusion sat in ; he was entirely unconscious ; tossed about the right leg in a restless manner, while the left lay paralysed and motionless; occasionally sudden starts of the whole body, and screaming fits ; the eyeballs were drawn spasmodically up- wards, and only partially covered by the lids ; the pupils were entirely immovable and very widely dilated; the conjunctiva was reddened and the cornea and edges of the lids covered with IODINE AND HYDRIODATE OF POTASH. 131 purulent mucus ; the nostrils were dry ; face pale and sunken; mouth distorted and partly opened, with frequent sucking mo- tion of the lips; tongue moist; gums touched, and together with the teeth and lips were covered with brown sordes; there was frequent gritting of the teeth ; slow and unfrequent pulse ; dry skin ; great thirst; constipation and almost entire suppres- sion of urine. Treatment.—Kali-hydriod., half a drachm in three ounces of water, and one ounce of simple syrup,, a moderate tablespoonful every two hours. On the next day, with the exception of some congestion of the head, for which seven leeches were applied to the mastoid processes, there was evident improvement, which progressed steadily under a renewal of the prescription on the 28th and 30th of June, and 2d of July. The critical appear- ances were a profuse secretion of urine, which was at first tur- bid, but soon became clear ; several semi-fluid stools ; moderate warm perspiration, some white miliary eruption upon the chest and neck, especially in the outbreak of boils upon the forehead, scalp and nape of neck; these were of various sizes, some as large as a hazel-nut; they suppurated and ulcerated, and their irruption was aided by the application of Tartar-emetic ointment for several days. Dryness of the mouth, and a frequent, dry cough, were also noticed as effects of the remedy. The child was entirely restored in eighteen days, under the use of half an ounce of Hydriodate of Potash.—Amelung. CASE 68.—A little boy, aged 2£ years, suffering with dropsy of the brain and consumption, was so far restored by the use of six drachms of Kali-hydriod. in four days, that there seemed but little doubt that he would recover from the brain. disease. The pupils became regular, consciousness was re- stored, although the little patient could not speak, he could hold up his head somewhat, and move his emaciated limbs, he passed much urine, had several stools per day, and pimples and boils commenced to break out upon his head, aided by the appli- cation of Tartar-emetic ointment. Finally the hydrocephalic symptoms disappeared entirely, but the child ultimately died of consumption.—Dr. Roeser. CASE 69.—A boy, aged 2£- years, previously quite healthy, 132 I,DINE AND HYDRIODATE OF POTASH. was attacked with decided inflammation of the brain attended with fever, headache, contracted pupils, intolerance of light, vomiting and constipation. Treatment and Result.—Eight leeches were applied to the temples, and two grains of Calomel given every two hours ; the Mercury had not operated upon the bowels at the end of several days, the vomiting had ceased, the headache persisted, also the stupor, from which, however, the little patient occasionally started up with frightful screams. Ice was applied to the head, eix more leeches to the temples and a blister to the back of the neck. After the use of several drachms of Calomel, the con- stipation persisted and the most decided signs of dropsy of the brain sat in. There was constant stupor, squinting, very much dilated and insensible pupils, frequent automatic screaming, dirty and dry tongue and slowness of the pulse. Treatment.— Kali-hydriod., two drachms in one and a half ounces of water, twenty to thirty drops per dose, every hour; the whole quantity to be used every twenty-four hours. At the end of two days several loose stools had occurred, the pulse was fuller, harder and quicker, the pupils somewhat contracted and sensitive to light, gums touched by Mercury. At the end of nine days consciousness was entirely restored, pupils natural, sopor gone, and there was only a little squinting with one eye. Violent mercurial gangrene of the mouth was followed by great restlessness and delirium; and the Hydriodate of Potash was stopped, but had to be resumed again in seven days on ac- count of a return of the brain symptoms; two drachms were used per day with rapid improvement for seventeen days, when the patient had perfect possession of his mental faculties, was Btout and blooming, but some of his teeth had fallen out, and part of his jaw-bone was loose.—Dr. Roeser. N. B.—Since Roeser has resorted to such heroic doses of Hydriodate of Potash, sometimes using three ounces and six drachms in one case, he has only met with three fatal cases out of many; in one of these cases a post mortem examination re- vealed tubercles and ulceration of the lungs ; in the two other cases the remedy was given too late and qi ite irregularly. CASE 70.—A boy, aged 5 years, was attacked with vio- lent inflammation of the brain, eight cays after a fall upon the head. IODINE AND HYDRIODATE OF POTASH. 133 Symptoms.—Perfect stupefaction and blindness, heat of the head, immoveableness of the pupils, entire suppression of all the secretions, quickened pulse, and violent, finally incessant con- vulsions, passing over into opisthotonos. Treatment.—After the fruitless use of leeches, ice to the head, Calomel and Sublimate in unction, Kali-hydriod. was given, one to two drachms in two ounces of water, a tea- spoonful per dose. At first the symptoms were rather aggra- vated, but improvement soon sat in after the occurrence of pro- fuse urination and copious discharge from the nose.—Zimmer- mann. CASE 71.—A boy, aged 2 years, previously afflicted with eruptions upon the head and face, was attacked with violent in- flammation of the brain, apparently in consequence of repeated falls upon the head. Very active antiphlogistic and counter- irritant treatment had produced no good effect at the end of five days, on the contrary all the signs of effusion had taken place. Symptoms.—The eyes were fixed and Avatery; pupils im- moveable and widely dilated ; absolute blindness ; tetanic rigid- ity of the muscles of the nape; retraction of the head ; paralysis of the left side ; deep stupor; slow pulse, down to 50 ; frequent screaming and vomitin^. Treatment.—Kali-hydriod., one drachm in half an oz. of water, forty and finally fifty drops per dose, every two hours ; without improvement for the first three days ; but on the fourth day of the Potash treatment and ninth of the disease, profuse secretion of urine sat in, with evident improvement in all the alarming symptoms; after the use of two drachms of the Hy- driodate he was almost out of danger on the twelfth day of the attack.—Frank's Magazine.—Dr. Woeniger. CASE 72.—The head of the patient at birth was unusually large and the fontanelles widely separated, the membranous portions being quite protuberant, with fluctuation ; the child had had frequent convulsions and occasional paralysis. When Dr. Bvrbouii saw the case, the head was of monstrous size; the fontanelles very large, the anterior being at least three inches in diameter, and occupied by a large fluctuating tumor, elevated about an inch above the level of the skull; the sagittal 134 iodine and hydriodate of potash. suture was widely open, and all the bones of the head quite moveable and compressible; his neck was remarkably emaciated and slender, so much so, that the weighty head could only be sustained by the shoulder on which it constantly leaned. Chro- nic diarrhoea also existed, attended with general emaciation, tumid abdomen and irritative fever; in fact he presented the most prominent symptoms of marasmus in connection with chronic dropsy of the brain. Treatment.— In order to improve the secretions and check the diarrhoea Ilydrarg.-cicuta and Pulv.-dover, grs. xv., made into twelve powders, one every six hours ; this had such decided effect that an occasional laxative had to be given. To promote the absorption of the fluid and improve the general constitution, Hydriod.-potass., half a drachin in 2 ounces water, one teaspoon- ful three times a day was given. A blister was applied to the head, and frequent effusions of cold water were used. This course was continued for six weeks, and the result was highly gratifying; the irritative fever gradually yielded; the head diminished in size, day by day; the fontanelles became gradu- ally reduced to their natural size; the convulsions did not recur; and the little boy gained flesh, strength and color, and finally appeared perfectly well. Dr. Barbour's great reliance, at least theoretically, Avas upon the Hydriodate of Potash. CASE 73.—A girl, 12 years of age, was attacked with ar- thrit. acut. vaga. About midnight on the 16th of January, she became delirious and restless, sometimes sitting up in bed, at others lying down again. The inflammation of the wrists had ceased, and appeared to settle in the meninges; the patient was nearly given up. Treatment—Iod.-solut., (ten gran, in half ounce of Alcohol,) two drops, p. d., to be taken half-hourly, for one day ; on the second day, hourly; on the two following days every two hours. On the 17th the consciousness was already regained, the right hand had re-inflamed, the meninges were free. She then took Ant.-cr. and Bryon., and on the 26th was also recovered from the arthritis.— Schmid, 130. iodine and hydriodate of potash. 135 NATURAL CURES. CASE 74.—A boy, aged 2-£ years, robust, with a large head, and prominent forehead, was taken sick on the eighth of Decem- ber. Six days afterwards acute hydrocephalus, was fully de- veloped ; the fontanelles were still Avidely open ; leeches, Calo- mel, (fee. were given Avithout benefit, and on the eighteenth day the boy lay helpless and stupefied; his head and face were alternately hot and red ; he gritted his teeth ; the pupils were dilated and insensible to light; he SAvallowed fluids hastily: this state lasted tAvo days more, when a larger quantity of clear watery fluid flowed from the ear, and the patient improved on the same evening; profuse flow of urine also sat in and lasted for several days ; in a feAV days more the little patient was decidedly convalescent, and recovered perfectly in six Aveeks. Two profusely suppurating spots also formed on the back of the head. The author had previously witnessed a similar case.—■ Riecke. CASE 75.—A little girl, aged 4 years, had been sick for five days with inflammation of the brain, for which she had received no medical treatment, and now seemed at the point of death. Her face Avas red; eyes rigid and immoveable; breathing fre- quent and irregular; pulse hard and - intermitting; for two days everything that she had SAvallowed had been ejected again through the nostrils. Ice to the head, leeches and injections were used without benefit; at the end of eight days more, her face AAras pale and sunken ; nose and ears cold ; pupils dilated; eyes turned up ; mouth open ; breathing scarcely perceptible ; pulse small, frequent and intermitting; constipation for eight days, and no urine had been passed for three days ; the right arm and leg were moved automatically; the Avhole left side seemed paralyzed. On the next day the whole scalp Avas slight- ly reddened and covered Avith an immense number of small miliary vesicles, which increased in size for two days more, then ran together, burst and discharged a large quantity of yellowish watery fluid, folloAved by improvement of the brain symptoms. At the end of a few days more the whole head and face were covered with a thick scab, through the fissures of which a bloody 136 IODINE AND HYDRIODATE OF POTASH. serous fluid exuded; evacuations from the bowels and bladder had commenced. In eight days more the little patient was cut of danger; but she did not recover her speech or the use of the left side until after the lapse of many weeks.— Malin. CASE 76.—A little boy, aged 1£ years, became sick Iavo weeks after an attack of scarlet fever; gradually all the signs of dropsy of the brain developed themselves; his fiice became pale; pupils dilated and fixed ; the conjunctiva reddened ; cor- nea dull and coated with mucus ; entire stupor for three days ; convulsions of the right side; boring of the head into the pillow; vomiting and constipation had been followed ly in- voluntary diarrhoea ; pulse aa as small and frequent, vith ccca- sional intermissions. Elder tea caused such a jrotuse perspi- ration that a large bed was saturated both above and below, and the child speedily recovered.—Ritscuer. CASE 77.—A boy, aged 1£ years, had so large and heavy a hydrocephalic head that he could not hold it up withcut si:] | tit; the head was soft and doughy to the feel; the fcntanellcs w every six to twelve hours, effected the cure; to one child, Phos- phor, -fc was given with the best effect. Course of the Disease.—After giving Aeon, and Bellad.; crying out in the sleep rarely took place, sleep became more natural, still the child complained about pain of the fore- and hind-head, as well as about the vertex. From the use of Sul- phur and Phosphor., the vomiting ceased, constipation abated, the symptoms of fever ceased, as well as the heavy sweating of the head, the skin got moist and a cure followed. Some chil- dren were cured after sixteen, others after twelve, and still others after eight doses.—Arch. 16, 1, 61, Weber. CASE 87.—A boy, 2£ years of age, was taken sick with the folloAving: Symptoms.—Head so heavy that it could scarcely be kept straight and fell to the side; holding it erect produced vomiting of liquids, or of slime ; the child slept most of the time ; was frightened, as if from anxiety; the cheeks changed frequently from pale to red, or if one was red, the other was pale. The limbs Avere cold; there was perspiration only on the head, which was very hot; thirst; pulse 100. Treatment.—Aeon. -3-5-, ten drops, every two hours, followed by Bell. 30. after eight hours, without effect. Afterwards Sul- phur Tg-oTTj every twelve hours. After four doses the child was perfectly cured, with the exception of great debility. Bell. -5-5-, removed the weakness within four days.—Arch. 16, 2, 3, Weber. CASE 88.—Three cases of inflammation of the brain, in the persons of a boy, aged three years, and two girls of five years. Symptoms.—Could only lay the head in certain situations; it had to be kept low, otherwise the child would cry and vomit; deep sleep, interrupted by raving ; aAvaking Avith a heavy start, although ordinary calling and speaking would not awaken the patient; penetrating sour smell of the mouth. Treatment.—Aeon, and Bellad. were of no use, but after several doses of Sulph. 1500. a cure began instantly.—Arch. 16, 2, 5-10, Weber. VERATRUM. 151 Review.—Of no remedy have we so many observations as of Sulph.; it proved useful even when the disease was approach- ing to the second stage, and when Aeon., Bell, and Hellebore had been given without effect. It was given in high potencies, the 30th, 60th or 1500th. Among the characteristic symptoms we do not find the boring with the head, but rather a sinking doAvn from heaviness; SAveat on the head Avith a musk-like smell; changing of the color of the face; sour smell of the mouth. The cure was in all cases rapid and progressive. The doses as above mentioned were all high potencies. VERATRUM. CASE 89.—A child, 11 months of age, had on the fifth day of illness the following : Symptoms.—It lies slumbering upon its back; eyes half closed; face pale and thin; it rolled its head violently from side to side, with sharp screams; or bored into the pillow; transient redness of the cheeks ; throAving off the bed-clothes ; the head when raised fell doAvn backwards, with convulsive mo- tions of the limbs ; the eyes were languid and lifeless, with greatly contracted pupils ; the child noticed nothing ; its eyes resembled a dull, gliding glass, covered Avith a thin transparent mucus, Avhich dried into hard masses in the corners ; it remained in a torpid state even when spoken to loudly: when it was raised up it had several convulsive shocks and inclination to vomit. At the beginning of the attack there were frequent paroxysms of vomiting and diarrhoea; the head was hot, the body almost cool; pulse without strength and of diminished frequency ; it refused to nurse. Treatment and Result.—Verat.-alb. 2., twenty drops in two ounces aq. d., a teaspoonful every three hours. At the end of twenty-four hours after the patient had received three doses, there seemed little chance of life; but on the fourth day of the treatment, the patient having taken the Veratrum regularly, the following state of things was present: when called, the child cast its eyes to the place where the call came from ; the pupils were of natural size, eyes bright and expressive; the child was 152 GENERAL REVIEW. awake almost every hour ; has taken the mother's breast; tried to hold its head up ; there were thin discharges from the bowels. The recovery was soon perfected.—Allg. Horn. Ztg. 19, 38, Knorre. ; Z I N C U M . General Remarks.—In the irritative stage, says Hart- mann, if Bell, is without effect, Zinc, is incomparable in the second to third triturations; it should be given every two hours. He has never given this medicine in vain, and generally after the lapse of twelve to twenty-four hours, the crisis was perfect- ly formed.—Dess. Therap. 1, 540. GENERA! REVIEW, BY RUECKERT. The principal remedy was Bell, thirty-seven times. Sulph. sixteen times. Aconite fifteen times. Bryon. and Opium three times. Arn., Hell., Hyosc. and Stram. twice. Cupr., Digit., Iod., Rhus, and Verat. once. Zinc, is recommended. Opium, Stram. and Spir.-nitr.-dulc. were frequently used in some epi- demics. Form of inflammation: 1. In encephalitis : Bell., Bry., Hyosc. 2. In inflammation of the meninges: Bell., Bry., Iod., Op., Spir.-nitr.-dulc, Stram. 3. In hydrocephalus-acut. a. In the first stage : Aeon. 6. " second stage : Arn., Bell., Digit., Hell., Rhus., Sulph., Verat. c. In the third stage : Helleb. In order to secure a quick survey of the principal indications, we append the annexed synopsis. During and after acute exanthems, such as scarlet fever or measles, when inflammation of the brain appeared, Arn., Bell., Cupr.—From dentition, Aeon., Cupr.—During febrile catarrh, Cupr.—After sun-stroke, Bell.—During and after small pox, general review. 153 Stram. Reports of cases have been contributed by thirty-eight physicians. . Doses.—The strong tincture was only used in a few cases ; from the first to the third potencies 35 times, viz.: 5 times in drop doses, 14 times in single doses, and 15 times in Solution and repeated doses. From the fourth to the high potencies were used in 58 cases. 24 times but one remedy Avas given, 10 times single doses, 7 times in solution, 17 times in high potency in repeated doses. Of the cases in which one remedy alone proved successful: Aeon, was given in 3 cases. Bell. " " "21 " Bryon." " " 1 case.—25 cases. To these we may add the 16 cases treated with Sulph., in which Aeon, and Bell, were given without effect; 16, without regard- ing many other cases in which other remedies were given with- out effect, thus we have in whole 41 cases cured by one remedy. These cases deserve sufficient attention to encourage us to at- tempt to cure without a sudden change of remedies. In general we may say that 12 children were cured by taking Sulph. Some required 16, others 12, others eight doses to effect a cure. Among 18 cases : In 10 the cure was effected in from 4 to 12 hours. " 6 " " " 15 to 24 " « 2 " " " 3 to 5 days. A complete cure was effected in 30 cases; 23 times in from 1 to 5 days. 6 " "6 to 12 " once in 4 weeks. Most of the cases, after the dangerous signs had ceased, were cured gradually without particular crisis. In 7 cases there was a quiet, many hours' lasting sleep; in 5 cases sweat; in 2 cases diarrhoea; in 2 cases boils ; in 2 cases discharge from the ears; in one case a loose cough. L 154 SPECIAL INDICATIONS. SPECIAL INDICATIONS 1* o 1 T3 I1 £ •a* o bo S •5 O •3 .5 i Op. Op. Op. Op. s 6 Str Sir Str Sir Str. Str. Str Str Str. 1 * 3 £ Headache," violent anc piercing,............ In the head, like swinging Head warm and body cold Heat of the head,---.... Sweat of the head, smell-Boring with the back ol Ac Ac Ac- Arn. Arn Arn Arn. Arn •• Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell Bell BelJ Bell Bell. Bell. Bell. Bell Beil Bell Bell. Bell Bell Bell Bell Bell Bell Bell Ltell. Bell Bell. Bell. Bell. n'-n Bell Bry Bry Bry Bry Bry Bry Bry. Bry Bry. Bry. Bry. Bry. Bry. Bry. Bry Bry. Cup Cup Cup. Cup Dig Dig Dig Dig Di| Dig. Dig. Dig. Dig. Dig. Dig. Dig. Hell Hell Hell Hell Hell. Hell Hell. Hell. Hell. Hell. Hell. Hell. Hell. Hell. Hell. Hyos Hyos. Hyos. Hyos. Hyos. Hyos Hyos Hyos. Hyos Hyos Hyos. Iod. 1 Rhus Rhus. Rhus. Rhus. Rhus. Rhus. Rhus. Rhus. Rhus. Sulp Sulp. Sulp. Sulp. Sulp. Sulp. Sulp. Sulp. Suip. Suip. Sulp. Sulp Sulp. Vera. Fluctuating, tailing back Head, violent turning in,. " bright, nearly brown, Cheeks red,............. Eyes rolling, turning,--- Vera. Vera. " half open,.......... " sparkling,.......... " dim, weak,......... Vera. Vera. " contracted,....... Tongue, dry, ........... Sour smell of the mouth,. Great thirst.............. Gnashing of the teeth,.... Vomiting,............... " on rising up, ... Abdomen, painful and Stool, hard, wanting, — " involuntary,...... Urination involuntary,... Breathing, anxious, groan- Ac. Ac. Ac. Ac. Ac. Vera. Breathing quickened,.... Pulse, quick, weak,...... " full, hard,......... " trembling, inter-" scarcely percepti-Beating of the carotids,.. Ac. Trembling of the limbs,.. Grasping with the hands at the head,............ Inclination to paralysis,.. Heat, general............ Skin, dry, hot,........... Sleep, with snoring,..... " " starting,___ " " gnashing of Inclined to sleep, but not able, .................. Ac. Ac. Ac. Ac. A.C A.C. Inclination to run away,. INDEX. A. [PASS Atrophy of the Brain,............................................... 52 Acute and general Inflammation of the Brain,........................... 65 Abscess of the Brain,.............................■................. 6 Aconite,.....................................................-..... 79 " General Remarks,.......................................... 79 " Cases,.................................................... 82 " Doses,.................................................... 85 Amica,........................................................... 86 Arsenicum,........................................................ 87 B. Belladonna,........................................................ 88 " General Remarks,........................................ 88 Cases,.................................................. 90 Doses,................................................... 103 Bryonia,........................................................... 104 C. Congestion of the Brain,..........'. ................................ 4 Cancer " "......................................*•..... 77 Cuprum,.......................................................... 107 D. Digitalis,.......................................................... ni F. Fully developed Tuberculous Meningitis,.............................. 34 G. General Review,............^.....................•................ 152 H. 117 Hellcborus-ni^er,................................................... Hydrocephaloid Disease,............................................ 43 Hypertrophy of the Brain,........................................... 156 INDEX. PAGE Hydrocephalus,.................................................... " Internal,............................................. " Chronic,............................................. " External,..............................,......•...... 62 • fift Hydatids of the Brain,.............................................. 122 Hyosciamus,....................................................... Hydriodate of Potash................................................ 127 I. Irritation of the Brain,.............................................. Inflammation of the Dura Mater,..................................... *° » " Arachnoid,...................................... !*> « " Pia Mater,...................................... 17 Iodine,............................................................ m N. Natural Cures...................................................... 135 0. Opium,........................................................... 139 R. Rhus-toxicodendron,...............,................................ l^2 S. Stramonium,....................................................... I44 Sulphur........................................................... 149 Special Indications,................................................. 154 T. Tubercular Meningitis,............................................. 24 Tubercle........................................................... 27 Tuberculous Blood,............................................... . 29 " Dyscrasia,............................................. 29 " " Dietetic Treatment of,......................... 29 " Indigestion,............................s............... 32 Tubercles of the Brain.............................................. 70 V. Veratrum,......................................................... 151 Z. Zincum............................................................ i NATIONAL LIBRARY OF MEDICINE NLfl DEDTSni 2 NLM020951912